Table of Contents. Principles of Body Mechanics and Movement Wheelchair Considerations Gait Techniques Using Assistive Devices...

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1 Table of Contents Tab Principles of Body Mechanics and Movement... 1 Techniques of Proper Movement Positioning Techniques Bed Mobility Techniques Upright Mobility Techniques Wheelchair Considerations... 2 Transfer Guidelines and Techniques Gait Techniques Using Assistive Devices... 3 Instructions for using a Cane Types of Canes Instructions for using a Walker Orthopedic Considerations... 4 Use of a Gait Belt... 5 Gait Belt Training Record Gait Belt Policy (Sample Form) Inservice Guidelines/Competencies... 6

2 Adult Positions, Transitions, and Transfers Resident s Name: Therapist: Date: Sidelying, Affected Side (A) With extended arm and pillow support Bring affected (bottom) shoulder blade forward Position affected arm straight, with elbow down and thumb up Place pillows comfortably under top leg Sidelying, Affected Side (B) With extended arm and half roll support Bring affected (bottom) shoulder blade forward Position affected arm straight, with elbow down and thumb up Shape affected hand with fingers open on half roll Place pillows comfortably under top leg SPECIAL INSTRUCTIONS: The specific technique for each resident should be determined by a physical or occupational therapist after evaluation. Reviewed with: Signature Date: Page 1 of 1

3 Adult Transitions Resident s Name: Therapist: Date: Bed Mobility Lateral Movement with Draw Sheet Position draw sheet under trunk, shoulder, and head if needed Position legs in knee-bent, feet-flat position Use your body to stabilize lower legs Gather draw sheet in hands Lean back to produce life Move upper body to desired side Give downward pressure through the knees and slight traction toward the feet Guide hips to desired side SPECIAL INSTRUCTIONS: The specific technique for each resident should be determined by a physical or occupational therapist after evaluation. Reviewed with: Signature Date: Page 1 of 1

4 Correct Wheelchair Positioning General Positioning The pelvis is the key to correct postural alignment Hips are centered between the armrests, and buttocks against the backrest The person does not lean to one side Weight bearing is equal on both sides You can place a flat hand between the person s hips and the armrests Seat belt fits snugly but does not cause red marks There are three to four finger widths between the back of the knee and the edge of the seat Footrests are adjusted so that the person s thighs are parallel with supporting surface Hips, knees, and ankles are bent or flexed 90 degrees Knees and feet are in line with the centers of the hip joints Feet are flat on the floor pedals with the backs of the heels against the heel loops and the toes pointed straight ahead. Correct Postural Alignment Note the slight anterior tilt (neutral) pelvis and erect position of the head. Faulty Postural Alignment Note the pressure points caused by the posterior tilt of the pelvis. The knees are higher than the hips and the head is aligned forward.

5 Wheelchair Preparation Resident s Name: Therapist: Date: Wheelchair Preparation Position wheelchair at a 45-degree angle to transfer surface Remove armrest closest to transfer surface, EXCEPT in Standing Pivot Transfers Remove footrest closest to transfer surface Swing away other footrest LOCK BRAKES SPECIAL INSTRUCTIONS: The specific technique for each resident should be determined by a physical or occupational therapist after evaluation. Reviewed with: Signature Date:

6 Instructions for Transfers Commode/Wheelchair Resident s Name: Date: Wheelchair to Commode Transfers 1. If possible, position wheelchair so that the resident is facing commode or so commode is on resident s uninvolved side. Lock brakes and lift footrests. 2. Have resident move forward in order to sit on the front edge of the wheelchair. 3. Place uninvolved arm on the armrest and feet on the floor directly beneath the front edge of the seat. Lean forward and push to standing with uninvolved arm and leg. If resident requires assistance, support at the strong hip and under the involved arm, reaching around the back. Do not pull on the involved shoulder. 4. Place uninvolved hand on the grab bar, sink, etc. Pivot on uninvolved arm and leg, and slowly sit down on commode. (Note: Resident s clothes may be fastened before standing up from the wheelchair. Clothing should be lowered when resident is holding firmly to a grab bar, sink, etc.) Commode to Wheelchair Transfers 1. Position the wheelchair, lock the brakes, and lift the footrests. 2. Place uninvolved arm on bar, sink or wheelchair armrest if nothing else is available. Have the resident lean forward and push to standing. Block the strong knee and guide at the hips and shoulder. 3. Place uninvolved arm on opposite wheelchair armrest. Pivot on uninvolved arm and leg and slowly sit down in the wheelchair. Special Instructions: Nursing Staff: Therapist:

7 Standing Pivot Transfers Resident s Name: Therapist: Date: Standing Pivot Transfer, Cued Prepare wheelchair. Assume sitting position (see Rolling and Sidelying-to-Sit sequences and Scooting to Edge sequences) Prepare for sit-to-stand (see Sit-to-Stand sequences) Position the impaired person s hands around your upper arms. Support the person s arms from behind Shift your weight backward, cuing the individual to move forward to stand Pivot around, taking small steps Shift your weight forward, cuing the impaired person to sit SPECIAL INSTRUCTIONS: The specific technique for each resident should be determined by a physical or occupational therapist after evaluation. Reviewed with: Signature Date: Page 1 of 1

8 Types of Walking Canes Adjustable cane with standard handgrip Wide-base quad cane HOLDING THE WALKING CANE Large-base quad cane Small-base quad cane THE FIT OF THE WALKING CANE

9 Elevations with Canes Resident s Name: Date: Length The length of your cane should be inches. When standing erect with your arm completely relaxed at your side, the top of your cane should come to the wrist joint. Walking Place the cane in the hand opposite the involved side (your cane should be used in the hand). The cane should move with the foot at all times. Put as much weight on the cane as indicated by your instructor or as necessary to make walking comfortable, stable, and smooth. Stand tall with good posture and look ahead, not down at your feet. Going Up Stairs (Up with the Good) Lead with foot. Then move the cane and foot up the step at the same time. Continue the sequence, one step at a time. Going Down Stairs (Down with the Weak) Lead with the cane and foot. Bring down to same step. Continue the sequence, one step at a time. When using steps, use the railing with the free hand whenever possible. REMEMBER The purpose of using a cane is to add stability, relieve or decrease pain, and to ease the pull of certain muscle groups. SPECIAL INSTRUCTIONS: Nursing Staff: Therapist:

10 Gait Belt Training Record Checklist Review facility policy and use of a gait belt Application of a gait belt and precautions for use Sit-to-stand and pivot transfers Two-man transfer Ambulation Techniques to prevent falls Floor-to-stand transfer Employee Initials Therapist Initials Comments I verify that I have received training on the use of a gait belt and understand the importance of using these techniques during resident care. Employee Signature Date I verify that the above employee received training on the use of a gait belt and demonstrated the techniques satisfactory. Therapist Signature Date Tab 5 - Gait Belt Use 2

11 Instructors Notes: Body Mechanics, Positioning, Transfers, Ambulation Objective 1 Body Mechanics, Normal Movement 1. Review basic spine and lower extremity anatomy. 2. Demonstrate neutral spine posture. 3. Demonstrate proper body mechanics for picking up small object from floor such as ink pen vs. picking up a box from the floor. 4. Demonstrate proper mechanics for reaching for object overhead. 5. Demonstrate proper mechanics for pushing/pulling object. 6. Demonstrate effect of posterior pelvic tilt/kyphotic posture on reaching overhead vs. upright posture. 7. Demonstrate effect of posterior pelvic tilt/kyphotic posture on performing sit to stand. Objective 2 Positioning 1. Demonstrate bed positioning in supine and sidelying for patients with hemiplegia and orthopedic conditions. 2. Demonstrate how to assist patient with hemiplegia to perform rolling and supine to/from sitting. 3. Review Total Hip Replacement (THR) precautions as outlined in handout. 4. Demonstrate how to assist patient with orthopedic diagnosis (specifically THR) to perform rolling and supine to/from sitting. Objective 3 Sit to Stand and Transfers 1. Demonstrate how to apply gait belt. 2. Demonstrate how to facilitate upright posture and scooting to edge of chair prior to transfer. 3. Demonstrate how to assist patient with hemiplegia to perform sit to stand. 4. Review differences between partial weight-bearing, toe-touch weight-bearing and full weight-bearing. 5. Demonstrate how to assist patient with orthopedic condition with varying weightbearing status to perform sit to stand. 6. Demonstrate squat transfer, stand pivot, sliding board and dependent transfer from bed to wheelchair. 7. Demonstrate squat pivot and stand pivot transfer wheelchair to/from bedside commode and/or toilet. Tab 6 - Inservice Guidelines/Competencies 1

12 Objective 4 Ambulation 1. Demonstrate how to assist patient with different levels of weight-bearing status to ambulate with a standard walker and with a quad cane. Emphasize sequence of activity and safety precautions using gait belt. 2. Demonstrate how to assist patient with hemiplegia to ambulate with quad cane, standard and rolling walker. 3. Demonstrate how to lower a patient to the floor. Objective 5 Application of Knee Immobilizer 1. Review precautions in applying immobilizer. 2. Demonstrate how to adjust size of immobilizer. 3. Demonstrate how to apply immobilizer and evaluate for proper fit. Tab 6 - Inservice Guidelines/Competencies 2