Mobility in Context: Principles of Patient Care Skills

Inside Front Cover
Title Page
Copyright
Dedication
Preface
Reviewers
Acknowledgments
Brief Contents
Contents
Establishing the Bar: AN INTRODUCTION
	The Fundamentals of Progressive Mobility
		Contexts
			Patient-Centered Care
			Dynamic Systems
			Professionalism
			Health and Wellness
		Decision-Making Guides
			As Much as Possible, as Normallyas Possible (AMAP/ANAP)
			Control Centrally, Direct Distally (CCDD)
			Biomechanics
			Stability to Mobility
			Focusing on the Objective
		Behaviors and Techniques
			Developing Expertise
			Mindful Practice
			Beginning the Progression: Movingthe Bar
		References
Moving the Bar: Part 1
	Preparing Yourself for Patient–Clinician  Interaction
		Preparing for Personal Interaction
			Awareness of Values and Beliefs
			Practicing Mindfully
			Communication Skills
			Collaborative Goal Setting
		Preparing for the Task
			Knowing the Objective
			Mechanics of Movement
		Preparing the Environment
		Conclusion
		References
		Chapter 1 Establishing the Therapeutic Alliance
			Patient–Clinician Interaction:The Therapeutic Alliance
			The Person
				The Clinician’s Perspective
				The Patient’s Perspective
			The Tasks
				Collaboratively Set Goals
				Motivating and Engaging Patients in Healthful Activities
				Patient Education
				Patient Education Techniques
				Patient Adherence
				Challenging Patient Encounters
			The Environment
			Conclusion
			References
		Chapter 2 
The Mechanics of Movement
			Biomechanical Aspects of Human Movement
				Mass
				Center of Mass
				Force
				Gravity
				Friction
				Representation of Forces
				Line of Action
				Components of Force
				Levers
				Moments and Moment Arms
				Application: Proper Body Mechanics, Part 1
				Force Couples
				Loading
				Stress and Strain
				Pressure
				Managing
			Stability and Mobility
				Base of Support
				Dynamic Trunk Stabilization
				Controlled and Uncontrolled Mobility
				Application: Positioning for Stability
				Application: Directing Forces—Blocking the Knee
			Laws of Motion
				Inertia
				F = ma
				Action–Reaction
			Muscles Acting on Bones
				Open and Closed Chains
				Osteokinematics and Arthrokinematics
				Application: Glenohumeral Movement During ROM
			Putting It Together: Body Mechanics
				Application: Proper Body Mechanics, Part 2
			Clinical Review Questions
			Reference
		Chapter 3 
Special Environments
			Introduction
			Critical Care Environments
				Working as a Team
				Applying a Systematic Approach to Mobilizing the Patients in ICU
				Mobility Progression
				Critical Care Devices
			Home Environment
			Other Environments
			Clinical Review Question
			References
Moving the Bar: Part 2
	Initiating Mobility
		Attending to the Person: Establishing Rapport
		Creating a SupportivePhysical Environment
		Performing the Task
			Engaging the Patient in the Task
			Establishing Baselines
		References
	Chapter 4
Keeping It Clean: Maintaining Cleanliness in the Clinical Environment
		Cleanliness
			What Is Clean?
			Healthcare-Associated Infections
		How Infection Happens
			The Cycle of Infection
			Infectious Agents
			Pathogen Reservoirs
			Portal of Exit
			Means of Transmission
			Mode of Entry
			Susceptible Host
		Standard Precautions
			Hand Hygiene
			Respiratory Hygiene
			Personal Protective Equipment
			Application of Standard Precautions
			Clinical Attire
			Clean Environment
			Disposal of Soiled Items
			Sharps Containers
		Transmission-Based Precautions
			Contact Precautions
			Droplet Precautions
			Airborne Precautions
		Donning and Doffing PPE
			Donning PPE
			Doffing PPE
		Clean and Sterile Techniques
			Clean Technique
			Sterile Technique
		Protective Precautions for Special Populations
			Transplant Recipients
			Pediatric and Geriatric Patients
			Psychosocial Aspects of Isolation
		Clinical Review Questions
		References
	Chapter 5 Assessing Physiological Status
		Introduction
		Heart Rate
			Overview of Heart Rate
			Reasons for Assessing Heart Rate
			Normal Heart Rate
			Factors Affecting Heart Rate
			Methods of Assessing Heart Rate
		Blood Pressure
			Overview of Blood Pressure
			Reasons for Assessing Blood Pressure
			Normal Blood Pressure
			Factors Affecting Blood Pressure
			Methods of Measuring Blood Pressure
			Technique for BP Assessment by Auscultation
		Respiration
			Overview of Respiration
			Reasons for Assessing Respiration
			Factors Affecting Respiration
			Normal Respiration Rate and the Quality of Breathing
			Method of Assessing Respiration
		Temperature
			Overview of Temperature
			Reasons for Assessing Temperature
			Factors Affecting Temperature
			Normal Temperature
			Methods of Measuring Core Body Temperature
		Other Measures of Physiological Status
			Pulse Oximetry
			Pain Assessment
			Rate of Perceived Exertion
			Gait Speed
		Patient Education and Self-Monitoring
		Clinical Review Questions
		References
	Chapter 6 Draping for Minimum Exposure and Maximum Dignity
		Introduction
			Awareness of Abuse: Empowerment, Trust, and Control
			Cultural Competence
		Maximizing Comfort and Dignity
			Provide Privacy
			Provide Chaperones When Needed
		Covering
			Provide Clinical Attire
			Drape With Linens
		General Procedures for Draping
			Prior to Treatment
			During Treatment
			After Treatment
		Draping Techniques by Patient Position
			Supine
			Prone
			Sidelying
			Sitting
		Draping While Adjusting Patient Position
		Clinical Review Questions
		References
	Chapter 7 Positioning Your Patient for Mobility
		Introduction
		Short-Term Positioning
			Objectives
			Positions for Short-Term Therapy
			Special Considerations for Short-Term Positioning
		Long-Term Positioning
			Objectives
			Preventing Pressure Injuries
			Preventing Contractures
			Preventing Edema and Cardiopulmonary Complications
			Minimizing the Risk of Deep Venous Thrombosis
			Long-Term Positions
			Special Considerations in Long-Term Positioning
		Positioning Devices
			Equipment Used for Positioning
			Restraints
		Conclusion
		Clinical Review Questions
		Appendix A STAGING OF PRESSURE INJURIES
			Stage 1 Pressure Injury:Nonblanchable Erythemaof Intact Skin
			Stage 2 Pressure Injury: Partial-Thickness Skin Loss With Exposed Dermis
			Stage 3 Pressure Injury: Full-Thickness Skin Loss
			Stage 4 Pressure Injury: Full-Thickness Skin and Tissue Loss
			Unstageable Pressure Injury: Obscured Full-Thickness Skin and Tissue Loss
			Deep Tissue Pressure Injury: Persistent Nonblanchable Deep Red, Maroon, or Purple Discoloration
			No Reverse Staging
		References
	Chapter 8 Transferring Dependent Patients: Safe Patient Handling and Mobility
		Introduction
		Risks Inherent in Manual Dependent Lifts
			Development of Safe Patient Handling and Mobility Programs
		Standard Hospital Equipment
			Standard Hospital Beds
			Standard Wheelchairs
		Safe Patient Handling and Mobility
		Vertical Lifts
			Total Body Lifts
			Choosing a Sling
			Being Lifted: The Patient’s Perspective
			Techniques for Vertical Lifts
			Techniques for Sit-to-Stand Lifts
		Lateral Transfers
			Indications for Use
			Lateral Transfers in Context
		Repositioning With Assistive Devices
			Supine Repositioning
			Seated Repositioning
		Special Consideration: Bariatrics
		Clinical Review Questions
		Appendix 8-A Definitions of Dependence
			Total Dependence
			Extensive Assistance
			Limited Assistance
			Supervision
			Independent
		Appendix 8-B ALGORITHMS FOR TRANSFERS
			Algorithm 1: Transfer to and From Bed ↔Chair, Chair ↔Toilet, Chair ↔ Chair, orCar ↔ Chair
			Algorithm 2: Lateral Transfer toand From Bed ↔ Stretcher ↔ Trolley
			Algorithm 3: Reposition in Bed: Sideto Side, Up in Bed
			Bariatric Algorithm 1: Bariatric Transferto and From: Bed ↔ Chair, Chair ↔Toilet, or Chair ↔ Chair
			Bariatric Algorithm 2: Bariatric Lateral Transfer to and From Bed ↔Stretcher ↔ Trolley
		References
Moving the Bar: Part 3
	Engaging the Patient in Early Functional Mobility
		Early Function
			Range of Motion
			Bed Mobility
			Transfers
		Motor Learning
		References
	Chapter 9 Maintaining Capacity for Mobility Through Range of Motion
		Introduction
		The Nature of Joint Motion
			Osteokinematics and Arthrokinematics: A Review
			Planes of Motion
			Muscle Excursion and Two-Joint Muscles
			Types of ROM
		Effects of Joint Motions
			Effects of ROM on Joint Tissues
			Effects of Passive ROM
			Effects of Active ROM
			Skeletal Muscle Pump
		Skilled ROM Decision-Making
			Indications and Contraindications
			Tissue Healing
			PROM Dosage
			AROM Dosage
			Choosing Planes of Motion
			ROM Exercise Progression
		Upper-Extremity and Lower-Extremity ROM Procedures
			Body Mechanics
			Providing Support
			Controlling and Directing Movement
			Encouraging Independence
			Systematic Approach
			ROM Procedures
			Achieving Full Joint Capsule Range
			Additional PROM Procedure Notes
			Additional AAROM Procedure Notes
			Additional AROM Procedure Notes
			Therapeutic Interventions
		Axial ROM Procedures
			Temporomandibular Joint (TMJ)
			ROM of the Spine
		Observing and Documenting ROM Findings
			Quantitative Findings
			Qualitative Findings
			Normal End Feels
			Patterns of Movement
		Caregiver and Patient Education
			Assisting Self-ROM
			Education Tips
		Clinical Review Questions
		References
	Chapter 10 Bed Mobility
		Introduction
		Bed Mobility Progression
			Developmental Positions
			Environment
			Equipment
			Clinical Decision-Making
		Bed Mobility Tasks in Supine
			Hooklying
			Bridging
			Scooting in Supine
			Rolling
		Moving from SupineàSitting
			Sitting Up
			Lying Down
		Bed Mobility Tasks in Sitting
		Special Health Conditions
			Total Hip Arthroplasty
			Hemiplegia
			Following Back Surgery
			Spinal Cord Injury
			Tilt Table
		Clinical Review Questions
		References
	Chapter 11 Manual Lateral Transfers
		Introduction
		Maximizing Safety
			General Procedure for Manual Dependent Transfers
			Underlying Assumptions for a Dependent Transfer With One Clinician
			Using a Gait Belt
			Blocking the Patient’s Knees
		Seated Transfers
			Dependent Lifts
			Transfers Using a Transfer Board
			Clinician Assistance for Lateral Seated Transfer With Transfer Board
			Anteroposterior Transfers
		Pivot Transfers
			Setting Up the Pivot Transfer
			Performing the Pivot Transfer
			Completing the Transfer
			Using Assistive Devices
			Special Patient Considerations in Pivot Transfers
		Adapting Transfers
			Toilet Transfers
			Bathtub Bench Transfers
			Car Transfers
		Clinical Problem-Solving
			Example 1: From Impossible to Possible With a Change in Approach
			Example 2: Sliding to Safety
			Example 3: Facilitating Independence in a Dependent Transfer Using an Assistive Device
		Clinical Review Questions
		References
	Chapter 12 Vertical Transfers: Chair to Plinth and FLoor to Chair
		Introduction
		Chair ↔ Plinth Transfers
			Preparing the Environment
			Preparing the Patient
		Dependent Transfers Between Chair and Floor
			Preparing the Environment
			Preparing the Patient
			Clinician Preparation
		Independent Transfers Between Chair and Floor
			Preparing the Environment
		Clinical Variations
		Clinical Review Questions
Moving the Bar: Part 4
	Locomotion
		Changes in Body Structure and Function Affecting Locomotion
			Musculoskeletal Changes
			Neuromusculoskeletal Changes
			Cardiopulmonary Changes
			Integumentary Changes
		Seated Locomotion —Mobility With Wheels
		Standing Locomotion —Mobility on Foot
			Task
			Environment
			Person
		References
	Chapter 13 Seated Mobility: Sitting But Not Sitting Still—Fitting and Propelling a Wheelchair
		Introduction
		Selecting a Wheelchair: The Process of Matching Needs and Resources
			Identifying Needs and Resources
			The Standard Wheelchair
			Postural Support Options
			Mobility Base Options
			Wheelchair Selection Trade-Offs
		Types of Wheelchairs
		Wheelchair-User Interface
			Fitting the Manual Wheelchair
			Measuring the Patient for Wheelchair Fit
			Seat-to-Floor Height
			Confirming the Fit
			Negative Effects of Ill-Fitting Chairs
		Manual Wheelchair Propulsion
			Dependent Propulsion Over Level Surfaces
			Dependent Propulsion Over Uneven Surfaces
			Assisted Navigation Through Doorways
			Assisted Propulsion on Inclines
			Dependent Navigation Up and Down Curbs
			Dependent Navigation Up and Down Steps
			Independent Propulsion Over Level Surfaces
			Independent Propulsion Over Uneven Surfaces: Wheelies
			Independent Navigation Through Doorways
			Safe Use of Powered Scooters
		Controlled Falling
			Falling Backward
			Falling Forward
			Falling to the Side
		Wheelchair Care and Maintenance
			Depot Wheelchair Maintenance
			Recommended Wheelchair Maintenance by the Owner
			Recommended Wheelchair MaintenanceThrough a Service Center
			Electric or Power WheelchairMaintenance
		Clinical Review Questions
		Appendix 13-A Wheelchair Measurement Laboratory Worksheet
		References
	Chapter 14 Navigating the Challenges of Ambulating
		Introduction
		Weight-Bearing Restrictions
			Methods of Monitoring Weight-Bearing
		Choosing an Assistive Gait Device
			Amount of Support Required
			Amount of Stability Required
			Energy Cost
		Fitting an Assistive Gait Device
		Guarding During Gait
			Revisiting Moments, Distances, BoS,and Line of Action of Force: Creating aMechanical Advantage While GuardingDuring Ambulation
			Where to Stand—Right or Left Side?
			Gait Belt Use During Ambulation
		Gait Patterns
		Patient Instructions
		Sit
		Sit ↔ Stand With Assistive Gait Devices
			Standing
			Sitting
		Forward Gait
			Turning
			Troubleshooting
		Stairs
			Functional Strength and ROM Demands
			Basic Gait Pattern Up and Down Steps
			Up and Down Steps With Bilateral Assistive Devices
			Up and Down Steps With a Unilateral Assistive Device
			Guarding on Steps
		Falling During Ambulation
			Facts on Falls
			Assessing Fall Risk
			Reducing the Likelihood of a Fall
			Minimizing the Risk of Injury From a Fall
			Responding If a Patient Begins to Fall
		Other Ambulation Challenges
			Opening Doors
			Navigating Obstacles
			Carrying Objects
			Handling Hazardous Surfaces
			Lighting the Way
			Walking on Inclines
		Clinical Review Questions
		Appendix 14-A Parameters for the Community Ambulator
		References
	Chapter 15 Implementing Device-Specific Gait
		Introduction
		Parallel Bars
			Indications
			Fit
			Guarding
			Sit ↔ Stand
			Advancing
			Turning
			Readiness to Progress
		Walkers
			Indications
			Fit
			Sit ↔ Stand
			Guarding
			Advancing
			Turning
			Going Up and Down a Single Step
			Going Up and Down Multiple Steps
			Going Up and Down Multiple Steps Without a Handrail
			Troubleshooting
			Readiness to Progress
		Axillary Crutches
			Indications
			Fit
			Sit ↔ Stand
			Guarding
			Advancing and Turning
			Going Up and Down Steps
			Readiness to Progress
		Forearm Crutches
			Indications
			Fit
			Sit ↔ Stand
			Guarding
			Advancing and Turning
			Going Up and Down Steps
			Guarding
			Troubleshooting
			Readiness to Progress
		Falling and Getting Back Up With Crutches
			Guarding
			Troubleshooting
			Indications
			Fit
			Sit
			Stand
			Guarding
			Advancing and Turning
		Knee Walker
		Hemi Walker or Walk-Cane
			Indications
			Fit
			Sit ↔ Stand
			Guarding
			Advancing and Turning
			Readiness to Progress
		Canes
			Indications
			Fit
			Sit ↔ Stand
			Guarding
			Advancing and Turning
			Steps
			Troubleshooting
			Readiness to Progress
		Clinical Considerations for Selected Conditions
			Alzheimer’s Disease
			Muscular Dystrophy
		Clinical Review Questions
		References
GLOSSARY
INDEX