ADLRehabLecture II Posture and Body Mechanics

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ADL/Rehab/Lecture IIPosture and Body Mechanics

• Veronica Southard PT MS GCS

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Body Mechanics

• Proper use of the body has the following
  benefits
• 1. Energy conservation
• 2. Stress reduction
• 3. Strain reduction on bodily structures
• 4. Reduced possibility of personal injury
• 5. Production of safe movement patterns

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Body Mechanics Defined

• The efficient use of the body to produce safe,
  energy conserving, anatomically and
  physiologically efficient movement which allows
  maintenance of body balance and control.

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Principles and concepts of body mechanics

• Resistance to mvt is produced by gravity and
  friction.
• Relies on Newtons three laws

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Review of Newtons laws

• 1. For every action there is an equal and
  opposite reaction.
• 2. Law of Inertia/Equilibrium, objects at rest
  remain at rest or in constant motion remain in
  constant motion until acted on by an unbalanced
  force.
• 3. Acceleration of an object is proportional to
  the unbalanced forces acting on it and inversely
  proportional to the mass of that object.

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Examples of impairments causing changes in body
mechanics

• Obesity
• Musculoskeletal imbalance
• Neurologic entities
• Cardiovascular deficits
• Trauma
• Bad habits
• Pain

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Lifting/ Bending Key Concepts

• 1. Move pt. or object as close as possible.
• 2. Center of Gravity.
• 3. Increase your base of support.
• 4. Mentally survey what you are about to move.
• 5. Plan the move before attempting it.
• 6. Prior to the lift, assure the availability of
  assistance and the final location.

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Key Concepts cont

• Use gravity and momentum where possible.
• Roll, slide, push, pull rather then lift.
• After training a caregiver ask them to repeat
  the entire sequence verbally, and then
  demonstrate.
• Concise directions are a must.
• Get help anytime you feel uneasy or unsafe,
  before the move.

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Donts for lifting and bending

• 1. Simultaneously flex and rotate the spine when
  lifting or reaching.
• 2. Assume trunk flexion for long periods of time
  as this stresses and strains m, ligs, and post
  articulations.

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LIFTING MODELS

• SEVERAL MODELS HAVE BEEN STUDIED.
• Rationale for traditional and back school models.

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Traditional Model

• Lift objects below waist level using squatting
  and or stooping positions.
• 1. Grasp object
• 2. Lifting with straight L and T spine
• 3. Incorporate pelvic tilt for isometric
  abdominal contraction

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Lumbar Lordosis Models

• Considered protective lifting and preventative
  back management.
• The lumbar spine is maintained in slight
  lordosis.
• Consists of deep squat, power lift, straight leg
  lift.

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Rationale for Lordotic models

• 1. Dec. stress on PLL, Interspinous lig, lig
  flavum, post annulus fibers
• 2. Pressure is directed more ant at the disc.
• 3. Reduction of post and post lat herniation
• 4. Lordosis allows the vertebral facets to
  engage each other more fully, which in turn
  increases LS stability

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One Leg Stance Lift

• Light objects
• Good for pt.s with recent THR
• Looks like golfer removing the ball from the cup.

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Pushing/Pulling/Reaching/Carrying

• 1. Lifting principles apply
• 2. Crouch or semisquat where possible
• 3. Apply push/pull force parallel to the surface
  over which the object is to be moved and in the
  line of the movement desired.
• 4. Rock to initiate movement.

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Evaluating for Body Control Impairments

• Educate those with LBP hx,proper body mechanics.
• Examine- check Posture- PMH- Mechanisms for
  current bout- Lifestyle- Work- Work environment

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Methodology for teaching body mechanics

• 1. Teach anatomy
• 2. Explain proper body mechanics and correction
  of faulty posture.
• 3. Instruct in ways to maintain proper
  alignment, flexibility, and strength.
• 4. Show and demonstrate any adaptive appliances
  necessary

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Teaching body mechanics cont

• 5. Teach pt. What chronic overuse does.
• 6. Advise the pt. To avoid prolonged anything.
• 7. Encourage and motivate the client to accept
  responsibility for following through.

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BED MOBILITY

• 1. Moving up or down in bed
• 2. Side to side,
• 3. Rolling,
• 4. Sit to supine and back
• 5. Bridging

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BED MOBILITY

• Sometimes under the broadest circumstances
  categorized as a transfer.
• Truly a precursor to transfer training.
• May be combined with m strengthening, development
  of joint flexibility and endurance ex.

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Additional Equipment

• Draw sheets
• Trapeze
• Bedrails

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Bed mob training

• 1. Check record for other disciplines reports.
• 2. Note any special precautions.SAFETY
• 3. Assess pt.s skill, inform and instruct.
• 4. Demonstrate using another pt. In the area or
  on the mat table next to the pt.
• 5. Based on your eval, decide the goals and plan
  execution.

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Principles

• Analyze the movement into component parts,
• Positions of pt. and equipment, movements pt.
  will perform.
• Pt may have to practice components first
• Ask pt to verbalize what you need him to do
• During training stay with pt. To assist/guard

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Precautions

• Watch out for vertigo
• THR- esp. the first two weeks
• Low back pain- avoid rotation, SB, Trunk flexion.
  Logroll
• SCI- external appliance may be in place. Avoid
  rotation and distraction- logroll
• Burns no friction at the graft site.
• CVA watch the shoulder.

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Mobility Activities

• In general the pt. Must become I in bed mobility
  to be I in sitting transfers and standing.
• Initiate the program by asking pt. To control his
  head, position his UEs or LEs or use U and LEs
  to help within his functional ability.

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Assisted Bed Mobility

• Greater control is achieved by moving individual
  body segments to reduce the effort required.
• Position yourself as close to the side of the
  pt.so arms are shortened levers.
• Bend your hips and knees.
• Raise the bed to be in your C o G.

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Side to Side

• Slide upper body then legs to you. Support head.
• Have pt. bridge to side and assist upper body.

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Moving up

• Bring pt. to edge.
• Flex hips and knees, feet flat on bed(bridges).
  Support with pillows if cannot maintain.
• Come behind pt or under upper back or have pt.use
  arms
• Reposition yourself every 6-10

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Moving to Sidelying from Supine

• 1. Pt moves to far side Bedrails up!!
• 2. Facing pt., turn toward you to sidely. To
  move to R, place L LE over R LE. Place L UE on
  chest and R UE in ABD. Roll pt. By gently
  pulling L post scap and L post pelvis.
• 3. Stand facing pt. touching mat.

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Moving to Prone from Supine

• 1. Move to mats edge.
• 2. Position arm close along his side with
  shoulder ER elbow Ext palm up, and hand tucked
  beneath pelvis or fully flexed so arm is next to
  ear with elbow straight. The other arm is at the
  side.
• 3. Face pt to roll to sidely, check space
  available to complete.
• 4. Roll pt toward you. Place thigh against mat

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Moving Prone to supine

• 1. Move close to mats edge.
• 2. If rolling L, cross R LE over L, position L
  UE close to body or ear.
• 3. Reach sidely, check space.
• 4. Return to supine.

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Moving to Sitting

• From supine
• 1. Move close to edge
• 2. Flex hips and knees
• 3. Arms across chest or as an assist
• 4. Place one arm under head and upper back
• 5. Elevate trunk until a sitting position is
  attained
• 6. Pivot pt. By supporting under thighs

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Side to Side- Pt supine

• Flex hips and knees, feet flat on bed.
• One UE ABD from trunk about 4 .
• Push down with LEs lift pelvis and move toward
  ABD arm.
• Elevate trunk by pushing into mat with UEs and
  move toward ABD arm.

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Moving UP

• Bend up LEs, feet near butt.
• Flex elbows, next to trunk, elevate scapulae.
• Raise pelvis pushing into feet, elevate upper
  trunk, push into mat with the elbows and back of
  head.

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Moving Down

• Bend knees and hips 8-12 inches from butt,
  depress scap, flex elbows.
• Elevate pelvis using LEs elevate upper trunk by
  simultaneously pushing into bed with elbows and
  back of head.

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Teaching techniques

• 1. Instruct pt. to reach across the bed.(roll)
• 2. Have pt forcefully flex LE across the
  other.(roll)
• 3. Use momentum.
• 4.Use the head and neck.
• 5. Come to sit by walking up the hands.

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Transfer Techniques

• Special Equipment
• Wheelchairs with swingaway legrests
• Sliding boards
• Hoyer lifts
• Stretchers
• Gait belts
• Footstools

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Types of transfers

• Standing with or without pivot/ footstool
• Sitting transfers with sliding boards
• Sitting transfers with Lateral swings
• Amputee A/P transfers
• Lifts
• One person
• Two person

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Other Transfers

• Toilet, commode
• Shower
• Tub
• W/C to floor

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General Guidelines

• Use a gait belt.
• Request assistance if in doubt.
• With two or more person transfers, the person at
  the head leads and calls the lift
• Get as close to the destination before starting.
• Verbally walk the person through the process
  first, demonstrate if possible.

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Assisted standing pivot transfer

• W/c to mat table or bed.
• A. position w/c ll or at an 45 angle to bed.
• B. Apply gait belt, lock w/c.
• C. Set up LEs, Remove armrest closest to bed.
• D. Pt moves to edge of chair.
• E. Partially flex your knees, hips.

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Assisted standing pivot cont

• F. Have pt.use the UEs as feasible.
• G. Grasp gait belt, explain to pt. What is going
  to happen.
• H. Elevate pt. High enough so he clears the w/c
  wheel , pivot toward bed, feel legs against bed,
  sit..

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Considerations

• Hemiplegic
• Orthopedic
• SCI

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Footstool

• Used for pts having difficulty getting up on the
  plinth. Pt. Steps up onto the footstool with the
  uninvolved LE.
• You guard the involved during the transfer.
• Strong side toward the plinth.

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Sliding board Transfers

• Indications pt. Unable to stand but has strong
  UEs. Or weakness on one side, unable to stand.
• W/c to bed
• Position sliding board beneath thigh in front of
  the drive wheel, and extending back to ischium.
  The edge should rest on the bed.

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Lateral Swinging Transfers

• As with sliding board, but no board is necessary.
• Very strong UEs required

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Two Person Lifts

• Pt is unable to stand or assist.
• One person leads so everyone works together.
• Tallest person supports the trunk
• Counts 1-2-3- lift

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Hoyer Lifts

• Used for large dependent pts.
• Lifts are pneumatic or hydraulic
• U shaped base has 4 casters, 2 lock
• Has a support column that attaches to the base
  and allows for the controls for the lifting
  column and spreader bar.
• A sling is placed under the patient and attaches
  to the spreader bar by chains

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Exceptional Transfers

• THR precautions and no twisting or pivoting on
  the operative extremity

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W/C to Floor

• Hemi Moves uninvolved hip to locked chairs
  edge. Reaches down to touch floor on uninvolved
  side. Lowers self toward strength. To return
  uninvolved side sit R, pulls up into 1/2kneel
  with R foot on floor, kneeling on L. Put hand on
  w/c seat or armrest, use R exts to push up to
  partial stand facing w/c, turns and sits.