Provide support under arms or forearms- Provide support at back or waist- Provide verbal cues26TS-2_by SHAMIMA_20174/8/2023STAND TO SIT (Radomoski and Latham2013)• Back up to the seated surface until the back ofthe legs touch the surface.• Maintain an upright posture with the trunkextended and symmetrical.• Shift weight back by posteriorly tilting thepelvis and flexing the hips and knees.• Control the descent by slowly lowering thebuttocks onto the seated surface.27TS-2_by SHAMIMA_20174

FUNCTIONAL MOBILITY
Part I- Bed Mobility
Shamima Akter
B. Sc in Occupational Therapy &
M. Sc in Rehabilitation Science
Assistant Professor
Bangladesh Health Professions Institute
Centre for the Rehabilitation of the Paralysed
Chapain, Savar

Functional Mobility
• Functional mobility can be defined as, “moving from
one position or place to another (during
performance of everyday activities)
• Such as in-bed mobility, wheelchair or powered
mobility, and transfers (e.g., wheelchair, bed, car,
tub, toilet, tub/shower, chair, and floor).
• Includes functional ambulation and transporting
objects” (AOTA, 2008, p.631, cited in Radomoski and
Latham 2013).
– Bed mobility
– Transfer mobility
– Functional ambulation for ADL
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Skill Building for Mobility
• Moving in the immediate space, such as rolling from
a supine to prone position, repositioning the trunk
and extremities, or moving from a lying to seated
position.
• Moving in the bed for body positioning or basic ADL
such as dressing or skin inspection.
• Moving out of bed and into the surrounding areas
such as into the bathroom for hygiene activities.
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Continue…
• Moving around the level, accessible environment of
the therapy setting for intervention of performance
skills or for other ADL such as kitchen activities or
feeding
• Moving on the uneven terrain of the outdoor
environment
• Moving about the chosen community environment
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PATIENT HANDLING TECHNIQUES
Guidelines for using proper mechanics during
handling. The therapist should be aware of the
following principles of basic body mechanics:
– Get close to the client or move the client close to
you.
– Position your body to face the client.
– Bend the knees; use your legs, not your back.
– Keep a neutral spine (not a bent or arched back).
– Keep a wide base of support.
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Continue…
– Don’t tackle more than you can handle; ask for
help.
– Don’t combine movements.
– Avoid rotating at the same time as bending
forward or backward.
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BED MOBILITY
• It is the ability to move the body in bed to
perform activities in the various positions of
supine, prone, side lying, or sitting.
• Bed mobility includes all of the tasks of rolling
from side to side, rolling from supine to prone
and back, and sitting up.
• It is the ability to roll to sit up in bed, and to
handle the upper and lower extremities
during these maneuvers.
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IMPORTANCE
Bed mobility is an important skill to learn
because:
– It allows the patient to relive the pressure
independently
– It allows the patient to change the position when
they become uncomfortable and changing
positions for sleep
– It is a necessary skill to dressing in bed
– It forms a component of transferring in and out of
bed, or
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Assistive device for bed mobility
• A person with motor impairment in the trunk
or one or more extremities may require an
assistive device to pull on in order to begin
rolling and then to assist with maintaining a
side-lying position or with the movement of
toward sitting.
• Devices are commonly used are a rope ladder,
an overhead trapeze bar, a bed rail, or even a
wheelchair positioned near the bedside.
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• These devices can be used to give a person
something to grasp with the hand(s) or
forearm(s) so that rolling can be initiated or
pulling to a seated position in a long-or short-
leg position in bed can be accomplished.
• Good scapular, shoulder, and elbow strength
are the minimum requirements for using
these devices.
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Activities of daily living in bed
• Some people may be able to, or choose to,
dress while sitting on the edge of the bed or
while standing.
• For example: persons with lower extremity
paralysis may need to perform BADL such as
dressing, skin inspection, self-catheterization,
and/or a bowel program while lying in bed.
• While dressing in bed, it is necessary to reach
one’s feet by flexing the hips and kness so that
the feet are closer to the hands for preparing
to don pants, socks, and/or shoes.
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Continue…
• Independence in rolling from side to side and reaching
one’s buttocks are important for performing manual
bowel stimulation and clean up or using a long-handled
mirror for skin inspection.
• Good strength in the deltoid, pectoralis major and
minor, biceps, wrist extensors, and scapula muscles is
key to support these tasks without assistive device, so
strengthening these muscle groups in therapy is
preparatory to learning this technique.
• A sense of balance for sitting and transferring must be
developed, practiced, and accomplished during
intervention.
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TECHNIQUES OF BED MOBILITY POSITION
Bridging
• Bridging is simply lying supine on a surface
and by using the back and hip extensors, the
buttocks, upper legs, and lower back are lifted
off of the supporting surface so that contact is
only made with the upper back, shoulders,
head, and feet.
• The occupational therapist can incorporate
these movement strategies while training the
patient in self-care activities.
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• The first task to accomplish in bed mobility is bridging
the hips.
• Bridging is a movement strategy that is taught by the
occupational therapist to allow the patient to move the
buttocks onto a bedpan, to pull pants over the hips,
and to assist with moving the body laterally for
changing bed positioning.
• Bridging requires trunk extension, which is necessary at
the trunk and hips to assume a functional bridge
position.
• For example, bridging is a mobility function necessary
for the use of a bedpan, reduction of pressure on the
buttocks, movement within the bed (bed scooting), to
move up in the bed and bridging to don/doff pants.
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Rolling
Rolling the body is vital for Start with the patient
already at one side of the bed.
– Knee on the bed
– Turn head
– Bend knee
– Place arm across body- other arm out of the body
– Use shoulder girdle and pelvis key points
– Have your body square to segment
– Roll the patient towards you
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Activities for rolling practice
• Practice rolling on a narrow surface such as sofa
• Encourage abrupt change in direction, as in
reversing the movement in midstream
• Practice rolling under a heavy quilt
• Try rolling with an object such as a newspaper in
the hand
• Attempt propping to sidelying to adjust pillows
• Practice rolling in a darkened room
• Ask the patient to roll quickly
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Sitting in bed
• Long-leg sitting is the [posture in which the legs are
extended straight out in front of the person on a flat
surface and the hips are flexed to at least 90⁰.
• Long-leg sitting can permit other activities in bed such as
watching TV, reading, donning a shirt, or taking
medication.
• Short-leg sitting is the posture in which a person sits with
the hips flexed at least to 90⁰ and knees are flexed over
the edge of the surface.
• Short leg-sitting allows for activities to be performed
while sitting on the edge of the bed such as donning a
shirt, putting on shoes, or preparing to stand or to
transfer to a wheelchair.
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BED MOBILITY IN PREPARATION FOR
TRANSFER
Step1: Rolling the client who has hemiplegia
Step 2: Side-lying to sit up at the edge of the bed
Step 3: Scooting
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Step1: Rolling the client who has
hemiplegia
• Before rolling the client, you may need to put
your hand under the client’s scapula on the
weaker side and gently mobilize it forward
(into protraction) to prevent the client from
rolling onto the shoulder, potentially causing
pain and injury.
• Assist the client in clasping the strong hand
around the wrist of the weak arm, and lift the
upper extremities upward toward the ceiling.
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• Assist the client in flexing his or her knees
• Assist the client to roll onto his or her side by
moving first arms toward the side, then the
legs, and finally by placing one of the
therapist’s hands at the scapular area and the
other therapist’s hand at hip, guiding the roll
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Step 2: Side-lying to sit up at the edge
of the bed
• Bring the client’s feet off the edge of the bed
• Stabilize the client’s lower extremities with
your knees
• Shift the client’s body to an upright sitting
position
• Place the client’s hands on the bed at the
sides of his or her body to help maintain
balance
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Step 3: Scooting
• Scooting is an important skill for moving to the
edge of a bed or seat and can be a useful
movement pattern in activity of daily living tasks
such as donning pants in a seated position.
• The patient should begin in symmetrical sitting
• The therapist can encourage scooting by first
cueing a lateral weight shift and
• Then advancing the non-weight-bearing buttock
to move anteriorly.
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TECNIQUES FOR TRANSFERRING
MOBILITY
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SIT TO STAND (Radomoski and Latham
2013)
• Scoot forward on the seated surface and establish
a position of “readiness to stand” (hip, knee, and
ankle <90º, pelvis neutral in all planes, trunk
extended and symmetrical).
• Bring centre of mass (COM) over base of support
(BOS) by anteriorly tilting pelvis and flexing hips,
while keeping the trunk and neck extended and
symmetrical.
• This also establishes momentum that will assist
with step 3. Mnemonic for patients: “Nose over
toes.”
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Continue…
• Transfer momentum from the upper body and
raise buttocks off the seated surface onto
both legs.
• Rise to the upright position by extending (but
not locking) the hips and knees.
• Adjust standing postrure to meet
environmental/ task demands.
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STAND TO SIT (Radomoski and Latham
2013)
• Position body directly in front of the seating
surface (“feel” the seat behind both legs).
• “Fold” body onto the chair (anterior pelvic tilt,
hip and knee flexion, ankle dorsiflexion, while
keeping trunk and neck extended and
symmetrical).
• Eccentrically contract leg extensors to control the
downward pull of gravity.
• After upper thighs are resting on the seating
surface, “scoot” to assume a position of
“readiness for function” in seated activities.
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Possible Environmental Modification (Radomoski and Latham
2013)
• Raise seat to decrease lower limb force
requirements (while still providing a stable
surface of the feet).
• Grade seat to lower heights as strength in leg
extensors improves.
• Use chair without arms if patient shows too
much reliance on using hands for push-off.
• Select chair that allows for placing the feet
back (knee and ankle 90)
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