WC Flashcards
(11 cards)
Equipment to use in positioning
a. Shoulder roll– against ER
b. Trochanter roll– against ER
c. Hand roll—it is too soft if push into it hand sweats can get skin breakdown, better to use a hand splinting device
d. Foot board—to prevent PF contractures but bracing works much better
e. Foot supports—to keep foot in a functional position and keep blanket off feet
f. Splints
Multi-podus splint:
- Puts the foot in DF
- Heel is suspended in the air so there is no skin breakdown
- Keeps foot from rolling out to sides
- Lining is removable
- Good for keeping toes in line with calcaneus
What to consider in a position
- Obtain the correct alignment of fracture if present—spine or bones
- Prevent CONTRACTURE—if already present, prevent progression or improve
- –Position them out of contractures - Prevent PRESSURE SORE—bridge ischemic areas (or if risk of pressure sore): protect the ares where pressure sores are most likely to occur
- Inhibit the onset of SPASTICITY—example slight knee flexion
- –if the person is likely to go into a knee flexor spasm which is common positioning the knee in slight knee flexion so muscle isn’t maximally lengthened, but the issue is the position can lead to a contracture - In complete lesions of C6, don’t leave the hand flat on the bed: want tenodesis
- Prevent contractures of adductors, flexors (shoulder and hip adductors)
- Internal rotators of LE, drop foot, claw toes
SUPINE
- head
- trunk
- hips
- knees
- ankle
- toes
1) Head on a small pillow: not excessive forward head position
2) Trunk optimal alignment in all planes including support under the lumbar spine
3) Hips as extended as possible (not in flexion) with Small amount of hip abduction pillow between knees
4) Knees extended, not hyperextended (about 5 degrees of flexion, just shy of terminal)
5) Ankle neutral, toes extended (brace, footboard)
6) Toes pointed to the ceiling (splinting)
2 options in SUPINE for UE
shoulder
wrist and hand
SHOULDER
a. shoulder abducted to 90 / ER 45 / elbow 90
b. shoulder abducted to 90 / IR 45 / elbow 90 /forearm slightly pronated
c. shoulder extended / abduct 30 / ER forearm supinated
WRIST AND HAND
Wrist extend / MP extend / IP extend / thumb abduct / opposition
Option 2: hands behind the head
1. Shoulder abducted / shoulder ER / elbow flexion / wrist extended / fingers slightly flexed / –hand behind head
- May not be comfortable but it is good for increasing airway
SIDLIE:
HEAD
BACK
LOWER ARM
UPPER ARM
TOP LEG
BOTTOM LEG
ANKLE
TOES
HEAD on pillow or a few pillows for neutral neck
BACK support with pillow –don’t want spine rotated asymmetrically
LOWER ARM HAS TO BE EXTENDED: do not want him lying on his shoulder : Lower arm has to be fully extended, elbow extended, forearm supinated
UPPER ARM with pillow on chest
TOP LEG: Flex top leg and bring forward for balance—top leg is flexed
BOTTOM LEG: Pull hip back to stabilize –bottom leg is pulled back to stabilize
ANKLE: dorsiflexed
TOES: extended
PRONE
why use it
HEAD
TRUNK
SHOULDER
ELBOW:
WRIST:
HAND:
FEET
Make sure that this position is not contraindicated
If you can use this position helpful to prevent hip and knee flexion contractures, maintain lumbar lordosis, postural drainage: need to monitor when in this position
HEAD: straight, support foreahead
TRUNK: good alignment of trunk, Avoid increased lordosis
SHOULDER: Slight abduction
ELBOW: flexion or extension
FOREARM: supination
WRIST: extended
HAND: Rolls in hands for functional position
FEET: Feet in space between mattress and footboard allowing 0 degrees of DF
Goals in mat and transfer (5)
1) develop good physical conditioning
2) Improve ability to learn and perform ADL
3) Breakdown activities into components
a. Analyze task, breakdown components, reintegrate missing component back into the original task
4) Develop functional carryover
a. Motor learning programs to promote carryover
5) Concentrate on strength, range, balance, coordination, endurance, speed, timing
Vary exercise according to goal, use assistive and adaptive equipment, can use weights, thera-band, and pulleys
Practice tasks in different settings
Long sitting balance, short sit balance, bed mobility, etc many times in different ways
Stretching of appropriate tight structures
what dont we stretch
Hamstrings need to go to 110 degrees
DO NOT STRETCH THE BACK: want thoracolumbar fascia to be tight to support the low back and hold in place, need anterior capsule of hip and illiofemoral ligaments to hold up in gait, need tightness in hand flexor for tenodesis
COG must remain inside BOS
in long sit or short sit keep head and shoulders in front of hip because don’t have hip muscles (ie in long sit and short sit)
if don’t have trunk cant use to sit up: need to use a COG over BOS position
In order to lift trunk up the hand must be in front of the hip –keep head, trunk and hips flexed
Hands must be in front of the hip so that the body doesn’t just go forward
head-hip relationship
Head acts as weight to assist or resist movement:
- –To assist, head should follow the movement
- –Eyes should follow the movement
b. The head and hips always move in opposite directions—use the relationship to facilitate movement and lifting
c. Ie in sit: push down through hands and rapidly turn head to rotate hips
d. Longsit: start head down then throw head back to move hips forward while pushing fists into the floor
e. Start head back and bring it forward to move hips back while pushing down through fists
Level of independence with Transfers
• C5:/C6: chair to bed with sliding board
- C7/C8 and better:
- Chair to toilet
- Chair to car
- Chair to easy chair
- Chair to bath
- T1:
- up and down curbs using rear wheel balance
- Chair to floor
