Bed positioning quadriplegia: positioning of upper limbs in supine
Bed positioning quadriplegia, with greater potential to be independent: supine to side lying - assisting lower limb movement
Bed positioning quadriplegia, with greater potential to be independent: supine to side lying - assist rolling to the side and support the back
Bed positioning quadriplegia: supine to side lying - position upper limb
wheelchair positioning: shoulders and hips straight; 1: quick checks for possible areas of pressure
Wheelchair positioning: shoulders and hips straight; 1: quick checks for possible areas of pressure
Wheelchair positioning: foot squarely on foot rest; 3: knees at right angles
Bed positioning quadriplegia : lower limbs in supine with pillows
to avoid soresfor good pressure distribution in sitting, avoid leaning sideways or sliding forwards on the chair!
to avoid sores: poor posture
to avoid sores: leaning forward and sideways regularly (once an hour for 2 minutes each time) can greatly reduce risk of pressure sores. use assistance for balance if needed
to avoid sores: leaning forward and sideways regularly (once an hour for 2 minutes each time) can greatly reduce risk. Use assistance for balance if needed
Lower limb passive movements to the hip and knee to be done daily; bend and extend hip and knee
Lower limb passive movements to the hip and knee to be done daily: bend and extend hip and knee
maintaining range of movement in ankle. Pillow for positioning and prevention of ankle contractures
maintaining range of movement and muscle length through sitting positions: frog sitting and long sitting
maintaining range of movement and muscle length through sitting positions: half-ring sitting
Range of movement upper limb; hold 30 seconds for each direction, whilst avoiding painful movement; full flexion of shoulder; flexion and extension of wrist
maintain range of movement open the web space between the thumb and index finger
maintain range of movement in fingers: bend and straighten all individual joints of the fingers while keeping the wrist straight
maintain range of movement in fingers
Maintain range of movement: use assisted finger abduction and adduction
Bend and straighten all individual joints of the patient's fingers while keeping the wrist straight
Support feet in the bed and in wheelchair
elbow flexion and extension hold 30 seconds for each direction, whilst avoiding painful movement; wrist flexion and extension
Resting splint lower limb: splinting may be used to prevent soft tissue shortening at the Achilles tendon; extra strap for night use
Bed positioning quadriplegia: side lying with pillow between knees and under head
Abduction and adduction of shoulder Hold the position 20 to 30 seconds and avoid painful movements
splinting upper limb: prescribed to maintain the web space and promote functional hand position and prevent hyperextension of metacarpal joints. 1: thumb spica 2: Metacarpal extension restriction splint
bed mobility paraplegia; to assist rolling from supine to side lying, pillows are often used. 1: cross patient’s legs in the direction to be moved
patient rolls upper body to right; 3: and then swings to the left
bed mobility paraplegia: non-assisted positioning from supine to sitting. low quadriplegia; 1: support weight on one elbow; 2: transfer weight to forearms
maintain range of movement in fingers: bend and straighten all individual joints of the fingers while keeping the wrist straight
bed mobility ladder, low quadriplegic C5-6; a short ladder can be tied to the legs of a bed near the feet so patient can pull themselves up into sitting
1: hook one arm round back of chair and place board between chair and bed, 2: use fist to adjust board
3: prepare to take weight on arms; 4: bend forward and lift body weight to balance directly above feet
5: gently swivel hips to other end of board ;
6: move hips onto bed and push away board; 7: then push away chair, until needed again!
transfers bed sit to supine; 1: on side of bed with bottom as far back as possible, support torso with both arms; 2: hook one wrist under opposite knee
Bed transfers sit to supine; 3: pull knee onto bed; 4: push heel into line with knee;
Bed transfers sit to supine; 5: hook wrist under next knee; 6: pull leg up onto bed;
7: place knees above one another; 8 job done!
Transfers high quadriplegia; transfer from bed into wheelchair with two assistants; 1: one assistant positioned behind patient; note hands around body and onto arms of patient
Transfers high quadriplegia; 2: lift and place patient in chair in one sustained movement
Upper limb, ROM stretches: elbow flexion/extension and wrist extension/flexion
transfers chair to bed aided; 1: note the use of a strong belt or tie, used by the physio to lever patient’s weight
transfers chair to bed, aided; 2: physio swings patient onto bed
pivot transfers chair to bed, aided
transfers chair to bed, unaided; lock the wheels, remove the inside arm rest and place feet on floor; 1: lean trunk forward and place inner hand on bed
transfers chair to bed; 2: lean trunk forward and place inner hand on bed; 3: raise the trunk with body weight directly above feet
transfers chair to bed; 4: stabilise body on bed and push away chair; 5: swing hips around in one movement where possible
uneven transfers bed to chair, unaided; 1: prepare to lean forward
uneven transfers bed to chair, 2: reach forward for arm rest
uneven transfers bed to chair, 3: supporting body weight on arms, stand up
4: swivel hips toward chair
5: move hands opposite one another and sit
sitting balance quadraplegia; elbows locked straight and depress scapula
Personal care, dressing, trousers; no zips or buttons; start position
Personal care, dressing, trousers; 1: lean forward to grip ankle; 2: pull ankle onto opposite thigh
3: pull trousers over foot; 4: pull trousers up, first one leg, followed by second
Personal care, dressing, trousers; where finger grip is weakened, use the wrist to grasp opposite ankle, with either an inside or outside grip
Eating and grooming aids
Personal care, dressing Paraplegic & C7 socks; 1: with one hand, grasp opposite ankle; 2: pull foot across onto opposite knee
Personal care, dressing Paraplegic & C7 socks; 3: pull sock over toes; 4: ...and over heel
Personal care, dressing Paraplegic & C7; trousers in wheelchair; 1:hook one elbow around back of wheelchair; 2: then pull lower leg over opposite knee
Personal care, dressing Paraplegic & C7 socks; 3: pull sock over toes; 4: ...and over heel
Dressing Paraplegic & C7 in wheelchair; with/without assistance for some C5 individuals; 1:hook one elbow around back of wheelchair; 2: then pull lower leg over opposite knee
3: push arm through trouser leg and loop foot through; 4: repeat for second leg and then pull trousers up and around hips
Dressing; 1: pull each arm through its sleeve by using whole hand movements/ teeth to assist manipulating the garment". 2 once over head, shrug shoulders up and back a few times to help shirt over shoulders
3: once over head, shrug shoulders up and back a few times to help shirt over shoulders and pull it downwards
Personal care, dressing , two assistants; 1: put on trousers, one leg at a time, starting from ankle and pull up to hips
Personal care, dressing; 2: with assistants, bend one knee of patient
Personal care, dressing; 3: roll patient onto their side and pull up trouser leg. repeat for second side
Personal care, washing quadriplegic; two assistants usually required for bowel management and fully body wash in bed; check for pressure sores and test for water temperature
Drinking; whilst fingers may not function fully, a two handed grasp or the aid of handle may prove effective; 1: fingers not possible to control independently 2: press glass with left hand into right hand; 3: two handed grip
Drinking; 4: a two fingered grip may sometimes work when thumb used as clamp
Equipment, drinking straw; because patient is unable use hands to grip, various supporting alternatives provide good solutions; fixed points for drinking
Equipment, hooks and handles; using adapted handles or a hooked arm to act as lever or offset balance
Equipment; eating aids
Resting Splint – Upper limb : Patient should be splinted with position of wrist with slight extension and should aim to wear splint at night to prevent soft tissue shortening
Equipment; wheelchair commode; use safely if available
Equipment, wheelchairs; vary widely and familiarity with details essential; support for the trunk, arms and a high pressure relieving cushion are essential features
Equipment, wheelchairs; vary widely and familiarity with details of the different attributes is essential
Equipment, wheelchairs; a manual wheelchair with a pressure relief cushion may be used by some indivudual and for short distances on level surfaces
Exercises; Stretching the muscles in the front of the shoulder, and strengthening the back of the shoulder is important to decrease pain and prevent shoulder injuries for wheelchair pushers
Exercises; use elastic band to pull muscles; (note use of wheelchair arm rest can provide extra tension). If unable to grip the elastic bands tie it around the hands
Exercises; use elastic band to pull muscles. If unable to grip the elastic bands tie it around the hands
Exercises; small weights and repetition stimulate shoulder and arm muscles. If unable to grip a dumbbell use a wrist weight or elastic band tided around the hands
Exercises; using small dumbells to strengthen and invigorate. If unable to grip a dumbbell use a wrist weight or elastic band tided around the hands
Exercises; using small dumbells to strengthen and invigorate. If unable to grip a dumbbell use a wrist weight or elastic band tided around the hands
When extended, fingers and thumb naturally flex into palm, and with tendodesis it is critical to use this to gain wrist function
Exercises; Tendon glide exercises. Hold each position 3 seconds; hook fist, straight, full fist, platform, straight fist
Exercises; stretching back of upper arm and engaging shoulder muscles
Respiratory cough manage; 1: self-assisted cough technique uses arm pressure inwards and upwards; 2: attempt to cough as carer pushes in and up
C1-C4 Respiratory management; In an assisted cough the carer places pressure inwards and upwards through hand with straight arm
C1-C4 Respiratory management; At the start of an assisted cough the carer places hand on abdomen; as the patient coughs the carer pushes rib cage upward
Education bowel care/ abdominal massage to help bowels; give laxatives 8-12 hours beforehand
maintain range of movement in fingers and thumb; thumb extension and flexion; opposition and reposition
strengthening scapula: squeeze shoulder blades back and down, hold for five seconds and then repeat ten times
begin in neutral position, extend wrist back and hold for 3 seconds, then forward for 3 seconds
With a tendodesis grip, objects with wide handles, like a shaver or a brush, become possible
1 note wide and raised arm; 2 both arms are flung together to gain momentum; 3 with arms positioned at right angle to torso, the roll can begin
4 roll head and shoulders over onto forearms; 5 use upper body position to lever hips and lower limbs over; 6 rocking on alternate elbows, pull them in under shoulders; 7 ready to begin sitting position
8 with weight down through shoulders to elbows; 9 nudge alternate elbows toward feet; 10 continue as far as possible
11 with weight on one elbow, fling the other across both legs; 12 with upper body weight resting on legs, move hands into support position; 13 and raise upper body into sitting position
11 with weight on one elbow, fling the other across both legs; 12 with upper body weight resting on legs, move hands into support position; 13 and raise upper body into sitting position
11 with weight on one elbow, fling the other across both legs; 12 with upper body weight resting on legs, move hands into support position; 13 and raise upper body into sitting position
1 with chair and low seat to either side; 2 transfer weight onto low seat
3 with weight vertically down through both arms;
4 swivel hips to chair;
5 arm can now move to chair; 6 pull feet onto footplate
1 keeping knees/ankles together; 2 prepare right arm to support; 3 prepare left arm to support
4 raise body weight through arms; 5 and swivel hips toward chair
6 keeping knees/ankles together; 7 swivel hips fully into chair
8 push hips to back of chair; 9 place feet on footplate; 10 complete
transfers into/out of bath; for safety, ensure surfaces are dry prior to transfer; 1: place first leg onto side of bath; 2: place second leg beside first
3: slide forwards, lowering feet; 4: with weight still on side, reach hand to other side of bath
5: supporting weight through arms, lower body down; 6: starting from sitting position
7: use arms to pull forwards until weight above feet; 8: raise body weight directly upward
9: swivel to sit on bath edge; 10: push hips back onto chair (nb: cloth tied round knees may aid stability)
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Extra mobility resources
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