CVA stroke patient: getting out of bed

[jjose_01]

The truth is...PRACTICE MAKES PERFECT! Just let him to do it again and again at his "mode of comfort"! Well,at first, it will be ergonomically bad but as he do it with your assistance, having his endurance as his limitation, you can then slowly incorporate the "proper way" of moving him out of bed! Observe how he want to do it on his own,you can find the clue from there!

[mcasus]

Practice indeed does make perfect. We often see CVA patients a number of years post-stroke who find they have lost some capacities from their initial rehab, sometimes due to bad habits, but often these can be regained with practice. Sometimes it means practicing each stage of the transfer many times before putting them all together to go from lying to sitting, and reverse. The most efficient way to do that transfer is:

1. Sleeping on the left side of the bed so that his right / strong side is positioned to help him in the movements.

2. Lying on his back, have him bend his right knee up with his foot on the bed.

3. While pushing with the right foot to roll the right side of his pelvis over towards the left, he should reach with his right hand toward the side of the bed, effectively rolling onto his left side by pushing with his foot and pulling on the mattress with his hand.

4. While holding the side of the mattress with his right hand at the level of his right shoulder, he should then move his legs to the side of the bed. If he is able, he could help his left leg with the right, but otherwise may need help sliding his legs forward to the edge of the bed.

5. He should then lower his feet over the side of the bed while pushing with his right arm to get his upper body up off the mattress. He may need some help with lifting his upper body and/or controlling the descent of his legs.

Getting into bed is the reverse of the above--sit, lie upper body onto left side, lift legs in, roll onto back. Never let him just sit down and flop into bed. It seems easier at the outset, but then valuable transfer skills are lost.

In all cases where you are helping him, make sure to protect your own back. Never bend over from the waist, and make sure you bend your knees and keep your back with the normal slight hollow in it. Move your body weight from one foot to the other in the direction you want to move your Dad, never twisting your body as you move.

If you are doing this as an exercise you should avoid doing all the work for him, as tempting as it is when we see someone struggling. Maybe just stabilize his body at each step to give him a chance to move further after a short rest. If I were treating your Dad, I would get him to just do steps #2 and #3 many times (i.e. 10 times, several times a day for several days) without trying to go further. Once that got easier, I would add #4, and finally #5.

There are technical aids that can help stroke victims to do these transfers. One is a kind of grab bar: Part of it goes under the mattress, while the rest is beside the bed at the level of the upper body. It provides a hand-hold to pull on for rolling onto the side, and also as a point of support when going from sitting to standing. Another very useful thing if it is affordable is an electric bed. That way the upper body can be raised using the bed controls and to alleviate some of the effort required to raise the weight of the trunk. There are also easy-chairs that through electric controls can raise the person to almost-standing.

Good luck, and hope this helps.

[jjose_01]

I think,the description is too technical for the primary audience(patient's daughter)! Let your physios read this forum and let them do it for your father. Hope we helped you by not just adding years to your father's life but also adding life to his years!

[mcasus]

I don't think the reply is too technical, since in my 30+ years of experience, 10 of them in home care, I have done much teaching to caregivers of how to help with transfers--I think more credit needs to be given to caregivers. It is merely a question of mechanics and ergonomics, and you don't have to be a physio to practice it. In my home care practice I rely heavily on caregivers to carry out the exercises in between my visits, and am rarely disappointed. It may well be that the gentleman concerned might not learn how to do this transfer, but regardless of that the steps outlined are the steps I would teach a caregiver in order to help their loved one transfer. It isn't rocket science, merely a question of good body mechanics. The professional association I belong to publishes a pamphlet for families on how to transfer patients, and families/caregivers have found this to be extremely helpful.

Often when patients are seen in rehab but not at home, we as physios assume that the learning that takes place in rehab will be easily transferred at home. This is not always the case. Once at home there may be architectural barriers, physical limitations of the care givers, environmental constraints, psychological constraints, caregiver burnout, patient demotivation.... What happens in the clinic is seldom what happens at home, and we physios need to be cognizant of that in our approach to patients who have acquired handicaps and are returning to the home setting.