R EHABI L I TATION
adjunct to therapy – regularly challenged sitting during the day31
– particularly useful
for those patients where sitting out is more challenging or requires a high number of staff to facilitate the transfer out of bed. Evidence suggests that upright positioning can provide an orthostatic challenge to prevent cardiac function deterioration32
postural hypotension; increase functional residual capacity;33 impairment34
and ensure a better position
for active exercises and intervention within the clinical environment. An early method to support in bed rehabilitation is cycle ergometry, used during the acute phase of illness when out of bed mobility is contraindicated or as an adjunct to progressive mobility to improve strength and cardiorespiratory fitness.35
Electrical muscle
stimulation may also be utilised during acute periods of immobility – although, at present, the effectiveness of this remains inconclusive.36
Pressure ulcer prevention In order to assist the prevention of pressure ulcers developing over body areas such as the face, breast region, genitals, knees and toes when in a prone position, an appropriate pressure redistribution mattress should be used. Consideration could be given to a mattress, which allows carers to deflate individual mattress cells under the patient’s body, providing an adaptable support surface and selective off-loading for the management of highly vulnerable areas.37 Regular repositioning is essential to help prevent the development of pressure ulcers whenever patients are spending extended periods in bed due to excessive loading onto sensitive areas of skin with increased contact directly over bony prominences.38,39
Such
injuries can lead to a protracted hospital stay, patient suffering, possible surgical intervention, and increased costs of care.40 To further support the care of patients in bed, early detection41
using a specialised
scanner can assist clinicians to identify anatomical areas at increased risk of pressure ulcers developing five days earlier than visual inspection alone and potentially reduces the incidence of hospital acquired pressure ulcers by an average of 89% based on an individual care pathway.42
Early
detection provides an opportunity for timely intervention in the management of pressure
and reduce risk of neurological
ulcer prevention and the rehabilitation and recovery process.
VTE prevention Another important area in the care of immobile patients is preventing venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) which can lead to serious and potentially life changing complications, while increasing healthcare cost. Venous stasis is naturally avoided through the biomechanical action of the calf and foot muscle pump, which is why early ambulation / mobilisation is the treatment of choice for patients at lower risk of VTE.43
When walking is not possible,
the benefits of the muscle pump can be simulated by mechanical means. Prevention strategies commonly incorporate the use of pharmacological prophylaxis and/or mechanical methods44
including intermittent
pneumatic compression and passive graduated compression stockings.
Sitting on the edge of the bed The process of sitting a patient on the edge of the bed forms an important part of the patient assessment and subsequent provision of a structured rehabilitation programme
and seating plan. The assessment would consider the body anthropometrics, shape, sitting balance and readiness for sitting out of bed, ensuring the bed height is adjusted so the person’s feet are placed on the floor providing proprioceptive feedback.
Out of bed mobilisation Passive standing: The process of sitting on the edge of the bed can at times be labour intensive, particularly for patients who are obese, of low arousal or with profound ICU- AW.45
In these instances, equipment such as a tilt table, ceiling lift / passive mobile hoist with an ambulation sling, or a multi- positional aid can support patient care in the acute care setting.
Evidence suggests that a multi-positional aid that can support supine, sitting or standing position, early in the rehabilitation process can have positive outcomes to patient care, length of stay and facility costs.46
Active standing: Once the patient is able to maintain their sitting balance with minimal support and move their legs against gravity, they may be ready to progress to stand at the side of the bed.
Using a standing and raising aid is one potential solution for those patients aiming to
Figure 3. SEPTEMBER 2020
WWW.CLINICALSERVICESJOURNAL.COM l 45
▲
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92
