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R EHABI L I TATION


achieve a full standing position and improve confidence following lengthy periods of immobility and illness. Active standing aids encourage the patient to participate with the transfer and standing process, supporting early standing activities, weight bearing exercises, standing practice and short distance transfers.


Seating: Evidence suggest that effective seating can help to reduce muscle atrophy, improve sitting balance, strength and conditioning with potential positive effects to improve patient flow.47


The principles of


good seating consider: l Loading the body - maximising the contact with the seating surface can provide good proprioceptive feedback;


- to achieve this the chair must be adjusted to the individuals body shape and weight distribution, ensuring the patients feet are on the footplate to prevent any neurological complications;


l Provide postural support - considering the armrest angle, ensuring the torso and head are supported effectively;


l Allow effective repositioning - by using the tilt in space 30-45˚ functionality;


- off-loading anterior tilt to support standing, with a stand aid and 24-hour care;


l Appropriate surface / cushion - which supports immersion and envelopment in conjunction with a documented risk assessment regarding pressure ulcer prevention.


Walking


Once patients are sitting out more frequently, progression towards active exercises commences with a natural pathway leading


Loss of muscle mass (up to 20% per week), and nerve dysfunction or damage leading to ICU acquired weakness appears to start within the first few days of critical illness. Muscle loss in the large lower extremity muscle groups will affect standing and walking ability.


to standing and ambulation. To support standing and ambulation, ceiling lifts with a walking sling or a mobile standing and raising aid can be used to support the patient and protect them from falls during stepping or walking practice. Gradually, as muscle strength and stamina increase, levels of functional independence improves – having beneficial effects on the patient’s physical and psychological status, they can become more independent in undertaking activities of daily living.


Summary In summary, during the patient’s recovery process, they can face a series of physical, psychological and cognitive health impairments, with effects on survival and physical functioning lasting potentially for years post-discharge.


Evidence suggests that the benefits associated with early mobilisation and rehabilitation using the appropriate technologies, knowledge and skills can support the patient to be mobilised early, often and at a safe and optimal level of functioning, helping to improve outcomes, quality of life and maximise efficiencies.48


About the authors


CSJ


References for this article are available upon request.


Mary Muir, Marketing Manager, Arjo UKI, BA (Hons), Dip N (Lon), FAETC, Patient Handling Cert, SRN (Rtd). Mary had 34 years’ experience of working in a variety of healthcare settings as a nurse, manager and back care advisor. Mary joined Arjo in 2004 and has worked as a clinical specialist, sales and contract manager, before taking up her current position of marketing manager. Mary has presented at international, national and regional conferences and has published on the management of plus size people.


Mark Pinder, Clinical Lead Patient Handling, Arjo UKI, BSc (Hons) Physiotherapy. Mark has over 14 years’ experience working with complex neurological disorders in community and acute care setting. Mark has worked for Arjo for 13 years and has experience of training provision and delivery on medical beds, therapeutic surfaces and a recent clinical focus on patient handling within specialist areas.


46 l WWW.CLINICALSERVICESJOURNAL.COM SEPTEMBER 2020


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