Body Mechanics Principles

KEY PRINCIPLES OF BODY MECHANICS AND TRANSFERS
Lisa Taipalus PT Regional Stroke Best Practice Consultant Northeastern Ontario Stroke Network www.neostrokestrategy.com

OUTLINE
Provide you with some tools and options to use with your stroke survivors Review principles of body mechanics Review good practices for transfers Positioning the stroke survivor Bed Mobility Repositioning Transfers Opportunity to problem solve some issues you may have

BIOMECHANICS
Body movements and the forces that act on the musculoskeletal system Good body mechanics helps to keep your body in good alignment during activities to reduce the stresses and strains you are subject to. Avoid awkward postures.

KEY PRINCIPLES

Good posture
Spine is not straight
but curved Important to maintain the lordosis or curvature of your lower spine Influences the rest of your body

KEY PRINCIPLES

Engage your core muscles
Tuck in your belly button Activating abdominal, spine, leg muscles Prepares the body with good postural alignment and leg muscles are ready for your activity Leg muscles are lifting muscles

KEY PRINCIPLES

Good base of support
The wider the base of support the lower your centre of gravity Provides you with stability Move your base of support as needed, do not twist Position feet in the direction you are going

KEY PRINCIPLES

Reduce your lever arm
Keep the load close to you Get close to the load This decreases the amount of force exerted on your body

KEY PRINCIPLES

Communicate clearly
Maintain eye contact Provide simple clear instructions Agree on the process and count together

KEY PRINCIPLES

Prepare the environment
Ensure you have adequate space for both you and the client to move Remove or move any items that can present a hazard to footing or movement Have all your equipment ready Adjust the height of the bed Remove footrests or armrests Adequate lighting

THE STROKE SURVIVOR
What are some key points to remember when working with a stroke survivor?
Personalized approach Unique set of problems
Impaired cognition Impaired communication Impaired mobility

Use problem solving approach Interact with the stroke survivor/team/family Recognize that the stroke survivors energy levels can change throughout the day

POSITIONING
Goals of positioning are: Support the affected limbs Manage and prevent pain Support muscles and prevent spasms Maintain skin integrity Increase awareness of the affected side Promote body symmetry and alignment Comfort Prevent joint and muscle stiffness

LYING ON THE
BACK
Caution: always support and move limbs carefully, do not pull on the limbs Head – in neutral position, not tipped or turned but in line with the body Affected Arm – positioned away from the body, with the elbow straight and the elbow crease facing up

LYING ON THE BACK
Affected Hand – elevate to reduce/prevent swelling, separate the fingers Affected Leg – level the hips with a towel or flat pillow.
To reduce pressure on the heels the knees can be bent and supported with a folded pillow but only for a short time so as to not encourage knee flexion stiffness. Caution: ensure that pillows or towels are not cutting off circulation or increasing pressure on the skin

LYING ON THE AFFECTED SIDE
Head – neutral position Shoulder – draw the shoulder complex out by gently bringing the shoulder blade slightly forward. Support the arm on a pillow with the elbow bent and resting away from the body or with the arm out straight Leg – both knees bent with the bottom leg slightly forward, pillow between knees Back – pillow lengthwise behind back

LYING ON THE UNAFFECTED SIDE
Head – neutral position Shoulder – bottom shoulder slightly forward, the top supported on 2 pillows to keep the arm from dropping down and pulling on the shoulder, elevate the hand as needed with fingers spread Leg – the bottom leg straight, the top leg bent and supported on a pillow slightly forward Back – pillow tucked in lengthwise behind back.

BED
MOBILITY
Rolling to affected side – ensure that affected arm is slightly forward so to prevent rolling onto the shoulder Legs – leg closest to side you are rolling to is straight and the other leg is bent with foot flat on bed Roll – assist the stroke survivor by helping at the back of the shoulder and hip as needed encourage them to roll themselves as much as possible by turning their head and reaching over with the unaffected arm and pushing with the leg

BED MOBILITY
Rolling to the unaffected side – ensure the affected arm is supported, the stroke survivor can support their arm and bring it across their body Legs – leg closest to side you are rolling to is straight and the other leg is bent with foot flat on bed Roll – assist the stroke survivor by helping at the back of the shoulder and hip as needed encourage them to roll themselves as much as possible by turning their head, pushing with the leg and drawing their affected arm across their body

BED MOBILITY
Sitting up from sidelying – bend the hips and knees, let the legs come over the edge of the bed, scoop under the shoulder and ask the stroke survivor to lift their head and push up with their arms You can assist by applying a bit of pressure to the top of the pelvis to help lever them up Lower the bed to ensure the stroke survivor’s feet touch the floor to assist with sitting balance

REPOSITIONING IN BED
Remove pillows Lower bed rails and lower head of bed Adjust height of bed Stroke survivor bends knees, feet flat on bed Use draw sheet Stroke survivor tucks chin, pushes with legs to help slide up the bed You should not be lifting – shift your weight toward the direction you are moving, your feet should be apart, with back straight and knees bent Use a mechanical lift if the stroke survivor cannot assist with the repositioning

TRANSFERS
Transfer to the stronger side Put the stroke survivor’s shoulder sling on if they are unable to use the arm to assist to prevent injury to the shoulder Ensure w/c is positioned at a 900 angle with armrest and foot rests removed and brakes applied Ensure the stroke survivor is sitting with the balls of his/her feet under their knees, turn the heels in the direction you want to go Put transfer belt on, ensure it is on snug

TRANSFERS
Ask the stroke survivor to bring shoulders forward over their knees but still keeping their back straight and head up Keep your back straight, have a good base of support and bend your knees Ask the stroke survivor to push up from the bed and you guide the turn to transfer A second person behind can guide the hips to the chair The stroke survivor can wiggle hips back into the chair

TRANSFERS
Transfer to the weak side Be sure the stroke survivor is strong enough and stable enough to perform the transfer to the weak side Put the stroke survivor’s shoulder sling on if they are unable to use the arm to assist to prevent injury to the shoulder Ensure w/c is positioned at a 900 angle with armrest and foot rests removed and brakes applied Ensure the stroke survivor is sitting with the balls of his/her feet under their knees, turn the heels in the direction you want to go Put transfer belt on, ensure it is on snug

TRANSFERS
Ask the stroke survivor to bring shoulders forward over their knees but still keeping their back straight and head up Keep your back straight, have a good base of support and bend your knees Ask the stroke survivor to push up from the bed and you guide the turn to transfer A second person behind can guide the hips to the chair The stroke survivor can wiggle hips back into the chair

POSITIONING IN WHEELCHAIR
Ensure the stroke survivor is sitting up with back straight, with the hips touching the back of the chair Weight should be equal on both hips Feet resting flat on footplates in neutral position, not turned in or out

SIT TO STAND
Ensure the wheelchair brakes are applied Remove footrests Feet should be flat on floor with balls of feet under knees Apply transfer belt Support a flaccid arm with a hemi-sling Bring shoulder forward over knees with back straight and head up Stroke survivor pushes up on armrest/s You provide supervision/cueing or minimal guidance to complete the stand

REPOSITIONING IN THE CHAIR
Reposition for comfort and safety Brakes on, foot rests removed, feet on floor with balls of feet under knees Stroke survivor supports unaffected arm Person in front maintains straight back and bends knees and helps to bring stroke survivors shoulders forward Person behind, places hands under sit bones in bottom and guides the stroke survivor as they scoot hips back one at a time

SUMMARY
Use good body mechanics Prepare the stroke survivor for the activity Prepare the area for the activity Use the appropriate equipment Protect the hemiplegic shoulder and leg with good positioning and handling skills Each stroke survivor has their unique problems to be aware of

REFERENCES
Facilitator’s Guide for Positioning, Transfer and Mobility of the Stroke Survivor DVD, South East Toronto Stroke Network Occupational Health and safety Council of Ontario – Musculoskeletal Disorders Prevention Series Occupational Health Clinics for Ontario Workers Inc – Healthcare Workers Patient Handling