Exam Card 1

Exercises for patient to do in bed:

Firstly introduce yourself. Then explain that you are going to go through a few exercises that they should do while in bed and tell them that these exercises help the blood circulating around and it will help increase their range of movement. Make sure you ask for consent before you begin.

1) Physio- While you are laying in bed wiggle your toes, move your feet up and down and rotate them. Doing this will keep your blood circulating around your feet and lower legs.

2) Physio- Ok, now can you tighten your thigh muscles by pushing your knee down into the bed, this will build up your quads. Do 5 of these every hour, or if you find that to easy do 10.

3) Physio- Now we are going to do the hardest exercise, the straight leg raise, I will assist you for the first 2 and then I want you to do 3 more yourself. So keep your leg straight and pull your toes to your nose. Then slowly raise your leg and hold for 5 seconds, then slowly back down again. It is important that you don’t raise your leg past 90º. Again do this 5 times every hour, or just as many as you feel you can do.

4) Physio- There is another exercise similar to the straight leg raise, but slightly easier. For this one you need to put a pillow or rolled up towel under your knee. Then you simply raise your heel up off the bed until your leg is straight. Then lower slowly.

5) Physio- And now the last exercise for today. I want you to lay straight and then slide your leg slowly out to the side and back. I will assist you with the first 2 again.


How to sit on side of bed and using a walking frame:

Now I am going to show you how to get to get up to sit on the side of your bed. I will slide your operated leg to the edge of the bed first, this is so your operated leg does not cross the midline. Then move your good leg around. Keep sliding across like that, until your legs are both off the bed and your feet are on the floor.
It is important that the bed is high and firm so that when you sit on the edge of the bed your knees are lower than your hips.

Ok, how are you feeling now? Will we try and use the walking frame now?
I will show you how to firstly. These are the steps:

· To get from sitting to standing, you need to have both hands on the edge of the bed and you then push up off the bed. Once you are off the edge, you can hold onto the frame.
· Then to walk, you lift the frame out in front of you then put your operated leg out first followed by your good leg. Make sure you lift your feet each time and don’t just slide them.
· When turning around or turning corners you must be careful that you don’t pivot or twist on the operated hip, and just take small steps.


Analyse the components of movement in the hip during a gait cycle.
· Gait cycle begins with initial contact. The model has a good BOS as both feet are on the ground. Friction between the models feet and the floor.

(The movement is all in a sagittal plane and coronal axis)

· Next is the right heel contact. Here the right hip is in flexion and the muscles working are the rectus femoris, the tensor fasciae latae, the iliacus the psoas major and sartorious. Here their is a small BOS as the models heel and toes of left foot will have contact with the floor. So also less friction.

· Then the left toe off. Now the left hip is in extension so the muscles that are working are the hamstrings( biceps femoris, semimembranosus and semitendinosus) and the gluteus maximus. Even smaller BOS as the left foot lifts off the ground, so only right foot has contact. Model will be unstable at this point.

· Now the right is in stance phase and left is in swing phase.
Swing phase can be broken down into 3 parts, acceleration, mid-swing and deceleration. Acceleration occurs at toe off until about 60 degree knee flexion. Then mid-swing is the period between knee flexion and the forward movement of the tibia (shin bone) to a vertical position. Deceleration is the end of swing phase, before heel strike.
Stance phase is broken down to: heel strike- which is the point when the heel hits floor. Flat foot-point where the whole foot comes into contact with floor. Mid stance-where we are transferring weight from the back to the front of the foot. Toe off-pushing off with toes to propel forwards


· So left heal contact. Here the left hip is in flexion so the hip flexors are working. The rectus femoris, the tensor fasciae latae, the iliacus the psoas major and sartorious. Small BOS as only heel and toes have contact with floor.

· Next is right toe off. The right hip is in extension so the hip extensors are working. The hamstrings( biceps femoris, semimembranosus and semitendinosus) and the gluteus maximus. Smaller BOS as right foot is off ground. Only friction between left foot and floor.

· Finally is back to right heel contact. The right hip is in flexion so the hip flexors are working.