Therapeutic Scenario 8

Examination Card 8, Therapeutic
Hoisting From Wheelchair to Plinth.

Firstly introduce yourself and assistant to patient, explain what you are going to do in relation to hoisting from chair to plinth, how you will carry it out etc. That you are then going to carry out passive mvts on lower limbs, and then finally you are going to analyse the components of rolling from supine to side lying.

Ensure you have all the equipment near by necessary 4 hoisting. Check and observe the patient to determine what size sling will be required and sling suits hoist, also check that the hoist being used is suitable for the patient (weight capacity). Position two philislides on bed so when patient laid down they are lying on them. You are then going to position the sling down behind the patient in the chair, ask patient to sit forward in chair changing their centre of gravity,(get assistant to support patient as they lean forward so the don’t fall forward) ensuring the end with the leg support go 1st, put sling down as far as possible, sit patient back, loops on back of sling should be between scapulas and then lift patients leg and rest their foot on your knee and pull sling under legs, with the straps on the end of the leg support, loop 1 through the other. The straps at shoulder are free also and not stuck behind patient. Then move the hoist around the chair, asking assistant to hold the head of the hoist still so it doest swing and catch the patient, spread the legs if necessary to fit around the chair. Connect the straps to the hooks on hoist, (as you want them in a supine position on bed, you are going to go to the 1st or 2nd loops) Warn patient when you are going to start lifting, let them now they may feel like their slipping in the sling 4 a second, but not to worry they will be fine. Slowly start to lift, when patient is lifted of chair, get assistant to remove wheelchair, you can either higher hoist to bed height or get assistant to lower bed, ensure bed is flat. Then move hoist into position then move patient in line with plinth in the direction you want them lying using rotating head on hoist. Lower patient slowly until they are completely flat on plinth, lower until there is slack on the sling and are able to remove sling from hoist. Position in an appropriate position toturn them into side lying for hip extension etc.Can leave the sling under patient. Talk to patient then and ask them are they comfortable, do they want extra pillows for behind head etc. CAn use philislides to also position patient.


Passive Movements of Lower limbs
Describe clearly to the patient what you are going to do and the benefits of it. It involves the physio doing the following movements without any help from the patient, abduction and adduction, flexion & ext of hip, knee and ankle, internal & external rotation, also bilateral abduction and adduction (compare each side to each other). These movements will be performed to full available ROM. These movements will help with circulation, proprioception, sensory awareness. Make patient aware the movements should cause NO pain and if they do ensure to let you know. Complete relaxation is required and slight overpressure may be applied at end of range. Ask for any contraindications such as pain or inflammation etc and obtain consent.

1. Hip and Knee flexion – Hand positioned behind ankle and other at popliteal space, as u move from extended knee and neutral hip, hand at popliteal space will slide out to lateral side of knee stops leg abducting and allows extra pressure to be applied to movement to feel end feel. Once this point is reached patients limb is returned to staring position.

2. Hip flexion and knee extension – Keeping knee extended flex the hip, One hand behind ankle and other just above patella, so to maintain knee extension. This will test the hamstrings and there elasticity, never push past the end feel and stop if uncomfortable for patient.

3. Hip abduction – Patient in supine, hands placed at ankle and popliteal space, take leg away from mid line of body. Physio has to aware of base of support and posture. Come out to end feel and den return towards mid line.

4. Hip Adduction – To adduct for example left hip.abduct right leg slightly and then adduct left leg bringingleg across midline

5. Hip External Rotation – Hands supporting ankle and medial aspect of the popliteal space. Flex knee and hip to approx about 90degrees, then keeping knee stable, move foot across the body,keeping knee and hip flexed

6. Hip Internal Rotation - Hands supporting ankle and lateral aspect of the knee. Flex knee and hip to approx about 90degrees then move foot outwards as much as possible not as much movement as in external rotation

7. Hip extension – Role patient into side lying position, knee in flexed position,physio supporting leg appropriately and then extends the hip.Ask assistant to support patient at shoulder and just above hip while physio carrying out movements

8. Dorsiflexion – Place hand on calcaneus and run forearm of same hand along plantar surface of foot and with other hand stabilise distal tibia (just below Knee). Then pull down on calcaneus and with forearm push on plantar surface.

9. Plantarflexion – Place one hand on dorsum of foot and other on distal tibia, using hand on dorsum push down on foot. NB avoid pressure over the toes

10. Ankle Inversion - Stabilise calcaneus and then with other hand invert the foot
Same for eversion but evert the foot when hands are in position.

11. Phalangeal Flexion and Extension – One hand on dorsum, other hand around toes

In Passive movements you must always be aware of your own posture, very important. Also state how many times you will be doing each movement to patient, 5-10. Ensure to have communication with patient to ensure the movements are ok for them and keep an eye on expressions for any sight of pain that they might not want to mention.


Functional Analysis From supine to side lying position.

It is important for everyone to know that everyone’s functional analysis of this movement is going to be different. What you are meant to look at though is joint movement the muscles involved in these movements. What we are mainly looking at though is axial components (trunk – Spine)
Hopefully your patient will roll in a similar way as you turned them for passive movements.

Form the top of the spine it is divided into cervical, thoracic, lumbar, sacrum and coccygeal. The cervical is made up of 7 vertebrae and is lordotic in shape; the body of the vertebrae is the smallest out of the thoracic and lumbar, lumbar being the biggest. Thoracic has 12 vertebrae and is kyphotic in shape. Lumbar has 5 vertebrae and is lordotic. Sacrum has 5 vertebrae but they are all fused together and the coocygeal has 4.
The movements of the spine are flexion, extension, lateral flexion and rotation. These are what you are looking for when the patient rolls to side lying and any changes that may occur in the spine curvature. And also muscles involved in these movements.

Sternocleidomastoid is involved in lateral flexion of the head and rotates head to opposite side.
Semispinalis extends and rotaes the neck.
Splenius capitis and spenlius cervicis extends and laterllay flexes neck and head, rotates to the same side.
Erector Spinae are involved in extension and lateral flexion of trunk and neck. This muscle runs down along spine.
Longissimus and Iliocostalis extend and laterally flex trunk, neck and head.
Multifidus rotates, extends, lateral flexion and stabiliser.
Rectus abdominus flexes trunk
Transverse abdominus flexes and laterally flexes trunk
External obliques flex and laterally flex trunk, more noticeable in bringing shoulder to knee.
Internal obliques flex and laterally flex trunk, knee to shoulder


PHASE 1: Start Position:
Head flexed due to pillow, shoulders on bed and thoracic spine. Although due to the curvature shape of the lumbar spine (lordotic) it is slightly off the bed.

PHASE 2: Head flexes further (saggital), rotation (transverse) and is then placed back on pillow and for this to happen, head & neck is laterally flexed (saggital), muscles working eccentrically for head to lower.

PHASE 3: Flexion of knee and hip causes the reduction of lordosis in the lumbar spine (saggital)

PHASE 4: Pelvis is lifted (saggital plane) off the plinth and rotation occurs at the lumbar (transverse). Base of support at this point is made less stable. Gravity is working down on the body

PHASE 5: Thoracic spine then follows the lumbar. Transverse plane. Friction occurs at the turning shoulder between the bed. Base of support is made smaller from supine lying to side lying. COG also changes

PHASE 6: Knee then follows to allow stability in side lying; with knees being flexed the lumbar lordosis is reduced further. COG changes.