The last 4 weeks has really gone by so fast. Eight courses in four weeks has been a whirlwind of great revision of some of the fundamental techniques I use, literally, on a daily basis. This week I have been focusing on exploring positioning and transfers, which both provided a great overview of fundamental rehabilitation interventions.
As Physiopedia massive open online course (MOOC) Manager, I have been completing this year’s courses alongside learners from all over the world. This week I really found the positioning course useful as it has aligned my knowledge more with the nursing staff I work with regularly, putting specific terminology to many positions that I use regularly has been really beneficial for me, specifically around better documentation of positioning and alignment with other rehabilitation professionals. While I have always used these ranges of positioning I was not so familiar with some of the terminology for the specific positions. For example, Fowler’s position and Sim’s position were terms I had not previously used but had seen written at times in documentation by nursing and medical teams.
The case studies in particular were really useful to consider both positioning and transfers within different contexts. It can be very different exploring these in an acute hospital setting in comparison to exploring options within someone’s home environment. Hospitals can often have more space to manoeuvre, bigger toilets and bathrooms and often an electric bed that you can modify positioning. Then someone gets back to their own environment and it is often very different – as was the case with our case study. Kurt, a 34-year-old male, was discharged home from the hospital with an external fixation device for left leg limb reconstruction of the tibia and fibula after a serious car accident. It was great to see the discussions around Kurt’s options for positioning to help with pain and transfer options once he was able to start to increase his weight bearing. There were great ideas here around supporting the leg both for sleep and during the day.
“pillows/rolls in bed to support the sides of his leg and provide some elevation to help reduce pain and swelling and aid blood flow. During the day, long sitting would be appropriate, again with his leg elevated, a reclining chair with integrated leg support would be a good option. He can use a variety of cushions to provide the support he needs and to get comfortable.”
Also a great option of using a wheelchair with an elevating leg rest initially, when he was unable to weight bear, providing him with some independence to move within his home.
“A wheelchair with an adjustable leg support to allow for elevation and support of his left lower leg could improve his mobility throughout the home (consideration: depending on his height, the space required for a sufficient turning radius to avoid bumping his left leg is significant and might not be feasible within some homes).”
Finally some great options to build his ability to transfer and start to mobilise as he was able to increase his ability to weight bear.
“Stand Pivot Transfer: This allows Kurt to gradually introduce weight-bearing on the left leg while promoting controlled standing and transfer movements. Transfer with a Gait Belt: Using gait belt provides additional support and safety during the transfer process, allowing Kurt to gradually introduce weight-bearing on the left leg.”
My overall highlight of this week though was the live webinar with Stacy Schurring and Matt Huey, which explored some more complex case studies involving all elements of the MOOC. I just feel it brought all the fundamental skills together, looking at initial assessment, what techniques to use and then how that progressed to goal planning and intervention using the ICF framework to guide the process. Both Matt and Stacy shared some really interesting case studies and shared their clinical reasoning for both their assessment and interventions. There were also some great questions from the participants, which I feel really allowed for an in-depth understanding of the choices they had made and why. I just love the chance to hear rehabilitation professionals share their knowledge and reasoning around decision making, there are so many different options available to make and seeing how someone else approaches a case can really help to increase my options in similar cases. Thanks Matt and Stacy for a great webinar.
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This work is supported by the USAID funded Learning Acting Building for Rehabilitation in Health Systems (ReLAB-HS) project and is not possible without the generous and committed contribution of the Leahy War Victims fund.
ReLAB-HS is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and is implemented under cooperative agreement number 7200AA20CA00033. The consortium is managed by prime recipient, Johns Hopkins Bloomberg School of Public Health.