This article will address assisting a patient after a stroke with walking, transfers from wheelchair to bed and with proper sequencing of getting up off the floor.
Providing Close Supervision with Walking:
Often times, a person who suffers from a stroke will present with one sided weakness and may need an assistive device for walking. Depending on the age, past medical history and general health of a patient, a cane or walker may be helpful. If you are uncertain which device a person would benefit from, a medical doctor can prescribe a physical therapy evaluation and treatment. A physical therapist can help determine which assistive device is appropriate for the patient to walk as safely and independently as possible. If a patient needs assistance or supervision with walking to prevent falls, a physical therapist can train caregivers how to help them. A gait (walking) belt may be used around a patient's waist for safety.
In general, to guard a person walking, one should stand on the weaker side slightly behind the patient. If a cane is used it should be in the stronger, uninvolved side. When a person is strong enough to advance their limbs independently but their dynamic balance is fair to poor, a caregiver can provide close supervision by standing within arms length's distance with points of control at the shoulder or hips if necessary. If a patient should experience a loss of balance that they are unable to correct independently, the caregiver can help by giving firm but gentle support at the pelvis/trunk until the patient can regain their center of gravity.
Assisting a Patient from Wheelchair to Bed:
1) A gait belt may be used around the patient's waist for safety.
2) Slightly angle the wheelchair toward the bed. In most cases it is easier to transfer toward the patient's stronger side.
3) Lock the brakes of the wheelchair.
4) Remove armrest nearest the bed and move footplates out of the way if able.
5) Have the patient scoot forward in the wheelchair, or assist scooting at the hips if necessary so that the patient's feet can reach the floor.
6) Make sure the patient's feet are flat on the floor and the knees are bent such that the knees are over the toes.
7) Transfer motion should be a diagonal rocking motion, leaning the person forward slightly. Hands on the patient's hips or on the belt for support.
8) Coordinate with patient "1-2-3" to initiate stand pivot transfer to the bed. After standing, patient should be encouraged to assist in small steps and weight shifting to transfer from the chair to bed. Patient should be reaching for the surface they are tranferring to (the bed).
9) Once onto the bed, have to patient scoot back so they are securely sitting on the bed. Assist patient at hips if necessary. Make sure patient is stable and secure at the edge of the bed to prevent falls.
Getting up from the Floor:
It is not advised that a person sit on the floor if there is marked leg and arm weakness involved. However, often times in the later stages of physical therapy treatment, floor transfer training is included should the patient somehow end up on the floor unintentionally.
1) If a person is strong enough, they can crawl to sturdy piece of furniture, i.e. a couch.
2) Once near something sturdy, the patient can hold onto it with hands for safety and assistance.
3) Usually a 1/2 kneeling position with the stronger leg up and closest to the couch works best. Using their hands for balance, patient assumes a 1/2 kneeling position, then using their arms and strong forward leg, pull themselves up to standing. Or if they are near the front of a couch, they can transfer from 1/2 kneeling to partial standing and pivot their hips onto the couch into a seated position.
4) If a patient is too weak to pull up to standing on their own, a caregiver can assist patient in assuming the 1/2 kneeling position and help the patient with initiation of 1/2 kneel to stand-pivot to soft with their hands on the patient's hips.
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Great article. Appreciate the step by step instructions.
This is really a great article. When my mother had her stroke, she needed the hoyerlift than gradually worked her way up as she got stronger..All thats mentioned here, its all that I learned how to do, I was also her caregiver..