CVA stroke patient: getting out of bed

[nuhag]

My father suffered a stroke 5 yrs ago which affected his left side. He can speak but doesn't have good control of neither his left leg nor his left arm. He took intensive physiotherapy for most of the 5yrs since his CVA with limited success.

Our main problem now is that he cannot get out of bed by himself. Someone has to pull him up from the lying down position to the sitting down position. He is overweight and his stomach muscles are weak because of the lack of exercise. He sleeps on his back all night but occationally turns onto his left side (albeit with assistance). He sleeps in a king sized bed with his right side on the edge of the bed (ie his left side is on the wide side so that he doesn't fall out).

Can anyone PLEASE provide us with information about the correct technique for how he can get up from the bed by himself? what kind of exercises can we help him do to strengthen his upper torso to enable him to get up, etc.

We have asked the physiotherapists that he has had over the years but none of them have been able to get him to get up by himself.

[vikphy]

hi there
This is dr vikram, a physio from india.ur dad's probllem is a very common problem. try to make him sleep with his right side towards broad side of bed. when this is done ask him to turn on left side, put his right hand in front so as to catch the bed & then get up. u can call me on my cell - 919920489382 anytime for anymore queries.

[jjose_01]

The truth is...PRACTICE MAKES PERFECT! Just let him to do it again and again at his "mode of comfort"! Well,at first, it will be ergonomically bad but as he do it with your assistance, having his endurance as his limitation, you can then slowly incorporate the "proper way" of moving him out of bed! Observe how he want to do it on his own,you can find the clue from there!

[mcasus]

Practice indeed does make perfect. We often see CVA patients a number of years post-stroke who find they have lost some capacities from their initial rehab, sometimes due to bad habits, but often these can be regained with practice. Sometimes it means practicing each stage of the transfer many times before putting them all together to go from lying to sitting, and reverse. The most efficient way to do that transfer is:

1. Sleeping on the left side of the bed so that his right / strong side is positioned to help him in the movements.

2. Lying on his back, have him bend his right knee up with his foot on the bed.

3. While pushing with the right foot to roll the right side of his pelvis over towards the left, he should reach with his right hand toward the side of the bed, effectively rolling onto his left side by pushing with his foot and pulling on the mattress with his hand.

4. While holding the side of the mattress with his right hand at the level of his right shoulder, he should then move his legs to the side of the bed. If he is able, he could help his left leg with the right, but otherwise may need help sliding his legs forward to the edge of the bed.

5. He should then lower his feet over the side of the bed while pushing with his right arm to get his upper body up off the mattress. He may need some help with lifting his upper body and/or controlling the descent of his legs.

Getting into bed is the reverse of the above--sit, lie upper body onto left side, lift legs in, roll onto back. Never let him just sit down and flop into bed. It seems easier at the outset, but then valuable transfer skills are lost.

In all cases where you are helping him, make sure to protect your own back. Never bend over from the waist, and make sure you bend your knees and keep your back with the normal slight hollow in it. Move your body weight from one foot to the other in the direction you want to move your Dad, never twisting your body as you move.

If you are doing this as an exercise you should avoid doing all the work for him, as tempting as it is when we see someone struggling. Maybe just stabilize his body at each step to give him a chance to move further after a short rest. If I were treating your Dad, I would get him to just do steps #2 and #3 many times (i.e. 10 times, several times a day for several days) without trying to go further. Once that got easier, I would add #4, and finally #5.

There are technical aids that can help stroke victims to do these transfers. One is a kind of grab bar: Part of it goes under the mattress, while the rest is beside the bed at the level of the upper body. It provides a hand-hold to pull on for rolling onto the side, and also as a point of support when going from sitting to standing. Another very useful thing if it is affordable is an electric bed. That way the upper body can be raised using the bed controls and to alleviate some of the effort required to raise the weight of the trunk. There are also easy-chairs that through electric controls can raise the person to almost-standing.

Good luck, and hope this helps.

[jjose_01]

I think,the description is too technical for the primary audience(patient's daughter)! Let your physios read this forum and let them do it for your father. Hope we helped you by not just adding years to your father's life but also adding life to his years!

[mcasus]

I don't think the reply is too technical, since in my 30+ years of experience, 10 of them in home care, I have done much teaching to caregivers of how to help with transfers--I think more credit needs to be given to caregivers. It is merely a question of mechanics and ergonomics, and you don't have to be a physio to practice it. In my home care practice I rely heavily on caregivers to carry out the exercises in between my visits, and am rarely disappointed. It may well be that the gentleman concerned might not learn how to do this transfer, but regardless of that the steps outlined are the steps I would teach a caregiver in order to help their loved one transfer. It isn't rocket science, merely a question of good body mechanics. The professional association I belong to publishes a pamphlet for families on how to transfer patients, and families/caregivers have found this to be extremely helpful.

Often when patients are seen in rehab but not at home, we as physios assume that the learning that takes place in rehab will be easily transferred at home. This is not always the case. Once at home there may be architectural barriers, physical limitations of the care givers, environmental constraints, psychological constraints, caregiver burnout, patient demotivation.... What happens in the clinic is seldom what happens at home, and we physios need to be cognizant of that in our approach to patients who have acquired handicaps and are returning to the home setting.

[jjose_01]

I hope to hear from nuhag herself to end this discussion and if she is succesful with the functional outcome, which is the proper and efficient mobilization of an obese left-sided hemiplegic patient in "getting up by himself"!

[mcasus]

While I agree with jjose that the best person to teach the transfer to the patient is a physio, it is important for the caregiver to know how to do the transfer so that she can provide the help needed in an safe way for her and her father. So the ideal situation would be for the physio to teach the patient in the home setting if he was able to do transfers in a physio clinic, but has not been able to do them at home. Hopefully nuhag can get the help she needs at home in terms of transfer training and/or technical aids to make the job of helping her father easier, and to avoid caregiver overload or burnout, but if this is not possible, or in the meantime, perhaps the steps I outlined may help. Without actually physically evaluating her father it is impossible to determine the real nature of the problem, so obviously a professional "on site" would be the only one to actually understand what the problem is. In the meantime, perhaps a few of the suggestions would help, but I encourage nuhag if it is at all possible to see if a physio can come to her home to analyze the transfer process and make the necessary suggestions, be they for how the transfer is done, or for technical aids to make the process easier.

[sarapollo08]

HI friend,
I have seen ur details u have mentioned about ur dads condition.
a}Encourage him rolling to left and right side with claspped hands in the bed. with the momentum he can be made to turn to right side from lying straight position.
b}Now slowly he has to put his both legs down the bed slowly with the help of his right leg curling over his left leg;
c)Now he has to press his right forearm down the bed slowly putting weight, then slowly change weight to elbow from forearm then to wrist finally with locking the elbow straight.now he ll be to nearly sittting position.
d} The same thing to be done in reverse to make him lying straight from sitting .


this is a way of training him transfer to sitting from lying and reverse by using his right side limb power{normal)


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