POSTURE, BODY

MECHANICS AND
MOBILITY OF CLIENT AND
CAREGIVER
 NORMAL MOVEMENT
 Equilibrium is a normal movement and
stability that are intact with:
1. Musculoskeletal system.
2. Nervous system.
3. Inner ear structures.
Normal movement (cont)..

 Body movement required coordinated

muscle activity and neurologic integration.
 It involves four basic elements:
Body alignment (posture)
Joint mobility
Balance
Coordinated movement
 JOINT MOBILITY
 Refers to the person’s ability to move
freely.
 Serves many purpose, such as expansion
of an emotion with a nonverbal gesture,
self defense, satisfaction of basic needs
and performance of Activity of Daily Living
(ADLs) and recreational activities.
Joint mobility (cont)..

 Many function of the body need mobility to

function optimally. To maintain optimal
physical mobility, the musculoskeletal and
nervous systems of the body must be
intact and functioning.
 IMMOBILITY
 Refer to inability to move freely.
 ALIGNMENT AND POSTURE
 Proper body alignment and posture bring
body part into position in a manner that
promotes optimal balance and maximal
body function (sitting, standing or lying
down)
 A person maintains balance as long as the
line of gravity passes through the center of
gravity and the base of support.
Alignment and posture (cont)..

 In human, the usual line of gravity begins

at the top of the head and falls between
the shoulders, through the trunk, slightly
anterior to the sacrum and between the
weight-bearing joints and base of support.
Alignment and posture (cont)..

 When body is well aligned, strain on the

joints, muscles, tendons or ligaments is
minimized and internal structures and
organ are supported.
Alignment and posture (cont)..

 A person’s posture is one criterion for

assessing general health, physical fitness
and attractiveness.
 Posture reflects the mood, self-esteem
and personality of an individual.
 JOINT MOBILITY
 Are the functional units of the
musculoskeletal systems.
 The bones of the skeletal articulate at the
joints and attach to the two bones at the
joint.
Joint mobility (cont)..

 The muscles are categorized according to

the type of joint movement they produce
on contraction.
Muscles are called flexors, extensors, internal
rotators.
The flexor muscles are stronger than the
extensor muscles.
Joint mobility (cont)..

When a person inactive, the joints are pulled

into a flexed (bent) position. If this tendency is
not countered with exercise and position
changes the muscle permanently shorten and
the joint becomes fixed in a flexed position
(contracture)
Types of joints
Joint mobility (cont)..

 Range of motion (ROM) is the maximum

movement that is possible for that joint.
 BALANCE
 Mechanisms involved in maintaining
posture are complex and involve
informational inputs from the inner ear,
from vision and from stretch receptors of
muscles and tendons.
 Mechanisms equilibrium (sense of
balance) respond, frequently without or
awareness to various head movements.
Balance (cont)..

 Under normal conditions the equilibrium

receptors in the semicircular canals and
vestibule, collectively called the vestibular
apparatus, send signals to the brain that
initiate reflexes needed to make required
changes in position.
 The receptors, hair like cells, respond to
displacement of the head in any direction.
Balance (cont)..

 When the head moves, the fluid flow within

the vestibule and semicircular canals
stimulates sensory hair cells.

 Information from these balance receptors

goes directly to reflect centers in the brain
stem. This enables fast reflexive
responses to body imbalance.
 COORDINATED MOVEMENT
 The cerebellum coordinates the motor
activities of movements and basal ganglia
maintain the posture.
 When a client’s cerebellum is injured,
movement become clumsy, unsure and
uncoordinated.
 BODY MECHANICS
 Is the term used to describe the efficient,
coordinated and safe use of the body to
more objects and carry out the activities of
daily living.
 Using principles of body mechanics during
routine activity will prevent injury.
 The nurse teaches a colleagues and
clients families to lift, transfer or position
clients properly.
 PATHOLOGICAL INFLUENCES
ON BODY MECHANICS
 For example:
Congenital defects (disorders of bones, joints
and muscles- Osteoporosis)
Central nervous system damage
Musculoskeletal trauma- bruises, confusions,
sprain and fracture.
 PRINCIPLE OF BODY
MECHANICS
 The wider the base of support , the greater
the stability of the nurse.
 The lower the center of gravity, the greater
the stability of the nurse.
 The equilibrium of the subject is
maintained as long as the line of gravity
passes through its base of support.
Principle of body mechanic (cont)..

 Facing the direction of movement prevents

abnormal twisting of the spine.
 Dividing balance activity between arms
and legs reduces the risk of back injury
 Rolling, turning or pivoting requires less
work than lifting.
Principle of body mechanic (cont)..

 When friction is reduced between the

object to move and the surface on which it
is moved, less force is required to move it.
 Reducing the force of work reduce the risk
of injury.
 Maintaining good body mechanics reduce
fatigue of muscle groups.
 Alternating period of rest and activity helps
to reduce fatigue.
 LIFTING
 Nurse should not lift more than 51 lbs
without assistance from proper equipment
and/ or other persons.
 When a person lift or carries an object, the
weight of the object becomes part of the
person’s body weight – affects the location
of the person’s center of gravity
Lifting (cont)..

 To counteracts this potential imbalance,

body parts (e.g. arm & trunk) move in a
direction away from the weight – center of
gravity is maintained over the base of
support.
Holding the lifted objects as close possible to
the body – avoids undue displacement of the
center of gravity and achieves greater
gravity.
Lifting (cont)..

 Lifting involves movement against gravity.

 The nurse must use the major group of the
thighs, knees, upper and lower arms,
abdomen and pelvis to prevent back
strain.
 PULLING AND PUSHING
 When pulling and pushing an object, a
person maintains balance with least effort
when the base of support is enlarged in
the direction in which the movement is to
be produced or opposed.
 PIVOTING
 Is a technique in which the body is turned
in way that avoids twisting of spine (turn
90 degree in the desired direction )
 PREVENTING BACK INJURY
 The major contributor is habitually poor
standing and sitting posture – lordosis.
 Overweight individuals who carry their
extra weight over their abdomen, pregnant
women and women who consistently wear
high-healed shoes are at risk –
exaggerated lumbar.
POSTURE, BODY MECHANICS
AND MOBILITY OF CLIENT AND
CAREGIVER (PROCEDURE)

MOVING / LIFTING
MOVING IMMOBILITY CLIENT UP
IN BED (ONE NURSE)

 Place client on back with head of bed flat.

Stand one side of bed.
 Remove pillow from under head and
shoulders and place pillow at head of bed
Moving immobility client up in bed (cont)..

 Begin at client feet. Face foot of bed at 45

degree angle. Place feet apart with foot
nearest head of bed behind other foot
(forward-backward stance). Flex knees
and hips as needed to bring arms level
with client’s legs. Shift weight from front to
back leg and slide client’s legs diagonally
toward head of bed.
Moving immobility client up in bed (cont)..

 Move parallel to client’s hips. Flex knees

and hips as needed to bring arms level
with client’s hips.
 Slide client’s hip diagonally toward head of
bed.
 Move parallel to client’s head and
shoulders. Flex knees and hips as needed
to bring arms level with client’s body.
Moving immobility client up in bed (cont)..

 Slide arms closest to head of bed under

client’s beck with hand reaching under and
supporting client’s opposite shoulder.
 Place other arm under client’s upper back.
 Slide client’s trunk, shoulders, head and
neck diagonally toward head of bed.
 Elevate side rail.
AUSTRALIAN LIFT
 ASSIST CLIENT IN MOVING UP IN
BED (ONE OR TWO NURSES)-
AUSTRALIAN LIFT.

 Remove pillow from under head and

shoulders and place pillow at head of bed.
Assist client in moving up in bed (cont)..

 Face head of bed

 Each nurse should have one arm under client’s
shoulder and one arm under client’s thighs.
 Alternative position; one nurse client’s upper
body. Nurse’s arm nearest head of bed should
under client’s head and opposite shoulder; other
arms should under client’s closest arm and
shoulder. Position other nurse at client’s lower
torso. The nurse’s arm should be under client’s
lower back and torso.
Assist client in moving up in bed (cont)..

 Place feet apart, with foot nearest head of

bed behind other foot.
 When possible, ask client to flex knees
with feet flat on bed.
 Instruct client to flex neck, tilting chin
toward chest.
Assist client in moving up in bed (cont)..

 Instruct client to assist moving by pushing

with feet on bed surface.
 Flex knees and hips, bringing forearms
closer to level of bed.
Assist client in moving up in bed (cont)..

 Instruct client to push with heels and

elevate trunk while breathing out, thus
moving towards head of bed on count of
three.
 On count of three, rock and shift weight
from front to back leg. At the same time
client pushes with heels and elevates
trunk.
MOVE WITH DRAWSHEET
MOVE IMMOBILE CLIENT UP IN BED
WITH DRAWSHEET OR PULL SHEET
(TWO NURSES)

 Place drawsheet or pull sheet under client

by turning side to side. Have sheet extend
from shoulders to thighs. Return client to
supine position.
 Position one nurse at each side of client.
Move immobile client up in bed with
drawsheet or pull sheet (cont)..
 Grasp drawsheet or pull sheet firmly near
the client.
 Place feet apart with forward-backward
stance. Flex knees and hips. Shift weight
from front to back leg and move client and
drawsheet or pull sheet to desired position
in bed.
 Realign client in correct body alignment.
 LOGROLLING THE CLIENT

LOGROLLING THE CLIENT

 LOGROLLING THE CLIENT
(THREE NURSES)
 Place pillow between client’s knees.

 Cross client’s arms on chest.

 Position two nurse on side to which the

client will be turned. Position third nurse
on the other side of bed.
Logrolling the client (cont)..

 Fanfold or roll the drawsheet or pull sheet.

 Move the client as one unit in a smooth,

continuous motion on the count of three.
Logrolling the client (cont)..

 Nurse on the opposite side of bed places

pillows along the length of the client.

 Gently lean the client as a unit back

towards the pillows for support.
ASSIST TO SITTING POSITION
ASSIST TO SITTING
POSITION
Assist to sitting position (cont)..

 Place client in supine position.

 Face head of bed at a 45 degree angle
and move pillows.
 Place feet apart with foot nearer bed
behind other foot, continuing 45 degree
angle to head of the bed.
 Place hand further from client under
shoulders, supporting client’s head and
cervical vertebrae.
Assist to sitting position (cont)..

 Place other hand on bed surface.

 Raise client to sitting position by shifting

weight from front to back leg.

 Push against bed using arm that is placed

on bed surface.
SIT ON SIDE OF BED
ASSIST TO SIT ON SIDE OF
BED
Assist to sit on side of bed (cont)..

 Turn client to side, facing you on side of

bed on which client will be sitting.
 With client in supine position, raise head of
bed 30 degrees.
 Stand opposite client’s hips. Turn
diagonally so you face client and far
corner of foot of bed.
Assist to sit on side of bed (cont)..

 Place feet apart with foot closer to head of

bed in front of other foot.

 Place arm nearer head of bed under

client’s shoulder supporting head and
neck.

 Place other arm over client’s thighs.

Assist to sit on side of bed (cont)..

 Move clients lower legs and feet over side

of bed. Pivot toward rear legs, allowing
client’s upper legs to swing downward.

 At same time, shift weight to rear leg and

elevate client.
TRANSFERRING FROM
BED TO
CHAIR
Transferring for bed to chair (cont)..

 Assist client to sitting position on side of

bed. Have chair in position at 45 degree
angle to bed.
 Apply transfer belt or other transfer aids.
 Ensure the client has stable nonskid
shoes. Weight-bearing or strong leg is
place forward, with weak foot back.
Transferring for bed to chair (cont)..

 Spread feet apart.

 Flex hips and knees, aligning knees with
client’s knees.
 Grasp transfer belt from underneath.
 Rock client up to standing position on
count of three while straightening hips and
legs and keeping knees slightly flexed.
Transferring for bed to chair (cont)..

 Maintain stability of client’s weak or

paralyzed leg with knee.

 Pivot on foot farther from chair.

 Instruct client to use arm rest on chair for

support and ease into chair.
Transferring for bed to chair (cont)..

 Flex hips and knees while lowering client

into chair.

 Assess client for proper alignment for

sitting position. Provide support for
paralyzed extremities.

 Praise client’s progress effort or

performance.
THREE MAN LIFT
THREE- PERSON ( THREE MAN LIFT )
CARRY FROM BED TO
STRETCHER
Three- person ( three man lift ) carry from
bed to stretcher (cont)..
 Three nurses stand side by facing side of
client’s bed.
 Each person assumes responsibility for
one of three area; head and shoulder, hips
and thighs and ankles.
 Each person assumes wide base of
support with foot closer to stretcher in front
and knees slightly flexed.
Three- person ( three man lift ) carry from
bed to stretcher (cont)..
 Arms of lifters are placed under client’s head
and shoulder, hips and thighs and ankles with
fingers securely around other side of client’s
body.
 Lifters roll client toward their chest. On count of
three, client is lifted and held against nurses.
 On second count of three, nurses step back and
pivot towards stretcher, moving forward if
needed.
Three- person ( three man lift ) carry from
bed to stretcher (cont)..
 Gently lower client onto center of stretcher
by flexing knees and hips until elbows are
level with edge of stretcher.

 Assess client’s body alignment, place

safety straps across body and raise side
rails.
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