EARLY MOBILITY

"Nothing good ever happens on bed rest"

The Benefits of “Early Mobility” are well known and the TLB can help facilitate and/or enhance those benefits

EarlyMobility.com

"It's imperative that early mobility starts on day one of admission"
Within just hours of patient being confined to bedrest, muscles begin to atrophy (1), and changes begin to occur in the skin, the gut, the lungs and the body’s homeostatic mechanisms. (2,4,6) Human beings are made to be upright and moving. That is how we function best. Early mobility should occur as soon as the patient is medically or hemo-dynamically stable, and should continue throughout the course of their hospital and post-acute length of stay.

The Total Lift Bed is the perfect tool for this. Getting patients upright and weight bearing can be very challenging, and many protocols recommend 4-5 person teams to get patients up. (7,8). The Total Lift Bed is an innovative solution to helping weak and debilitated patients stand upright not just once per day, but as often as the patient can tolerate. The TLB is the only bed designed specifically to to take an active role in the patient’s therapy 24 hours a day.

The TLB’s patented Foot Lifter Footboard comes in toward the user to meet their feet before tilting, eliminating the need to reposition the patient to the end of the bed, then tilts them gradually, in a controlled manner, to a tilted position.

The Weight bearing Control System enables real time monitoring of patient weight, tilt angle, and amount of weight bearing through the feet (actual or percentage of body weight). This allows for documentation of progress, goal setting, as well as a great biofeedback tool for patient motivation.

A. Early Mobilization of Critical Care Patients

Mobilizing critically ill patients is difficult for many reasons, including medical complexity and instability, presence of multiple lines and tubes, pain, anxiety, sedation levels and debility level.

Deconditioning and dys-regulation of multiple systems occurs very quickly (within hours, not days) with critical illness and immobility. The evidence is clear: The sooner patients can be up and moving the better, and the time for movement and progressive upright mobility is as SOON as the patient is hemodynamically stable, rather than after they have been weaned from the ventilator or discharged from the ICU.

The Total Lift Bed allows you to provide vertical re-orientation from partial to full standing, as well as chair position as soon as the patient is stable. The weight bearing control feature of the Total Lift Bed allows the clinical team to grade a progressive upright protocol to gradually progress the patient as they can tolerate vertical orientation. For example, on day one, the patient may not be able to sit up over the side of the bed, but can tolerate 30 degrees of tilting with 30% of their body weight transferring through the footboard of the bed for 3 minutes. This can be documented and used as a baseline from which to progress. The plan of care can then include strategy to increase tolerance to upright positioning and weight bearing, through frequent tilts, and documented progress. For example, Target for day 2 might be to tolerate 40 degrees of tilt with 45% of the weight being transferred through the feet, for 5 minutes. The plan is to tilt 3 -4 times per day, trying to increase max angle to 40 degrees, evaluating hemodynamic stability. The beauty of this innovation is that you do not have to wait until the patient can tolerate a full standing position to begin frequent training towards upright mobility. Traditional mobility is more “all or nothing” from lying to sitting, then “all or nothing” from sitting to standing. The Total Lift Bed allows the clinician to grade the position between these extremes, and document progress, and targets to increase patients’ ability to stand and prepare for ambulation.

There are many studies that have shown improved alertness, improved breathing and improved function with upright positioning. Unfortunately, many ICU patients are not stood up because it takes too many caregivers and too much time to do so. The Total Lift Bed is an ideal way to enable upright positioning with fewer caregivers, and without the strain on the caregivers’ backs. PT and OT can do exercises, Activities of Daily Living, in any degree of tilt, with known weight bearing and tilt angle, at the same time. The Total Lift Bed promotes progressive Upright mobility both “In bed” and “out of bed”, and brings a whole new meaning to the phrase “Bed Mobility”, while requiring fewer staff and without the risks of lifting the patient manually.

1. Vollman K. Progressive Mobility in the Critically Ill. Critical Care Nurse, 2010; 30(2): S3-S4.

2. Dean, E. Bedrest and Deconditioning. Neurology Report. 1993; 17(1):6-9.

3. Brower RG. Consequences of bed rest. Crit Care Med 2009; 37:S422-428.

4. Casey C. The Study of Activity. An Integrative Review. Journal of Gerontological Nursing. Vol 39(8), 2013.

5. De Johnge B, et al. Paresis acquired in the Intensive Care Unit: A prospective multicenter study. JAMA 2002; 228(22): 2859-2867

6. Krolner B, Toft B, Vertebral bone loss: an unheeded side effect of therapeutic bed rest. Clin Sci (Lond), 1983; 64(5): 537-40.

7. Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008; 36:2238-2243

8. Winkelman C, Higgins PA, Chen YJ. Activity in the chronically critically ill. Dimens Crit Care Nurs. 2005;24(6):281–290.

Imagine having the ability to have patients upright and weight bearing 24 hours a day with the push of a button and no transferring

B. Early Mobilization of Bariatric Patients

Caregivers are seeing more patients with size every day. Caring for these patients comes with numerous challenges. The Total Lift Bed allows care for patients up to 1000lbs without having to transfer them. Everything can be done right in the bed. Even Therapy can be done on the bed itself. Just by tilting the patient upright while standing on the footboard. Progressive Therapy is very important with bariatric patients because there are so many variables to consider when transferring a bigger person. .

B. Early Mobilization of Burn Patients

A prolonged immobility has significant and long-term negative health consequences in physical psychomotor and quality of life domains. Burn victims experience additional psychological and physical impairments especially when the burns are extensive or involve the lower extremities and their ability to walk and perform activities of daily living. The socioeconomic costs of these impairments are high, including costs to the patient and family, to the caregiver(s) and to the healthcare facilities where the care is provided. In addition to the physical difficulty of mobilizing these patients, additional quality care and patient satisfaction considerations include protection of skin graft sites, limited tolerance for activity, and emotional trauma of working through pain that can be severe, as burned and healing tissues are stretched and moved. The TLB is now available that can accomplish the health benefits of standing, upright positioning and pre-gait activities, without the risks to the patient and/or caregiver. Tilt tables are routinely used in caring for burn patients, but the risks and time involved in performing transfers from the bed to the tilt table and back can be avoided with the Vitalgo Total Lift Bed. page.

Testimonials

I am extremely excited about the possibilities that the Vitalgo bed opens up for physical and occupational therapy in acute care and rehabilitation units. It has all the benefits of a tilt table, without the hassle of having to perform lateral transfers to and from the patient's bed.

This technology is a great asset in the advancement of early mobility programs, and will assist in weight bearing and early mobility for the patient, without the risk to the caregiver(s) that early weight mobility often carries.

Margaret Arnold
Coordinator of Rehabilitation Services & Safe Patient Handling Program Manager
McLaren Bay Region, Bay City, MI

Products

  • Total Lift Bed
    425lb/192KG. Weight Capacity Tilts a patient from a 0° flat position to an 82° fully upright position, and any degree in-between.
  • Total Lift Bed Bariatric
    1,000lb/453KG. Weight Capacity You can begin weight bearing at any stage and progressively enable bariatric patients to weight bear.