WE'RE STARTING THE SECOND WEEK OF THE SECOND MODULE.
SO, JUST A REMINDER, NO BLACKBOARD THIS WEEK.
ALRIGHT. YOU SOME OF THOSE QUESTIONS ABOUT RESTRAINTS
AND WALKERS AND CANES. ANYONE?
HAVEN'T READ ALL THAT YET, SO. WE'LL CATCH UP ON THAT.
BUT IT HELPS YOU GET AHEAD A LITTLE ON YOUR READING
AND KIND OF KNOW WHAT I'M TALKING ABOUT.
SO, I DID WANT TO ADDRESS A FEW THINGS
THAT WE'RE NOT GOING TO BE ABLE TO TEST ON,
BUT THE THINGS YOU NEED TO BE AWARE OF
AND YOU MIGHT WANT TO REVISIT WHEN YOU'RE DOING YOUR READING.
AND THOSE THINGS ARE SAFETY, FIRE SAFETY, AMBULATION, FALLS.
AND I DO WANT TO GO OVER THE HOYER LIFT.
THERE'S A LOT OF MACHINERY THAT'S OUT THERE FOR YOU TO USE,
A LOT OF TECHNOLOGY, BUT WE DON'T HAVE IT ALL.
BUT SOMETIMES IF YOU JUST GET THE BASICS OF A FEW THINGS,
YOU CAN APPRECIATE THE OTHERS WHEN YOU RUN INTO THEM.
SO, LET'S DO THE HOYER LIFT FIRST
AND THAT WAY YOU CAN SIT AND LISTEN TO THE REST.
ALRIGHT, LINDSAY, OUR GRACIOUS VOLUNTEER, IS UNABLE TO GET OUT OF BED.
AND IF SOMEONE CAN'T BEAR THEIR WEIGHT,
BUT THEY CAN SIT UP IN A CHAIR, MAYBE A QUADRIPLEGIC, A PARAPLEGIC,
SOMETHING WITH A GENERAL WEAKNESS, A MASS THAT'S GOTTEN WORSE
AND THEY JUST HAVE A LOT OF WEAKNESS, SOMEONE THAT'S GROSSLY OBESE
AND YOU CAN'T GET THEM UP BY YOURSELF.
THERE'S JUST A LOT OF SCENARIOS, THEN YOU CAN USE A LIFT.
THIS PARTICULAR LIFT IS PORTABLE
AND YOU COULD GET IT OUT FROM CENTRAL SUPPLY OR SOMETHING
AND GET YOUR LIFT, MAYBE ON THE FLOORS.
SOME OF THE LIFTS ARE BUILT INTO THE ROOMS.
AND YOU'LL SEE A MECHANICAL LIFT FROM THE CEILING
AND YOU CAN JUST ATTACH THE SLING FROM THE CEILING LIFT
AND THEN MOVE THEM TO THEIR LOCATIONS.
SO THEY'RE IN VARIOUS AND IN SUNDRY PLACES.
THE PRINCIPLE IS BASICALLY THE SAME AS TO HOW YOU WOULD USE IT.
MY LIFT IS FAIRLY NEW.
AND SO IT'S A LITTLE DIFFERENT AS FAR AS SETTING IT UP.
SOME OF THE LIFTS THAT YOU'LL SEE IN YOUR INSTITUTIONS
AND I WOULD ENCOURAGE YOU WHEN YOU TAKE YOUR FIRST TOUR
AND YOU DO YOUR SCAVENGER HUNTS AND THAT KIND OF STUFF THE FIRST DAY,
THAT YOU SEE IF YOU CAN FIND A HOYER LIFT
AND SEE HOW OLD IT IS AND SEE HOW IT WORKS.
OKAY. AND SEE IF YOU CAN IDENTIFY SOME MARKINGS ON IT.
BECAUSE MANY OF THOSE CLIENTS NEED HELP GETTING UP.
ALRIGHT. SO I KNOW MY CLIENT NEEDS HELP,
AND I ALSO KNOW THAT I PROBABLY SHOULDN'T DO A HOYER LIFT BY MYSELF,
SO I SHOULD HAVE ASKED FOR ONE MORE VOLUNTEER.
SO COULD I HAVE ONE MORE VOLUNTEER THAT'S JUST A STANDBY, SPOTTER.
BRIAN'S GOING TO GO FOR IT. COME ON DOWN.
WHENEVER YOU GET SOMEONE UP IN A LIFT YOU SHOULD ALWAYS HAVE TWO PEOPLE.
AND SOMETIMES MORE, DEPENDING ON THE WEIGHT OR THE AWKWARDNESS OF THE MANEUVER.
BUT YOU WANT A STANDBY, YOU WANT TO MAKE SURE SOMEONE'S WATCHING.
THAT THEY DON'T BUMP THEIR HEAD, CATCH THEIR FEET,
TIP THINGS OVER AND THAT KIND OF STUFF.
ALRIGHT. SO I WOULD HAVE CHECKED MY DOCTOR'S ORDERS.
AND THE DOCTOR'S PROBABLY NOT GOING TO ORDER A HOYER LIFT.
THERE'S NO CHARGE FOR IT. IT'S JUST TO HELP US.
SO IT'S PROBABLY GOING TO BE IN THE CARE PLAN IN THE CHART, WHERE THEY SAY,
"UNABLE TO MOVE SELF. NEED FOUR PEOPLE FOR A TURN.
TWO PEOPLE. HOYER LIFT TO GET UP ON A CHAIR."
YOU'RE GOING TO GET YOUR CLUES FROM THERE.
AS FAR AS GATHERING UP EQUIPMENT, ALL I NEED IS THE HOYER LIFT,
WHICH COMES WITH A SLING. SO YOU'RE GOING TO FIND A SLING ATTACHMENT.
AND THEN I WOULD NEED TO ANTICIPATE
WHERE I'M GOING TO PUT THE CLIENT AFTER I GET HIM UP.
SO, I THINK, I'D LIKE TO PUT MY CLIENT IN A WHEELCHAIR.
SO I HAVE A WHEELCHAIR READY TO GO ONCE WE HAVE HER UP.
AND THAT'S ALL THE EQUIPMENT I NEED.
YOU MIGHT WANT TO GET A BATH BLANKET FOR PRIVACY
IF YOU WANT TO DRAPE THEM.
WHATEVER. THEY NEED SHOES, ROBES, PRIVACY, BUT SHE'S FULLY DRESSED.
AND WE'RE OKAY, THEN.
ALRIGHT. I WASHED MY HANDS. YOU WASHED YOUR HANDS. WE'RE GOOD TO GO.
ALRIGHT. I'M GOING TO COME IN MY ROOM,
I'VE IDENTIFIED MY CLIENT, WHICH IS LINDSAY.
- WHAT'S YOUR LAST NAME? - MADDOX.
AND LINDSAY, I'M DIANE, I'M GOING TO BE YOUR NURSE TODAY.
AND THE DOCTOR REALLY WANTS YOU TO GET UP IN A CHAIR.
IT'LL BE NICE TO SIT UP A LITTLE BIT AND EAT YOUR FOOD.
AND WE'LL GET YOUR LINEN ALL STRAIGHTENED UP.
THAT WILL BE MUCH EASIER THAN ROLLING YOU ALL OVER THE BED.
SO, WE'RE GOING TO GET YOU UP TODAY IN THIS HOYER LIFT.
HAVE YOU EVER BEEN UP IN A HOYER LIFT BEFORE? - NO.
WELL, IT IS AN ADVENTURE. AND WHAT WE'RE GOING TO DO..
THINK OF LIKE A HAMMOCK OR A SLING AND WE'RE GOING TO..
I'M GOING TO ROLL YOU TO ONE SIDE
AND PUT IT DOWN AND ROLL YOU TO THE OTHER.
AND THAT WILL SIT UNDERNEATH YOU LIKE A SLING
AND THEN I'M GOING TO PUT HOOKS ON IT.
AND WE'RE JUST GOING TO PUMP IT UP AND YOU'LL BE LIKE IN A HAMMOCK SWING.
WE'LL SLIDE YOU OUT, PUT YOU IN THE WHEELCHAIR.
BRIAN'S GOING TO HELP ME AND MAKE SURE YOU
DON'T BONK YOUR HEAD ON ANYTHING, OKAY?
WE'LL GET YOU UP IN A CHAIR. KIND OF, TALK TO YOU AS WE GO,
SO YOU'LL KNOW WHAT TO DO.
AND I WOULD MAKE SURE I PROVIDE PRIVACY, SO THE WHOLE WORLD DOESN'T SEE.
THIS UP-AND-DOWN.
ALRIGHT. FIRST THINGS FIRST, I'M GOING TO PUT THE BED UP,
BECAUSE I NEED TO PUT THE FEET OF THIS HOYER LIFT UNDER THE BED.
AND THEY WONT FIT IF I DON'T GET THE BED UP.
NOT TO MENTION IT'S EASIER FOR US TO ROLL BACK AND FORTH
IF SHE IS AT OUR HEIGHT.
OKAY.
ON THE LIFT IS THE SLING.
THEY'VE JUST, KIND OF, STORED IT HERE. THEY PUT THEM IN ALL SORTS OF PLACES.
THIS IS ONE MODEL OF A SLING. AND IT'S A WHOLE SLING.
THE SLING DOESN'T HAVE ANY HOLES IN IT
OR ANYTHING SPECIAL TO IDENTIFY THE TOP OR THE BOTTOM,
EXCEPT FOR THE THIS LITTLE DART AT THE BOTTOM,
WHICH TELLS US THAT'S WHERE THE BUTTOCKS GO.
THERE IS ANOTHER SLING THAT THEY MADE
AND IT HAS A HUGE HOLE CUT OUT AT THE MIDDLE.
AND IT'S TO HELP PEOPLE GET UP AND GO TO THE BATHROOM.
SO YOU WANT TO MAKE SURE THAT WHEN YOU'RE PUTTING IT UNDERNEATH
AND YOU POSITION IT CORRECTLY.
BUT PEOPLE GO TO THE BATHROOM BETTER,
IF YOU'RE DOING BOWEL AND BLADDER TRAINING,
IF THEY SIT UP AND HAVE GRAVITY HELPING THINGS OUT
RATHER THAN LAYING DOWN.
SO IDENTIFY YOUR TOP AND YOUR BOTTOM.
AND THEN THE FIRST THING I WANT YOU TO DO IS..
LINDSAY, CAN YOU ROLL OVER ON YOUR SIDE?
YEAH, SHE CAN. SO SHE ROLLS OVER.
OKAY. WHAT I'M GOING TO DO IS I'M GOING TO GET THIS SITUATED.
AND I WANT TO MARK HER BOTTOM IS
AND I'M GOING TO ROLL HALF OF IT HERE..
..TOWARDS ME.
AND THEN, THAT LOOKS LIKE SHE'LL LAND PRETTY GOOD.
ALRIGHT, LINDSAY, THERE'S A LUMP OF LINEN FROM THAT SLING.
SO IF YOU COULD ROLL OVER THE LUMP TOWARDS ME,
JUST ROLL A LITTLE MORE TOWARDS ME.
AND THEN, BRIAN IF YOU'LL PULL THAT OUT...
OKAY, AND THEN ROLL BACK. AND IT LOOKS LIKE SHE LANDED.
OKAY, THIS IS THE PERFECT SIZE FOR HER
BECAUSE HER HEAD FITS IN THE SLING.
AND HER BOTTOM'S IN THAT, SHE'S GOT GOOD THIGH SUPPORT.
WHEREAS, SOMETIMES, IF SOMEONE IS REALLY TALL,
LIKE CHRIS, IF WE WERE PUTTING YOU BACK IN HERE LIKE LAST WEEK,
YOUR HEAD WOULD PROBABLY HANG OFF THE TOP.
SO, YOU NEED SOMEONE TO GIVE SUPPORT TO THE HEAD
BECAUSE THEY DON'T MAKE THESE IN, LIKE, SUPER LONG SIZES OR ANYTHING.
IT'S KIND OF ONE SIZE, FITS ALL OF THEM.
ALRIGHT. THE NEXT THING I NEED TO DO --
THE NEXT THING I NEED TO DO IS GET MY LIFT SITUATED.
AND I WANT TO EXPLAIN A COUPLE OF THINGS.
DOES IT SAY ON THIS SIDE? YES, IT DOES.
THE FIRST THING THAT YOU WANT TO DO IS,
MAKE SURE YOUR LIFT WILL SUPPORT THE CLIENT YOU'RE LIFTING.
SO, HOW MANY POUNDS DO YOU THINK THIS WILL LIFT? - 450.
450. BUT THEY DON'T ALL SAY. AND LOOK ON THOSE OLD ONES.
THEY DON'T HAVE TAGS ON THEM. THEY'RE REAL OLD.
AND SO, YOU'RE GOING TO HAVE TO FIND OUT FROM YOUR CENTRAL SUPPLY AREA,
FROM YOUR PLAN OPERATIONS, WHAT IS THE WEIGHT LIMIT FOR YOUR SLING.
THE NEXT THING YOU WANT TO KNOW IS JUST BASICALLY HOW IT WORKS.
AND WE'RE GOING TO BE HOOKING ON OUR SLING ON TO HERE.
BUT THE MAIN THING I'M CONCERNED ABOUT RIGHT NOW IS MY BASE OF SUPPORT,
WHICH IS DOWN HERE.
REMEMBER, JUST AS WE DID IN BODY MECHANICS, IN MACHINE MECHANICS,
WE HAVE TO DO THE SAME THING.
AND RIGHT NOW I HAVE A PRETTY NARROW BASE OF SUPPORT,
WHICH IS FINE FOR WHEN I AM JUST MOVING IT
FROM ROOM TO ROOM, BED TO BED.
BUT I'M GOING TO NEED TO DO WHEN I START LIFTING HER
WITH THIS PIECE RIGHT HERE,
WIDEN MY BASE OF SUPPORT SO THAT IT'S STEADY.
CAN YOU SEE? IT WENT WIDE, SO IT'LL SUPPORT HER.
AND IT'S ON THIS BAR RIGHT HERE.
I ALSO HAVE BRAKES ON MY WHEELS
FOR WHEN I'M PUTTING HER IN SO IT DOESN'T START SHIFTING AROUND.
I HAVE A LEVER HERE TO PUMP THE BAR UP,
SO THAT I CAN LIFT HER OUT OF THE BED.
THERE IS A LITTLE -- I SAW IT TOO. THERE ARE SO MANY THINGS.
THERE IS A LITTLE LEVER RIGHT HERE THAT RELEASES THE PRESSURE IN THE VALVE
OR THE VALVE RELEASES THE PRESSURE IN THIS ARM WHEN YOU TURN IT.
AND IT MAKES IT GO DOWN.
SO THAT'S HOW I'M GOING TO LOWER HER.
AND I HAVE TO HAVE IT IN A LOCKED POSITION TO GET HER IN.
AND I DON'T WANT IT TOO HIGH BECAUSE MY STUFF WON'T REACH.
ALRIGHT. I'M GOING TO SLIDE THIS UNDER THE BED FRAME
AND GET IT PRETTY MUCH RIGHT HERE.
I'M GOING TO LOCK, OR SPREAD MY BASE OF SUPPORT,
AND LOCK MY WHEELS.
AND THAT'S VERY GOOD. OKAY.
THE NEXT TRICK IS -- AND BRIAN OUR SIDES HERE ARE EXACTLY THE SAME,
IS TO ESTIMATE ON THIS,
WHICH OF THESE LOOPS WILL PUT HER IN THE BEST SITTING POSITION.
AND THE WAY THAT THEY CALIBRATED IT IS THAT
IF YOU DECIDED THAT GREEN IS THE BEST,
BECAUSE SHE'S SMALL, WE MAY GO GREEN AND GREEN, THAT'LL MATCH.
WE WANT IT TO BE HIGHER, SHORTER ON THIS END
SO THAT IT PULLS HER HEAD UP TO SITTING
AND LONGER ON THE BOTTOM END SO THAT SHE'S SITTING. ALRIGHT.
I'VE ALWAYS USED PURPLE, BUT I'VE ALWAYS HAD A LITTLE BIGGER CANDIDATE IN HERE.
SO I'M GOING TO JUST TEST GREEN.
OKAY, WELL, LET'S JUST TRY. WE'LL KNOW THE LOOK.
ON THE TOP AROUND HERE AND THEN YOU CAN DO THE TOP OR THE BOTTOM.
AND THIS HOOK GREEN.
WE'LL SEE WHAT HAPPENS WHEN WE START LIFTING IT.
AND WE'RE NOT GOING TO GO ANYWHERE.
YOU KNOW, SHE'S STILL IN THE BED. SHE'S NOT GOING TO FALL.
KEEP YOUR HANDS IN AND WE'LL SEE HOW IT FEELS AS IT'S COMING UP.
AND IF IT'S TOO WEIRD, I'LL JUST LOWER YOU DOWN AND WE'LL READJUST.
ON THE OLDER HOYER LIFTS, THERE ARE CHAINS.
YOU'LL SEE THAT THESE LITTLE SLINGS HAVE CHAINS, AND YOU'RE COUNTING LINKS.
AND SO, YOU'RE GOING TO DO, LIKE, THREE OR FOUR OR FIVE LINKS HERE
AND, LIKE, EIGHT LINKS HERE.
SO YOU GET THAT LONG AND SHORTER PULL.
IT'S A LITTLE BIT DIFFERENT. SO I WANT YOU TO BE LOOKING FOR THAT.
ALRIGHT.
I'M GOING TO JUST START PUMPING HERE.
AND BRIAN, YOU'RE GOING TO WATCH, BECAUSE THIS SWIVELS
AND YOU JUST DON'T WANT HER TO BUMP HER HEAD ON HERE.
WE'RE GOING TO WANT IT TO SWIVEL IN A LITTLE BIT. THAT'S OKAY.
BUT THAT'S WHAT TENDS TO HAPPEN.
SHE ACTUALLY IS ENDING UP MORE LAYING THAN SITTING.
SO I'M GOING TO LOWER THIS.
I WANT YOU TO.. LET'S PUT HER ON PURPLE AND BLUE
AND WE'LL GET HER MORE SITTING. YOU DO THAT.
- WE'LL GET YOU MORE SITTING. - YOU'RE DROPPING ALL THE WAY ON...
THANK YOU. THAT'S WHY YOU HAVE TWO PEOPLE THAT SAY, "HEY, WATCH IT."
SO I NEED PURPLE.
I THINK YOU PURPLE AND I THINK I'M GOING TO GO BLUE.
LET'S SEE WHAT WE COME UP WITH HERE.
ALRIGHT. LET'S TRY THIS ONE MORE TIME.
WHAT?
NOW THIS IS GOOD. MUCH BETTER.
PUMP HER. MAKE HER BETTER. YOU CAN LET YOUR KNEES RELAX
AND JUST GO SITTING.
AND..
I THINK SHE'S GOOD. ALRIGHT.
BRIAN, I THINK IT WOULD BE BEST IF YOU CAME ON THIS SIDE.
I'M GOING TO UNLOCK. I'M GOING TO PULL HER OUT.
AND WHAT WE WANT TO DO HERE..
THIS IS WHERE YOU WANT TO WATCH YOUR HEAD.
I MEAN, PEOPLE START SPINNING AROUND AND STUFF.
NOW WHAT WE WANT TO DO IS, SPIN HER TOWARDS YOU.
NO, HEAD TOWARDS YOU.
- THAT'S WHAT I WAS DOING. IT'S FINE. SORRY. - WHICH WAY ARE YOU GOING?
WHAT IS IT? WE DON'T HAVE MUCH SPIN THERE. OKAY.
WELL, LET'S DO THIS. I THINK SHE'LL SPIN WHEN WE INCH THIS WAY.
OKAY, I'M GOING TO STOP RIGHT NOW AND HIT SOME BRAKES.
AND GET MY WHEELCHAIR READY
BECAUSE I WANT YOU TO COME DOWN INTO THE WHEELCHAIR.
HOW ARE YOU DOING THERE, LINDSAY? WONDERFUL.
AND I HAVE MY WHEELCHAIR IN AND MY WHEEL LOCK SET.
BUT I WANT YOU TO APPRECIATE, AS SHE'S GOING DOWN.
WATCH A COUPLE OF THINGS. ONE, AS SHE GOES DOWN. BUT, TWO..
I'M GOING TO HAVE, BRIAN.. I'M GOING TO HAVE YOU,
KIND OF, LOWER HER AND STABILIZE HER.
BUT I'M GOING TO BE THE ONE THAT'S GOING TO SITUATE HER IN THE CHAIR.
IF YOU LOOK CAREFULLY.. I'LL SPIN YOU A LITTLE BIT HERE, LINDSAY, FOR SHOW AND TELL.
BUT UNDERNEATH THIS ARE LITTLE HAND GRABS,
FOR ME TO PULL HER LIKE THIS FOR WHEN SHE GOES DOWN.
OKAY, SO THAT SHE ENDS IN A SITTING POSITION.
SO I'M GOING TO BE PULLING HER BUTTOCKS BACK AND SHE'LL LAND.
BUT WATCH HOW THE WHEELCHAIR TIPS.
REMEMBER, THESE ARE WHEEL LOCKS THEY'RE NOT BRAKES.
IF IT'S GOING TO TIP A LITTLE LIKE THIS BECAUSE OF THE AWKWARD ANGLE...
ALRIGHT. I'M GOING TO PUT YOU IN CHARGE OF THE VALVE.
LET'S SEE IF HE GIVES YOU THE SLOW RELEASE OR THE PSHHIK.
HEAVY, HUH? BUT, WE'RE SET HERE. AND HE'S GOOD TO YOU.
- JUST LIKE AN ENGINE REPORTS. - UH-HUH. EXACTLY.
LINDSAY'S JUST NICE AND LIGHT AND THIS IS SO EASY THAT I PULLED HER BACK,
SEE HOW IT JUST TIPS A LITTLE BIT.
BUT I'M ABLE TO PULL HER BUTTOCKS NICE.
OKAY, NOW THIS IS WHERE WE NEED TO WATCH HER HEAD.
- GET HER OUT A LITTLE BIT MORE. - I THINK SHE'S GOOD. YEAH.
WATCH HER AND STOP. WE JUST NEED A TIP TO BE ABLE TO GET THESE OFF.
OH-H, YOU HAVE A MAN WORKING. - YEAH.
OKAY, SO THEN, WE'VE WATCHED HER HEAD, NO INJURIES.
YOU GOT BRAKES ON, REMEMBER?
YOU JUST KICK THOSE OFF.
THERE YOU GO.
IT'LL COME OUT.
OKAY. SO MY CLIENT.. HOW DO YOU FEEL IN THE CHAIR?
GOOD BODY ALIGNMENT. OKAY, SO I HAVE HER GOOD.
IF I DIDN'T, I WOULD HAVE BRIAN COME DOWN
AND DO KNEES OR DEPENDING ON WHICH END I NEEDED,
I WOULD COME UNDERNEATH LIKE THIS.
AND ON THE COUNT OF THREE, I'D HAVE HIM PUSH IN KNEES AND I WOULD PULL UP,
ONE, TWO, THREE. WE DON'T HAVE ANY PLACE TO GO.
BUT THAT'S HOW I WOULD SITUATE HER AGAIN IN THE CHAIR.
SHE'S GOOD. IF I NEEDED SOMETHING TO HOLD HER STRAIGHT,
I'D MAYBE PUT A BELT OR SOMETHING ON THE TABLE IN FRONT OF HER.
LEAVE THE SLING UNDER, DON'T TRY TO TAKE IT OFF,
BECAUSE THAT'S THE SAME WAY WE'RE GOING TO PUT HER BACK.
AND THERE WE GO. SO, IT'S BEEN HOURS, SHE'S READY TO GO BACK TO BED.
SO, WE'RE GOING TO PUT HER BACK THE SAME WAY.
OH. WATCH HEADS, HEADS, HEADS.
I THINK THIS IS THE MOST DANGEROUS PART OF THE WHOLE THING.
BECAUSE, YOU GET WHEEL FOCUSED AND YOU'RE BANGING
AND ALL OF A SUDDEN, YOU'VE WONKED THEM IN THE HEAD, SO.
WE'RE WATCHING OUT FOR YOU, LINDSAY. OKAY.
WE'RE GOING TO DO THE SAME THING WE DID BEFORE.
WE'RE GOING TO HOOK YOU UP IN THE SLING, YOU KNOW,
AND IT'LL FEEL LIKE A HAMMOCK.
PUT YOU BACK IN THE BED, LOWER YOU DOWN. YOUR SHEETS ARE ALL CLEAN. OKAY.
AND I DID BLUE AND YOU DID PURPLE.
AND THOSE ARE THINGS THAT YOU NEED TO BE WRITING IN THE NURSING CARDEX
AND CARE PLANS, SO PEOPLE AREN'T HAVING TO GUESSTIMATE
AND GIVE HER A LITTLE WILD RIDE EVERY TIME SHE..
WHENEVER YOUR HANDS ARE FULL, LIKE, TELL ME..
OKAY. I THINK I'M GOOD.
IF YOU WANT TO JUST, YEAH, PUT YOUR HEAD UP OVER HERE.
WATCH MY HEAD. WHOA.
YEAH, THIS IS THE TRICKY PART HERE.
IF I BEND IT, DOES THAT HELP? - YEAH.
- WE GOT TWO PURPLES. - YEAH.
NOW, HE'S GOING TO CRANK, I'M GOING TO JUST STAND BY.
I'M GOING TO WATCH HEADS, BODY PARTS,
MAKE SURE ALL OUR LOOPS ARE IN. KEEPS YOUR HANDS IN.
WATCH YOUR HEAD HERE STILL A LITTLE BIT.
AND I WANT MY BRAKES ON. ARE YOU BRAKES ON? YEAH.
I DON'T CARE IF THE CHAIR TIPS A LITTLE BIT
BECAUSE I CAN'T REALLY PULL IT OUT TO YOUR..
I CAN GET REALLY MY CHAIR.
JUST LEAN BACK AND RELAX. THERE YOU GO.
DON'T JUST FALL INTO HELL.
- SURE.
OKAY, I THINK WE'RE GOOD.
UH-HUH. SO TAKE THE BRAKES OFF THE WHEELS,
I'LL LET YOU STEER THIS TIME.
I'LL WATCH THE BODY.
NOW, THE THING IS.. OKAY, WATCH YOUR WHEEL QUICKLY.
COME BACK, BACK. IN HERE.
OKAY, I'M GOING TO GO TO THE OTHER SIDE, NOW THAT SHE'S OVER THE BED.
AND WE'VE GOT TO GET HER STRAIGHT ON THE BED.
SO, IF YOU CAN LIFT HER... YEAH.
THE THING HERE IS THAT WE WANT TO GET HER SITUATED.
IF SHE HAS TROUBLE MOVING,
WE WANT TO GET HER AS HIGH UP IN THE BED AS POSSIBLE.
THINK THROUGH THE WHOLE MANEUVER SO YOU'RE NOT
PULLING UP AND DOING ALL THAT.
SO, I THINK SHE LOOKS GOOD HERE.
JUST LOCK THOSE WHEELS. OH, THAT'S A GOOD SOUND.
A LITTLE LOWER AND I'LL WATCH FOR POSITION.
BECAUSE I CAN STILL PULL AND MANEUVER HERE.
AND THAT SHE'S CENTERED.
GOOD.
YOU CAN STILL A LITTLE BIT FURTHER, I THINK YOU CAN FEEL IT'S PRETTY TIGHT.
LITTLE LOWER.
ALRIGHT.
THAT'S CLEAR.
ALRIGHT. WHEN BRIAN GETS TO THIS SIDE OF THE BED,
I'LL HAVE YOU ROLL TOWARDS HIM.
I DON'T WANT HER TO ROLL WITH THAT SIDE RAIL DOWN.
SO ROLL TOWARDS BRIAN, I'M GOING TO ROLL THIS UNDERNEATH YOU
TO GET IT OUT HALFWAY.
AND IF YOU ONLY GOT THA T BIG LUMP OF LINEN THERE..
SO IF YOU CAN COME BACK TOWARDS ME.
AND HE'LL PULL THAT OUT AND HERE AND THERE.
TA-DA! SHE'S GOOD. SIDE RAIL.. DON'T GET UP YET,
WE PUT THE BED IN A LOW POSITION.
WASH YOUR HANDS AND DOCUMENT. AND WE WOULD DOCUMENT THE LIFT.
THAT WE USED A HOYER LIFT.
WE WOULD DOCUMENT HOW LONG SHE WAS UP IN THE CHAIR, HOW SHE TOLERATED IT.
BUT IT'S NICE, I DON'T FEEL STRAINED WHATSOEVER
OTHER THAN A LITTLE OUT OF BREATH JUST FROM RUSHING AROUND.
NOT.. YOU KNOW, I DON'T FEEL PHYSICALLY STRAINED OR ANYTHING.
THAT'S BEAUTIFUL. FEET DOWN.
THANK YOU VERY MUCH. HOW WAS THE RIDE?
- IT WAS FUN. - IT'S A WEIRD FEEL.
IT'S A WEIRD FEEL DOWN. SO, YOU KNOW, A COUPLE OF MINUTES ANTICIPATE WEIRDNESS, I GUESS.
ALRIGHT. THAT'S GREAT.
I'M GOING TO TAKE A LITTLE INTERMISSION HERE.
BRAKES. THEY'RE WHEEL LOCKS.
SO THEY CAN MOVE AND SLIDE WHEN YOU PUT PEOPLE IN THEM.
SO YOU NEED TO BE PREPARED FOR THAT.
WHEN I TRANSFER PEOPLE OUT OF BEDS OR WHEELCHAIRS,
ESPECIALLY IF THEY'RE NOT VERY STRONG AND VERY HELPFUL,
I TRY TO ALWAYS MAKE SURE MY WHEELCHAIR IS AGAINST THE WALL.
SO THAT I DON'T HAVE THAT WHUSHHK OUT.
ALSO, THERE'S FOOTRESTS AND I USUALLY PULL THEM OFF
JUST FOR THE INCONVENIENCE OF US BUMPING INTO THEM.
BUT ON YOUR FOOTRESTS, THEY SWING OUT, SO HAVE...
WE CAN SHOW YOU LATER HOW THE LEVERS WORK.
IT'S HARD TO SEE IN A GROUP SETTING.
BUT THEY SWING OUT AND GET OUT OF THE WAY AND THEN THEY POP BACK IN
SO THAT THEY HAVE A FOOTREST.
WHEN YOU'RE WHEELCHAIRING SOMEONE, YOU WHEELCHAIR THEM STRAIGHT.
BUT WHEN YOU GET ON TO AN ELEVATOR, MAKE SURE YOU BACK THEM IN,
INSTEAD OF JUST PUTTING THEM IN FORWARD,
SO THAT THEIR EXIT IS STRAIGHT OUT.
AND THAT'S PRETTY MUCH IT ON WHEELCHAIRS. OKAY.
FIRE SAFETY.
YOU'LL HEAR ABOUT FIRE SAFETY WHENEVER YOU GO TO ANY OF YOUR INSTITUTIONS
BECAUSE YOU HAVE TO KNOW WHAT TO DO.
MAKE SURE THAT YOU CAN FIND THE FIRE ALARMS.
MAKE SURE THAT YOU KNOW WHAT THEIR PROCEDURE IS.
AND MOST OF THEM HAVE ADOPTED THE ACRONYM RACE, WHICH IS IN YOUR BOOK.
R STANDING FOR? - REMOVE.
RESCUE OR REMOVE.
CLIENT IS FIRST. CLIENT IS ALWAYS FIRST, REMEMBER THAT.
SO, GET RID OF THE -- GET RID OF THEM!
REMOVE THEM FROM THE PLACE OF DANGER.
- THEN WHAT? - ALARM.
ALARM. GET THAT ALARM SET AND YELL FOR SOMEONE TO GET IT SET,
I MEAN YOU CAN BE DOING THINGS SIMULTANEOUSLY. THEN C? - CONTAIN.
CONTAIN WHICH CAN BE A LOT OF THINGS.
YOU CAN THROW A PILLOW IN A WASTE CAN.
YOU CAN SNUFF IT OUT. SHUT DOORS.
- AND THEN E? - EXTINGUISH.
EXTINGUISH AND/OR EVACUATE DEPENDING ON WHOSE 'E'. YOU'RE USING..
YEAH, EXTINGUISH, IF YOU CAN.
AND THEN THEY TALK ABOUT ALL THE DIFFERENT FIRE EXTINGUISHERS.
MOST OF THEM WILL USE C OR SOMETHING THAT WILL..
A CHEMICAL COMPOUND THAT WILL ADDRESS ANY KIND OF FIRE,
WHETHER IT BE THE WOOD BURNING OR THE ELECTRICAL.
AND THEN IN YOUR ELECTRONIC, YOUR HIGHLY SENSITIVE AREAS,
LIKE YOUR COMPUTER AREAS, THEY'LL HAVE THEIR SPECIAL DRY EXTINGUISHER
FOR THOSE, SO THAT WE DON'T DAMAGE WITH WATER.
OKAY. WALKING.
JUST WANTED TO MENTION A COUPLE OF THINGS RELATED TO WALKING.
WHEN YOU WALK A CLIENT, WE'VE USED THE GAIT BELT.
AND YOU'RE NOT GOING TO WALK LIKE THIS WITH THE GAIT BELT,
LIKE WE GOT THEM OUT. THE GAIT BELT IS JUST SOMETHING
SO THAT YOU CAN HAVE YOUR HAND TO THEIR WASTE
AND BE ABLE TO STABILIZE THEM.
YOU ALWAYS WALK ON THE STRONG SIDE OF THE CLIENT,
NOT THEIR WEAK SIDE. SO THAT IF THEY GAVE INTO WEAKNESS,
YOU CAN PULL THEM BACK TO STRENGTH.
THAT'S THE THEORY OF THAT.
WHEN I WALK WITH THE CLIENT, I TRY TO WALK
SO THAT THE CLIENT IS NEXT TO THE WALL
AND I'M TO THE MIDDLE OF THE ROOM.
BECAUSE IF THEY TIP, THEN THEY'VE GOT A WALL TO CATCH THEM,
NOT TO MENTION THEY'VE GOT ME TO PULL THEM.
AND SO YOU'VE KIND OF GOT TWO PEOPLE WALKING,
IF THEY'RE AMBULATORY. AND THAT'S NICE.
REMEMBER WHEN YOU WALK WITH SOMEONE, AS FAR AS YOU GO,
YOU HAVE TO COME BACK.
YOU POOP OUT SOMETIMES, SO.
WE'LL TALK A LITTLE BIT ABOUT THAT WITH THE WALKER, BUT KEEP THAT IN MIND.
I'M ALWAYS CHECKING, "HOW ARE YOU DOING?" YOU KNOW, AND I REMIND THEM,
"AS FAR AS WE GO, WE GOT TO GO BACK." THAT KIND OF A THING.
AND FINALLY WE NEED TO MENTION ABOUT FALLS.
IF SOMEONE IS GOING TO FALL, IF SOMEONE TIPS,
THE GOAL FOR YOU IS TO GET THEM DOWN SAFELY.
THEY HAVE SOME GREAT PICTURES IN YOUR BOOK.
AND IT'S REALLY HARD TO SIMULATE A FAKE FALL,
BUT THE IDEA IS THAT YOU CATCH THEM AND IF YOU CAN'T,
LOWER THEM DOWN, PROTECTING THEIR HEAD.
LOWER THEM DOWN YOUR LEG IF YOU CAN
AND HOLLER FOR HELP SO THAT SOMEONE CAN HELP YOU CATCH THEM.
AND THEN JUST GET THEM DOWN TO THE GROUND.
ONCE THEY'RE TO THE GROUND, IF YOU'RE IN AN INSTITUTION,
THERE'S USUALLY LOTS OF HELP FOR YOU.
AND SO YOU CAN EITHER PUT THEM ON A BLANKET,
AND LIFT THEM, PUT THEM ON A GURNEY STRETCHER, LIFT,
OR JUST PULL THEM, BODY LIFT, TO GET THEM TO WHERE YOU NEED THEM TO GO.
IF THEY WERE..
IF YOU NEEDED TO, LIKE, EVACUATE SOMETIME,
YOU NEEDED TO GET PEOPLE OUT, ONE OF THE INTERESTING TECHNIQUES IS..
- I NEED TO BACK UP TO FALL, SORRY. LOST MY TRAIN OF THOUGHT.
IF THEY FALL,
YOU CAN ALSO INSTRUCT THEM TO ROLL OVER ONTO THEIR STOMACH
AND TRY TO GET TO THEIR HANDS AND KNEES
AND SEE IF THEY CAN STAND BACK UP.
ESPECIALLY IF THEY'VE SUSTAINED NO INJURIES.
YOU SUPPORTED THEM AND THEY JUST WENT DOWN.
MAYBE THEY JUST GOT DIZZY AND YOU JUST..
THEY JUST KIND OF WENT DOWN.
GIVE THEM A LITTLE SMELLING SALTS, THEY'RE GOOD TO GO.
THEY'RE USUALLY EASIER TO GET UP IF THEY ROLL OVER
AND GET UP ON THEIR HANDS AND KNEES.
THAT'S AN IMPORTANT PIECE OF INFORMATION TO TELL YOUR CLIENTS,
IF THEY WERE TO FALL AT HOME.
YOUR GRANDMOTHER, YOU KNOW, IF THEY'RE HOME AND THEY FALL,
REMIND THEM TO GET ON THEIR HANDS AND KNEES AND CRAWL TO A CHAIR
OR SOMETHING THAT COULD HELP THEM GET UP.
AND IT'S MUCH EASIER WHEN THEY'RE HOME ALONE.
OKAY. IF THERE'S A FIRE, IF THERE'S AN EMERGENCY,
IF YOU HAVE TO EVACUATE AND SOMEONE'S NOT ABLE TO HELP YOU TO AMBULATE,
YOU'RE OUT OF WHEELCHAIRS, YOU CAN'T FIND STRETCHERS,
YOU KNOW, YOU'RE IN A NURSING HOME,
ONE OF THE THINGS YOU CAN DO IS GET A REALLY STURDY BLANKET.
YOU COULD GET SOMETHING SIMILAR TO THIS. PUT THE BLANKET ON THE FLOOR.
GET SOME HELP OR HAVE THE CLIENT HELP YOU.
YOU CAN DANGLE THEIR LEGS OVER AND THEN KIND OF SUPPORT THEIR BODY,
GET THEM TO THE GROUND
AND THEN YOU CAN KIND OF WRAP THEM IN THAT BLANKET
AND PULL THEM WITH THE BLANKET.
IT'S KIND OF A FLOOR SLING, AND JUST SCOOT THEM,
DRAG THEM RIGHT OUT THE DOOR.
AND GET THEM TO A PLACE OF SAFETY
WHEN YOU CAN'T PHYSICALLY CARRY THEM
OR YOU DON'T HAVE ANYTHING TO PUT THEM IN.
ALRIGHT. READ OVER THOSE SECTIONS, THEY HAVE SOME PRETTY DECENT PICTURES.
AND I'LL TALK YOU THROUGH SOME OF THOSE.
ALRIGHT.
THAT'S MOST OF THE INFORMATION I WANTED TO TALK ABOUT.
WHAT WE NEED TO DO IS GO OVER OUR STATIONS THAT WE'RE GOING TO TEST ON.
YOU'RE GOING TO HAVE FOUR STATIONS THIS TIME.
NOTICE WE JUST KEEP INCREASING THEM AND INCREASING THEM.
REMEMBER I TOLD YOU, NOTHING REALLY IS HARD. IT'S JUST LOTS OF IT.
ALRIGHT. YOU'RE GOING TO HAVE FOUR STATIONS.
YOU'RE GOING TO PUT RESTRAINTS ON THE CLIENT.
WRIST AND POSEY RESTRAINT AT ONE STATION.
WE'RE GOING TO DO A RANGE OF MOTION AT ONE STATION.
WE'RE GOING TO DO A CANE AND A WALKER DEMONSTRATION AT ONE STATION.
AND YOU'RE GOING TO DO CRUTCHES, ALL FOUR GAITS
AND HOW TO MEASURE CRUTCHES OUT IN THE HALLWAY.
THAT IS THE PROP THAT I FORGOT TODAY.
PROBABLY GET ONE.
HUH? MY LITTLE STEPSTOOL.
I NEED MY LITTLE STEPSTOOL FOR STAIRS, BUT...
YE-E-AH! OKAY THAT'S FINE.
ALRIGHT. THE FIRST THING WE'LL DO..
LET'S DO RESTRAINTS, I'LL TRY TO, KIND OF, STAY IN THE ORDER OF YOUR PAGES.
RESTRAINTS.
AGAIN, WE HAVE TO DO A LITTLE BIT OF THEORY ABOUT RESTRAINTS
BECAUSE WE JUST DON'T RESTRAIN ANYBODY WE FEEL LIKE RESTRAINING.
IT'S AGAINST THE LAW.
IT USED TO BE THAT WE WOULD..
I'M NOT GOING TO EVEN PUT MY NAME IN WE, I DON'T USUALLY DO THAT,
JUST FOR MY CONVENIENCE.
BUT CLIENTS ARE RESTRAINED FOR CONVENIENCE,
MAYBE EVEN FOR PUNISHMENT.
THINK ABOUT THAT.
AND IT'S AGAINST THE LAW.
IN FACT, WE HAVE TO HAVE STRICT ORDERS, STRICT OBSERVATIONS
AND THINGS THAT WE HAVE TO DO TO MONITOR CLIENTS THAT ARE RESTRAINED.
WE NEED TO DEFINE WHAT A RESTRAINT IS.
IT'S ANYTHING THAT KEEPS SOMEONE FROM MOVING FREELY
OR GETTING ACCESS TO THEIR BODY FREELY.
IT CAN BE PHYSICAL OR IT CAN BE CHEMICAL.
SO MOST OF THE TIME, IT'S A PHYSICAL RESTRAINT,
SOMETHING WE DO TO TIE OR IMMOBILIZE SOMEONE.
BUT IT CAN BE A DRUG THAT KEEPS THEM FROM MOVING.
SOME THINGS WE NEED TO APPRECIATE IS WHAT IS A RESTRAINT, NOT.
THERE ARE SOME THINGS THAT RESTRICT OUR MOVEMENT,
BUT THEY'RE FOR CLINICAL PURPOSES
AND THEY AREN'T A RESTRAINT IN THAT MODALITY.
FOR EXAMPLE, IF I PUT AN IV RIGHT HERE IN MY WRIST,
AND EVERY TIME I MOVED,
THE IV QUIT DRIPPING, WE MIGHT PUT WHAT'S CALLED AN IV BOARD ON,
TO KEEP ME FROM BENDING THE WRIST SO MUCH SO THAT THE IV WORKS.
IT'S RESTRAINING MY MOVEMENT A LITTLE,
BUT IT'S NOT CONSIDERED A RESTRAINT IN THAT I'M HARMING MYSELF.
IT'S FOR CLINICAL PURPOSES.
ORTHOPEDIC DEVICES, KNEE BRACES, CASTS,
THEY'RE RESTRICTING MOVEMENT, BUT THEY'RE BEING USED FOR CLINICAL THINGS.
A BABY THAT'S PUT IN AN INFANT SEAT,
RESTRAINED, BUT IT'S NOT A RESTRAINT.
IT'S HOW YOU USE IT EXACTLY THAT KIND OF DEFINES IT.
THERE'S A GOOD LIST OF THOSE IN ONE OF YOUR BOXES.
NO, ACTUALLY IT'S IN THE ARTICLE I GAVE YOU.
AND I WANTED TO JUST GIVE YOU A FEW LITTLE STATISTICS
I THOUGHT WERE VERY IMPRESSIVE.
THEY SAID IN THE ARTICLE I GAVE YOU THAT
PEOPLE ARE EIGHT TIMES MORE LIKELY TO BE...
..IS IT INJURED OR DIE WITH THAT? WHATEVER.
MORE LIKELY TO DIE THAN THOSE NOT RESTRAINED.
EIGHT TIMES MORE LIKELY.
AND THIS IS THE INTERESTING THING.
THEY INTERVIEWED AND DID SOME RESEARCH ABOUT RESTRAINTS.
WHY DO WE DO THEM? WHEN DO WE DO THEM?
AND THE NURSES WOULD SAY, "WELL, SO SOMEONE WOULD FALL.
THEY WERE CONFUSED SO THEY WOULD HURT THEMSELVES."
WHAT THEY FOUND WAS THAT RESTRAINTS WERE COMMONLY USED
IN THE OLDER POPULATION, WITH THE GERIATRIC CLIENTS TO PREVENT FALLS.
BUT 47% OF THE PEOPLE FELL ANYWAY WITH THE RESTRAINT.
THAT'S A HUGE STATISTIC RELATED TO IT.
SO WHAT IS THE POINT HERE? THAT WE SAVE 50%?
I DON'T KNOW. THAT IS NOT A VERY GOOD STAT.
SO JOINT COMMISSION OF ACCREDITATION FOR NURSES
AS WELL AS THE FEDERAL DRUG ADMINISTRATION,
WHO ARE THE ONES, REALLY, TO SET THE FEDERAL LAW
RELATED TO HOW WE WILL USE RESTRAINTS,
HAVE SAID, WE NEED A PURPOSE TO HAVE A RESTRAINT FREE ENVIRONMENT.
WE NEED TO DO EVERYTHING WE CAN POSSIBLY DO TO NOT RESTRAIN SOMEONE.
SO I GAVE YOU SOME COPIES OF SOME FORMS THAT ARE IN ALL YOUR HOSPITALS.
BEFORE A RESTRAINT IS EVER APPLIED
WE HAVE TO BE ABLE TO DOCUMENT THAT
WE'VE DONE EVERYTHING WE CAN POSSIBLY DO NOT TO RESTRAIN SOMEONE.
SO, WE'VE GOT TO DO THINGS LIKE TALK TO CLIENTS,
ORIENT CLIENTS, SEE IF A FAMILY MEMBER CAN COME
AND STAY WITH THE CLIENT, SEE IF WE CAN GET SOME PERSONNEL TO STAY.
SEE IF WOULD OFFER TOILETING EVERY TWO HOURS,
IF WE WOULD GO IN EVERY HOUR AND OFFER A SNACK,
IF WE WERE ANTICIPATING THEIR NEEDS INSTEAD OF NEGLECTING
AND THEY GET WANDERING AND THAT KIND OF THING.
WE'VE DONE EVERYTHING. WE'VE TRIED EVEN MEDICATIONS
TO HELP WITH THE ORIENTATION AND NOTHING'S WORKING,
WE NEED A RESTRAINT.
THERE ARE SOME RULES ABOUT RESTRAINT.
YOU'LL REVISIT RESTRAINTS WHEN YOU GET INTO THE PSYCH ENVIRONMENT.
BUT, ISN'T IT, TOM, IN PSYCH, IF SOMEONE WERE ADMITTED ACUTELY
AND THEY CAME IN AND THEY WERE -- I DON'T KNOW, ON DRUGS OR SOMETHING
AND YOU COULDN'T CONTROL THEM,
YOU CAN PUT THEM IN RESTRAINTS FOR ONE HOUR,
BUT YOU'VE GOT TO HAVE AN ORDER WITHIN AN HOUR?
IN THE ACUTE CARE SETTING, IT'S FOUR HOURS, LIKE IN AN ICU, CCU AREA.
AND IN THE MED-SURG AREA, IT'S 12 HOURS.
SO YOU CAN MAKE AN INDEPENDENT DECISION
BECAUSE THERE'S HARM
FOR YOU OR FOR THE CLIENT AND YOU MIGHT NEED A RESTRAINT.
BUT YOU HAVE TO HAVE A DOCTOR'S ORDER.
YOU HAVE TO HAVE CONTACT WITH A PHYSICIAN
WITHIN A VERY SHORT AMOUNT OF TIME,
BEFORE YOU CAN MAINTAIN THAT RESTRAINT.
ONCE YOU HAVE AN ORDER FOR A RESTRAINT,
THE RESTRAINT ORDER HAS TO BE RENEWED EVERY 24 HOURS, PERIOD.
YOU CAN'T JUST LEAVE THEM ON AT YOUR DISCRETION.
SO YOU CAN NEVER HAVE A RESTRAINT PRN. WHAT DOES PRN MEAN?
- AS NEEDED. - AS NEEDED.
CAN'T HAVE IT. AGAINST THE LAW, OKAY?
SO IT HAS TO BE REEVALUATED ON A DAILY BASIS.
IN ADDITION, ONCE YOU'VE DECIDED AND WITH THE PHYSICIAN,
AND WITH THE FAMILY, I WANT TO INTERJECT.
THE FAMILY HAS TO BE IN AGREEMENT,
HAS TO BE INFORMED ABOUT THE NEED OF
AND THEIR WILLINGNESS TO SUPPORT OR HELP OUT IN THIS ISSUE.
SOMETIMES THE FAMILY IS LIKE, "WE'RE EXHAUSTED.
THEY'RE HERE NOW. YOU MANAGE THEM. WE'RE JUST EXHAUSTED.
DO WHAT YOU'VE GOT TO DO." AND THEY ARE SUPPORTIVE.
AND SOMETIMES, THEY ARE LIKE, "NO WAY."
DON'T EVEN THINK ABOUT RESTRAINING MY MOM.
I'LL SIT HERE, I'LL SPEND THE NIGHT HERE,
I'LL DO WHATEVER YOU WANT ME TO DO.
AND THEY NEED TO BE INCLUDED IN THAT CARE PLAN.
YOU JUST CAN'T DECIDE WELL,
"WE'RE STRAPPING THEM DOWN. YOU KNOW, THEY WANDER."
FOR CLIENTS THAT WANDER, THERE'S A LOT OF THINGS THAT WE CAN DO.
MOST OF THE TIME THEY FOUND THAT PEOPLE THAT WANDER,
LIKE IF THEY HAVE ALZHEIMER'S,
AND THEY JUST GET UP AND THEY WANDER THROUGHOUT THE HOSPITAL,
THEY PUT ALARMS ON THEM.
THEY MIGHT PUT A WRIST BRACELET OR AN ANKLE BRACELET.
AND THEY SET ALARMS AT THE DOORWAYS
OR WHEREVER THEY'VE DECIDED IS WHERE THEY DON'T WANT CLIENTS TO GO.
BUT CLIENTS DO MUCH BETTER,
THEY WANDER, FINE. YOU JUST DON'T WANT THEM WANDERING AWAY,
YOU KNOW, OUT ON THE STREET.
YOU DON'T WANT THEM WANDERING INTO YOUR BEDROOMS AND THINGS LIKE THAT.
SO, IF THEY WERE LOCKING APPROPRIATE DOORS
AND ALARMING DOORS APPROPRIATELY, THE CLIENTS DID JUST FINE WANDERING.
BUT WHEN WE PUT ALL FOUR SIDE RAILS UP AND WE STRAP THEM DOWN,
WE ARE ACTUALLY CAUSING INJURY AND KILLING THEM.
BECAUSE THEY WOULD STRANGLE THEMSELVES, TRYING TO GET OUT.
THEY WOULD HURT THEMSELVES CRAWLING OVER AND UNDER AND GETTING OUT.
AND THEY CAN GET OUT.
ALRIGHT. I'LL TELL YOU SOME STORIES LATER. OKAY.
SO, RESTRAINTS.
ONCE YOU'VE DECIDED YOU CAN PUT RESTRAINTS ON,
WE STILL HAVE TO MONITOR THEM.
YOU CAN'T JUST PUT THEM AND GO, "OOH, THAT'S OVER."
THE REGULATION NOW IN CALIFORNIA IS THAT
SOMEONE HAS TO BE MONITORED 24X7.
SOMEONE HAS TO STAY PHYSICALLY WITH THEM
TO MAKE SURE THAT THEY'RE SAFE.
BECAUSE THEY CAN GET OUT AND GET IN A PREDICAMENT SO VERY FAST.
EVERY 15 MINUTES, WE HAVE TO VISUALLY MAKE SURE THAT EVERYTHING'S OKAY.
THAT THEIR CIRCULATION'S NOT CUT OFF, THAT THEY'RE NOT TWISTED,
YOU KNOW, THAT KIND OF THING.
AND EVERY TWO HOURS, WE'RE GOING TO TAKE THE RESTRAINT TOTALLY OFF,
GIVE THEM RANGE OF MOTION, MAKE SURE THEIR SKIN INTEGRITY IS GOOD.
LOOK AT PULSES, MAKE SURE THAT WE HAVEN'T CAUSED ANY SKIN ABRASIONS
AND WE'RE GOING TO CHECK THEM EVERY TWO HOURS.
AND THEN RE-APPLY THE RESTRAINT.
SO IT'S NOT JUST RESTRAINT AND GONE.
YOU MIGHT NOT TAKE THEM ALL OFF.
YOU MIGHT TAKE ONE OFF AT A TIME AND DO IT.
THAT'S A GOOD POINT. BUT THEY WILL COME OFF.
THEY HAVE TO COME OFF, BUT YOU..
UH-HUH. BUT FOR SAFETY REASONS,
YOU MIGHT NOT WANT TO TAKE ALL FOUR OFF AT THE SAME TIME.
IF THEY WERE IN A FOUR POINT RESTRAINT FOR EXAMPLE,
WHAT KIND OF CLIENTS, DRUG ABUSE CLIENTS TYPICALLY?
- YEAH. MOSTLY PSYCHOTIC CLIENTS. - PSYCHOTIC.
VARIETY OF REASONS.
VERY RARELY IN THE MEDICAL SETTING DO WE USE FOUR-POINT.
MOST OF THE TIME WHEN I'VE USED RESTRAINTS,
IT'S BECAUSE THEY'RE PULLING THEIR FOLEY CATHETERS OUT,
THEY'RE PULLING THEIR IV'S OUT,
THEY'RE PULLING THEIR NG TUBES OUT AND SO FORTH.
SO, IT'S A SAFETY ISSUE.
BUT WE'RE GOING TO TALK ABOUT, IN THOSE DIFFERENT SECTIONS
WHEN WE DO FOLEYS AND IV'S AND SO FORTH,
HOW CAN WE PROTECT THAT SITE,
SO MAYBE NOT EVEN HAVE TO RESTRAIN FOR THAT SITE.
YOU WANT TO DO EVERYTHING YOU CAN.
SO THEN YOU CAN VALIDATE, I'VE WRAPPED THE IV WITH GAUZE,
I PUT A LEG BAND ON, I PUT SHEETS OVER
AND SHE STILL GETS IN AND RIPS IT OUT.
YOU KNOW. AND SO YOU HAVE TO DOCUMENT TO THAT.
SO THAT YOU CAN DEFEND THE RESTRAINT FOR SAFETY ISSUES.
OKAY. ALL THAT'S SAID AND DONE,
OUR CLIENT NEEDS RESTRAINT.
SO, YOU'RE GOING TO CHECK YOUR DOCTOR'S ORDERS
AND YOU'LL HAVE AN ORDER
AND YOU'LL REVIEW IT EVERY 24 HOURS.
AND YOU'LL CHECK THE CARE PLAN
AND THEY'LL TELL YOU WHAT KINDS OF RESTRAINTS YOU CAN USE.
WRISTS, VESTS, WHAT FITS AND SO FORTH.
YOU'RE GOING TO GATHER UP YOUR EQUIPMENT,
AND MY EQUIPMENT TODAY IS WE'RE JUST GOING TO PUT A VEST ON.
YOU HAVE TWO SHEETS. ONE FOR THE VEST
AND THEN WE'RE JUST GOING TO PUT ONE WRIST RESTRAINT ON.
SO THAT YOU CAN, KIND OF, GET THE FEEL OF HOW TO DO IT,
HOW TO TIE KNOTS AND WHERE TO TIE THEM.
I'VE WASHED MY HANDS. I'M GOING TO IDENTIFY MY CLIENT HERE IN A SECOND.
AND..
..WHEN I GET IN HERE, AND SEE, MR. SPADE, HOW ARE YOU DOING TODAY?
NOT SO GOOD, HUH? I KNOW. AND YOU KNOW WHAT,
YOU'VE BEEN GETTING OUT OF THAT BED
AND IT'S BEEN PULLING YOUR OXYGEN OFF OF YOUR HEAD
AND IT'S RIPPED YOUR EARS. AND YOU'VE BEEN PULLING AT YOUR FOLEY CATHETER.
AND IN SPITE OF THE MEDICATION AND US TELLING YOU..
AND HE MAY NOT BE UNDERSTANDING A WORD I'M SAYING,
BUT I'M STILL TELLING HIM.
WE'RE GOING TO JUST PUT A LITTLE REMINDER ON YOUR WRIST
SO THAT YOU DON'T PULL.
AND IT'LL, KIND OF, KEEP YOU FROM GETTING CLOSE TO THAT CATHETER.
AND THEN THE VEST WILL KEEP YOU FROM PULLING THAT OXYGEN TOO FAR.
YOU'LL STILL BE ABLE TO MOVE AND BREATHE,
BUT HOPEFULLY IT WILL REMIND YOU NOT TO MOVE TOO FAR.
EXPLAIN WHAT YOU'RE DOING. IT'S THEM. AND WHATEVER.
PROVIDE PRIVACY. OKAY, I'M GOING PUT THE BED IN THE HIGH POSITION.
AND THERE'S NOT MUCH HARD.. WELL, PATIENTS ARE MUCH HARDER,
BUT PUTTING A POSEY VEST ON A MANNEQUIN, NOT MUCH.
SO WHAT WE'LL PROBABLY DO IS WE'LL JUST HAVE THEIR ARMS IN
WHEN YOU COME TO TEST, AND WE'RE JUST MORE INTERESTED IN TYING THEM.
BUT WHEN YOU HAVE A POSEY VEST, THEY COME IN DIFFERENT SIZES.
AND THEY AREN'T A ONE SIZE FIT ALL.
THEY'RE SMALL, MEDIUM, LARGE AND EXTRA LARGE.
AND THEY COME LIKE THIS.
THEY NEED TO -- THEY HAVE A TAG.
AND THE TAG WILL TELL YOU THE SIZE,
BUT THAT'S ALSO A REMINDER THAT THIS PART GOES IN THE BACK.
AND THEN THEY CRISSCROSS IN THE FRONT.
THERE'S A LITTLE SLIT
AND THAT'S THE FIRST PLACE YOU WANT TO THREAD YOUR STRING THROUGH.
YOU GOT THESE LONG OLD STRINGS.
AND OURS ARE PRETTY DIRTY
AND WE DON'T REALLY HAVE PATIENTS LIE WITH WOUNDS AND THINGS.
SO THAT MEANS THEY'VE BEEN DRAGGED ON THE GROUND WAY TOO MUCH.
OKAY.
WHAT WE'RE GOING TO DO IS PUT THIS ON THEM.
AND MR. SPADE, COULD YOU SIT UP HERE AND HELP ME? GREAT.
WE'RE GOING TO PUT THIS ON. YOU CAN UNCROSS YOUR HANDS NOW.
THAT'S GOOD.
PUT THIS ON.
PUT YOUR ARM THROUGH THERE FOR ME. THANK YOU.
YOUR ARM'S STILL A LITTLE LOOSE. DOCTOR HASN'T SEEN THAT? YEAH.
IT'LL PROBABLY FALL OFF HERE.
ALRIGHT. I WANT TO PUT THIS THROUGH THE BACK..
..AND THEN LAY HIM DOWN.
WE USED TO..
..OUT OF LOGICAL THINKING PUT THE VEST ON THE OTHER WAY.
DOESN'T IT SEEM LIKE IT'D BE A LOT STURDIER
IF I PUT THAT FULL PIECE THERE, BUT I CHOKED ON HIM.
NOT GOOD.
SO, THEY MUST GO THE OTHER WAY.
WE DO THIS TOWARDS THIS ELBOW.
COULD YOU BEND YOUR ARM A LITTLE MORE?
SOMETIMES IT'S JUST THAT HARD.
SOMETIMES I'VE HAD CLIENTS WHO JUST GO, "SURE, WHATEVER YOU WANT."
THEY'LL JUST.. THEY'RE SO CONFUSED AND HAPPY AND TENSE.
OKAY. YOU CAN PUT YOUR ARM DOWN NOW.
OKAY. SO I WANT TO GET THIS STRAIGHT ON HIM.
WHEN YOU REALIZE IT'S HITTING YOU ON YOUR STOMACH
AND YOU'RE GOING LIKE THIS, YOU'RE PROBABLY NOT USING VERY GOOD BODY MECHANICS.
ALRIGHT. SO, THAT'S NICE AND STRAIGHT HERE ON HIS WAIST.
FIRST CRISSCROSS GOES THROUGH THE SLIT,
YOU CROSS AND THEN I HAVE MY STRING.
AND THEN MY SECOND ONE GOES OVER THE TOP.
I'LL COME AND TIE ON THIS SIDE,
BUT YOU GUYS CAN SEE OVER HERE WHAT I'M DOING.
YOU CAN'T REALLY SEE EITHER SIDE MOVE.
WHAT WE WANT TO DO IS NOW TIE THIS ON TO THE BEDFRAME,
NOT BED RAIL.
THERE'S A COUPLE OF PLACES THAT I TIE.
THE FIRST TIE THAT I DO IS ON THE BED FRAME ITSELF,
JUST RIGHT HERE. USUALLY WHERE THE BED BENDS AND GASHES.
BECAUSE IT'S EASY TO REACH.
BUT I'VE HAD MY CLIENTS GO LIKE THIS AND POOCHHK, UNDO MY TIES.
SO THEN I'LL TIE IT UNDER THE BED, WHERE THEY CAN'T REACH.
BUT, FOR THE MOST PART,
PEOPLE AREN'T THAT INVESTIGATIVE, YOU KNOW.
SO I'M GOING TO COME DOWN HERE.
NOW, KEEPING IN MIND FIRE SAFETY AND PATIENT SAFETY,
I'M NOT GOING TO TIE THIS INTO A KNOT THAT I CAN'T GET UNDONE.
SO EVERYTHING THAT YOU TIE HAS TO BE A SLIP KNOT,
SO THAT ONE PULL, YOU'LL BE OUT
AND THAT CLIENT COULD GET OUT FOR A FIRE.
OKAY, SO TO DO A SLIP KNOT, WE'RE GOING TO COME DOWN HERE.
I KNOW. YOU CAN'T SEE, BUT I'LL DO IT ON THAT SIDE.
I'M GOING TO COME DOWN HERE AND SEE HOW MY FINGERS ARE IN,
AND HOLDING THIS HOLE HERE.
YOU CAN TIE ONE IF YOU WANT AND COME DOWN.
AND THEN YOU HOLD IT AND THEN A LITTLE LOOP CAN COME IN THE LOOP
AND GO DOWN LIKE THAT SO THAT I GO CHUUK.
AND I'M OUT. THERE'S NO KNOT, THERE'S NO FUSSING TO PULL IT APART.
OKAY, ONE MORE TIME. I'LL JUST DO A QUICK ONE.
HOLD HERE, PUT THIS HERE. DONE.
I HAVE TO MAKE SURE THAT IT'S NOT SO TIGHT THAT HE CAN'T BREATHE.
AND I'M HAPPY.
HOW DOES THAT FEEL?
OKAY, BREATHE. THAT'S GOOD.
I'M GOING TO COME OVER HERE.
AND THIS IS PROBABLY THE MORE CRITICAL ONE,
MAKE SURE I DON'T DO IT TOO TIGHT.
COME OVER HERE, WHERE THE BED GASHES.
AND COME DOWN..
..IN HERE. SO, IT'S THE SOLID PART OF THE BED, NOT THE SIDE RAIL.
BECAUSE UP AND DOWN, YOU'LL BE YANKING ON THEM.
I'M JUST GOING TO DO ONE LITTLE SLIP HERE,
AND THEN I'M GOING TO TAKE MY HANDS AND PULL OPEN A HOLE
AND PULL THROUGH THAT HOLE AND HAVE A SLIP KNOT.
SO I'M OUT AND GO.
IF YOU DO A SINGLE SLIP,
WHICH IS THE SECOND THING I SHOWED, IT'S THE SAME THING.
I HOLD THE HOLE AND I JUST SLIP DOWN LIKE THIS.
SOMETIMES THEY SHIMMY OUT OF THESE AND THEY PULL ON THEM.
AND IT'S TOO FAST.
THAT'S WHY I LIKE THAT FIRST TIE,
BECAUSE IT'S JUST A LITTLE MORE STABLE IN THE SLIP KNOT WORLD.
SO I DO THAT AND I'M DOWN.
THEN I'M GOING TO CHECK AND MAKE SURE NOTHING'S TWISTED
AND THAT HE CAN BREATHE. IS THAT OKAY? NOT TOO TIGHT?
BUT TIGHT ENOUGH TO GET THE JOB DONE.
AND THERE HE GOES.
YOU CAN GO AHEAD AND PUT YOUR WRIST RESTRAINT ON
AND THEN WE'LL TALK THROUGH THE PARAMETERS HERE.
WRIST RESTRAINT LOOKS LIKE THIS.
THEY COME IN A LOT OF DIFFERENT FORMS.
I HAPPEN TO HAVE CLOTH WRIST RESTRAINTS,
JUST BECAUSE WE REUSE THEM AND I DON'T HAVE CLIENTS
AND BODY SUBSTANCE ISSUES.
BUT YOU'LL SEE SOME BLUE, PAPER DISPOSABLE ONES.
AND THEY'RE NICE. YOU JUST HAVE TO BE CAREFUL NOT TO GET THEM TOO TIGHT.
THEY CAN KIND OF TOURNIQUET.
AND THEY ALSO HAVE.. SOME HAVE LAMBS WOOL ON THEM.
AND THOSE ARE NICE, THEY KIND OF PROTECT THE SKIN.
EXCEPT THAT THE LAMBS WOOL MAKES THEM SO FLUFFY
THAT THEY JUST SQUISH THEIR HANDS RIGHT OUT.
SO I DON'T REALLY LIKE THEM VERY WELL
UNLESS MY CLIENT'S JUST NEEDING A LITTLE REMINDER.
OR LIKE IT'S STROKE CLIENT WITH WEAKNESS,
AND I'M USING IT TO MAINTAIN BODY POSITION OR SOMETHING
AND THEY'RE NOT REALLY FIGHTING IT. AND THAT'S A GOOD ALTERNATIVE.
BUT FOR A REAL RESTRAINT, RESTRAINT, NOT SO HOT.
ALRIGHT.
YOU WANT TO CHECK THE SKIN, PRIOR TO PUTTING THE RESTRAINT ON.
AND SOMETIMES WHAT I LIKE TO DO,
IF THIS CAUSING ABRASION OR RUBBING,
ESPECIALLY LIKE THOSE PAPER ONES, I MAY WRAP THEIR ARMS WITH SOME GAUZE.
JUST TO PROTECT IT FROM THE FRICTION OF THIS.
AND THAT'S NOT ON THERE, BUT THAT'S JUST FOR YOU.
THESE NAME BANDS ARE KIND OF IN THE WAY AND HE'S GOT TWO ON.
AND SO, IT MIGHT BE PRACTICAL TO LOOSEN THOSE UP
AND MAKE SURE THEY'RE NOT DIGGING INTO HIS SKIN.
FIND ANOTHER WAY TO IDENTIFY HIM.
PUT IT ON HIS ANKLE OR SOMETHING.
YOU HAVE A LITTLE SLIT RIGHT HERE
AND YOU WANT TO MAKE YOUR FIRST PASS THROUGH THE SLIT.
THEN YOU WANT TO PUT IT SNUGLY ON THE WRIST.
MAKE SURE YOU CAN GET A FINGER IN THERE SO THAT YOU'RE NOT CUTTING OFF CIRCULATION.
AND I'M GOING TO COME AROUND HERE.
THIS ONE HAS A VELCRO ON IT,
SO YOU'RE PROBABLY NOT GOING TO GET A LOT OF SLIDE AND PULL.
BUT I NEED TO STABILIZE THIS.
SO I'M GOING TO PUT A LITTLE TIE HERE,
MAKE SURE IT'S NOT TIGHT.
AND I'M GOING TO TIE A SQUARE KNOT. NOT.
DOESN'T THAT JUST GO AGAINST EVERYTHING I SAID? NO, NOT REALLY.
BECAUSE THEY COULD STILL GET TO A FIRE, COULDN'T THEY,
WITH THEIR LITTLE WRIST BRACELET ON.
IT'S THE ONE THAT TIES TO THE BEDFRAME THAT'S GOING TO BE THE SLIP KNOT.
BUT IF I DON'T TIE A KNOT ON HERE, WHAT HAPPENS IS,
THIS COMES LIKE THIS, AND THEY PULL AND THEY FIGHT
AND THIS GETS TIGHTER AND TIGHTER AND TIGHTER.
AND THEN I'VE CUT OFF THEIR CIRCULATION.
SO THE KNOT IS TO PROTECT AND STABILIZE THIS BRACELET
SO THAT IT DOESN'T GET ANY TIGHTER ON THE WRIST.
SO I'M GOING TO PUT A SQUARE KNOT HERE.
AND THAT'S GOING TO KEEP THIS AT THIS TIGHTNESS
ON THEIR WRIST.
AND THEN I'M GOING TO DETERMINE WHERE I WANT THEM.
DO I WANT THE HAND UP LIKE THIS FOR A BREAK?
DO I WANT IT ACROSS THE CHEST LIKE THIS FOR A CHANGE OR WHAT?
THEY COULD BE IN A LOT OF POSITIONS.
IF WE KEEP OUR CLIENTS IN THIS LOCKED DOWN POSITION ALL THE TIME,
THEY'RE GOING TO GET ATROPHIED.
THEY'RE GOING TO GET CONTRACTURES AND WEAKNESS IN THAT EXTREMITY.
THEY'VE GOT TO MOVE THOSE EXTREMITIES.
SO, I'M GOING TO COME DOWN HERE. AND I'VE GOT ANOTHER LITTLE CATCH PLACE.
YOU COULD DO IT.
YOU GUYS CAN'T REALLY SEE, BUT IT'S THE SAME THING OTHER THAN..
I HAVE TWO TIES NOW.
OKAY, LET'S JUST DO IT HERE WHERE YOU CAN SEE.
THIS IS A BEDFRAME. NEVER, NEVER TIE..
OKAY, BUT YOU CAN'T SEE.
YOU CAN TAKE TWO TIES AROUND YOUR BED FRAME,
AND GO LIKE THIS AND TIE A BOW.
BECAUSE, THE BOW IS A SLIP KNOT AND YOU CAN GET OUT.
OR YOU CAN DO THE KNOT THAT I SHOWED YOU
AND JUST BRING IT AROUND AS IF THIS IS A ONE TIE.
AND JUST DO YOUR LITTLE THING.
AND THEN MAKE YOUR LITTLE PULL RIGHT HERE AND STICK IT IN HERE.
A SLIP KNOT.
SO EITHER ONE.
BUT, A BOW COUNTS. OKAY?
SO NOW THAT YOU'VE SEEN THEM, I'LL TIE THEM TO THE FRAME,
SO YOU GET THE RIGHT LOOK. I DON'T WANT TO LEAVE A WRONG LOOK PICTURE.
WE WOULD NEVER DO THAT.
THIS IS WHEN IT'S HELPFUL TO KNOW HOW YOUR SIDE RAILS MOVE
SO YOU CAN JUST GET THEM OUT OF THE WAY.
JUST COME DOWN HERE.
OKAY. THAT'S ALL THE MOVEMENT I REALLY WANT YOU TO HAVE RIGHT THERE.
AND THERE.
SO HE PROBABLY STILL COULD REALLY SHIMMY HIMSELF DOWN
AND PULL THOSE OUT IF HE WANTED TO. BUT, HOPEFULLY HE WON'T.
ALRIGHT. PUT THE BED IN A LOW POSITION. WASH YOUR HANDS.
I'M GOING TO FIND SOMEBODY TO SIT WITH THIS CLIENT ALL THE TIME.
SO THEY CAN TAKE HIM TO THE BATHROOM,
WATCH AND JUST MAKE SURE THAT THEY'RE SAFE.
EVERY 15 MINUTES, THEY'RE GOING TO HAVE TO TAKE A VISUAL
TO LOOK EXACTLY AT HOW THESE ARE ON THERE,
THAT THE KNOTS ARE STAYING GOOD,
AND THAT THEY HAVEN'T CUT OFF CIRCULATION IN ANYWAY.
AND THEN, EVERY TWO HOURS RESTRAINTS ARE RELEASED.
YOU CHECK THE SKIN TO MAKE SURE THAT THE SKIN HASN'T BEEN BROKEN DOWN.
YOU'RE GOING TO PUT A LOTION ON THEIR SKIN.
YOU'RE GOING TO PUT THEM THROUGH A RANGE OF MOTION.
AND THEN YOU'RE GOING TO REPOSITION THEM IN A TOTALLY DIFFERENT WAY.
YOU'RE NOT GOING TO KEEP SLAPPING HIM DOWN LIKE THIS.
YOU'RE GOING TO DO SOMETHING ELSE,
SO THAT YOU'RE MOVING THOSE EXTREMITIES. OKAY?
WHEN YOU COME TO THE STATION,
WE'RE NOT GOING TO WATCH YOU, LIKE DO IT.
YOU'RE JUST GOING TO TIE HIM UP.
I CAN TELL WHEN IT'S ALL SAID AND DONE WHAT YOU DID.
SO I'LL LOOK AND I'LL JUT GRAB THOSE SLIP KNOTS,
MAKE SURE THAT I CAN GET THEM UNDONE.
I'LL CHECK, YOU KNOW, CIRCULATION TO MAKE SURE THEY'RE NOT TOO TIGHT.
AND THEN I'LL SAY, WHAT ARE THE PARAMETERS FOR CHECKING THIS CLIENT?
AND YOU'RE GOING TO SAY, "I'M GOING TO CHECK EVERY 15 MINUTES.
I'M GOING TO HAVE SOMEONE STAY WITH HIM 24 HOURS
I'M GOING TO CHECK HIM EVERY 15 MINUTES.
AND THEN EVERY TWO HOURS I'M GOING TO PUT HIM THROUGH RANGE OF MOTION,
REPOSITION, SKIN CARE, THOSE THINGS.
AND THAT'S ALL YOU'RE REALLY GOING TO DO AT THAT STATION. OKAY?
ALRIGHT. THE NEXT STATION, LET'S DO WALKER AND CANE.
LET'S DO WALKER FIRST.
YOU CAN CHECK THE DOCTOR'S ORDERS.
THE DOCTOR MAY OR MAY NOT HAVE WRITTEN AN ORDER DEPENDING ON,
IF YOUR CLIENT CAME TO THE HOSPITAL
WITH A WALKER OR IF YOUR CLIENT NEEDS A WALKER.
SO THEY MAY COME WITH THEIR WALKER
AND THERE JUST NEEDS TO BE SOMETHING RELATED TO AN ACTIVITY.
ORDER. "UP IS TOLERATED, UP WITH WALKER," OR SOMETHING.
BUT THE NURSING CARE PLAN SHOULD SAY,
CLIENT NEEDS TO TRANSFER OR AMBULATE WITH WALKER
SO THAT YOU GET AN IDEA OF WHAT THEY NEED.
THEN YOU'RE GOING TO GATHER YOUR EQUIPMENT, WHICH IS THE WALKER
AND POSSIBLY A GAIT BELT TO SUPPORT
AND GIVE YOU SOMETHING TO GRAB ON TO,
ESPECIALLY WHEN THEY'RE WEARING JUST A GOWN.
IF THEY HAVE PANTS ON, I'LL PROBABLY USE THE BELT LOOPS
OR THEIR BELT OR SOMETHING. BUT WHATEVER. ALRIGHT.
WASH MY HANDS. I'LL IDENTIFY MY CLIENT, WHICH IS ME TODAY.
AND PROVIDE PRIVACY.
WHEN YOU'RE THINKING ABOUT YOUR CLIENTS AND PRIVACY,
BUT YOU DON'T REALLY PULL A CURTAIN, BECAUSE THEY'RE GOING TO BE WALKING.
SO PRIVACY IS GOING TO BE BACK HERE.
MAKE SURE THEY HAVE A ROBE ON OR PUT ANOTHER GOWN ON AS THEIR ROBE,
SO THEY'RE NOT EXPOSED. AND THEN THEY NEED GOOD NON-SKID SHOES,
SLIPPERS TO AMBULATE WITH.
AND IT'S EVEN BETTER IF THEY CAN AVOID LIKE THOSE SLIP-ON LITTLE SLIPPERS,
YOU KNOW, THAT'S JUST THAT LITTLE PIECE ACROSS
BECAUSE THEY SLIP OUT OF THEM AND THEY'RE AT RISK FOR FALLING.
SO, I WOULD RECOMMEND A SHOE
OR A FULLY ENCLOSED SLIPPER OR SOMETHING THAT STAYS ON THEIR FOOT.
ALRIGHT. THE FIRST THING WE NEED TO DO IS HAVE --
DETERMINE WHAT, IF THE CLIENT HAS ANY WEAKNESS ON ONE SIDE OR THE OTHER.
AND LET'S SAY I HAVE LEFT SIDED WEAKNESS.
BUT I'M ABLE TO WALK OBVIOUSLY. I CAN GET UP AND WALK.
I JUST NEED A WALKER FOR SUPPORT.
AND WE WANT TO MAKE SURE THE WALKER FITS THE CLIENT.
SO, WE'RE GOING TO NEED THE CLIENT TO COME
AND STAND INSIDE THE CAGE OF THE WALKER.
AND I CALL THIS THE CAGE.
IN THE CAGE, THEY SHOULD BE ABLE TO GRIP THE HAND REST.
AND ONCE THEY'RE GRIPPED, YOU'RE GOING TO CHECK
THAT THEIR ELBOWS ARE BENT AT 15 TO 30 DEGREES.
YOU DON'T WANT THEM BEND REALLY HIGH LIKE THIS
BECAUSE THEY TEND TO LUNGE WHEN THEY HAVE SO MUCH ROOM.
SO THEN YOU WANT THEM.. THAT 15 TO 30 DEGREES
ONLY ENCOURAGES THEM TO STRAIGHTEN OUT THAT SIX TO EIGHT INCHES WORTH.
AND THEY DON'T TAKE AS HUGE OF STEPS.
SO 15 TO 30 DEGREE BEND.
SLIGHTLY BELOW THE WAIST DEPENDING ON THE WALKER YOU USE.
I DON'T LIKE THAT CRITERIA VERY WELL
BECAUSE IF YOU HAVE A WALKER LIKE THIS,
THAT'S WAY BELOW THE WAIST, SO THAT'S NOT A CLEAN CRITERIA.
THE ELBOWS ARE A CLEAN CRITERIA.
THE DIFFERENCE BETWEEN THESE TWO WALKERS IS,
THIS ONE IS CALLED A PICKUP WALKER
BECAUSE YOU HAVE TO PICK UP ALL FOUR FEET
AND THEN STEM DOWN BEFORE YOU WALK INTO IT.
THIS IS A WHEELED WALKER AND THIS IS FOR PEOPLE
THAT WANT TO MAKE A LITTLE SPEED AS THEY GO.
AND SO THEY CAN.. IT KEEPS THE TWO WHEELS ON THE FLOOR ALL THE TIME
AND THEY CAN CLIP AT A PRETTY GOOD PACE.
SO THIS IS FOR SOMEONE THAT'S RELATIVELY..
I MEAN, ALMOST READY TO BE RID OF THE WALKER.
IT'S JUST THERE AS A KIND OF A BACKUP AND THEY CAN CLIP.
WE ARE GOING TO USE THE PICKUP WALKER.
WE ALWAYS DO THE, KIND OF, HARDEST OF THEM.
IF THERE'S ANYTHING THAT'S A LITTLE HARDER.
ALRIGHT. WE'VE GOT OUR CLIENT UP.
WE'VE MEASURED THAT WE HAVE THE RIGHT BEND.
THEY'RE IN THEIR GOOD NON-SKID WALKING SHOES.
THEN WE WANT TO TEACH THEM HOW TO AMBULATE WITH THIS WALKER.
SO YOU WANT TO TEACH THEM THAT THEY'RE GOING TO TAKE THE WALKER,
AND PICK IT UP, ALL FOUR FEET
AND SET IT SIX TO EIGHT INCHES IN FRONT OF THEM.
YOU'RE GOING TO BE STANDING SLIGHTLY BEHIND THEM ON THEIR
STRONG OR WEAK SIDE? - STRONG.
STRONG. WE ALREADY KNOW. THIS PRINCIPLE IS THE SAME FOR ALL WALKING.
SO, WE'RE GOING TO BE SLIGHTLY ON THE STRONG SIDE,
WHICH WILL BE MY RIGHT SIDE. GAIT BELT, FELT I NEEDED IT.
AND NOW, THEY'RE GOING TO MOVE A FOOT INTO THE WALKER.
WHICH ONE? STRONG OR WEAK. - WEAK.
WEAK. BECAUSE YOU WANT TO LEAVE A TRIPOD OF STRENGTH, RIGHT?
SO, IF I LIFT MY WEAK, I'VE GOT EVERYTHING STRONG HELPING ME.
AND IF I STEP ON WEAK NOW I'VE GOT MY TWO HANDS TO HELP ME.
I'M NOT LETTING THE WEAK LEG BEAR ALL THE WEIGHT.
THEN ONCE I'VE STEPPED IN, YOU PICK UP, GO, GO.
IT'S A THREE STEP..
AND THEY NEED TO GET ALL FOUR FEET DOWN
BEFORE THEY START RUNNING OFF. SO REMIND THEM.
YOU DON'T WANT TO SEE..
THESE ARE SOME OF THE THINGS I'VE SEEN OVER THE YEARS.
I THINK IF THEY WALK LIKE THIS,
THAT MAYBE THEY DON'T NEED THIS WALKER VERY MUCH.
SOMETIMES THEY DRAG THEM AND THEN MAYBE THEY DON'T NEED IT VERY MUCH
OR WHAT'S GOING ON IS MAYBE THEY NEED TO GO TO WHEEL.
SOMETIMES, WHAT THEY'VE DONE IS, THEY DON'T LIKE THIS CLICKING SOUND
AND IT KIND OF STICKS A LITTLE, THESE RUBBER STOPPERS.
SO YOU'LL SEE TENNIS BALLS ON THE END OF THE WHEELS.
IT TAKES THE CLICK OUT AND IT LETS THEM GLIDE A LITTLE BETTER.
AND THEY LIKE THOSE, SO.
YOU JUST.. THE MAIN THIS IS YOU DON'T WANT THEM STICKING AND TRIPPING.
YOU WANT THEM TO PICK UP, SET AND GO. THAT'S THE SAFER WAY.
IT'S INTERESTING AS YOU START WATCHING. AND I WATCH ALL OF IT,
ALL THE TIME. WHEN I SEE SOMEONE IN A RESTAURANT OR OUT SHOPPING,
AND I LOOK TO SEE WHAT THEY'RE DOING AND HOW THEY'RE DOING IT.
AND I DON'T KNOW IF YOU'VE NOTICED,
BUT WE DON'T HAVE A VERY HANDICAPPED WORLD IN WHICH WE LIVE.
IF YOU'RE HANDICAPPED WITH A WHEELCHAIR OR A WALKER,
YOU JUST TRY TO EAT AT MARIE CALLENDER'S.
THEY'LL PUT YOU AT THE BACK TABLE, I'VE WATCHED IT HAPPEN.
AND THEY JUST HARDLY HELP YOU. AND HERE'S THESE POOR, WALKER PEOPLE.
IT TAKES THEM LIKE 15 MINUTES TO GET FROM THE FRONT DOOR
TO THE BACK TABLE BECAUSE THEY DON'T FIT WHEN THE RESTAURANT'S FULL.
TRY TO GET INTO A BATHROOM, YOURSELF. THINK OF YOUR BATHROOM.
MOST OF US DON'T HAVE THESE HUGE, GARGANTUAN BATHROOMS.
WE GOT LITTLE TINY ONES. BARELY FIT THROUGH THE DOOR..
TRYING TO GET TO THE SEAT, YOU KNOW.
AND WE GOT TO GET UP, WE GOT TO THE --
YOU KNOW, SO WE DON'T HAVE MUCH OF A WALKER WORLD.
AND SO, WHAT DO THEY DO? SO OFTEN THEY NEED TO BE STABLE ENOUGH
THAT THEY COULD LEAVE THE WALKER AT THE DOOR AND MANAGE WITHOUT IT.
BUT THEY DON'T ALWAYS GET UP WELL.
SO THEN YOU'VE GOT TO THINK ABOUT TOILET SEAT HANDLES SO THEY CAN GET UP,
BECAUSE THAT'S WHAT THEY MAY PRIMARILY USE IT FOR.
SO, THINK THROUGH. IT'S NOT JUST, "OH, GOOD. I TAUGHT MY CLIENT,
THEY'RE GOOD TO GO." YOU WANT TO TALK TO THEM.
HOW DO YOU GET AROUND IN YOUR HOUSE?
HOW'S YOUR BATHROOM? DO YOU HAVE STAIRS?
I DON'T KNOW HOW TO DO A WALKER WITH STAIRS.
I DON'T THINK YOU CAN.
SO, WE'VE GOT TO TALK THROUGH SOME OF THOSE THINGS TO HELP THEM.
MAYBE THEY LEAVE IT PARKED AT THE BOTTOM OF THE STAIRS,
GO UP WITH HAND RAILS AND HAVE ANOTHER WALKER FOR, IN THE HOUSE.
BUT, YOU KNOW. OKAY. LET'S THINK THROUGH ONE MORE THING.
WHAT HAPPENS WHEN YOU GOT TO DO THE LAUNDRY WITH YOUR WALKER?
WHAT DO YOU DO? HOW DO YOU GET GROCERIES WITH THE WALKER?
IN SMALL FREQUENT LOADS, WOULD BE MY GUESS.
YOU KNOW, IT'S A VERY DIFFICULT, VERY FRUSTRATING LIFESTYLE.
YOU'LL SEE THAT THEY'LL PUT BICYCLE BASKETS
AND BAGS IN FRONT SO THAT THEY CAN CARRY PARAPHERNALIA,
THEIR READING BOOK, THEIR.. YOU KNOW, THE STUFF OFF LIFE.
BUT YOU WANT TO REMIND THEM NOT TO OVERLOAD THIS.
THEY COULD GET THIS SO HEAVY AND SO LOPSIDED
THAT THEY CAN HARDLY MOVE THE WALKER.
VERY TRICKY. ALRIGHT.
WE'VE WALKED. AFTER YOU'VE WALK,
YOU WANT TO MAKE SURE THAT YOU PUT YOUR CLIENT BACK TO BED
OR IN THE CHAIR OR WHATEVER. WASH YOUR HANDS
AND THEN DOCUMENT HOW FAR THEY'D TRAVELED.
AND HOW THEY TOLERATED IT.
AND BE EVALUATING ALL THE TIME, "IS THIS THE BEST METHOD FOR MY CLIENT
OR COULD THEY USE A CANE?"
WOULD THAT BE BETTER SUPPORT FOR THEM? OR DO THEY NEED THIS?
OR MAYBE THEY HAVE A CANE AND THEY NEED TO MOVE UP
FOR SOMETHING MORE STURDY.
AND THOSE ARE SOME THINGS
THAT YOU'RE LOOKING AT RELATED TO THE WALKER. ALRIGHT.
SO OUR CLIENT'S JUST CLIPPING ALONG WITH THEIR WALKER,
AND WE'RE THINKING, "YOU KNOW, MAYBE A CANE WOULD BE THE BEST THING."
THEIR KNEE BUCKLES HERE AND THERE, BUT THEY HAVE SUPPORT WITH THE CANE,
THAT WOULD FREE UP THEIR HANDS
AND IT'S JUST A LITTLE BIT EASIER, YET THE SUPPORT.
THERE'S TWO KINDS OF CANES THAT ARE OUT THERE.
THERE'S THE QUAD CANE AND THE POLE CANE.
THE QUAD CANE IS A LITTLE STABLER, AS YOU CAN SEE.
WHEREAS THIS IS JUST -- THIS IS LIKE THE BARE MINIMUM OF CANE.
AND THIS IS A LITTLE MORE SUPPORT. SO YOU'LL HAVE TO DECIDE.
AND PHYSICAL THERAPY CAN HELP CONSULT WHEN YOU'RE THINKING.
I THINK THEY NEED SOMETHING ELSE,
SOMETHING DIFFERENT. WE'RE GOING TO USE JUST THE POLE CANE HERE.
THE SINGLE CANE.
SO, YOUR CLIENT NEEDS A CANE, YOU'VE CHECKED YOUR DOCTOR'S ORDERS, CHECKED YOUR CARE PLAN,
GET SOME INPUT AS TO WHY THEY NEED THIS, WHAT FOR?
MAYBE IT'S FOR MINIMAL KNEE INJURY,
OR SOMETHING AND THEY JUST -- THEY NEED A LITTLE SUPPORT.
YOUR PATIENT SHOULD BE BASICALLY INDEPENDENT.
THEY SHOULD BE AMBULATORY AND THIS IS JUST HARDLY ANYTHING FOR THEM.
JUST BACKUP.
YOU'RE GOING TO GATHER YOUR EQUIPMENT, WHICH IS YOUR CANE, A GAIT BELT,
POSSIBLY, GOOD WALKING SHOES, ROBE, PRIVACY.
IDENTIFY YOUR CLIENT. ME.
WASH YOUR HANDS, AND PROVIDE PRIVACY, WHICH IS AGAIN, THE ROBE.
ALRIGHT. THE FIRST THING WE WANT TO DO,
AND I MENTIONED IT BEFORE IS WE WANT TO ASCERTAIN
OR BE SURE THAT THIS IS THE APPROPRIATE WALKING DEVICE,
APPLIANCE FOR THE CLIENT.
ARE THEY SAFE WITH THIS? IS THIS GOOD FOR THEM?
ONCE WE'VE DONE THAT WE WANT TO MEASURE -- GET THEM DRESSED,
THE NON-SKID SHOES, GET THEM ALL DRESSED UP
AND THEN WE WANT TO MEASURE THAT WE HAVE THE RIGHT LENGTH.
YOU HAVE A LITTLE DIFFERENT CRITERIA ON THIS.
YOU'RE GOING TO PUT THE CANE TO THE GREATER TROCHANTER,
OKAY. MAKE SURE YOU KNOW THE DIFFERENCE BETWEEN THE GREATER TROCHANTER
AND THE ILIAC CREST.
BECAUSE IF YOU GO LIKE THIS AND SAY, I PUT IT AT MY GREATER TROCHANTER,
I'M GOING TO TAKE OFF ON THAT, BECAUSE IT'S NOT YOUR GREATER TROCHANTER.
AND IF I PUT IT UP TO HERE, WHERE WOULD THE BEND IN MY ELBOW BE?
- 15 - NOT 15 TO 30.
IT'S GOING TO BE MORE LIKE 90. SO, BY PUTTING IT TO THE GREATER TROCHANTER,
YOU MAINTAIN THAT SAME RULE OF THE 15 TO 30 DEGREE BEND IN YOUR ELBOW.
YOU WANT THE CANE TO BE ON THE STRONG SIDE.
AGAIN, IT'S SUPPORT, SO THAT IF THEY BUCKLE,
THEY'RE GOING TO GO TOWARDS THEIR SUPPORT,
WHICH IS STRONG SIDE SUPPORT.
MY LEFT LEG IS WEAKER, IF I'M GOING TO HAVE A WEAK ONE.
THIS IS GOING TO BE SIX TO EIGHT INCHES IN FRONT OF MY FOOT,
AND OUT HERE A LITTLE BIT.
AND I'M GOING TO TEACH MY CLIENT TO WALK WITH THE WEAK LEG
AND THE CANE AT THE SAME TIME.
LIKE YOU WALK. IT KIND OF SIMULATES A STRONG LEG SUPPORT WITH THEM.
SO I'M GOING TO WALK.
PUT BOTH DOWN, SO THAT MY CANE SUPPORTS MY WEAK LEG
AND I'M GOING TO TAKE MY STRONG FOOT,
STRONG LEG THROUGH AND CAST
THAT LINE OF CANE.
AND JUST WALK.
THAT'S ALL THERE IS TO IT. THIS WAY. LET'S SEE.
CAST.
CAST AND JUST WALK.
AND THEY SHOULD LOOK LIKE THEY'RE WALKING. THAT'S THE WHOLE POINT.
NOW, THEY CAN DO A SLOWER GAIT AND GO, ONE..
WELL, NO, YOU GO, CANE, LEG, WALK.
CANE, LEG, WALK. BUT IF YOU GOT TO THINK TOO MUCH FOR THAT,
THEN THERE'S ANOTHER GAIT WHERE YOU GO, CANE, LEG, EVEN.
CANE, LEG, EVEN.
AND THAT'S A LITTLE CHOPPY TOO.
I'M THINKING IF THEIR THAT SLOW THEY PROBABLY NEED A WALKER.
BUT YOU'LL SEE THOSE DIFFERENT.. IN THE VIDEOS AND IN YOUR BOOKS,
THEY HAVE ALL THESE DIFFERENT GAITS. BUT WE'RE JUST GOING TO DO A WALK.
CHINK, CHINK.
AND THAT'S WHAT I AM DESCRIBING ON THOSE PAGES.
AFTER THEY'VE AMBULATED, YOU CAN PUT THEM..
THEY CAN WALK BACK TO THEIR CHAIR, WHATEVER.
WASH YOUR HANDS AND DOCUMENT THE DISTANCE TRAVELED.
AND HOW WELL THEY TOLERATED IT.
WATCH PEOPLE WITH CANES.
IT'S PROBABLY THE MOST ENTERTAINING OBSERVATION YOU'LL EVER MAKE.
I'VE ONLY SEEN IN THE LAST MAYBE EIGHT OR 10 YEARS,
LIKE ONE PERSON DO IT RIGHT.
MOST OF THE TIME, AND I'M JUST WATCHING, LIKE I'M IN THE LAWN ON CAMPUS
AND I'M JUST WATCHING, AND I'M GOING, "WRONG SIDE.
NO GAIT. OH, MY GOODNESS! WHAT IS THAT?"
AND I THINK SOME PEOPLE JUST CARRY THEM FOR THE STATUS OF THE CANE.
AND LOOK, I MEAN, THEY'VE GOT SOME GORGEOUS CANES OUT THERE.
AND I THINK THEY JUST LIKE THEIR CANE.
BUT THEY JUST DO CRAZY THINGS AND THERE'S NO RHYME OR REASON
TO ANY KIND OF GAIT OR ANY KIND OF LIKE, THING, YOU KNOW.
IT'S JUST KIND OF THERE.
AND I'M THINKING, "OH, THEY REALLY DON'T NEED THAT.
SO IT'S PROBABLY GOOD FOR THEM."
BUT WATCH IT.
I HAD A FRIEND, AND IT'S A FUNNY LITTLE STORY.
THIS GUY WAS LIKE 92 YEAS OLD AND HE FELL OUT OF A TREE.
YOU WANT TO ASK YOURSELF WHY HE FELL OFF THE TREE? HONESTLY.
AND HE WAS ALWAYS CLEANING. HE'D GO TO THE SCHOOL GROUNDS
AND HE'D CLEAN EVERYDAY. JUST FOR FREE, AROUND THE SCHOOL GROUNDS.
PICK UP THE TRASH. AND HE WAS JUST A BUSY GUY.
AND HE HAD TO GET ON THE TREE AND DO SOMETHING. SO HE DID. AND HE FELL OFF. OKAY.
HE BROKE HIS HIP AND THEY TOLD HIM HE'D NEVER WALK AGAIN. DIDN'T KNOW HIM VERY WELL.
AND HE GOT UP AND HE WALKED, SURE ENOUGH. AND HE HAD HIS WALKER
AND HIS CANE. HE TOLD HIS GRANDDAUGHTER WHEN HE HAD HIS CANE,
HE SAYS, "I REALLY DON'T KNOW WHAT THIS CANE IS.
I JUST NEED IT FOR A JUMPSTART.
THAT'S ALL HE USED IT FOR. AND I AM NOT KIDDING.
AND HE IS TO THIS DAY, 100 YEARS OLD.
HE JUST CELEBRATED HIS BIRTHDAY LAST OCTOBER. HE IS A TRIP.
SO, HE'S WALKING. I DON'T THINK HE'S CLIMBING TREES ANYMORE.
BUT NEVERTHELESS, PEOPLE ARE FUNNY. ENJOY THEM.
APPRECIATE HOW THEY USE THE STUFF THEY DO. AND TALK TO THEM.
WHEN DO YOU USE YOUR CANE? WHAT GAITS HAVE YOU USED?
AND JUST SEE WHAT THEY TELL YOU.
ALRIGHT. SO THAT'S..
ALRIGHT, THE NEXT THING YOU'RE GOING TO DO IS USE CRUTCHES.
YOU'LL SEE THAT YOU GOT TWO SCORES THERE ON CRUTCHES.
YOU'RE GOING TO GET GRADED ON MEASURING YOUR CRUTCHES,
BECAUSE THERE'S A FEW MORE THINGS THAT WE NEED TO DO.
AND THEN THERE'S A BUNCH OF DIFFERENT GAITS THAT YOU GOT TO DO.
I PUT SOME CRITERIA ON ALL THE GAITS, LIKE EXPLAINING AND ALL THE STUFF.
BASICALLY WE JUST WANT YOU TO LOOK THAT UP
AND KNOW WHO MIGHT USE THESE GAITS,
WHICH IS THE MOST STABLE GAIT
AND THEN JUST DEMONSTRATE THE GAITS TO US.
BUT FIRST THINGS FIRST. DOCTOR'S ORDER. YES.
YOU NEED THE DOCTOR'S ORDER SO THAT THEY GET REIMBURSED.
THAT'S REALLY IMPORTANT. NOT TO MENTION, THE DOCTOR NEEDS
TO KNOW WHAT THEY'RE USING AND NEEDS TO BE INVOLVED IN SAFE AMBULATION.
DOCTOR'S ORDER, NURSING CARE PLAN. GOING TO GATHER UP YOUR EQUIPMENT,
WHICH IS YOUR CRUTCHES, AGAIN GAIT BELT, ROBE FOR PRIVACY, NON-SKID SHOES.
AND SHOES THAT THEY'LL WALK WITH.
THAT'S REALLY IMPORTANT FOR GETTING THE RIGHT MEASUREMENT,
FOR THE STUFF. BECAUSE IF THEY'RE IN SLIPPERS ONE DAY
AND HEELS THE NEXT, YOU KNOW, IT KIND OF MESSES THINGS UP.
I NEED TO SHOW YOU ACTUALLY HOW TO ADJUST THIS. REMIND ME.
OKAY.
I'VE GATHERED MY EQUIPMENT, I WASHED MY HANDS, IDENTIFIED MY CLIENT,
WHICH IS ME AND PROVIDED PRIVACY, WHICH IS MY CLOTHES.
AND I AM NOW GOING TO MEASURE THESE.
THERE ARE A COUPLE OF WAYS TO MEASURE. YOU CAN HAVE A CLIENT LAYING DOWN.
AND YOU CAN MEASURE
FROM THEIR AXILLA WITH A MEASURING TAPE STRAIGHT OUT
BECAUSE IF THIS WAS A MEASURING TAPE, TWO, SIX TO EIGHT INCHES
OUTSIDE OF THEIR FOOT.
AND THEN SUBTRACT TWO INCHES
SO THAT YOU CAN GET TWO FINGERS UNDERNEATH THE AXILLA.
YOU DON'T WANT THE CRUTCH ON THEIR AX, AXILLA.
NOW THIS IS WHY THEY'RE CALLED AXILLARY CRUTCHES,
BECAUSE THEY GO UNDER AXILLA.
THERE ARE TWO OTHER KINDS OF CRUTCHES THAT ARE OUT THERE.
THE LOFSTRAND CRUTCH.
YOU MAY HAVE SEEN THE LOFSTRAND CRUTCH FOR SOMEONE THAT HAS POLIO
AND IT'S GOT THE LITTLE WRIST BRACE AND HANDS ON IT
OR LOWER HANDS. AND THEN THERE IS A --
I FORGET THIS ALL THE TIME.
PLATFORM CRUTCH, WHERE YOU CAN LAY THE WHOLE ARM.
CRUTCHES REALLY DO A NUMBER ON YOUR WRISTS
AND SO YOU CAN PUT THE WHOLE FOREARM ON THE PLATFORM
AND USE IT AS SUPPORT TO GIVE THE WRISTS A BREAK.
I JUST WANT TO SAY, CRUTCHES ARE FOR THE STRONG,
THE VERY, VERY STRONG.
YOUTHFUL, STRONG UPPER BODY. STRONG.
THEY'RE KILLER. AND MOST OF YOU, IF YOU'VE HAD A BROKEN
SOMETHING HERE OR THERE, BEEN ON CRUTCHES,
WERE YOU JUST LIKE, WOW, OH MAN, THEY'RE TOUGH.
OKAY. SO YOU'VE IDENTIFIED YOUR CLIENT AND YOU KNOW THEY'RE STRONG.
THEY CAN DO THIS. OKAY, SO YOU'VE MEASURED AND YOU'VE GOT YOUR LENGTH.
BUT THERE'S ANOTHER WAY YOU CAN JUST HAVE THEM STAND,
PUT THEIR CRUTCHES SIX TO EIGHT INCHES OUT.
MAKE SURE THAT WHEN THEY PUT THEIR HANDS ON THE HAND REST,
THE ELBOW BEND IS 15 TO 30 DEGREES. IT'S KIND OF THE RULE OF BEND.
AND THAT YOU CAN GET TWO FINGERS UNDER THE AXILLA.
YOU DON'T WANT IT REAL LOW. THAT'S TOO MUCH AND YOU LOSE STABILITY.
YOU JUST DON'T WANT THEM WAY UP HERE, PRESSING. WHY?
WHAT'S THAT NERVE? - LOW, THE BRACHIAL ARTERY.
THE BRACHIAL NERVE..
HERE CAN GET DAMAGED AND YOU CAN CAUSE PARALYSIS AND NUMBNESS
IN THAT EXTREMITY. SO, YOU WANT TO AVOID THAT.
THE OTHER THING YOU CAN DO IS JUST TO GUESSTIMATE, AND I LOVE THESE
IS YOU CAN DO IT BY YOUR HEIGHT.
I'M ACTUALLY 5'3.5".
SO I COULD PROBABLY GO BETWEEN 5'3"AND 5'4".
BUT USUALLY BY THE TIME I'VE GOT A LITTLE HEEL ON WITH MY TENNIS SHOE
OR WHATEVER, I NEED A LITTLE MORE.
SO IT ACTUALLY FITS ME PRETTY GOOD AT 5'5".
AND SO YOU CAN ADJUST ACCORDINGLY.
THESE ARE SO EASY TO ADJUST, YOU GUYS CAN FIGURE IT OUT.
THE THING IS THAT GOT ME THE FIRST TIME WAS I WAS PUSHING
AND PUSHING THIS BUTTON, AND I COULDN'T GET ANY MOVEMENT
BECAUSE IT'S A TWO-SIDED BUTTON. YOU HAVE TO PUSH BOTH TO GET IT UP. YEAH.
AND THEN YOU GOT TO BE CAREFUL THAT YOU DON'T DO TOO MUCH TWISTY STUFF,
BECAUSE ONCE THE BUTTON GETS LOST IN HERE,
YOU'RE SEARCHING FOREVER TO FIND IT.
WHILE I'M TAKING THE MEASUREMENTS, LET ME JUST BACK UP WITH THE WALKER.
THE WALKER WORKS BY THE SAME BUTTON.
LET'S SAY YOU NEED THIS TO BE HIGHER.
SO YOU GET -- SO I NEED IT TO BE TWO THINGS HIGHER.
SO PRESS THIS, YOUR TWO.
PULL IT DOWN. OH, IT CAN'T GO MUCH HIGHER.
AND YOU PUT IT IN HERE, SEE HOW EASY IT IS TO LOSE THAT BUTTON?
THERE YOU GO.
AND THEN, TEST THE ONE LEG BEFORE YOU DO ALL FOUR LEGS.
IT'LL SAVE YOU A LOT OF TIME ON THAT.
SEE IF SOMEONE CAN FIGURE OUT LOPSIDED. OKAY.
ALRIGHT. SO, I'VE CHECKED MY HEIGHT. I'VE ADJUSTED.
EVERYTHING LOOKS GOOD. GAIT BELT, AGAIN AS NEEDED, SHOES ARE GOOD.
AND I AM READY TO GO ON THIS.
ALRIGHT. WE'RE GOING TO START FROM WHAT IS THE MOST STABLE GAIT
TO WHAT IS THE LEAST STABLE GAIT.
THE RULE OF CRUTCH WALKING AND REMEMBER THIS FOR THE REST OF YOUR LIFE
IS YOU ALWAYS TEACH THE MOST STABLE GAIT FOR YOUR CLIENT.
IF YOU HAVE OPTIONS WHEN YOU'RE INPLEX TESTING,
IF YOU HAVE OPTIONS ON A TEST,
YOU'RE GOING TO PICK WH AT'S MOST STABLE AS APPROPRIATE FOR THAT CLIENT.
AND WE DETERMINE THAT BY THEIR WEIGHT BEARING.
CAN THEY BEAR WEIGHT ON TWO LEGS, ARE THEY NON WEIGHT BEARING,
WHICH IS NWB, FOR ABBREVIATIONS.
NON WEIGHT BEARING, PARTIAL WEIGHT BEARING.
WHAT DO THEY DO WITH AN EXTREMITY?
SO, LET'S JUST SAY, I'M NON-WEIGHT.
WELL, I HAVE TO BEAR WEIGHT FOR FOUR-POINT.
ALRIGHT. SO THE FIRST GAIT, THE MOST STABLE GAIT IS THE FOUR POINT GAIT,
WHICH IS FOUR POINTS DOWN AT ANY GIVEN TIME.
OKAY, SO, RIGHT NOW I HAVE MY CRUTCHES IN THE RIGHT POSITION,
I HAVE A GOOD BODY STANCE HERE.
LOOKING UP, WATCH YOUR CLIENTS TO MAKE SURE
THEY'RE MAINTAINING GOOD BODY POSTURE.
AND WHAT I'M GOING TO DO IS, I'M GOING TO PUT ONE CRUTCH OUT
SO I HAVE FOUR-POINT DOWN.
I'M ONLY GOING TO MOVE ONE THING AT A TIME.
I'M GOING TO MOVE MY WEAK LEG NOW,
THE OPPOSITE EXTREMITY TO BE EVEN WITH CRUTCH.
THEN I'M GOING TO TAKE CRUTCH AND NEXT LEG.
SO ONE, ONE, ONE, ONE.
FOUR POINTS ARE DOWN BETWEEN EVERY MOVEMENT.
WHO MIGHT USE THIS GAIT?
MAYBE A PATIENT WHO'S HAD KNEE SURGERY AND THEY NEED REHABILITATION?
HMM, POSSIBLY. BECAUSE IT'S MOST STABLE.
BUT WHERE YOU'VE SEEN IT IS WITH THE LOFSTRAND CRUTCH
AND SOMEONE THAT'S GOT LOWER BODY WEAKNESS.
REMEMBER THE BRACES.
AND DON'T WE SEE THIS?
- THAT KIND OF A TWISTED BODY. - DOESN'T HAVE THOSE CUFFS.
SO THEY NEED MORE STABLE, THEY HAVE GOT GOOD UPPER BODY STRENGTH,
THEY'VE GOT LOWER LEG WEAKNESS.
THEY'RE GOING TO HAVE EITHER THE...
WHY CAN'T I REMEMBER THAT... PLATFORM, I WANT TO SAY POSTURE ALL THE TIME?
THEY'RE GOING TO HAVE EITHER THE PLATFORM CRUTCH
OR MORE OFTEN THE LOFSTRAND BRAND BRACE CRUTCH.
AND THAT'S WHERE YOU'RE THE FOUR-POINT.
BUT AGAIN, THE FOUR POINT IS MORE STABLE
AND IT CAN BE FOR ANYONE THAT NEEDS SUPPORT FROM TIPPING.
I JUST WANT TO CREATE A PICTURE, WHERE HAVE I SEEN THAT GAIT?
ALRIGHT. THREE-POINT GAIT.
THREE-POINT GAIT MOVES THREE-POINTS AND/OR
HAS THREE POINTS DOWN AT ONE TIME.
LET'S SAY, ON THIS ONE, I'VE HAD KNEE SURGERY
AND I HAVE A STRAIGHT LEG CAST ON.
I HAVE TWO OPTIONS HERE. NO WEIGHT BEARING
OR PARTIAL WEIGHT BEARING. MAYBE I CAN TOUCH MY TOE DOWN,
SO THAT I DON'T TIP.
YOU'RE GOING TO TAKE THREE LEGS, THREE THINGS OUT AT ONE TIME.
AND THE FIRST IS YOUR WEAK LEG WITH YOUR CRUTCHES.
SO THREE, ONE.
THREE-POINTS, ONE.
THREE POINTS, ONE.
OKAY, IT KIND OF LOOKS LIKE SWING TO AND SWING THROUGH
WHEN WE GET TO IT, BECAUSE IF I DON'T PUT ANY WEIGHT DOWN,
AND I TAKE THREE OUT, I'M HOPPING,
WHICH IS A KIND OF SWINGING TO THE CRUTCH.
SO, I CAN KIND OF MIMIC THOSE TWO.
SO IT'S CLEAR IN MY MIND IF WE HAVE THREE-POINTS DOWN.
THAT'S THE IDEA. SO YOU'RE THREE.
THREE...
..WITH THE STRENGTH OF THE CRUTCH. SO THIS IS MY KNEE BRACE.
AND JUST TOE TOUCH.
ALRIGHT.
THE TWO-POINT THEN WOULD BE THE LESSER OF THE STABLE GAITS.
BUT AGAIN, WE'D PICK UP A LITTLE SPEED NOW.
THE LESS STABLE THEY ARE, THE MORE SPEED WE CAN PICK UP.
AND FOR SOME PEOPLE, SPEED IS AN ITEM.
SO, AGAIN, YOU MAY SEE THIS PARTICULAR GAIT WITH THE LOFSTRAND
PLATFORM, CAN GET THAT IN MY BRAIN, CRUTCH.
AND IT LOOKS LIKE THIS, TWO POINTS MOVING AT ONE TIME.
AND IT'S VERY MUCH LIKE AN AMBULATION.
THINK OF SWINGING YOUR ARMS AS YOU WALK.
EASY. YOU JUST KIND OF WALK.
IT'S PRETTY EASY, I'VE BEEN DOING THIS FOR A LOT OF YEARS.
BUT YOU'RE GOING TO BE GOING..
NOW LOOK AT MY POSTURE WHEN I'M DOING THIS.
YOU WANT TO LOOK AT YOUR CLIENT AND SAY GET YOUR HEAD UP,
BECAUSE IF THEY'RE GETTING REALLY FEET CONSUMED, THEY'LL WALK INTO WALLS
AND THINGS AND PEOPLE.
AND IT'S VERY IMPORTANT THAT THEY'RE LOOKING UP.
ALRIGHT. TWO-POINT.
THE NEXT IS SWING TO AND SWING THROUGH.
AND THEY ARE OUR LEAST STABLE GAITS.
BUT THEY ARE FOR SOME SPEED.
SO, IF I HAVE A LEG THAT'S OUT HERE, WHERE YOU PUT YOUR CRUTCHES
AND YOU SWING TO THE CRUTCH. SWING TO, YOU'VE SEEN THIS ONE A LOT.
- IT'S HOW LOTS OF PEOPLE MOVE. - EVERYONE DOES THAT ONE.
WELL, NOT EVERYONE. I WATCHED THIS MAN LAST SEMESTER,
AND I DON'T KNOW WHAT HE HAD DONE TO HIS LEG,
BUT HE WAS DOING A REALLY GOOD FOUR-POINT.
THAT'S GOOD. SO WATCH THEM AND SEE.
WE HAD A COUPLE OF GALS ON CAMPUS A FEW YEARS AGO
THAT HAD THE LOFSTRAND CRUTCHES AND THEY DID A REALLY GOOD
FOUR-POINT AND TWO-POINT. I MEAN, IT'S KIND OF LIKE, WE HATE TO STARE,
BUT IT WAS LIKE, WATCH THEM, THEY'RE GOOD.
OKAY, AND SWING THROUGH, LOTS OF SPEED.
OKAY. BECAUSE YOU'RE SWINGING THROUGH THE CRUTCH,
AND THAT'S WHAT YOU'VE PROBABLY BEEN MOST FAMILIAR WITH.
CRUTCHES HAVE THE SAME PROBLEMS THAT WALKERS DO.
YOU CAN'T CARRY ANYTHING. SO WHAT'S YOUR OPTION HERE?
- BACKPACK. - BACKPACK.
I'VE PICKED UP SOME OF YOUR BACKPACKS.
IT'S A WONDER YOU GUYS HAVEN'T THROWN ALL YOUR BACKS OUT.
SO THEY CAN OVERWEIGHT THEMSELVES AND REALLY BALANCE BECOMES AN ISSUE.
SO, YOU WANT TO TALK TO YOUR CLIENTS TO MAKE SURE THEY DON'T DO THAT.
I NEED TO GET A STAIR HERE.
DON'T PRACTICE ON THIS.
THE ONLY REASON I USE THIS IS BECAUSE WE CAN'T ALL FIT IN THE HALLWAY.
BUT YOU'RE GOING TO PRACTICE IN THE HALLWAY DOING YOUR STAIRS,
YOU'RE GOING TO GO UP A STAIR OR DOWN THE STAIR OR TWO.
THE GOAL ISN'T THAT YOU GO TO THE TOP OR THE BOTTOM OF THE STAIRCASE.
WE JUST WANT TO MAKE SURE THAT YOU KNOW WHICH GOES FIRST ON THE STEPS.
WHEN YOU'RE PRACTICING WITH YOUR CRUTCHES AND ON THE STAIRS,
PLEASE WEAR FLAT SHOES, YOUR TENNIS SHOES,
CLOSE TOED SHOES AND NOT YOUR HIGHEST, HIGHEST HEELS
AND THAT KIND OF STUFF BECAUSE THEY'LL TIP YOU.
AND THEN SPOT EACH OTHER, SO THAT YOU DON'T FALL.
SOMEONE TO STAND BEHIND AND ON THE STRONGEST SIDE OF YOU.
ALRIGHT. CRUTCHES.
WHEN YOU GO UP THE STAIRS, WHICH GOES UP FIRST, THE CRUTCH OR THE FOOT?
- FOOT. - CRUTCHES.
NO. SO YOU CAN KIND OF RULE THAT OUT JUST BY TRYING THAT.
IT'S FOOT. SO...
AND UP...OH, LOST BALANCE.
AND THEN THIS UP ON THE STEP. AND THEN TO GO DOWN, JUST THE OPPOSITE.
YOU CAN'T TAKE BODY DOWN WITH A CRUTCH, IMPOSSIBLE.
SO YOU'RE GOING TO TAKE YOUR FOOT DOWN,
YOUR WEAKER LEG WITH THE CRUTCH
AND GO DOWN LIKE THIS.
DIDN'T I HAVE A NICE POSTURE WHEN I WENT DOWN?
NOW, WATCH ME DO IT WRONG.
AND YOU NEED TO WATCH THIS ON CLIENTS.
WHEN THEY COME UP, THEY TEND TO GO LIKE THIS AND LEAN IN.
BECAUSE IT'S HARD TO LIFT YOUR WHOLE BODY WEIGHT UP A STAIR.
BUT THIS IS WHAT SCARES ME EVEN MORE, IS THE COMING DOWN.
THEY GO LIKE THIS.
I FEEL LIKE A BIRD.
I LOOK LIKE ONE.
THE IDEA IS THAT, I MEAN, THIS IS NOT GOOD, AND THEY'RE GOING TO FALL.
SO, YOU WANT TO TEACH THEM ABOUT GOOD BODY ALIGNMENT.
THINK ALSO OF, IF I HAD LIKE A KNEE BRACE ON.
IF I LEFT MY KNEE BACK, IT'S GOING TO DRAG AND CATCH,
AND THAT'S GOING TO FLIP ME OFF THE STAIR AS WELL.
SO YOU'VE GOT TO TAKE THAT STRAIGHT LEG DOWN FIRST.
AND AGAIN IT'S THIGH AND ALREADY I'M FEELING THE BURN.
OKAY, SO JUST PRACTICE.
I HAVE THIS FUNNY LITTLE THING, AND I FORGOT TO TURN MY LITTLE OVERHEAD ON.
BUT JUST AS A REMINDER, THEY HAVE THIS LITTLE CARTOON.
AND FOR REMEMBERING WHICH GOES FIRST,
GOOD GOES TO HEAVEN, SO GOOD FOOT FIRST UPSTAIRS, GOOD GOES UP.
IF WE THINK OF HEAVEN AS UP. AND HELL BEING DOWN, BAD, DOWN FIRST.
SO THE WEAK LEG DOWN.
OKAY.
I LIKE ANYTHING THAT HELPS EVERYBODY REMEMBER.
BECAUSE IN SIX OR EIGHT WEEKS OR YOU KNOW, TWO YEARS YOU MIGHT...
OKAY, LAST BUT NOT LEAST, OUR 84 STEP
RANGE OF MOTION.
IT'S REALLY NOT THAT BAD, BECAUSE IT'S KIND OF REPETITIVE.
AN ARM AND A LEG PRETTY MUCH DO THE SAME THING. AND YOU KNOW,
THEY DO, HONESTLY.
WHAT I WANT YOU TO DO IS YOU'RE JUST GOING TO DO ONE RANGE
OF EACH THING, ONE TIME FOR EACH BODY PART ON ONE SIDE OF YOUR BODY.
NORMALLY, LET'S SAY I HAD RESTRAINED THIS GUY'S ARM.
I WOULD NEED TO RANGE THE SHOULDER, THE ELBOW,
THE WRIST AND THE HANDS OF THAT ARM.
EVERY MOVEMENT THAT THOSE JOINTS CAN MAKE NEEDS TO BE DONE 10 TIMES
WHEN YOU'RE RANGING SOMEBODY.
THERE'S THREE KINDS OF RANGING. THERE'S PASSIVE...WHAT IS THAT?
- YOU WORK. - I DO ALL THE WORK. THERE'S ACTIVE.
- THEY DO THE WORK. - THEY DO ALL THE WORK.
AND THEN THERE'S ACTIVE PASSIVE AND IT'S ASSISTED
AND SO MAYBE A LITTLE HELP AND SUPPORT
TO TEACH THEM OR TO GET THEM GOING.
SO WE'RE BASICALLY GOING TO BE DOING AN ACTIVE DEMONSTRATION
OR A RANGE OF MOTION.
I DO WANT YOU TO APPRECIATE, IF YOU WERE RANGING SOMEONE THAT
YOU WANT TO MAKE SURE AND SUPPORT THOSE EXTREMITIES.
YOU DON'T JUST KIND OF GRAB.
YOU'RE GOING TO BE SUPPORTING THE ELBOW IF YOU'RE MOVING IT.
YOU'RE GOING TO SUPPORT THE WRIST AS YOU MOVE IT AND SO FORTH,
SO THAT THINGS AREN'T FLOPPING IN IT SO THAT YOU CAN FEEL
HOW THEY'RE RESPONDING TO THE MOVEMENT.
OKAY, THIS IS ALSO AN A-SKILL.
COULD BE A FIRST A-SKILL,
BECAUSE YOU'RE GOING TO BE DOING ASSESSING
AND PALPATING WHICH ARE NURSING SKILLS AS WELL AS THE ACTIVITY.
SO, THERE ARE FOUR MODES OF ASSESSMENT FOR A NURSE.
WE'LL TALK ABOUT IT AND YOU'LL HEAR ABOUT IT FOR THE REST OF YOUR LIVES,
BUT HERE'S YOUR INTRODUCTION.
ASSESSMENT IS THE LOOKING AT. WE LOOK AT THINGS FIRST.
AND IN EVERY ASSESSMENT, THERE IS ALWAYS THE LOOKING AT
AND WE ALWAYS DO IT FIRST. SO THERE IS YOUR FIRST ALWAYS IN LIFE.
YOU ALWAYS LOOK BEFORE YOU TOUCH, PLOW IN, DO SOMETHING.
YOU LOOK FIRST. OKAY.
SO WE'RE GOING TO DO AN ASSESSMENT OF EACH JOINT.
AND THEN WE'RE GOING TO PALPATE EACH JOINT.
PALPATE BEING FEELING.
OKAY, SO YOU ALWAYS LOOK.
BUT THE ORDER OF WHAT YOU DO ON DIFFERENT ASSESSMENTS WILL VARY FROM...
WE DO PALPATION, AUSCULTATION,
WHICH IS THE LISTENING OF,
LISTENING TO AND THEN PERCUSSION,
TAPPING TO SEE WHAT IT SOUNDS LIKE.
SO THOSE ARE OUR FOUR MODES OF ASSESSMENT AS A NURSE.
WE'RE GOING TO START WITH THE FIRST TWO.
WE'RE GOING TO DO OUR HIGH FIVE, CHECK OUR DOCTOR'S ORDERS,
SEE IF A RANGE OF MOTION IS ORDERED. BUT IF THE DOCTOR ORDERS RESTRAINTS,
THE DOCTOR MAY NOT ORDER RANGE OF MOTION.
THAT'S NURSING. NURSING KNOWS YOU HAVE TO DO IT.
SO THAT WOULD BE UNDER CARE PLAN OR YOU JUST KNOW TO DO IT.
GATHERING UP EQUIPMENT, YOU DON'T NEED ANY. YOU NEED YOU.
ALTHOUGH YOU MAY NEED A GONIOMETER, IF YOU WERE DOING ASSESSMENT.
AND THE GONIOMETER IS A LITTLE GAUGE
THAT TELLS YOU WHAT THE DEGREE OF ANGLE OF MOVEMENTS YOU'RE GETTING,
WHETHER IT'S 90 DEGREES OR 180 DEGREES OR SOMETHING LIKE THAT.
WE'RE NOT SO INTERESTED IN THAT RIGHT NOW BECAUSE WE ALL PROBABLY HAVE
PRETTY FULL RANGE OF MOTION.
AND WASH YOUR HANDS, IDENTIFY OUR CLIENT, PROVIDE PRIVACY.
THE FIRST THING YOU WANT TO DO IS ASSESS.
AND SO YOU'RE GOING TO TALK TO YOUR CLIENT AND GET SOME HISTORY,
AND WE'RE LOOKING AT HISTORY RELATED TO BONES AND MUSCLES.
SO YOU'RE WANTING TO KNOW IF IN THEIR MUSCLES OR JOINTS,
IF THEY'VE HAD ANY PAIN, TENDERNESS, REDNESS, INJURIES.
IF THEY HAVE LIMITED RANGE OF MOTION,
IF THEY HAVE ANY CRAMPING IN THEIR MUSCLES.
YOU WANT TO KNOW IF THEY CAN PERFORM THEIR ACTIVITIES OF DAILY LIVING.
WHAT ARE ACTIVITIES OF DAILY LIVING?
EVERYTHING WE DO TO LIVE, THAT WE TAKE FOR GRANTED.
TOILETING, COMBING OUR HAIR,
BRUSHING OUR TEETH, DRESSING, PUTTING CLOTHES ON,
ANYTHING THAT CAUSES MANEUVERING, HOW ARE THEY DOING WITH THAT?
DO THEY HAVE ANY BACK PAIN?
DO THEY HAVE ANY LIMITED RANGE OF MOTION, ANY LIMITED MOVEMENT
THAT THEY'RE AWARE OF, ANY SWELLING, ANY TENDERNESS?
PAST INJURIES OR TRAUMAS?
WHAT'S GOING ON WITH THE MUSCLES OR JOINTS SO THAT YOU HAVE A HEADS UP?
- DID I HIT EVERYTHING? - YEAH.
WELL, GOOD FOR ME. OKAY.
AND THEN, YOU'RE GOING TO PALPATE. TAKE THAT BACK...
YOU'RE GOING TO INSPECT AND PALPATE.
ACTUALLY I SAID IT WRONG. IN THE ASSESSMENT, I MEANT INSPECT.
ASSESS, LOOK, INSPECT.
YOU'RE GOING TO LOOK FIRST, WE HAVE A DEAL FOR YOU.
EVERY JOINT NEEDS TO BE INSPECTED AND EVERY JOINT NEEDS TO BE PALPATED.
BUT YOU'RE GOING TO INSPECT AND PALPATE FOR THE SAME THING ON EVERY JOINT,
AND IT GETS A LITTLE REDUNDANT FOR THE LISTENER,
WHICH WOULD BE ME.
I'M LISTENING TO THAT OVER AND OVER AND OVER AFTER 84 THINGS.
SO IF YOU GET THIS RIGHT, ALL THESE LITTLE THINGS ON THE FIRST TIME,
THEN ALL YOU HAVE TO SAY FOR EACH JOINT IS, I HAVE INSPECTED AND PALPATED.
INSTEAD OF SAYING, I'D INSPECT FOR
SIZE, SHAPE, SWELLING, COLOR, MASS DEFORMITY.
I'M LOOKING TO SEE WHAT THE SIZE OF THE JOINT IS, IF THERE'S ANY SWELLING,
WHAT THE SHAPE OF IT IS. I TAKE SIZE, SHAPE, SWELLING,
BECAUSE THEY'RE ALL S WORDS. BUT SHAPE BEING CONTOUR.
SWELLING, MASSES OR ANY LUMPS OR BUMPS, DEFORMITIES.
ANYTHING THAT MAKES YOUR EYE GO, THAT'S KIND OF ODD LOOKING. OKAY.
THEN, ONCE YOU'VE LOOKED, THEN YOU WOULD PALPATE
TO SEE IF THERE IS ANY HEAT, ANY SWELLING, ANY MASSES,
TEMPERATURE OR PAIN, TENDERNESS. OH, THAT HURTS WHEN YOU TOUCH THERE.
YOU CAN'T SEE THAT. WHEN YOU'RE TOUCHING,
THEY'RE GOING TO GIVE YOU SOME RESPONSE.
SO THOSE ARE THE FOUR THINGS THAT WE'RE LOOKING FOR
WHEN YOU DO YOUR ASSESSMENT. OKAY.
SO, I WOULD HAVE INSPECTED, WE'RE GOING TO START WITH THE CERVICAL SPINE,
CERVICAL BEING HEAD UP TO YOUR NECK.
WE'RE GOING TO INSPECT FOR, LET'S GET THESE MEMORIZED, SIZE, SHAPE,
SWELLING, COLOR, MASS, DEFORMITY,
AND THEN I'M GOING TO PALPATE FOR ANY HEAT,
TENDERNESS, MASS, PAIN, SWELLING,
WHATEVER IT SAYS ON YOUR SHEET. I THINK I GET AN X-RAY HERE,
THAT I'M GOING TO FEEL. OK.
THEN I'M GOING TO RANGE THE JOINT. AND THIS IS WHAT A HEAD DOES.
AND LET ME JUST SAY, YOUR BOOK IS EXCELLENT AND IT GIVES YOU PICTURES
AND ARROWS FOR EVERY ONE OF THESE.
AND THEN THE VIDEO ON RANGE OF MOTION IS WONDERFUL.
AND THEN, OF COURSE, YOU HAVE THIS, AND YOU CAN REVISIT IT.
OKAY, THE HEAD, WHEN IT'S UP, EXTENSION IS ALWAYS THE GREATER ANGLE,
WHEREAS FLEXING CLOSES THE ANGLE.
SO MY HEAD, IN ITS UPRIGHT POSITION IS EXTENDED.
AND NOW I'M GOING TO FLEX.
AND IF I PUT IT BACK BEYOND ITS MID IT'S A HYPER EXTENSION.
THEN YOU CAN DO A RIGHT LATERAL BEND. I'M GOING TO MY RIGHT SIDE,
A LEFT LATERAL BEND,
AND THEN A RIGHT ROTATION AND A LEFT ROTATION.
I FIND IT INTERESTING, I WAS READING YOUR BOOK LAST NIGHT
THAT IT TALKS ABOUT A ROTATION BEING THIS.
THIS IS ALSO A CIRCUMDUCTION.
YOU CAN ONLY CIRCUMDUCT A BALL AND SOCKET JOINT.
THE HEAD ISN'T A BALL AND SOCKET.
SO REALLY YOUR ROTATION IS HERE.
I COULDN'T FIND ANOTHER BOOK TO SUPPORT THAT.
I WENT AND HIT A FEW MORE TODAY THINKING MAYBE SOMETHING'S CHANGED.
SO, I MEAN, YOU CAN ROTATE LIKE THIS FOR TENSION.
AND WHAT THEY SAY IS ONE PIECE OF THE BODY ON ROTATION,
THE DEFINITION, STAYS STABLE WHILE THE OTHER PART MOVES.
BUT THAT ALSO HOLDS TRUE FOR CIRCUMDUCTION.
SO I WASN'T FEELING GOOD ABOUT THAT.
SO, WE'RE JUST GOING TO ROTATE AS IF WE'RE SAYING NO.
AND THIS IS YES.
OKAY, SO FOR ROTATION.
ALRIGHT. WE'RE GOING TO MOVE ONTO THE SHOULDER, I'M GOING TO INSPECT
AND PALPATE. SO I DID ALL MY STEPS RIGHT. OKAY.
INSPECT AND PALPATE, YOU HAVE TO SAY IT OR YOU'LL MISS THOSE POINTS.
AND THEY'RE PRETTY CHEAP POINTS OBVIOUSLY.
EVERYTHING COUNTS ONE WHEN YOU MISS IT. SO DON'T JUST DIE
IF YOU FORGET ONE OR TWO THINGS.
OKAY. I'M GOING TO INSPECT AND PALPATE.
THE SHOULDER IS A BALL AND SOCKET JOINT.
SO IT WILL CIRCUMDUCT, WHICH IS GOING A FULL CIRCLE, BALL AND SOCKET.
IF IT'S DOWN, IT'S FLEXED.
AND IF IT'S UP, IT'S EXTENDED. RIGHT? BECAUSE I GET THE FULL.
AND FLEX AND EXTEND ARE FORWARD MOVEMENTS.
OUTWARD MOVEMENTS ARE CALLED ABDUCTION AND ADDUCTION.
SO, IF I'M GOING TO ABDUCT AN EXTREMITY, IT'S LIKE BEING KIDNAPPED,
AWAY FROM THE MIDLINE.
SO, AWAY FROM, ABDUCTION, IS ALL THE WAY TO THE TOP OF THE HEAD.
SHOULD BE A 180 DEGREE MANEUVER.
AND ADDUCTION, IF THIS IS THE CENTER OF THE LINE OF THE EXTREMITY,
IT HAS TO CROSS OVER IT. COMES IN, SO ADDS IN.
I THINK OF TENNIS FOR SOME REASON. OKAY. SO ADD IT IN.
THEN IF YOU PUT YOUR ARM LIKE THIS, LIKE YOU WERE DOING A SIGNAL,
STOP AND GO OR SLOW DOWN IN YOUR CAR, SAME THING.
THIS IS INTERNAL ROTATION BECAUSE MY PALM IS IN.
THIS IS EXTERNAL ROTATION, ROTATE OUT.
AND THAT'S HOW YOUR BOOK DESCRIBES IT. I THINK THE VIDEO
HAS IT GO LIKE THIS AND LIKE THIS.
BUT YOU'LL FEEL IT'S PRETTY MUCH THE SAME MOVEMENT THIS AND THIS.
OKAY, THAT'S ABOUT ALL A SHOULDER CAN DO.
WE'RE GOING TO MOVE TO ELBOW. SO JUST BE SYSTEMATIC, MOVE ON DOWN THE ARM.
THE ELBOW ONLY DOES A COUPLE OF THINGS, IT EXTENDS AND IT FLEXES.
BUT IT SUPINATES AND PRONATES. AND YOU NEED TO GET THIS ONE RIGHT.
SUPINATION AND PRONATION IS PALM UP OR DOWN.
BUT THE ELBOW HAS TO BE BENT SO THAT THE MOVEMENT HAPPENS IN THE ELBOW,
NOT IN THE ARM.
SEE THE DIFFERENCE? SO, BEND, ARM.
SUPINATE PALM UP. PALM DOWN PRONATION.
SUPINATION, PRONATION. AND THAT'S ALL IT DOES.
ALRIGHT. WE'RE GOING TO GO DOWN TO THE WRIST AND THE HANDS.
I'M GOING TO INSPECT AND PALPATE. DID I INSPECT AND PALPATE MY ELBOW?
I DID? WHATEVER. JUST TWO POINTS.
OKAY. INSPECT AND PALPATE. THE WRIST, SAME THING.
EXTEND, FLEX, HYPER EXTEND.
IT CAN ALSO DO AN ULNAR AND RADIAL DEVIATION.
AND THAT'S SIMPLY YOUR RADIAL NERVE HERE IS ON THE THUMB SIDE,
THAT'S WHERE YOU TAKE YOUR PULSE, AND SO YOU DEVIATE TO THAT SIDE.
AND ULNAR GOES TO THE OTHER SIDE.
DOESN'T CIRCUMDUCT, DOESN'T REALLY DO ANYTHING. OKAY.
THE HANDS, YOU CAN MAKE A FIST. YOU CAN...
WHEN YOU MAKE A FIST THAT ACTUALLY FLEXES
AND EXTENDS THE FINGERS.
BUT YOU CAN EXTEND THE FINGERS AND FLEX THEM FLAT.
SO I HAVE THE PLEASURE OF DOING TWO THINGS.
ABDUCTION AND ADDUCTION, YOU CAN...
IF YOU TAKE YOUR FINGERS AWAY FROM CENTER LINE, THAT'S ABDUCTION.
AND THEN ADDUCTION IS CALLED BACK IN THE SAME PLANE.
WE DON'T REALLY CROSS THEM OVER. SO I DON'T KNOW HOW THEY GET AWAY
WITH THAT DEFINITION. BUT IT'S IN EVERY SINGLE BOOK
THAT YOU'LL FIND ADDUCTION.
AND THEN YOU'RE GOING TO DO OPPOSITION OF THE THUMB
AND THAT'S JUST TOUCHING THE THUMB TO THE FINGERS.
LIKE THIS. THERE'S ACTUALLY RANGE FOR THE THUMB.
I JUST HAVEN'T PUT THEM ALL IN. AND YOU CAN SWEEP IT
ANDABDUCT AND ADDUCT, AND SWEEP IT ACROSS,
BUT WE'RE JUST GOING TO SETTLE FOR OPPOSITION FOR NOW.
OK, DID I GET THEM ALL?
OK. WE'RE GOING TO GO TO HIP.
INSPECT AND PALPATE.
AND ON THE HIP, IT DOES THE SAME THINGS AS THE ARM. SO...
...PRETTY EASY. WHAT IS IT IF IT'S DOWN?
EXTENDED. THAT'S THE WIDEST ANGLE, AND PULLED UP, JUST FLEXED.
SO IT'S A BALL AND SOCKET JOINT, YOU ONLY HAVE TWO BALL AND SOCKET JOINTS,
HIP AND ARM, SO IT CAN CIRCUMDUCT.
IT CAN...NO, WE ALREADY DID THE FLEX. THAT WAS KIND OF LIKE THIS.
YOU COULD STRAIGHT LEG IT. IT'S A LITTLE AWKWARD.
YOU CAN ABDUCT, WHICH IS GOING TO BE AWAY.
AND ADDUCT HAS TO CROSS OVER.
IF I CAN JUST GO LIKE THIS AND SEE WHAT IT DOES. I THINK I CAN...OH.
THEN YOU DO INTERNAL ROTATION,
LIKE YOUR BALLET CLASS. TURN YOUR FOOT IN.
EXTERNAL ROTATION, TURN YOUR FOOT OUT.
ALRIGHT. THAT'S ALL THAT A HIP DOES. KNEES.
INSPECT AND PALPATE. KNEES DON'T DO A WHOLE LOT EITHER.
KNEES JUST FLEX AND EXTEND. SO...
..WE KIND OF TOOK CARE OF THAT WHEN WE DID OUR HIP FLEXION.
BUT IT'S IN AN EXTENDED AND NOW IT'S FLAT.
YOU WANT TO DO A COUPLE OF OTHER THINGS WITH THE KNEES.
AND ALSO FITS FOR THE BACK. BUT YOU WANT TO MAKE SURE THAT
THEY HAVE A GOOD ALIGNMENT, THAT THEY'RE FORWARD,
CAN HAVE THEM DO A SHALLOW KNEE BEND. SEE IF THERE'S ANY CREPITUS,
THAT CREAKING WHEN THEY GO DOWN.
DOESN'T HAVE TO BE DEEP. AND THEN HAVE THEM WALK
AND SEE IF THEIR TOES POINT FORWARD AND IF THEIR KNEES POINT FORWARD.
ALRIGHT. WE'RE GOING TO GO DOWN TO ANKLES AND FEET.
AND ANKLES AND FEET ARE VERY SIMILAR TO HANDS.
YOU DON'T HAVE TO TAKE YOUR SHOES OFF. PLEASE DON'T.
AND YOU CAN JUST KIND OF DO THE MOTIONS, BUT DO THEM WITH YOUR HANDS,
SO I CAN SEE WHAT YOU'RE DOING. THERE'S JUST A COUPLE OF DIFFERENT TITLES THAT FEET DO.
FEET DO A PLANTAR FLEXION.
SO YOU PLANT IT IN THE GROUND. SO THAT'S DOWN.
OR A DORSAL FLEXION. DORSAL BEING THIS PART OF THE FOOT COMING UP.
SO, A DORSAL FLEXION COMING UP.
IT DOES AN INVERSION, WHICH IS TAKING THE SOLE OF THE FOOT AND TIPPING IT UP.
SO, INSIDE THE BODY. AND THEN AN EVERSION,
TIPPING IT OUT. IN, E.
AND THEN YOU JUST MOVE ON TO TOES, AND THE SAME THING. THEY'RE EXTENDED.
THEN YOU CAN FLEX THEM, CURL THEM DOWN, YOU CAN SPREAD THEM
FOR YOUR ABDUCT AND ADDUCT.
THAT'S ABOUT ALL A TOE CAN DO.
OKAY. DID I GET THEM ALL?
ALL ALONG? OKAY.
AND THEN WE'RE GOING TO GO FINALLY TO THE CERVICAL SPINE,
I MEAN, THE THORACIC LUMBAR SPINE HERE.
AND YOU'RE GOING TO ACTUALLY DO A LITTLE MORE INSPECTING
OF THIS ONE AND PALPATING BECAUSE THERE ARE SOME THINGS
WE NEED TO CHECK FOR THE SPINE.
AND AS WE INSPECT SOMEONE I THINK WE TAKE NORMAL FOR GRANTED.
SO WE'RE LOOKING FOR THINGS THAT MIGHT BE ABNORMAL OR OFF CENTER.
SO YOU'RE LOOKING TO SEE IF THE SHOULDERS ARE SYMMETRICAL.
YOU'RE LOOKING TO SEE IF THE SCAPULA,
THE LITTLE WINGS BACK HERE ARE SYMMETRICAL.
YOU'RE LOOKING TO SEE THAT THE ILIAC CREST ARE ON THE SAME PLANE.
AND IF THE GLUTEAL FOLD, THE UNDER THE BUTT FOLD IS ON THE SAME PLANE.
BECAUSE IF SOMEONE HAS A SCOLIOSIS,
THEY TEND TO HAVE A LITTLE BIT OF TIP OR A LITTLE BIT OF OFF SOMEWHERE.
SO YOU'RE LOOKING FOR SYMMETRY.
YOU'RE LOOKING AT THE SPINOUS PROCESS AS STRAIGHT.
YOU MIGHT EVEN HAVE YOUR CLIENT BEND TO SEE IF THERE'S...
IF IT'S STRAIGHT ALONG THAT CURVE, HANDS DANGLING.
AND THEN YOU'RE LOOKING FOR THE NORMAL CURVE OF THE SPINE.
THE S-CURVE YOU SHOULD HAVE A SLIGHT LITTLE CURVE HERE OF
THE CERVICAL SPINE, THORACIC AND THEN LUMBAR. THAT LITTLE S-CURVE.
THE OTHER THING YOU'RE LOOKING FOR IS THAT WHEN THEIR HANDS ARE HANGING DOWN,
THAT THERE'S EQUAL SPACE BETWEEN THE ARMS AND THE TRUNK.
IF I HAD MY SPINE OFF A LITTLE BIT, AND I HUNG LIKE THIS,
I GOT A BIGGER GAP HERE, THEN I HAVE NO GAP HERE.
AND SO AGAIN NOW I'LL GIVE YOU A CLUE AS TO THEM NOT BEING SYMMETRICAL.
ALRIGHT. AND THEN YOU WOULD PALPATE, THIS IS THE BEST PART. PALPATE.
SEE IF THE SPINE IS STRAIGHT.
AND FEEL. AND MAKE SURE THERE'S NO TENDERNESS THERE, PAIN.
AND YOU'RE LOOKING FOR THAT STRAIGHT BACK,
ANY MASSES OR DEFORMITY THAT YOU MIGHT PICK UP PALPATING.
AND THEN THE THORACIC SPINE DOES THE SAME THING THE CERVICAL SPINE DOES.
RIGHT? SO IN AN UPRIGHT POSITION, I'M EXTENDED,
FLEXED, AND THEN I COULD HYPER EXTEND.
I'M GOING TO LATERAL BEND RIGHT.
LATERAL BEND LEFT. RIGHT ROTATION. LEFT ROTATION.
WASH MY HANDS. DOCUMENT.
OKAY. SO, A LOT OF WORDS. YOU HAVE TO KNOW THE RIGHT WORD
WITH THE MOVEMENT. SO THAT'S WHERE IT GETS A LITTLE HARDER.
BUT ONCE YOU DO, YOU'LL HAVE THEM DOWN.
AND YOU NEED THOSE TERMS FOR MEDICAL TERMINOLOGY FOR OTHER THINGS.
- SOMETIMES YOU'RE NOT ON THE SAME PLANE.
- AND THAT YOU MIGHT PICK UP WITH THE KNEES AS WELL.
AND SO, YOU'RE DOCUMENTING. SOMETHING'S CAUSING THEM PAIN
AND CAN YOU GET YOUR FINGER ON IT?
AND IT BEGINS TO SHOW ON THE WHOLE BODY.
A SHORT LEG WILL PICK UP IN THE SHOULDERS.
ALRIGHT. ANY QUESTIONS?
- YOU SAID WHEN WE'RE DOING THE PALPITATING, WE HAVE
A WHOLE LIST OF WORDS THAT WE HAVE TO SAY.
DO WE HAVE TO SAY IT THE FIRST TIME?
- WITH THE FIRST ASSESSMENT OF THE CERVICAL SPINE,
UH-HUH, IF YOU SAY, I HAVE INSPECTED FOR, TOGETHER,
SIZE, SHAPE, SWELLING, COLOR, MASS, DEFORMITY.
THEN I'M GOING TO PALPATE FOR TEMPERATURE,
PAIN, SWELLING, MASS. ISN'T THAT THE NICE FOURSOME?
OKAY. IF YOU SAY IT RIGHT THE FIRST TIME,
ALL YOU HAVE TO SAY FOR EACH AND EVERY JOINT AFTER THAT
IS I'LL INSPECT AND PALPATE, INSPECT AND PALPATE,
INSPECT AND PALPATE, INSPECT...
WE KNOW YOU DO ALL THOSE THINGS AT ALL THOSE JOINTS.
BUT LET'S SAY YOU DO A COUPLE OF SCENARIOS HERE.
YOU GO, SIZE, SHAPE, SWELLING, COLOR...
HUH? IT'S GONE, BRAIN PAIN.
SORRY, YOU GET TO SAY IT FOR EVERY SINGLE JOINT.
I'LL TELL YOU THE RIGHT ONES, AND THEN YOU GOT TO SAY IT.
BECAUSE YOU GOT TO GET THEM MEMORIZED, YOU GOT TO CHECK FOR THOSE THINGS,
AND YOU DON'T GET THE LITTLE CHECKLIST EVERY TIME YOU'RE ON THE FIELD.
THE OTHER THING IS, LET'S SAY YOU GET GOING AND YOU CLIP ALONG
AND YOU DO EVERYTHING AND YOU GO, I FORGOT THE ELBOW.
DOES IT MATTER THAT IT'S OUT OF SEQUENCE? NOT AT ALL. HIT IT.
AND IF YOU GET STUCK AND YOU GO, I DON'T REMEMBER WHAT AN ELBOW DOES.
MOVE ON.
JUST MOVE ON AND THEN COME BACK TO IT. IF THE WORD JUST DELUDES YOU,
SOMETIMES YOU JUST GOT TO SET YOUR BRAIN FREE,
MOVE ON AND IT'LL COME TO YOU IN A MORE RELAXED MOMENT.
OKAY. SO SEQUENCE ISN'T CRITICAL. BUT IT JUST HELPS US
THINK LOGICALLY TO GO AHEAD AND MOVE ON.
- WHAT IF WE FORGET ONE? WILL YOU REMIND US? - NO.
- OKAY. - NO, I WON'T. YOU'LL JUST BE GOING ALONG.
AND AT THE END...NO, I WON'T.
THE ONLY TIME, REALLY, I'LL JUST GIVE YOU A CLUE AS TO WHAT I DO.
AND I'LL SAY, ARE YOU DONE?
YOU KNOW. I'LL SAY THAT TO YOU, ARE YOU DONE?
AND THAT USUALLY MEANS YOU FORGOT TO WASH YOUR HANDS,
DOCUMENT OR PUT THE BED DOWN.
SOMETHING REALLY OBVIOUS, OBVIOUS, OBVIOUS.
AND GET IN THE HABIT OF IT BEING DONE AND THEN STAND BACK
AND LOOK AT THAT PATIENT, LOOK AT THAT BED AND DECIDE IF YOU'RE DONE.
DO THE SAME THING IN YOUR CLIENT ROOM.
THAT BED HAS TO BE IN A LOW POSITION. IT HAS TO BE.
YOUR HANDS HAVE TO BE WASHED BEFORE THE NEXT CLIENT.
THEY HAVE TO BE. AND SO WE'RE JUST TRYING TO GET THAT INTO OUR REPERTOIRE,
GET USED TO THAT LOOK.
GET USED TO, WHEN YOU'RE PRACTICING, MAKING SURE WHEN YOU LEAVE MY LAB
THAT THOSE BEDS ARE IN A LOW POSITION AND THAT CLIENT LOOKS DECENT.
I CAN'T TELL YOU HOW MANY BEDS I HAD TO PUT DOWN LAST WEEK.
PEOPLE WERE LIKE, OKAY, WE GOT IT, AND THEY'RE OUT THE ROOM.
HEY. YOU KNOW. SALLY'S GOING TO FALL OUT OF THAT BED.
SO MAKE SURE YOU GET THOSE BEDS DOWN WHEN YOU'RE DOING YOUR TEST.
OKAY? YOU SAID THAT WHEN WE WOULD DO IT 10 TIMES...
- BUT YOU'RE TESTING ONLY ONE. - I JUST WANT TO MAKE SURE YOU KNOW THE WORD.
AND KNOW THE MOVEMENT. SO YOU'RE ONLY DOING IT ONCE.
ONE EXTREMITY. ONE THING ON EACH.
JUST ONE SIDE OF THE BODY. BUT IF YOU WERE DOING KNEE,
ONE, TWO, THREE, FOUR, FIVE,
SIX, SEVEN, EIGHT, NINE, TEN.
AND THAT'S ALL IT DOES. THANK YOU. AND THEN ONE, TWO...
LIKE THAT, TO GET ALL THE MOTION, WHY DO YOU DO RANGE OF MOTION?
WHAT'S THE POINT? THIS IS A GOOD QUESTION.
AND YOU MIGHT WANT TO LOOK IT UP IN YOUR BOOK.
PREVENT CONTRACTURES, ATROPHY, TO STRENGTHEN THE MUSCLES.
THERE'S A LIST OF ABOUT FIVE FOR CIRCULATION, TO PREVENT INJURY.
WHAT'S THE POINT OF IT? SO ALWAYS ASK YOURSELF, "WHY AM I DOING THIS?
WHAT IS THE POINT?" THAT'S A GOOD THING TO KNOW.
GOT TO BE SURE IT'S MAKING ME.
I JUST HAVE ONE MORE THING. SO I GOT MY PAPER,
DO YOU WANT US TO SAY, WE... - NO.
- I JUST WANT TO SEE IT. - I AM CHECKING RIGHT MOVEMENT, RIGHT WORD.
SO WHEN WE DO IT, DO WE NEED TO SAY, OOT?
- AND THIS IS THE DORSAL FLEXION OF THE F. - YES.
- THIS WILL BE FLEXION OF THE FOOT. THIS'LL BE CIRCUMDUCTION. - YES, UH-HUH.
THIS IS PLANTAR FLEXION, DORSAL FLEXION, INVERSION, EVERSION,
THE WHOLE THING.
I WANT TO SEE THE MOVEMENT WITH THE WORD, I WANT TO HEAR THE WORD.
I HAVE ONE QUESTION TOO. CAN THE FINGERS CIRCUMDUCT ALSO?
NO, THEY'RE NOT A BALL AND SOCKET. SO THAT WOULD BE A ROTATION
ACCORDING TO THE DEFINITION.
AND WE'RE NOT DOING IT. WE'RE GOING TO ABDUCT THIS.
YES, YOU'RE SHOWING ME THE MOTION IS ACTIVE RANGE OF MOTION.
AND SO WE'LL HAVE A CHAIR OR SOMETHING YOU CAN HOLD ONTO AND YOU...
- HOW DO WE... - HUH?
HOW DO WE DESCRIBE IT? - YOU JUST SAY.
YOU WISH SOMEONE WOULD PALPATE, LIKE "I WISH YOU WOULD PALPATE."
OKAY, HAVE FUN, HAVE A GOOD WEEK.