Alexander N B, Grunawalt J C, Carlos S, Augustine J
Department of Internal Medicine, The University of Michigan, Ann Arbor 48109, USA.
J Rehabil Res Dev. 2000 Sep-Oct;37(5):633-8.
Difficulty in transferring, the ability to rise in and out of a bed and chair, is a common problem in older adults, particularly those residing in skilled nursing facilities. Focusing on one aspect of transferring, rising from supine to sitting position, we devised a set of bed mobility tasks to test key arm, leg, and trunk movements that likely contribute to successful rising from bed. Healthy young controls (YC, n=22, mean age 23), and older adults (aged 60 and over) either residing independently in congregate housing (CH, n=29, mean age 84) or undergoing rehabilitation in a skilled nursing facility (SNF, mean age 77) were assessed in the time to rise from supine to sitting and in the ability or inability to perform 16 other bed mobility tasks. Trunk function-related tasks, specifically those requiring trunk elevation and trunk balance, were most difficult for the SNF, followed by CH, and then YC. Tasks focusing on trunk flexion strength (sit up arms crossed, bilateral heel raise) and lateral trunk strength/balance were the most difficult for both SNF and CH, although there was minimal difference in the percent unable to complete each task. The major CH-SNF differences occurred in trunk elevation tasks where the upper limb was important in facilitating trunk elevation (sit up with head of bed elevation with use of arms, sit up with the use of a trapeze, or sit up with use of arms from a flat bed position). These findings suggest that to improve frail older adult performance on bed mobility tasks, and specifically in rising from supine to sitting, training should move beyond improving trunk function (i.e., trunk strength). There should be an additional focus, either through therapy or bed design modifications, on how upper limb movements and positioning can be used to assist in trunk elevation.
在老年人中，尤其是那些住在专业护理机构的老人，转移困难，即从床上和椅子上起身的能力，是一个常见问题。针对转移的一个方面，即从仰卧位起身到坐位，我们设计了一组床上移动任务，以测试可能有助于成功从床上起身的关键手臂、腿部和躯干动作。对健康的年轻对照组（YC，n = 22，平均年龄23岁）以及独立居住在集体住房中的老年人（CH，n = 29，平均年龄84岁）或在专业护理机构接受康复治疗的老年人（SNF，平均年龄77岁）进行了评估，评估内容包括从仰卧位起身到坐位的时间以及执行其他16项床上移动任务的能力。与躯干功能相关的任务，特别是那些需要躯干抬高和躯干平衡的任务，对SNF组来说最难，其次是CH组，然后是YC组。对于SNF组和CH组来说，专注于躯干屈曲力量（双臂交叉坐起、双侧足跟抬起）和躯干侧方力量/平衡的任务最难，尽管在无法完成每项任务的百分比上差异最小。CH组和SNF组之间的主要差异出现在躯干抬高任务中，在这些任务中上肢对促进躯干抬高很重要（使用手臂在床头抬高时坐起、使用吊环坐起或从平卧位使用手臂坐起）。这些发现表明，为了提高体弱老年人在床上移动任务中的表现，特别是从仰卧位起身到坐位的表现，训练应超越改善躯干功能（即躯干力量）。无论是通过治疗还是床的设计改进，都应额外关注如何利用上肢动作和姿势来辅助躯干抬高。
