Rolling

There are numerous strategies used by people to accomplish the task of rolling over. When the neurological or musculoskeletal systems are disrupted by impairments related to a chronic or acute  health condition, there are even more variations. 

STEPS FOR TASK ANALYSIS:

1. Consider "normal" execution and basic required elements.

                           Normal Task Analysis form.docx

Remember your reference:

2. Hypothesize patient's ability

• Prior notes from PT/OT or nursing
• Conversation with patient/family
• Initial observation (what are the INITIAL CONDITIONS)
• Application of known health condition and co-morbidities on impact of necessary neurological, cognitive and musculoskeletal demands of the task

3. Prepare yourself for the needed level of assistance

• Now much assistance will the patient likely require? Do you need an additional person?
• Do you need to adjust the environment (for rolling- what about bed height)

4. Ask the patient to do the task:  "  Go ahead and roll over toward me"

And... WAIT!  Part of the assessment is the ability to initiate and being able to SEE HOW and WHERE they initiate the task form . This assists us in understanding their compensations and volitional access to movement.

4. Observe the INITIATION. Compare it to "normal" and assess if it is effective. (if it is effective and appropriate, and needs no modifying, let it go)

5. Provide assistance as needed to accomplish the task.

Know where to touch:  your touch should facilitate the movement. Your movements should align with the needed movement pattern/direction for the task to enhance the success and not "get in the way" of the patient's attempt.

                           Your Input  +  the patient's effort = Success.

                              *** Do Not Correct on the 1st Attempt***

6. REPEAT the task. 

This time, provide additional input to substitute for the impairment you hypothesized was limiting the patient's success. 

Example:  You think the patient is not strong enough to rotate their head , so you gently guide head rotation to see if it helps reduce the level of outside assistance for the task.

If so:  Add it to your problem list

If not:  move on to the next hypothesized impairment

Continue in this fashion until all possible impairments have been assessed.

RESULT:  A list of impairments directly impacting the performance of rolling. These impairments will be the initial goals of your interventions.

                 ROLE OF OTHER ASSESSMENTS IN THE TASK ASSESSMENT?

We have other assessment tools to understand the impact of a health condition on the human body. Tools such as MMT or ROM assessment.  The results of these tests will provide additional information to solidify your understanding of the true impairments impacting the task. For example:  I note that the ROM in the neck for right rotation is limited and I know that most folks use rotation during rolling.  I DO NOT want to put that impairment on my "recipe" list for interventions until I know it is a limiting factor.  So the ROM assessment confirms a ROM limitations is present... but you still have to answer the questions "So What?".  Meaning, does it impact function?  Repeat the task with YOUR giving the missing rotation and see if the task improves, if so, it matters. If not, it likely does not matter and  should not be added to your list of problems.

This is an important step so all positive findings (weak grip, kyphosis, asymmetrical pelvis) are not added to the treatment list unnecessarily. 

Watch this video of a technique for assessing rolling. 

LINKS TO ARTICLES ON THE TASK OF ROLLING:

https://www.hindawi.com/journals/bmri/2016/8743051/