| Level I |
- Patient in sitting position with legs supported
- BUE/BLE exercises as tolerated: movement against gravity, isometrics, weight-bearing, integration of trunk & core muscles; stretching, neuromuscular reeducation; sensory input using joint & touch receptors
- Familiar UB ADL, automatic activities, cognition/vision, coordination, sustained attention
|
Bed positioning:
- To increase tolerance for upright posture; promote effective respiration; encourage functional positioning for self-feeding, eating, and safe swallowing
- For basic ADL, especially oral care
- To promote function and minimize risk of skin breakdown
|
- Vitals stable in chair position ~30 minutes
- Vitals stable with exercises ~5 minutes
- Pain is controlled
- Patient pays attention to task/interacts with staff
- Patient moves arms/legs against partial gravity or with gravity eliminated (2/5 strength)
- Patient follows commands
If yes, consider progression to Level II
|
| Level II |
- Dangle EOB for seated ADL, cognition, vision, UE coordination; balance and UE use
- Education on the positive effects of movement & occupations and consequences associated with immobility
- Address visual-perceptual skills, tracking/scanning, accommodation, convergence
- Actively engage the patient through leisure activities, meaningful occupation, social interaction
- Address cognitive & mood through orientation/attention; working memory, decrease anxiety; increase multisensory experiences
- Support routine of daily activities & sleep-wake cycle; environmental modification; relaxation strategies; orientation to situation
|
Upright or varied posture to increase responsiveness and alertness, and address cognitive foundational areas of orientation, attention, and working memory
|
- Vitals stable
- Pain is controlled in sitting with or without support
- Hemodynamic stability (no dizziness or orthostatic BP)
- Patient sustains long arc quad (knee extension) for at least 5 seconds
If yes, progress to standing trials and assess:
- Stand at EOB with hand-held assist, RW, or appropriate device (e.g., standing device, mechanical lift)
- Vitals stable
- Completes weight shifts or side steps along EOB without knee buckling
- Marches in place
If yes, progress to Level III
|
| Level III |
- Transfer to bedside chair or commode for toileting, to progress to seated and sustained ADL tasks and functional transfers
|
Upright, out of bed, seated
|
- Vitals stable with activity at chair level
- Absence of persisting dizziness
- Absence of knee buckling or other safety concerns
If yes, progress to Level IV
|
| Level IV |
- In-room mobility relevant to daily routines using appropriate assistive device incorporating ADL: standing at sink for grooming, bedside commode transfers, chair/ambulation ADL; increasing activity tolerance, occupation-based cognition
- Reinforce purpose and goals for OT to tie mobility and transfers into self-care and safety; increased activity tolerance and energy conservation
|
Upright functional mobility
|
Progress as tolerated
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