Upper Extremity Weight Bearing During Bedside ADLs

Upper extremity (UE) weight bearing, a useful treatment method for stroke survivors, can be incorporated into bedside ADLs during the acute care and early rehabilitation phase.

Remember to position yourself for safety, have equipment ready, establish a good starting position and provide a good base of support. It is also extremely important to protect structures of the shoulder, elbow and wrist with proper positioning and correct alignment of the joints.

Begin with your patient sitting at the edge of the bed with the feet well supported.

Sit next to or in front of your patient. Position the involved hand on your femur, just above your knee. This allows you to feel the amount of weight you patient is actually bearing on their upper extremity. Place your hand behind the involved elbow, supporting their arm in a slight amount of extension and external rotation. Do not allow your patient to ‘hang’ on their extended elbow.
During UE weight bearing, incorporate simple ADLs into the task, such as brushing their hair or washing their face. Increase task complexity by having your patient reach for the object, encouraging weight shift over the involved UE.
Precautions, such as swelling of the hand or placement of the IV, may prevent weight bearing through the hand. Modify this task by having your patient weight bear through their forearm instead of their hand. Don’t forget: the physical properties of the objects used can influence your patient’s success. For example, a white washcloth placed on a white sheet may be difficult for them to find.
As your patient continues with grooming and hygiene tasks, monitor for signs of fatigue or dizziness. If, at any time, your patient becomes dizzy, tired or unable to participate, have them return to a supine position.

For more Therapy Tips for acute care patients, see: Treatment Strategies in the Acute Care of Stroke Survivors.