ASSUMING PRONE ON ELBOWS - The ability to assume the prone position on the elbows is used to move in bed and to come to a sitting position and can be achieved in several ways. Following are the physical and skill prerequisites and the functional skills required for each technique.

Physical and Skill Prerequisites

1. From Prone, Shoulders Abducted requires:
   • Greater than normal strength in the anterior deltoids
   • Normal range of motion in shoulder flexion, abduction, external rotation, and horizontal adduction, and elbow flexion
   • Ability to do weight shifts in prone on elbows and walk elbows in from abducted position

2. From Prone, Shoulders Adducted
   • Greater than normal strength in the anterior deltoids
   • Normal range of motion in shoulder flexion, abduction, and horizontal adduction, and elbow flexion
   • Ability to do weight shifts in prone on elbows and "walk" elbows forward from adducted position

3. From Side Lying
   • Greater than normal strength in the posterior deltoids, and strength in the anterior and middle deltoids and in the biceps, brachialis, and/or brachioradialis
   • Normal range of motion in shoulder flexion, abduction, external rotation, and horizontal adduction, and in elbow flexion
   • Ability to do weight shifts in prone on elbows and move from side lying to prone on elbows

4. At End of Roll From Supine
   • Greater than normal strength in the anterior and posterior deltoids and strength in the middle deltoids
   • Greater than normal range of motion in external rotation, and normal range in shoulder flexion and horizontal adduction, and in elbow flexion
   • Supine ability to position elbows in and maintain extension while flexing shoulders, throw arms across body with elbows extended, and roll supine to prone without equipment
   • Ability to move from side lying to prone on elbows

Functional Skills

1. From Prone, Shoulders Abducted - The patient:
   • Starts with arms resting on the mat, shoulders externally rotated and abducted 90 degrees, and elbows flexed to about 90 degrees
   • Shifts the body's weight to one side and horizontally adducts and shrugs the opposite shoulder, and then shifts to the opposite side and pulls the other arm in the same way, causing the elbow to move medially (or "walk") a short distance
   • Repeats the weight shifts and arm and elbow movements until the elbows are positioned vertically under the shoulders

     
     
                        

2. From Prone, Shoulders Adducted - The patient:
   • Starts with elbows flexed and shoulders adducted against the sides
   • Lifts the trunk slightly using forceful flexion of the shoulders
   • Shifts the body's weight to one side and flexes the unweighted shoulder (bringing the elbow forward slightly toward a position under the shoulder), and then shifts to the other side and pulls the opposite shoulder forward
   • Repeats the weight shifts to alternate sides and flexes the unweighted shoulder to "walk" the elbows into position under the shoulder

     
     
     

3. From Side Lying - The patient:
   • Starts by flexing the shoulder and elbow of the lower arm (the arm on which the patient is lying), or, by stabilizing the hand against the head if the shoulder muscles are nonfunctional

     

   • Pushes the elbow of the lower arm down into the mat, lifts the trunk up and forward on the elbows (tucking in the chin for assistance), and forcefully swings the free arm forward (adding momentum to move the trunk)
   • At the end of the arm swing, either uses momentum by reaching or punching the arm and protracting the scapula, or, stabilizes the hand against the supporting elbow and uses the arm to pull the trunk to a position over the supporting elbow

4. After Rolling from Supine - The patient with a C6 or lower lesion who is strong and skillful rolls forcefully past the side-lying position, pushes the elbow of the lower arm into the mat, and, without interrupting the roll, uses the free arm to reach or punch at the end of the arm swing, or, to stabilize the free hand against the supporting elbow and pull.