What is the role of SCUFF (Systematic Clinical Assessment and Feedback Framework) and sled (patient mobility device) in patient care?

SCUFF and Sled in Patient Care: Roles and Applications

SCUFF (Systematic Clinical Assessment and Feedback Framework) is not mentioned in the provided evidence, while sleds serve as important mobility devices for patients with functional limitations, helping to improve safety, independence, and quality of life.

Sleds as Mobility Devices

Definition and Types

• A sled is a type of mobility aid that helps patients who have difficulty with ambulation or transfers, providing a stable platform for movement 1
• Sleds are part of the broader category of adaptive equipment and mobility aids that help maximize independent functioning after stroke and other conditions 1

Clinical Applications of Sleds

• Sleds can be used as walking aids to increase the base of support around a patient's center of gravity, reducing balance requirements and effort needed to walk 1
• They provide support for patients who cannot ambulate safely, enhancing mobility and preventing falls 1
• Sleds may be particularly useful for patients with lower extremity weakness, instability, or balance issues 1

Benefits of Sled Use

• Improves ambulatory function including speed, step length, and functional ambulation category 1
• Enhances walking confidence and safety for patients with mobility limitations 1
• Reduces the risk of falls by providing additional stability and support 1
• Patients report preferring to walk with an assistive device rather than delay walking to achieve a normal gait pattern 1

Patient Selection and Assessment

Assessment for Mobility Aid Need

• Mobility assessment using validated tools such as the Timed Up and Go (TUG) test (time >12 seconds indicates increased fall risk) should guide mobility aid selection 1
• The 4-Stage Balance Test can help identify patients who might benefit from mobility aids (inability to hold tandem stand for 10 seconds suggests increased fall risk) 1
• Three key questions can help identify candidates for mobility aids: 1) Have you fallen in the past year? 2) Do you feel unsteady when standing or walking? 3) Are you worried about falling? 1

Factors to Consider

• Type and level of functional deficit 1
• Degree of achieved adaptation 1
• Structural characteristics of the living environment 1
• Patient's comorbidities and functional limitations 1
• Safety concerns during ambulation 1

Implementation and Training

Proper Use and Training

• Patients should receive proper training on how to use sleds and other mobility aids safely 1
• Physical therapy referral is recommended to create an appropriate exercise program and evaluate the need for walking aids 1
• Regular follow-up with rehabilitation professionals is important to assess ongoing need and proper use 1

Integration with Rehabilitation

• Sleds and other mobility aids should be incorporated into comprehensive rehabilitation programs 1
• Regular strengthening and aerobic exercise programs should complement the use of mobility aids 1
• Mobility aids should be used as part of a multipronged approach to maintaining mobility and preventing falls 1

Precautions and Considerations

Safety Considerations

• Patients using sleds should be monitored for proper technique to prevent injuries 1
• Sleds should be lightweight and foldable for use outside the home 1
• Some mobility aids require hand-motor coordination to manage (e.g., hand-brakes on downhill slopes) 1

Potential Risks

• Sledding as a recreational activity (different from mobility aids) carries risk of serious injuries, particularly when done near stationary objects 2, 3
• Most recreational sledding injuries are preventable by following safety guidelines 2

Monitoring and Follow-up

• Patients should be followed up by primary care providers within one month of discharge 1
• Follow-up with rehabilitation professionals 3-6 months after discharge is recommended 1
• Regular reassessment of mobility aid needs as patient's condition changes 1

Special Populations

Stroke Patients

• Up to 40% of stroke patients use manual wheelchairs at rehabilitation discharge 1
• More than half of stroke patients require an assistive device (cane, walker, wheelchair) to assist mobility 1
• For stroke patients, walking devices increase the base of support and reduce balance and effort needed to walk 1

Critically Ill Patients

• Mobility aids can be part of early mobilization strategies for critically ill patients 1
• Assistive devices represent an opportunity to overcome barriers to early mobilization, such as staff shortages 1

Pediatric Patients

• Children with various conditions may require mobility aids to maintain independence 1
• Assessment of mobility should be performed at regular intervals as children grow 1