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1/10/2018 Rolling

FUNCTIONAL REHABILITATION: MAT


TECHNIQUES: ROLLING
Exercise mats, which are firmer than most beds, are good
surfaces to learn skills required for independent mobility and
dressing, such as rolling, coming to sit, moving around on the mat,
unsupported sitting, and leg management. After the skills have been
learned on a mat, they must be practiced and learned on a bed.
Techniques to acquire the prerequisites for the following functional
skills appear in the Training Strategies section.

ROLLING - The ability to roll is required to turn in bed and come


to sitting, and for self-care activities, such as dressing. To be able to
roll from supine to prone and from prone to supine requires the
following:

Physical and Skill Prerequisites

1. Rolling from supine to prone requires:


Greater than normal strength in the anterior and
posterior deltoids and in the biceps, brachialis, and/or
brachioradialis, and some strength in the middle
deltoids
Greater range of motion for external rotation of the
shoulder and extension of the elbow, and normal range
for shoulder flexion, horizontal adduction and
abduction, elbow extension, and forearm supination
Ability to maintain elbow extension while flexing the
shoulders, combine arm throw across the body and head
swing, and roll toward prone using momentum or
pulling on equipment with the arm

2. Rolling from prone to supine requires:


Strength in the anterior, middle, and posterior deltoids,
and normal range of motion for shoulder flexion, elbow
extension, and forearm supination.
Ability to roll from prone by pushing with the arm

Functional Skills

1. Rolling from Supine to Prone


Without Equipment - The patient:
Throws the head and arms forcefully in the
desired direction of the roll, if able, OR
Builds enough momentum to roll, by swinging
the head and arms to one side and then the other
with enough force and frequency to cause the
trunk to rock, at first, and then by coordinating
the swings with the rocking of the trunk.
Momentum is maximized by holding the elbows
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in extension, protracting the scapula at the end of


the swing, and throwing the arms in an arc that is
either perpendicular to the mat, if the triceps are
functional, or, at a 45 degree angle above the
plane of the body, if the triceps are nonfunctional.
Externally rotating the shoulder and supinating
the forearm help hold the elbows in extension in a
patient with nonfunctional triceps.

View Rolling Proceedure

With Equipment - If unable to roll without equipment,


due to poor motivation, weakness, obesity, contractures,
spasticity, etc., the patient stabilizes the hand or arm and
pulls on a parked wheelchair next to the mat or on a
bedrail, and simultaneously:
Rolls the trunk toward the stabilized arm and
adds momentum by swinging the head and free
arm in the direction of the roll (at an arc about 45
degrees above the plane of the body if the triceps
are nonfunctional)
Completes the roll at the end of the free arm
swing by either pulling on the chair or rail with
the free arm, or, reaching or punching with the
free arm while protracting the scapula to add
momentum to the roll
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2. Rolling from Prone to Supine - The patient:


Pushes on the mat or other supporting surface with the
arm away from the direction of the desired roll, until the
side-lying position is achieved
Throws the head and arm in the direction of the roll

The PoinTIS SCI Physical Therapy site of the SCI Manual for Providers is based on information in Spinal
Cord Injury: Functional Rehabilitation, by M.F. Somers, Norwalk, CT, Appleton & Lange, 1992, and
information in "Respiratory Rehabilitation of the Patient with a Spinal Cord Injury", by J.L. Wetzel, B.R.
Lunsford, M.J. Peterson, and S.E. Alvarez, Chapter 28 in Cardiopulmonary Physical Therapy, S. Irwin and J.S.
Tecklin, eds., St. Louis, Mosby, 1995, unless otherwise indicated.

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