Dangling is a funny term for sitting on the edge of bed, but many occupational, physical, and other therapists use it quite often. Learn why it is done, when it is done, and other tips.
Dangling in bed means to sit on the edge of the bed with or without the help of the OT. The term probably came from the patient’s lower extremities dangling on the edge of the bed.
According to the NIH, dangling is an intermediary stage of assisting people into the sitting position with their legs hanging over the side of the bed, before moving them into the standing position, is therefore used to ensure that patients are moved safely. This can help to prevent notable reductions in blood pressure – ie, orthostatic hypotension.
Dangling is not only limited to patients with cardiac conditions. It can be used in patients who have deconditioned, for patients with poor balance such as the new onset of stroke, someone who is generally feeling unwell such as nausea, someone who has been in bed for several days, even an ortho patient such as one with non-weightbearing precautions for the lower extremities.
If OTs suspect orthostatic hypotension, they would take several blood pressure readings starting from laying down such as supine. When OTs plan to dangle their patients on the edge of bed, they typically will need to offer physical assist into sitting. This is done in the usual way such as helping with the upper torso and lower extremities. OTs may co-treat with PT to safely assist the patient from supine to sitting such as in the ICU in acute care, or ARU.
If patients are really weak or have poor balance, they may need to use both their own upper extremities to support themselves in sitting on the edge of the bed.
The OT then eases off and offers less support gradually until they can remove both hands off the patient. The OT may need to block the patient in the front to prevent them from falling towards their weaker side.
If there is a concern for orthostatic hypotension, the OT would immediately take another blood pressure to compare to prior readings. One goal besides offering less physical support can be to increase sitting tolerance time while dangling. Or the patient may complete seated edge of bed ADLs such as grooming or dressing if safe. Dangling is considered more difficult than having both feet on the ground because there is less support and the patient is forced to use their core muscles more.
If a patient is unable to tolerate dangling, the OT would assist the patient back into laying down position.
Here are some tips for dangling. Collaborate with nursing, PT, and speech for communication, recent symptoms, and physical assistance as needed before mobilizing the patient. Try to time medications for pain and other symptoms. Some patients may benefit from warming up with stretches or slowly raising the head of the bed up in increments.
Take time to prepare the environment such as removing obstacles, clutter, foley bags, managing oxygen lines, and having space for the patient in the dangling position. If the patient is shorter or the bed does not go very low, a step stool may help. Having a chux pad under the patient may help to slide and mobilize them. If you have an electric bed, use its adjustments to your advantage such as elevating head of bed or the entire bed itself. You can start with the bed in the lowest position so the patient can have both feet supported.
Remember to grab the blood pressure machine beforehand. It may be a good idea to grab a front-wheeled walker to have nearby if the patient easily progressed from dangling to sit to stands or even functional mobility. Address the patient’s fear of falling/psychosocial factors, use therapeutic breathing, remind the patient to be careful of precautions, and other needs based on the patient and their goals.