Therapeutic Use of Assistive Technology
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1 Therapeutic Use of Assistive Technology a clinical perspective Stephanie Radawiec, PT, DPT
2 What is Assistive Technology? Mechanical and non-mechanical devices which decrease the physical stresses of patient handling and movement for caregivers Safe Patient Handling and Movement (SPHM) Minimal lift programs
3 What is the challenge? Lack of awareness Risk Devices available Positive rehab outcomes Perceptions of passive patients
4 Injury Statistics Registered Nurses #8 for Work-related Musculoskeletal Disorders (WMDS)* *Number of work-related musculoskeletal disorders involving days away from work and median days away from work by selected occupations,
5 Injury Statistics Nursing Assistants, Orderlies, Attendants #2 Work-related Musculoskeletal Disorders (WMDS)* *Number of work-related musculoskeletal disorders involving days away from work and median days away from work by selected occupations,
6 Injury Statistics Physical Therapists 91% lifetime prevalence of MSDs 1 in 6 therapists moving out of profession as direct result of work-related MSDs Referenced in Guide to the Handling of People, 5 th Edition, from Crombie, et al, (2000), Physical Therapy, Vol. 80 (4):
7 Rehabilitation Myths: Traditional tools are ineffective protection from musculoskeletal injuries during patient handling tasks. Body mechanics Gait Belt Team lifts
8 First Do No Harm to anyone Patients Residents Caregivers Nurses Assistants Therapists Other direct-care staff
9 Safe Patient Handling and Movement (SPHM) equipment CAN be used in rehabilitation programs!
10 Requirements Safety-for-all attitude Knowledge of SPHM techniques/tools Education Creative problem-solving Appropriate devices/equipment for all tasks
11 Safe Patient Handling means. Safe for Patient Safe for Caregivers Consistent with Rehabilitation
12 Assistive Devices in Rehab Dependent Passive Cueing & Training Independent Active Dependent Lift Gait-Assist Lift Crutches No Device; No assist Cane Sit to Stand Lift Walker
13 To be safe, a technique must be repeatable and teachable A technique that relies on the lifter being at peak performance And the patient being of a particular build. IS NOT SAFE. Handling of People, 5 th Edition, Royal College of Nurses and Backcare, 2005
14 Dependent Patient Solutions: Passive Lifts Non-weight bearing patients Nursing staff Initiate mobility Complement therapies
15 Dependent Patient Solutions: Passive Lifts Non-weight bearing patients Therapy other than bed exercises Wheelchair mobility Sitting tolerance Other health benefits of mobility
16 Dependent Patient Solutions: Passive Lifts Dependent bariatric patients Out of bed almost as easily as others
17 Solutions for patients with difficulty standing and transferring: Sit-to-Stand Lifts Nursing: Initiate mobility Complement therapy treatment plans
18 Solutions for patients with difficulty standing and transferring: Sit-to-Stand Lift Patients: Practice sit to stand Increase standing tolerance With activity unlimited by staff fatigue
19 Solutions for patients with difficulty walking Gait Assist Devices Ceiling based systems Portable wheeled devices
20 Solutions for patients with difficulty walking Gait Assist Devices Practice gait and balance activities Lift-assist aid for difficult sit to stand maneuver Support while walking Prevent falls
21 Walker Crutches Cane
22 Assistive Devices in Rehab Dependent Passive Cueing & Training Independent Active Dependent Lift Gait-Assist Lift Crutches No Device; No assist Cane Sit to Stand Lift Walker
23 Choosing the right device A guide to assist in decision making
24 Is the patient able to demonstrate the prerequisite components of a safe sit to stand transfer? Strong hip extension - demonstrated by bridging? Strong knee extension - demonstrated by straight leg raise? Good trunk stability - demonstrated by sitting unsupported at the edge of the bed? NO: Consider a dependent lift until patient can safely perform these prerequisite activities. YES: Continue to the next set of tests
25 Is the patient able to demonstrate the advanced components of a safe sit to stand transfer? Can the patient perform all of the previous activities AND rise to standing from the edge of the bed or chair with minimal assistance or less? NO: Consider a sit to stand device until the patient can complete this portion of the test. YES: continue to the next test
26 Is the patient able to demonstrate the essential components of safe gait? Ability to shift weight and lift one foot off the ground in a mini march step with good balance and less than minimal physical assist? Repeat contralateral side. NO: Consider a walking assist device such as a lift walker or walking vest until the patient has these essential components of gait mastered. YES: No patient handling equipment needed.
27 FAQs If I m using patient handling equipment, it isn t really rehabilitation, is it? ANSWER: YES! Your asset in guiding your patient on his recovery is your KNOWLEDGE not your back! The equipment is simply a tool you use to safely apply your knowledge.
28 FAQs Aren t there times when use of patient handling equipment is inappropriate? ANSWER: Of course! An assessment tool can never substitute for sound clinical judgment. Benefits must ALWAYS outweigh risks. Be aware that the risk of injury associated patient handling is substantial.
29 FAQs But the patient won t have the equipment home, so why should they use it here? ANSWER: They won t have the rehabilitation staff at home either. Equipment is only one tool to safely allow the progression from passive to active.
30 Case Scenarios
31 Neurological Rehabilitation: 50 year male with dense right hemiplegia due to stroke.
32 General Medical Rehabilitation: 60 year old female with profound weakness due to extended illness.
33 Orthopedic Rehabilitation: 80 year old male nursing home resident with dementia and hip fracture stabilized with open reduction internal fixation.
34 First Do No Harm to anyone Second Use a rehabilitation philosophy from beginning to end
35 So what do you think?
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