Moving and Handling

Original Editors - Samuel Winter

Top Contributors - Leana Louw, Samuel Winter and Lucinda hampton

Introduction

Moving and handling forms a key part of most occupations. Safe moving and handling requires physiotherapists to know the correct procedures for moving adults and children without causing injury to either themselves or the person they are supporting. This includes learning to use hoists and other aids.

This page will look into the ergonomics behind the safe moving and handling practices relating to physiotherapy. See also Transfer Aids and Bed Mobility and Transfers in Spinal Cord Injury

Techniques

Preparation

• Check physician’s order to ambulate and any restrictions related to ambulation due to medical treatment or surgical procedure.
• Gather any supplies for ambulation required
• Introduce yourself to and confirm patient ID with two patient identifiers (e.g., name and date of birth)
• Perform an assessment of patient’s strength and abilities.
• Ensure clothing (including footwear) are appropriate
• Ensure all participants are aware of the task, including the order of specific task and end position of the patient
• Get the equipment ready and in order, with required accessories
• Prepare the environment, clear route and access ways are clear, move objects, and the destination is ready
• Prepare client, explain what will happen and what they are expected to do. Ensure clothes, including footwear, are appropriate, ensure they have any aids they need
• Choose a lead caregiver
• Count down "ready, steady, move" prior to the task

Communication between caregiver and patient

• Talk through the steps prior
• Ask if OK as being moved
• Ask how they felt after the transfer

Sitting

Preparation

1. Check a patients weight-bearing status with colleagues, medical notes, the client and family if needed
2. Consider hoisting if non-weight bearing, never put weight through a patients non-weight bearing leg
3. Make sure the patient knows what to expect during the transfer

Supervising sitting repositioning

1. Patient places feet flat of the floor and slightly under the chair
2. Patient leans forwards so weight is over their knees
3. Patient stands, moves as far back into the seat as possible OR pushes back on armrests and their feet to slide back into the seat

Assistance Sitting

1. Ask client to feel for chair on back of legs, reach for armrests and slowly lower themselves
2. Encourage client to bend at the hips

Standing

Supervising standing

1. Patient places hands on armrests, feet flat of the floor and slightly under the chair
2. Pt moves slightly closer to the edge of the seat
3. Pt sits forwards, "nose over toes"
4. If needed, the patient rocks backwards and forwards
5. Patient leans forwards so weight is over their knees
6. Carer counts down "ready, steady, stand". On stand, the patient pushes up into a standing position

Assistance Standing

1. Caregiver adopts the lunge position, beside the patient
2. Outside hand is flat on the front of patients shoulder, inside arm across lower back
3. With weight starting on the back foot, carer rocks forward with the client
4. Check clients arms are free and in front

Rolling in Bed

Supervised

1. Patient turns head in direction of roll
2. Patient flexes knee further from the direction of roll
3. Places arm across their chest in direction of roll
4. Client rolls over, pushing with outside of foot and reaching across body
5. Client completes roll

Assistance

1. Patient turns head in direction of roll
2. Patient flexes knee further from the direction of roll
3. Patient crosses arms against chest
4. Therapist stands in direction of roll and places one hand on furthest shoulder, other on the furthest hip
5. Client is rolled onto their side

Moving in Bed

Supervised bridge:

• Teach the patient to do a bridge to move up and down in the bed
• Patient to hold on to head of bed with arms and pull themselves up. This can be done in combination with a bridge, and works well in patients with an increased BMI, or that have specific lower limb weight bearing limitations/pain, preventing them to do an optimal bridge.

Supervised hip hitch:

Ask the client to:

1. Sit up in bed (1. Raise head 2. Put both hands on bed & raise upper body c arms 3. Pushup from bed c arms)
2. Make their hands into closed fists and put their fists just behind their hips
3. Bend their knees and dig their heels into the bed, ready to push themselves up the bed
4. Push themselves up by pushing through their heels and fists at the same time, to lift and move their bottom up the bed.

1 x assistance:

• Assist to lift pelvis
• Place patient in crook lying
• Put one around patient's shoulders and the other at the back of the scapula
• Assist with pulling upwards when the patient does a bridge

Sitting over the Edge of a Bed

Supervised

1. Patient turns to their side, facing the carer
2. Patient places outside hand and inside elbow flat on the bed
3. Client puts legs over the edge of the bed
4. Uses hands and elbow to push up whilst lowering legs to floor

Slide Sheets

Applying

1. Place slide sheets underneath a bed sheet
2. Keep edges of slide sheet to edge of the bed
3. Push slide sheet under the patient, pushing down on the mattress
4. Roll patient to the side and pull through the slide sheets

Pushing client up the bed with slide sheets

1. Apply slide sheets
2. Place extra pillow at head of the bed
3. Enter a lung position
4. Patient pushes up the bed with their feet, whilst carers slide up the bed

Removing slide sheets

1. Tuck in both sheets on one side
2. In a lunge position, a therapist pulls out diagonally from the other side
3. Place sheets neatly for next use

Sitting to sitting

Supervision

1. Patient leans forward and slides to the front of the chair
2. Client places leading foot in the direction they're going
3. Patient reaches forwards to take the far arm of the chair
4. The client pushes through their arms and legs
5. Client transfers to the other chair
6. Client lowers into chair

Therapist stays close by throughout

Assistance without an aid

1. Assisted sit to stand (as above)
2. Patient instructed to walk or step to another chair
3. Patient instructed to reach for the armrests
4. Patient sits down

Transfer Board and Slide Sheets

1. Beds moved together
2. Side sheets positioned on transfer board
3. Assistance to roll onto the side away from the direction of transfer
4. Transfer board placed underneath the patient
5. Patient rolled back to neutral
6. Patient slide to target bed
7. Transfer board and slide sheets removed

Hoisting

Hoist

Applying a sling in bed

Therapist one:

1. folds the sling with labels and handles on the outside
2. Position the sling from the base of the spine upwards
3. Feed the upper strap under the client's neck
4. Fold the upper shoulder loop into sling and roll the upper portion of the sling into the space behind the client's back

Therapist two:

1. Locate the loop from under the patient's neck and pull towards you

Both therapists:

1. Pull slings towards themselves, removing creases
2. Complete the sling positioning, crossing leg loops between legs

Applying a sling to a client in a chair

1. Ask the client to lean forward in the chair
2. Place the sling behind the client
3. Ensure the bottom of the sling reaches the base of the spine and that the sling is positioned correctly
4. Put the leg straps under each leg one at a time

Hoisting from bed to chair

1. Lower the sling bar above the client's chest
2. Attach the sling to the bar
3. Slowly raise the patient off the mattress
4. Move hoist so the client is over the chair, one person in-front & closely securing the patient, another behind & securing
5. Place a hand on the sling bar whilst lowering the patient
6. Remove the sling from the bar, hand still on the bar, and move the hoist away
7. Remove sling

Supervising a fallen client who is conscious and uninjured

Talk to the client and explain what you are doing throughout

1. Run through DR ABC with patient (If conscious and airway intact, continue. If patient is not breathing, commence CPR)
2. Do they remember falling?
3. Place a pillow under their head for comfort
4. Cover them if required.
5. Ask if they think they could stand themselves up with instruction, if they can, continue
6. Ask client to roll on to their side then get on to hands and knees . (When they have done this, ask if they are dizzy or feeling worse – if they are, get the client to lie down and hoist them instead) .
7. Once they are on their hands and knees, place a chair as close as possible to the client’s hip.
8. Ask them to use the chair to lean on with their closest hand, and using their nearest leg get them to put their foot flat on the floor then push up into a sitting position using their leg and arm. (If the client cannot get onto the chair, get them to lie down again and hoist them)
9. Alternatively, the client may prefer to use their furthest leg and foot to provide extra balance, particularly if the client is large .

Resources

• Manual Handling Assessment Charts
• Risk Assessment Tool for Pushing and Pulling
• Manual handling at work: A brief guide
• Getting to grips with hoisting people == A brief guide ==