III III ‐ Shift Shift yo your position position oft often Fatigued side can switch off Foramen opening Larger cone of stability 32
IV IV ‐ Use Use Te Teamwork fo for Hea Heavy Loads Loads 33
V ‐ Sl Slide ide a Load Load if if Possible ssible The wheel was invented between 5500 and 3000 BC We urge you all to use this device as often as possible 34
VI VI ‐ Nev Never( )T )Twist wi with a Hea Heavy Load Load Cervical Curve Cervical Curve Thoracic Curve Thoracic Curve Lumbar Curve Lumbar Curve 35
Definition of Twist: (We’ll get to that in a few moments) 36
VI VII ‐ Keep eep the the Load Load Cl Close ose to to Yo You If… We have… External force = Internal force ‐‐‐‐‐‐‐‐‐‐‐‐ Equilibrium External force > Internal force ‐‐‐‐‐‐‐‐‐‐‐‐ Trunk towards flexion External force < Internal force ‐‐‐‐‐‐‐‐‐‐‐ Trunk towards ext External Force Internal Force 37
VIII III ‐ Nev Never Hol Hold Yo Your Br Brea eathe the Can raise the BP to unsafe levels Orthostatic Hypotension Can be a sign that the load may be too heavy 38
IX IX ‐ Pl Plan an the the Lift Lift Be Before Yo You Lift Lift Assess the object to which is to be lifted Plan the pathway to follow Prepare the area Perform 39
X ‐ Lift Lift wi with Yo Your Head Head and and not not With Yo Wi Your Back Back Not all lifting situations will be ideal The body is more forgiving of bad lifts if the good lifts far outnumber them 40
Why Lift With The Legs? • Spinal muscles have to overcome upper body mass + any load at the UEs • Physiologically are endurance muscles. Therefore, do you want a Toyota Corolla pulling a boat? 41
Material Handling for the Smart Person …In Three Easy Steps 42
1 – Bec Become a Py Pyrami mid, not not a sky skyscr craper aper 43
Base Base of of Support Support 44
2 – Head Head is is lik like a baseball baseball catc catcher 45
3 – NEVER, NEVER, EVER EVER x ( ∞ ) TW TWIS IST Is simply when your hands and feet are not positioned or going in the same direction 46
The The Fo Forc rces ar are st strong wi with this this one! one!
VI VI ‐ Nev Never( )T )Twist wi with a Hea Heavy Load Load Cervical Curve Cervical Curve Thoracic Curve Thoracic Curve Lumbar Curve Lumbar Curve 48
Tr Tree Root oot Sy Syndrome THE CURE! 49
Casc Cascade ade of of chaos… chaos… Decreased functional mobility Decreased ability to perform mobility ADLs Disability 50
Con Consid ider eratio ions fo for Mo Mobilizing ng • Inability to lift trunk with HOB @ 45* • Three or more staff members • Perceived exertion with • Significant change in medical Supine ‐ sit > “HARD” or orthopedic stability • Not able to move extremities • Pain > Seven against gravity • Fear and/or anxiety • Unable to scoot up in bed Dionne, M: Dionne’s Safe Patient Handling and • Prolonged bed rest >72 hours Bariatric Rehab. Course Manual 2017. 51
Medi Medical cal Conditions Conditions Af Affecting cting Saf Safe Pa Patient Handlin Handling • Weight bearing • Strength • Cooperation and Comprehension • BMI 52
Medi Medical cal Conditions Conditions Af Affecting cting Saf Safe Pa Patient Handlin Handling • Pain • Orthopedic conditions • Prior Falls • Poor skin integrity • Postural hypotension • Weakness, paresis • Respiratory • Amputations • Stomas • Tubes/drains 53
GAI GAIT BEL BELTS TS 54
Gai Gait bel belt Feedback in detecting falling: 1. Auditory 2. Visual 3. Proprioceptive • Which is the weakest for purposes of guarding? • In which direction do most bariatrics fall? • Do not hook belts together! Use sheet if necessary 55
Gai Gait bel belt Feedback in detecting falling: 1. Auditory – complete disadvantage. Will not be able to redirect 2. Visual – we have to accelerate to the falling mass then redirect 3. Proprioceptive – Redirection can occur at the initiation of the fall Don’t put your spine on the line! Dionne, M: Dionne’s Safe Patient Handling and Bariatric Rehab. Course Manual 2017. 56
Reminder ‐ The human form is an awkward burden to lift or carry • We have no handles • The body is not rigid WE NEED TO PROTECT OUR SPINE! 57
LAB LAB TI TIME 58
Si Sit ‐ to to ‐ St Stand and Cr Cross oss Gr Grip Techni chnique que • Takes up soft tissue slack • Block the leg • Have the patient place their hands on the transfer surface and squeezed (Adduct) their arms against yours • Drop down, flex elbows to generate force Dionne, M: Dionne’s Safe Patient Handling and Bariatric Rehab. Course Manual 2017. 59
Si Sit to to sta stand • Cross grip with pronation on hand away from the guarded side • Patient MAY grip at the elbow but not higher! • Patient to ADDuct arms to reduce telescoping trunk • Blocking the tibia creates a fulcrum. • DO NOT use back extension to complete the lift. Rather, elbow flexion to draw the patient over his knee. Advanced Mobility DVD tall short.avi https://www.youtube.com/watch?v=IrIyd91HP1U 60
Fo Forward Sl Slide ide • Place a sheet below the patient’s waist • Position patient’s feet in front (knees approximately 70*) • Have patient BB the spine to move hips forward as much as possible • Place sheet below your waist to avoid lumbar Dionne, M: Dionne’s Safe Patient Handling and Bariatric spine recruitment Rehab. Course Manual 2017. • Step back to mobilize 61
Backw Backwards Sc Scooting ooting • Internally rotate legs and place sheet under thighs • Position the feet directly below the knees and tip the trunk forward • Wrap sheet below lumbar spine • Free hand used to Dionne, M: Dionne’s Safe Patient Handling and Bariatric Rehab. Course Manual 2017. balance as you sit or step back 62
La Lateral sliding sliding • Tuck sheet under shoulder. • Bring the sheet around and tuck under the opposite arm . • Cross over the torso, leaving the shoulder/arm free. • A second sheet may be passed under the knees, again, tuck under thigh. • Place sheet below your lumbar spine and take up the slack. • Step back or squat, using Dionne, M: Dionne’s Safe Patient Handling and Bariatric Rehab. Course Manual 2017. free hand to balance. 63
Rollin lling • Tuck sheet under shoulder, leaving about one foot of sheet on rolling side. • Bring the sheet around and tuck under the opposite shoulder. • Cross over the shoulder/arm • A second sheet may be passed under the knees, again, leaving a foot of excess. Tuck under thigh. • Bring the sheet around the opposite knee. Tuck under thigh • Place sheet below your lumbar Dionne, M: Dionne’s Safe Patient Handling and Bariatric Rehab. spine and take up the slack. Course Manual 2017. • Step back or squat, using free hand to balance. 64
Ceph Cephalic/Ca lic/Caudal Slid Slidin ing • Twist the sheet and pass it under the patient’s knees • Pull cephalically so the sheet is near the gluteal fold. • 2 person – place sheet around cephalic hip • 1 person – stand at head of bed, sheet below lumbar area • Use friction reducing Dionne, M: Dionne’s Safe Patient Handling and Bariatric Rehab. Course Manual 2017. surfaces if possible. 65
Wo Work = Fo Forc rce x Di Distance ance • Shorten the resistance 2 nd Class 3 rd Class 1 st Class Lever arm Lever Lever Effort Load Load Load • Lengthen the force arm Fulcrum Fulcrum • Move fulcrum as close Effort Effort to patient as possible 66
Wh Why Do Do Patien tients ts Fall? ll? Medical Issues Falls Environ ‐ Musculoske ment letial Meds 67
Should You Be Aware… • On average, a person loses a small portion of their overall balance every year starting from about the age of 20 mostly due to decreasing levels of activity, not aging. • Inactivity causes the balance system to weaken much like a muscle that isn't used. 68
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Body Body Follo llows Head Head • For every inch of Forward Head Posture, it can increase the weight of the head on the spine by an additional 10 pounds. • Most attempts to correct posture are directed toward the spine, shoulders and pelvis. • All are IMPORTANT, but, head position takes precedence over all others. • The entire body is best aligned by first restoring proper functional alignment to the head 70
The The eff effects of of the the movemen movement pa pattern ern during during fo forward bending bending in in people people wi with and and wi without out lo low back back pain. pain. • Individuals with low back pain moved with a stereotyped strategy at their lumbar spine and hip joints. • On average, people with LBP have reduced lumbar ROM, proprioception, and move more slowly compared to people without LBP. 71
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Wh Why do do the they fa fall? Medical Disorders Metabolic Neurological Orthopedic Visual Fear 74
Why do they fall? Medical Issues Falls Environment Musculoskeletial Meds 75
Why do they fall? Drugs! • Ototoxic • Side effects • Combinations/Poly ‐ pharmacy 76
Why do they fall? Medical Issues Falls Environment Musculoskeletial Meds 77
Environmental Influences • Improper footwear • Improper or Poorly used ADs • Lighting • Floor surfaces • Trip hazards • Furniture? 78
Wh What at Cons Constitut titutes a Fall… ll… Most people think they have to hit the ground to “count” that as a fall. A fall can be as simple as a loss of balance, hitting the walls at home, grabbing furniture or a rail going up stairs It is simply an unexpected event in which the participant comes to rest on the ground, floor, or lower level that may or may not be accompanied by injury 79
Fa Fall Ri Risk sk Assessm Assessmen ent To Tools • Different types of setting • Use of quick, reliable, and valid fall risk screens to (e.g., acute care, identify high ‐ risk patients outpatient, and extended and to trigger further fall ‐ care), should probably related assessments and use different assessment interventions is scales. important for each • Acuity of illness and clinical practice setting. medication changes will • They can play a crucial affect mobility, physical first step in implementing status, and cognition an effective and efficient • Will vary considerably fall reduction program within and between shifts. 80
Fa Fall Ri Risk sk Assessm Assessmen ent To Tools • Use of quick, reliable, and • Different types of setting valid fall risk screens to (e.g., acute care, identify high ‐ risk patients outpatient, and extended and to trigger further fall ‐ care), should probably related assessments and use different assessment interventions is scales. important for each • Acuity of illness and clinical practice setting. medication changes will • They can play a crucial affect mobility, physical first step in implementing status, and cognition an effective and efficient • Will vary considerably fall reduction program within and between shifts. 81
Fa Fall Ri Risk sk Screening Screening Tool ools ‐ STRA STRATI TIFY FY Sc Scale ale ‐ Answer all five questions below and Transfer score: Choose one of the following options which best describes the patient's count the number of "Yes" answers level of capability when transferring from a bed to a chair: 1. Did the patient present to hospital with a fall or has he or she fallen on 0 = Unable the ward since admission (recent 1 = Needs major help history of fall)? 2 = Needs minor help 2. Is the patient agitated? 3 = Independent 3. Is the patient visually impaired to Mobility score: Choose one of the following the extent that everyday function is options which best describes the patient's affected? level of mobility: 4. Is the patient in need of especially 0 = Immobile frequent toileting? 1 = Independent with the aid of a wheelchair 5. Does the patient have a combined 2 = Uses walking aid or help of one person transfer and mobility score of 3 or 3 = Independent 4? (calculate below) 82
Fa Fall Ri Risk sk Screening Screening To Tools ‐ ST STRA RATI TIFY Sc Scal ale ‐ Total score from questions 1 ‐ 5: • 0 = Low risk • 1 = Moderate risk • 2 or above = High risk STRATIFY Scale for Identifying Fall Risk Factors. http://www.ahrq.gov/professionals/systems/hospital/fallpx toolkit/fallpxtk ‐ tool3g.html 83
Fa Fall Ri Risk sk Screening Screening To Tools ‐ Schm Schmid id Fa Fall Ri Risk sk Assessm Assessmen ent ‐ Quantifies the degree of risk for falls based on five areas • Mobility • Mentation/cognition • Elimination • Prior history of falls • Medications 84
Fa Fall Ri Risk sk Screening Screening To Tools ‐ Schm Schmid id Fa Fall Ri Risk sk Assessm Assessmen ent ‐ • Schmid Score • > Score 0 ‐ 2 = Low risk • > Score > 3 = High risk Assess fall risk upon • Admission • Transfer to another level of care • Whenever there is a significant change in a patient’s status or after a fall incident • Daily or every shift 85
Fa Fall Ri Risk sk Assessm Assessmen ent To Tools ‐ Mo Morse Fa Fall Sc Scal ale ‐ • The MFS consists of six items: history of falling, presence of secondary diagnosis, use of an ambulation aid, i.v. therapy, type of gait, and mental status. • The predictive sensitivity was 83% and the specificity ranged between 55% (Morse et al. 1996, Eagle et al. 1999). • The inter ‐ rater reliability was 96% 86
Tim Timed Get Get up up and and Go Go Te Test (TU (TUG) “TUG test is a valid tool for screening balance deficits that lead to increased fall risk in senior citizens.” ‐ Nightingale CJ, Mitchell SN, Butterfield SA. Validation of the Timed Up and Go Test for Assessing Balance Variables in Adults Aged 65 and Older. Journal of Aging and Physical Activity. 2019; 27: 230 ‐ 233 87
Egr Egress ss Te Test • Patient clears hips 1 ‐ 2 inches from bed and returns to seated position. Two reps of sit to stand are then performed. • If successful, patient stands and marches in place for 3 repetitions • If successful, patient steps forward and back with one leg then the other 88
Egr Egress ss Te Test The test is stopped at any point where the patient cannot perform the task safely . The patient is always directly in front of the bedside so returning to seated position is possible. Passing the Egress test does not mean that the patient is independent , only that safe means to egress from the bed have been determined. Mechanical conveyance is appropriate if the patient cannot perform the steps of the Egress test. 89
Origins of Obesity • Genetics ‐ not due to heredity: we have had the same genes for thousands of years! • Metabolism of Nutrition ‐ food influences the way our bodies secure, collect and discharge energy (e.g. sugar, salt, fat) • Environment – Community may influence an obesogenic environment 90
The The Obesog Obesogenic enic En Envir vironm nmen ent • Social – Sedentary behaviors including inactivity and smoking • Cultural – Obesity is viewed differently among cultures • Medications ‐ antidepressants, antipsychotics, anticonvulsants, antihypertensives 91
Obes Obesity ma may le lead to to… • Orthopedic issues : • Obesity hypoventilation arthritis, osteoporosis syndrome : displacement and joint immobility of the abdominal contents causes • Obesity cardiomyopathy : increased work of decreased lean muscle breathing. Respiratory mass and increased fat muscle fatigue is mass causing decreased exacerbated by lack of systemic vascular sleep. Combined with resistance and increased hypoventilation and circulating blood volume, diminished ventilatory resulting in increased drive, the patients cardiac output. develop severe hypoxemia. • Obstructive sleep apnea 92
Obes Obesity ma may le lead to to… • Central abdominal fat ‐ associated with changes in blood glucose removal, insulin resistance, and increased sympathetic activity • Cancers ‐ esophageal, colon, rectal, liver, gallbladder, pancreatic, kidney, breast, uterine, stomach and ovarian cancers, as well as non ‐ Hodgkin’s lymphoma and multiple myeloma. 93
Body Body Com Compositio ition Measur asuremen ement • Components include fat, lean tissue and bone • Used for identifying possible at ‐ risk patients for not only obesity, but obesity ‐ related conditions • Used for following prevalence, trends and possible determinants of pathological consequences of obesity. 94
Wo Would BM BMI be be an an accur accurate in indicator of of obesity obesity fo for… • Athletes • Persons during puberty • Orthopedic deformities (scoliosis, kyphosis) • Pregnant Dionne’s Safe Patient Handling & Bariatric Rehabilitation Seminar Manual 95
Field Field met methods ods incl clude ude BM BMI BMI = weight (kg)/ height (m) ^2 BMI = ( Weight in Pounds / ( Height in inches x Height in inches ) ) x 703 May overestimate bodyfat in athletes and others that have a muscular build May underestimate bodyfat in older people and others who have lost muscle 96
Acc According ing to to their their BM BMIs, these these guy guys ar are ove overweight? 97
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Obl Obligator tory St Stats • Estimated that 1 out of every 3 people in the US are obese • Over 2/3 of Americans are overweight or obese • Overweight children are 5 times more likely to remain this way into adulthood • 30 percent of young people in the U.S. are now too heavy to qualify for military service. 99
Consequences Consequences • Obesity and overweight • $190.2 billion or nearly together are the second 21% of annual medical leading cause of spending in the United preventable death in the States is related to obesity. United States – over • Patients of size will spend 300,000 almost $2000/year more on • Multiple factors including medical expenses due to cardiovascular and more medical pulmonary disease, sleep complications. apnea, cancer and type II • Higher costs for disability diabetes and OA are and unemployment conditions strongly linked benefits. to obesity • $4.3 billion are lost due to obesity ‐ related job absenteeism and decreased productivity. 100
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