Chapter 8 E-materials
Author profiles
Case Study 8.1
Background
• Ian was a young man with profound and multiple disabilities.
• Ian had a moulded wheelchair insert, which was used mainly for transport, as he was unable to tolerate the corrected position for long.
• Much of his time was spent in a fixed-height reclined armchair.
• Physically he presented with:
stone (22 kg).Transfer issues
• There was a report in Ian’s physiotherapy and day service notes recommending that he was not to be transferred using a hoist as it could have a detrimental effect on his breathing.
• There was an additional statement from a consultant neurologist stating that a manual lift would be most appropriate due to Ian’s spasticity levels.
• The existing handling plan stated that one person lifted Ian for all transfers.
• Carers were reporting that lifting Ian had become increasingly difficult, although the reasoning behind this was difficult to pinpoint.
• The handling plan was initially changed to a co-ordinated 2-person lift while assessment was undertaken to define the types of specialist slings appropriate for Ian’s needs.
Problems identified with the standard slings
• Ian’s trunk was insufficiently supported, as the lifting points on conventional slings are at hip and shoulder level, which encouraged too much flexion at his hips for him to tolerate, i.e. encouraged a ‘jack-knife’ position.
• Due to the ‘closed’ position of conventional slings and the fact Ian’s head was fixed in left rotation, his nose was compressed against the sling, preventing him from breathing.
Assessment for a specialist sling
• It was thought that the statements in Ian’s records regarding the hoisting may have stemmed from the early days of hoist transfers when all slings were the same design and probably were unsuitable.
• Specialist slings were required that had the following characteristics:
Introduction of hoisting
• The carers were initially reluctant to assist Ian with transfers using a hoist because of the well established myth that Ian could not be hoisted.
• The specialist sling was trialled initially by a physiotherapist and 2 manual handling advisors in order to determine the effect on Ian’s breathing and pain levels by observing his facial expression.
Outcomes
• Use of the hoist and specialist sling was successfully trialled, gradually incorporating the carers into its use.
• Written instructions and photographs were provided for the carers to assist them with the positioning of Ian in the sling and where to attach the loops of the sling onto the spreader bar.
• Despite the initial reluctance Ian’s carers were able to observe the hoisting process and became convinced that they could continue this as the method of choice when transferring Ian.
Case Study 8.2
Background
• Mary is a 48-year-old female who has cerebral palsy and LD.
• She lives in 24-hour-staffed accommodation.
• She has no verbal speech and uses Signalong for communication.
• Mary is wheelchair-dependent and requires hoist transfers at all times.
• She has fixed flexion deformities of her hips and knees.
• Her knee position makes it difficult for her to keep her feet on ordinary footplates in her wheelchair.
• Mary has some functional movement of her upper limbs, which enables her to self-feed and hold a cup.
• She is unable to assist with dressing.
• Mary has a lot of extensor thrust, which she occasionally uses purposefully to reposition herself, but she also tends to use this as part of her unwanted behaviours.
Identified problems
• Mary spent a period of time in a nursing home following the death of her parents. During this time her weight increased as the staff used food to placate her.
• Added to this was increasing frustration at her isolation.
• Her posture within her wheelchair had deteriorated quite dramatically.
• These issues could not be resolved until she moved into staffed accommodation; even then they took some time to be resolved due to the waiting list for the wheelchair service provided by occupational therapy.
• Mary’s challenging behaviour manifested itself in episodes of crying and then screaming.
• The volume and intensity is such that she can be heard outside the house quite easily.
• She is inclined to pinch and grab at anyone close to her.
• In addition she tends to use the extensor thrust, which in the past has resulted in her sliding out of her wheelchair. The lap strap on her wheelchair has been changed so that she is unable to undo it herself.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
