multidisciplinary analysis of assisted sit-to-stand ... · • client is participating in transfer,...

MultidisciplinaryAnalysisofAssistedSit-to-StandTechniques:

Aworkinprogress

DrsCatherineBrookman,SheilaRitcey&EmilyKingFebruary26th,2020

Aworkingwebinar

•  Planfortheday

Background&Approach

CoreAssumptions

AnalysisofTechniques•  Gettingtoedge-sitting•  Standingup

AWorkingWebinar

Background

•  AssistingwithSit-to-StandisacommonactivityforPersonalSupportWorkers(PSWs)

•  Ifnotdoneproperly,bothclientandcaregiverareatriskofinjury

•  Clienthandlingaccountsforabout50%ofcaregivers’work-relatedlost-timeinjuries

•  PropertrainingofPSWsiscriticaltopreventingthesetypeofinjuriesandimprovingclientsatisfactionandwell-being

UnknownAuthorLicensedunderCCBY

Background(continued)

•  ThereisnostandardizedtrainingforPSWsthroughformaleducationalsystemoremployerin-services•  CoPmembersreportedthattheylackconfidenceintheeffectivenessoftheirexistingtrainingresources•  CoPmembersreportedaneedforanevidence-basedtooltoassistinimprovingthetrainingoftheirPSWsinclient/patienthandling•  CRE-MSDfundedaseedgranttodevelopFrameworkforEvaluatingPSWSit-to-StandandStand-to-

SitTraining[webinarheldJuly2019]andMultidisciplinaryAnalysisofAssistedSit-to-Stand

Techniques

Howdidwearriveatourcontent?

•  CollectPSWsit-to-standtrainingmaterialsandclient/patienthandlingtrainingsacrosstheCoPmembership•  Descriptiveanalysisoftrainingmaterials

UnknownAuthorLicensedunderCCBY

2WorkshopswithMultidisciplinarypanel1.  ReviewFrameworkforEvaluatingPSWSit-to-

StandandStand-to-SitTraining[webinarheldJuly2019]

2.  PerformMultidisciplinaryAnalysisofAssistedSit-to-StandTechniques

UnknownAuthorislicensedunderCCBY-SA

Thisapproachwouldworkfor10majorhandlingtasks

1.   Sittingtostanding2.  Standingtositting3.  Rollingorturningin

bed4.  Logrolling5.  Lyingtolongsitting6.  Movingupthebed

7.  Sidelyingtoedgesitting

8.  Edgesittingtosidelying

9.  Movingforwardinthechair

10. Movingbackwardinthechair

Focus-  Supportingclientstoachievetheiroptimalfunctionwiththe

lowestlevelofongoingsupport.-  Supportforpositiverisktaking

HealthBenefitsSupportingclientstothegreatestpossibleextentintheirownmobilityanddailyactivitiespromotesmaintenanceandrestorationoffunction,improvesself-ratedhealth,improvesconfidenceandwell-being,anddecreasesneedsforongoingcare.

CarePhilosophy:ARestorativeApproach

WhyaRestorativeApproach?

Goodfortheclient–  Helpsclientstoengageindependentlyineverydaylivingandsocialactivities

–  PSWassistancesupportsrehabilitationgoalsGoodforthecaregiver–  Reducedriskofinjurywhenclientparticipatesmorefullyineachactivity(lesslifting)

Thealternative–doingthingsto/forratherthanwiththeclient–  Encouragespassiveroleanddeconditioning–  Lossofclientconfidence,skillsandbeliefinpersonalabilities

Assumptions&Caveats•  AtransferassessmentbyanOccupationalTherapist(OT)orPhysiotherapist(PT)isstillrequired

•  Theclient’sweightbearingstatusmustbeknown

•  Ifnoneoftherecommendedtechniquesaresufficienttoassisttheclient,assistiveequipmentmayberequiredforclientandcaregiversafety

Factorsassessedforeachtechnique

•  Advantages•  Contributionstobuildingclientconfidence,skillsandindependence

•  Waysinwhichitreinforcesdependence•  Risktotheclient•  Riskstothecaregiver•  Necessaryclientability&space

AnalysisofTechniques

GettingtoedgesittingStandingup

OptimalStartposition

Gettingtoedge-sittingRecommended1.  Independentshiftorshimmy2.  Assistedshimmy

Controversial•  Slouch

AssistedShimmyAdvantages:-  Clientparticipatesinactivity,

increasingabilitytomovetoedgesittingindependently

-  CaregivercanuseleverageDisadvantage:-  Caregiverstillproviding

substantialassistanceRisks:-  Potentialforskin-shearing-  Minimalrisktocaregiver©BackCare2019

SlouchAdvantages:-  Clientactingindependently;may

increaseconfidence-  Lowrisktocaregiver(potentialfor

someriskifcaregiverassistsclienttositfromslouchedposition)

Risks:-  Riskofskin-shearing-  Riskofslouchingtoofarandfalling-  Reinforcespoormovementpatterns-  Gettingupfromslouchedposition

mayreinforcepoormovementpatterns

SlouchAdvantages:-  Clientactingindependently;may

increaseconfidence-  Lowrisktocaregiver(potentialfor

someriskifcaregiverassistsclienttositfromslouchedposition)

Risks:-  Riskofskin-shearing-  Riskofslouchingtoofarandfalling-  Reinforcespoormovementpatterns-  Gettingupfromslouchedposition

mayreinforcepoormovementpatterns

NOT RECO

MMENDED

‘Slouch’ IndependentorAssistedShimmy

NOT RECOMMENDED ✔Recommended

©BackCare2019

Standingup

1.Recommendedtechniques:-  Leasttogreatestassistance(4variants)-  Adaptationsfordifficultspaces(2variants)2.Controversialtechniques&alternatives

SupervisedSit-to-StandTechniqueAdvantages:•  Reinforcesoptimumindependentfunction,confidence

Risks:•  Minimalrisktoclientandcaregiver

MinimumAssistSit-to-StandTechniqueAdvantages:•  Easytoadjustlevelof

assistance•  Encouragesclienttoperform

majorityoftransferDisadvantages:•  Supportingclientathand/

forearmremovesoptionforclienttopushonthighs/armreststoparticipateintransfer–handatshoulderpreferred.

Risks:•  Minimalrisktoclientand

caregiver©BackCare2019

©BackCare2019

HigherLevelofAssistanceSit-to-StandTechnique

Advantages:•  Moderateclient

participationintransfer•  Contributestomaintaining

strengthandphysicalfunction

Disadvantage:•  Moderatereinforcementof

dependencewithincreasingsupportfromcaregiver


caregiver

TwoCaregiversSit-to-StandTechnique

Advantages:•  Clientisstillparticipatingin

transfer(thoughatalowerlevel)

•  Somemaintenanceofstrengthandphysicalfunction


dependencewithincreasingsupportfromcaregiver


caregiver

©BackCare2019

©BackCare2019

LimitedaccesstosideofchairOption1:Angledseating

Advantages:•  Clientisparticipatinginthe

transfer;minimalreinforcementofdependence

•  Moderateparticipationintransfercontributestomaintainingstrengthandphysicalfunction

Risks:•  Mildriskofclientskin

shearing•  Minimalrisktocaregiver

©BackCare2019

LimitedaccesstosideofchairOption2:FrontAccesstechnique

Advantages:•  Clientisparticipatingintransfer,

contributingtomaintenanceofstrengthandphysicalfunction

•  Securelinkbetweenclientandcaregiver;optionforcaregivertodisengageifneeded.


dependence•  Interfereswithnaturalsit-to-stand

movement–hardforclienttoleanforwardorengagearmsbypushingonthighs

•  LimitstoadjustdegreeofassistanceRisks:•  Psychosocialrisk–veryclosecontact

betweenclientandcaregiver

ControversialTechniques

‘Zombie’Advantages:•  Maygivefalseperceptionofrelative

independenceDisadvantages:•  Clientcannotusenormalmovement

patterns,usearmstoassist,orincreasefunction

•  Encouragescaregivertodomuchofthework

Risks:•  Client-highriskofshoulderstrain/

dislocation;elbow/wrist/backstrain•  Clientfallrisk•  Caregiver-highriskofshould

dislocation/strain,backstrain.•  Withoutclientagreement,canbe

consideredabuse©BackCare2019

‘Zombie’Advantages:•  Maygivefalseperceptionofrelative

independenceDisadvantages:•  Clientcannotusenormalmovement




dislocation;elbow/wrist/backstrain•  Clientfallrisk•  Caregiver-highriskofshould

dislocation/strain,backstrain.•  Withoutclientagreement,canbe

consideredabuse

NOT RECO

MMENDED

©BackCare2019

‘ChickenWing’Disadvantages:•  Stronglyreinforcesdependence•  Clientcannotusenormalmovement


•  Psychologicaldependence/lackofcontrol



dislocation;damagetobrachialplexus

•  Caregiver-highriskofshoulderstrain/dislocation

•  Ifclientisfalling,littleopportunitytodisengage

©BackCare2019

‘ChickenWing’Disadvantages:•  Stronglyreinforcesdependence•  Clientcannotusenormalmovement





dislocation;damagetobrachialplexus

•  Caregiver-highriskofshoulderstrain/dislocation

•  Ifclientisfalling,littleopportunitytodisengage

NOT RECO

MMENDED

©BackCare2019

‘ChickenWing’HigherLevelofAssistanceORFrontAccessifnecessary



‘BearHug’Advantages:•  RequiresminimalspacetoperformDisadvantages:•  Stronglyreinforcesdependence•  Clientcannotusenormalmovement




Risks:•  Psychosocialrisk–veryclosecontact

betweenclientandcaregiver•  Caregiver-highriskofbackinjury•  Ifclientisfalling,littleopportunityto

disengage©BackCare2019

‘BearHug’Advantages:•  RequiresminimalspacetoperformDisadvantages:•  Stronglyreinforcesdependence•  Clientcannotusenormalmovement




Risks:•  Psychosocialrisk–veryclosecontact

betweenclientandcaregiver•  Caregiver-highriskofbackinjury•  Ifclientisfalling,littleopportunityto

disengage

NOT RECO

MMENDED

©BackCare2019

‘BearHug’

NOT RECOMMENDED ✔RecommendedHigherLevelofAssistanceORFrontAccessifnecessary


AssistwithwalkerDisadvantages:•  Dependentonaccesstowalker

Risks:•  Highfallsriskforclient

NOT RECO

MMENDED

©BackCare2019

AssistwithWalker MinimalAssistClientpushonthighs/armrests



Summary:Sit-to-StandTechniques✔Recommended

Gettingtoedgesitting•  Skippingthisstep•  SlouchStandingUp•  Zombie•  ChickenWing•  BearHug•  AssistwithWalker

NOT RECOMMENDEDGettingtoedgesitting•  IndependentShift/Shimmy•  AssistedShimmyStandingup•  Supervised•  MinimalAssist•  HigherLevelAssist•  TwoCaregiversAssist•  AngledSeating•  FrontAccessTechnique

Contributors•  SherriBastos–PSHSA,Health&Safetyexpert•  TysonBeach–UofT,KinesiologyProfessor•  TarynBolt–MississaugaHaltonLHIN,OccupationalTherapist•  CatherineBrookman–UofWaterloo,AssociateDirectorKTE,Gerontologist•  CRE-MSD–PSHSAClient/PatientHandlingCommunityofPracticeMembers/Participants•  BernadineBulzeLicorish–TransCare,PersonalSupportWorker•  AndreaCook–VHAHomeHealthcare,OccupationalTherapist•  TilakDutta–TorontoRehabilitationInstitute,Scientist•  BrydneEdwards–VHAHomeHealthcare,OccupationalTherapist•  DavidFrost–UofT,KinesiologyProfessor•  KellyHebner,UofWaterloo,KinesiologyStudent•  EmilyKing-UofWaterloo/VHAHomeHealthcare,PSWHealthandSafetyResearcher•  MatthewLam–WestParkHealthcareCentre,OccupationalTherapist•  SandraMcKay-VHAHomeHealthcare,HomeCareResearcher•  JanetRhooms–TransCare,PersonalSupportWorker•  SheilaRitcey–SRConsulting,DisabilityManagementPhysicalandOccupationalTherapyServices•  BettyRivington-Law–ClosingtheGap,Physiotherapist•  SharonSwitzer-McIntrye–UofT,ViceChairEducationandDirectorOntarioInternationally

EducatedPhysicalTherapyProgram

multidisciplinary analysis of assisted sit-to-stand ... · • client is participating in transfer,...

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