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Case Study: Paediatric Moving & Handling

by Tess Whitehead

Jack is 5 years old and lives at home with both parents and his twin brother. Jack suffered hypoxia at birth resulting complex physical and cognitive disabilities which impact on every aspect of his life. Jack is developmentally delayed, wheelchair dependent and reliant on his family for all personal care, transfers, to keep him comfortable, safe and provide him with opportunities for fun and learning.

The family were previously living in a 3 bed semi-detached property that presented many challenges in terms of wheelchair access, carrying him up and down the stairs and lifting him on and off the floor, bed and bath. His mother in particular was experiencing back and shoulder pain due the amount of repetitive lifting. Statutory Services had provided basic aluminium ramps for the front door, however these could not be left in situ and were heavy to manoeuvre into position. A mobile hoist was also provided but not used due to the space constraints in the property and lack of appropriate training; Jack’s parents has only been shown once how to use the equipment and consequently lacked confidence and could not remember how to fit the sling correctly or what colour sling loops to use.

The family were actively looking for a more suitable property to meet Jack’s long-term needs. His Case Manger was keen to find an Occupational Therapist skilled in the adaptation design process and moving and handling who could work with the architect to ensure Jack got the maximum benefit from the adaptations and provide bespoke training to the care workers who were being recruited to work with him.

Using the extensive knowledge of specialist equipment and a good network of contacts and suppliers, the therapist was able to work collaboratively with the architect and specialist adaptations company to provide assessment, design and installation, taking into account the space requirements, client and carer needs, the building type, equipment being considered and budget.

The therapist recommended H Frame ceiling track hoists systems in Jack’s bedroom, bathroom, living room and therapy room as these provide full room coverage, ideal when a number of transfers need to be achieved. The additional advantage of being able to re-position furniture or re-design room layouts without having to consider the track hoist positioning offers flexibility without the additional cost of re-siting when circumstances change. Transition gates were also recommended between Jack’s bedroom and bathroom as this allowed the hoist to run between rooms for more seamless and comfortable transfers.

Including overhead hoisting in the living room was recommended to enable Jack to spend time on the floor or sofa with his brother and remain an integral member of the family, rather than remain in his wheelchair.

The therapist selected a hoist system with a two strap design that does not have an obstructive spreader bar. This is much easier for his family and carers to use and eliminates the risk of Jack injuring himself on a spreader bar due to involuntary limb movements.

The slings chosen were made from a breathable, stretch material to allow the sling to accommodate Jack’s body shape and to work with contours within his seating. It was designed to stay in place under Jack at all times meaning it did not need to be removed and re-applied every time he wanted or needed to be moved.

Jack loves all things sensory, especially water. The local authority OT Service only offered the option of a level access shower in his previous property. His mother felt this would not afford him the therapeutic benefits he derives from bathing and the spray of the water increases his tone and extensor spasms. The therapist recommended a height adjustable bath that could be raised to a comfortable working height for parents and carers. It was positioned so that carer access each side of the bath could be gained and over-head hoisting equipment was used to raise and lower Jack into the bath.

Upon completion of the adaptations, the family and support workers received comprehensive moving and handling training specific to Jack’s needs and were provided with written and photographic instruction for each task to ensure they are following the recommended handling techniques to keep themselves and Jack safe. The therapist recommended that any new support workers shadow shifts until they are deemed competent and they feel confident to work on their own.

Those involved in looking after Jack continue to receive on-going Moving and Handling input to assess any changes to his needs, to train any new carers, to update existing carers, to review slings as he grows and to advise on future equipment.

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