PT/OT

Creative Mobility Technology for Improved Outcomes

A Presentation at the APTA NEXT Conference Experience Zone

July 03, 2017 by Elena Noble, MPT

I recently attended the APTA Next Conference in Boston. A new component to this conference is the experience zone—an education space in the exhibit hall allowing presenters to draw on resources from the show floor as part of their presentations. A great idea. I attended a course called “Creative Mobility Technology for Improved Outcomes” in the zone.

safe patient handling mobility rehabHere we learned to get the most therapeutic value out of equipment commonly used by nursing or therapy. Contrary to the assumption that equipment encourages a passive approach to rehab, a growing body of safe patient handling evidence shows that using equipment not only improves patient outcomes but also prevents staff injury (a big deal for workers’ compensation)1-18 I came away from the course surprised at all the ways equipment contributes to rehab above and beyond the manufacturers’ basic uses.

apta next conference mobility rehabTake the session on advanced mobility products for instance. Therapists Margaret Arnold of Inspire Outcomes and Jamie Haines of Central Michigan University presented the Liko Golvo patient lift and Rifton TRAM (transfer and mobility device).

Fall Prevention Gains Patient Cooperation

Before launching into the products’ rehab possibilities, the presenters fitted a volunteer in each device and asked them to fall. They explained this is how they begin rehab with their new patients. By demonstrating the ability of the devices to prevent a fall they gain the patient’s confidence and cooperation during therapy because the patient feels safe enough to participate.

Additionally, because the equipment is there to support the patient, staff no longer put their energy into holding a patient upright but rather into thinking how to engage the patient for best rehab results. A rehab session ends when the patient is tired, not the therapist, with obvious benefits.

Balance Work

apta next conference creative mobilityWith a walking sling fitted on a volunteer in the Golvo mobile lift, the presenters guided tall kneeling activities with advancement to half kneeling. Then turning the patient to face outward, they played catch and kick-ball. Think about the great balance work and arm and leg movements incorporated in these activities—engaging and fun too. A good rehab day, according to Jamie, is when the gym looks a mess and everyone’s tired.

In the Rifton TRAM with the body-support in place, the volunteer practiced sitting balance on a therapy ball with reaching activities.

Dancing and All That Jazz

In standing, after clipping on the fall arrest harness and with the TRAM in reverse, Jaime set a metronome and asked the volunteer to march to the beat. Then to the music from an attendee’s iphone, Jaime danced with the volunteer. She explained that just this activity had brought tears to the eyes of an elderly patient of hers who finally could dance with his wife again. This video, taken during the course shows the dancing in the TRAM.


The low-profile, no-overhead design of the TRAM also gives room for the large-amplitude movements of patients with Parkinson’s as well as independence to those tired of the confinement of wheelchairs and parallel bars.

It only got better as the session continued. With one person in the TRAM and the other in the Golvo, there were ball catching games and running activities. And the “patients” were still safely positioned even with the most advanced activities.

rifton tram safe mobilityTherapeutic Progression with Equipment

Clinical progression happens in two ways. First, by increasing the difficulty of the therapeutic intervention. And second, by decreasing the supports on the equipment, for instance, removing the fall arrest harness or loosening the body weight support on the TRAM for additional trunk mobility and challenge. The therapist can also choose to guide the devices with the caregiver handle or allow the patient complete freedom of movement.

So it was a great session—fun, engaging, motivating and therapeutic—as it should be for all rehab intervention. The audience was mixed with therapists working in acute care, neuro-rehab, and early mobility settings. My key takeaway: we shouldn’t see equipment as simply necessary for patient and staff safety; we can transform equipment into amazing rehab tools by using it in forward thinking and creative ways.


References:

  1. Hignett S. Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review. Occup Environ Med. 2003; 69(9):e6-e6.
  2. Arnold M, Campo M, Radaweic S, Wright L. Changes in Functional Independence Measure Ratings Associated with a Safe Patient Handling and Movement Program. Rehabil Nurs. 2011; 36(4):138-44.
  3. Campo M, Shiyko M, Margulis H, Darragh A. Effect of a Safe Patient Handling Program on Rehabilitation Outcomes. Arch Phys Med Rehabil. 2013; 94(1):17-22.
  4. Campo M, Weiser S, Koenig KL. Job strain in physical therapists. Phys Ther. 2009; 89(9):946-56.
  5. Darragh AR, Campo M, Olson D. Therapy practice within a minimal lift environment: perceptions of therapy staff. Work. 2009; 33(3):241-53.
  6. Darragh AR, Campo MA, Frost L, Miller M, Pentico M, Margulis H. Safe-patient-handling equipment in therapy practice: implications for rehabilitation. Am J Occup Ther. 2013; 67(1):45-53.
  7. Nelson A, Collins J, Siddharthan K, Matz M, Waters T. Link between Safe Patient Handling and Patient Outcomes in Long-Term Care. Rehabil Nurs. 2008; 33(1):33-43.
  8. Garg, A. Long–term effectiveness of "Zero–Lift Program" in seven nursing homes and one hospital. 1999. Milwaukee, WI: University of Wisconsin–Milwaukee.
  9. Evanoff B, Wolf L, Aton E, Canos J, Collins J. Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace. Am J Ind Med. 2003; 44(5):451-57.
  10. Engkvist, I. Evaluation of an intervention comprising a no lifting policy in Australian hospitals, Appl Ergon. 2006; 37(2):141-8.
  11. Stenger K, Montgomery LA, Briesemeister E. Creating a culture of change through implementation of a safe patient handling program. Critical Care Nursing Clinics of North America. 2007; 19(2):213-22.
  12. Knibbe N, Hanneke J, Knibbe J, Crist J. Special approaches for safe handling of disabled children in The Netherlands. Rehabil Nurs. 2008; 33(1):18-21.
  13. Haglund K, Kyle J, Finkelstein M. Pediatric safe patient handling. J Ped Nurs. 2010; 25(2):98-107.
  14. Collins JW, Wolf L, Bell J, Evanoff B. An evaluation of a "best practices" musculoskeletal injury prevention program in nursing homes. Inj Prev. 2004; (10):206-11.
  15. Spiegel J, Yassi A, Tate R, Tait D, Ronald L. Implementing a resident lifting system in an extended care hospital. Demonstrating cost–benefit. AAOHN Journal. 2002; 50(3): 128-34.
  16. Siddharthan K, Nelson A, Tiesman H, Chen F. Cost Effectiveness of a Multifaceted Program for Safe Patient Handling. Advances in Patient Safety: From Research to Implementation. 2005. Rockville (MD): Agency for Healthcare Research and Quality.
  17. Nelson A, Matz M, Chen F, Siddharthan K, Lloyd J, Fragala G. Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. Int J Nurs Stud. 2006; 43(6):717-33.
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Reply by Michelle on July 05, 2017 at 12:09 PM
Love this article! Amazing way to improve quality and joy of exercise experience, which will translate into functional mobility skills for increased independence. Creativity is so important in preventing burn out among therapists as well.