Making manual handling safe, effective and fun
What comes to mind when you think of hoists and manual handling? Personally, I love being hoisted. I can’t wait to try out new slings and equipment as they becomes available, to work out the best ways to make the equipment work and learn what opportunities it might open up for someone. But that isn’t always the view of the end user, family and staff. As a manual handling adviser, I often meet people who are less than keen to use moving and handling equipment, so why should we sometimes have to consider alternatives to physically lifting a student?
There was an expectation, in the past, that musculoskeletal discomfort was part of the price you paid when lifting children. It was common for people assisting children to avoid considering hoisting for as long as possible because a manual lift was faster, and children were routinely thought of as little and light. As a result, being hoisted tended to have a negative image. This seemed set to change, though, with the introduction of the Manual Handling Operations Regulations in 1992, and manual handling advisers saw equipment as the way forward to reduce risks to the workforce. However, as the recent report by the Scottish Commissioner for Children and Young People (SCCYP, 2008) shows, some children themselves still do not have favourable opinions of hoisting or manual handling. My hope is that by working together we can change these opinions and design “safe systems of work” that really do work for everyone.
I met Jason when he first started at primary school. He was a little shy in this new environment, but he could tell me clearly his likes and dislikes, and what was comfortable and what wasn’t. He had difficulty standing, did not walk, and initially used a manually operated chair but later changed to a powered wheelchair. As the school was an old village school, space for equipment and wheelchairs was limited. Certainly, fitting in standing frames, wedges, therapy benches and possibly a hoist was proving challenging. So, in the early days, the decision was made to manually lift him or support him for standing transfers.
Trying to work out a moving and handling strategy can be exciting and daunting. So, starting from the beginning, there were some basic questions to ask:
- what does Jason do in a typical day, what does he want to do and can it be done easily and safely for all involved?
- what are everyone’s expectations, needs and wants, and who pulls this all together?
- who is available to help Jason in school and what do they need?
- can Jason be given more independence, freedom and voice by using equipment?
- are there any legal, moral and financial considerations?
- how do teaching and therapy aims interact with staff and student safety?
- how much space is available?
Understanding the roles different people play, and knowing who to talk to, is clearly very important, and the SENCO was in an ideal position to facilitate discussion between all parties and utilise their specific expertise. The manual handling adviser knew a great deal about equipment, training and how to prevent injuries; the therapists understood the short and long term therapy considerations; teaching staff were able to present the learning needs; Jason’s family brought an holistic perspective to their son’s development, and Jason, with the right encouragement, provided his own ideas and thoughts.
So, looking at Jason’s situation, the options considered were:
- adaptation to a storage area to convert it to a hygiene room with overhead tracking hoist (needs less space), drop down height adjustable change bed and commode seat
- therapy room with tracking hoist and height adjustable bench
- specialist sling, to allow easy access to the toilet, and prone standing frame.
In making the decisions, there was a huge range of equipment and many alternatives, even bespoke options, to consider. So it was crucial at the outset, to understand exactly what we were trying to achieve, and then seek advice on how to achieve it. For example, undoing Jason’s foot straps and lap belt frequently during the day could be awkward for some staff, and one of the simplest pieces of equipment that staff working with Jason found helpful was a star-based height adjustable wheelie stool. This brings staff to eye level, can avoid the need to stoop, and so encourages a more relaxed atmosphere. The latest piece of equipment to arrive was a simple height adjustable step, used in the hygiene room. As Jason grows, sections can be removed, so it’s a simple but effective solution.
Working with children is never static; it is not always easy and regular reviews still take place as Jason moves classes, grows, gets involved in different activities, and as his health needs alter and staff change. There are always new issues to deal with, such as staff noticing the increasing time spent away from the classroom, difficulty in using equipment anywhere other than in the hygiene and therapy rooms, and problems in achieving enough time for therapy, learning and play. So with Jason, as he moves through primary to secondary school, the next stage may be to look at a wheelchair that can also bring him into a standing position. This would not only enable him to become more involved in class, but would also mean that he could complete some of his therapy right where he is.
Developing a moving and handling strategy should help everyone arrive at a balanced decision on what the student, family and staff want to achieve. Appropriate equipment should be used from early on and moving and handling should be effective, pleasant and, dare I say it, fun!
Carole Johnson qualified as a Chartered Physiotherapist at Addenbrooke’s Hospital Cambridge in 1983 and currently works as a freelance manual handling adviser. She really enjoys working with children, students and staff to help them achieve the best in their setting.
Article first published in SEN Magazine issue 41: July/August 2009.