PS201 - Week 1 Cue Cards - Advanced Manual Handling

30 key vocabulary flashcards summarising essential terminology from the lecture on manual handling, transfers and gait-aid prescription.

Manual Handling

Any task that requires a person to lift, lower, push, pull, carry, move, hold or restrain a person, animal or object.

Hazardous Manual Task

A manual task that involves sustained or high force, awkward posture, repetitive movement, or vibration and poses a risk of injury.

Transfer

Moving a person from one place or position to another, e.g., bed-to-chair, lying-to-sitting, or up the bed.

Executing transfer:

• Test your hypothesis; risk can change mid-task.

• Be prepared to escalate assistance or abort.

• Post-task reflection → document & hand-over (nurses rely on physio safety plan for the other 23.5h).

SafeWork SA Risk-Management Framework

Four-step cycle: Identify hazards, Assess risks, Control risks, Review controls.

HALT Screen

Quick whole-body objective check: Head (flex/ext, rot), Arm, Leg, Trunk (flex/rot) to gauge a patient’s movement and strength before handling. (check grade 3 strength if limb is NWB)

Environment assessment

• Clear floor space, dry surfaces, appropriate bed/chair height.

• Infection-control (gloves if sheets soiled / oozing incision).

• Time constraints → rushing risk.

• Visitor or by-stander positions.

• Bariatric Equipment: Mobility or handling devices specifically weight-rated (> 200 kg) for clients with obesity.

Stand-by Assist (SBA)

Therapist within arm’s reach (‘Barbie arms’) ready to help but not touching unless needed.

Light Assist

Therapist supplies minimal physical help; patient performs > 75 % of the effort.

Moderate Assist

Therapist supplies noticeable support; patient performs 50–75 % of the effort.

Heavy / Max Assist

Therapist(s) provide most of the effort; patient performs < 50 % of the task.

Gate (Gait) Aid

Any external device (e.g., frame, crutch, stick) prescribed to:

1. improve stability,

2. decrease WB

3. conserve energy

4. increase confidence

5. maintain gait quality

Pickup Frame

Four-point, no-wheel walking frame lifted then placed; offers maximum base of support and stability.

Four-Wheel Walker (Rollator)

Frame with four wheels and hand brakes; provides moderate stability with smoother forward progression.

Gutter Frame

Forearm-support wheeled frame used when a client cannot bear weight through the hands or wrists.

Axillary Crutches

Under-arm crutches providing high stability and weight relief by supporting trunk as well as upper limbs.

Elbow (Forearm) Crutches

Crutches that cuff around the forearm; require more trunk control than axillary crutches.

Quad Stick

Walking stick with four small feet; slightly wider base than a single-point stick for added stability.

Weight-Bearing Status

Medical instruction dictating how much load may be placed on a limb; e.g., NWB, TTWB, PWB, WBAT, FWB.

Non-Weight Bearing (NWB)

No body weight may be placed on the affected limb when standing or walking.

Touch / Toe-Touch Weight Bearing (TTWB)

Permits the toes to touch for balance only; no load through the limb (< 10 % body weight).

Partial Weight Bearing (PWB)

Limited load allowed (e.g., 20–50 % body weight) as specified by the medical team.

Weight Bearing as Tolerated (WBAT)

Client may load the limb according to pain and comfort, progressing toward full weight bearing.

Two-Point Gait

Opposite arm aid and leg move together (e.g., right crutch + left foot), then repeat with the other pair.

Three-Point Step-Through Gait

Both crutches forward, affected limb lifted (no weight), strong limb steps past the crutches.

Step-To Gait

Unaffected limb steps only to the level of the aid, not beyond it; used for added stability.

Reflective Practice

Systematic self-evaluation of a clinical action to reinforce strengths and identify improvements.

Biopsychosocial Model

Framework that integrates biological, psychological and social factors into patient assessment and care.

Attachments

Medical lines or devices connected to the patient (e.g., IVs, oxygen tubing) that must be secured during handling.

Clinical Reasoning

Physiotherapist’s thought process combining assessment data, evidence and professional judgement to decide safe, effective interventions.

Why manual handling matters

Manual handling matters because it ensures the safety of both the person being moved and the handler, prevents injuries such as musculoskeletal disorders, and promotes efficient and dignified care by using proper techniques and equipment.

Cues, inferences, and hypotheses

• Cues = observable facts.

• Inferences = what the cues mean for safety/function.

• Hypothesis = impact on physio management.

non-negotiable patient risk factors

• Weight-bearing (WB) status.

• Attachments (IV, CVC, O₂, drains).

• Movement precautions (e.g.
  post-posterior-THR (hip flex >90º, adduction, etc.).

• Splints/braces that must remain.

Subjective questions for transfers

• Dizziness? SOB? Pain? Falls history? Cardiac / comorbidities?

• “Have you been out of bed before? How did it go?”

• Sleep quality → fatigue risk.

• Age (infant, child, adult) & cognition / language barriers.

Hierarchy of risk control

1.     Eliminate the hazard

2.     Substitute the hazard with another of lower risk, eliminate the manual handling risk.

a.     Examples:  remove broken hoist

3.     Substitute the hazard with a lesser risk

a.     Replace a hazardous work practice with a less hazardous one.

b.     Examples: Lifting x4 bottles of sanitiser at a time instead of a whole box

4.     Isolate the hazard

a.     Isolate the hazard from the person put at risk.  Place a barrier between the hazard and people within the workplace.

                      i.     Examples: Place sign up next to  a spill on the floor

5.     Engineering controls

                                               i.     Minimise the risk by engineering means

                                              ii.     Examples: using trolleys or mechanical lifting aids, change bed heights to reduce bending

 6.     Use administrative control

                                               i.     Minimise the risk by administrative means.  Establishing policies, procedures and work practices designed to reduce a worker’s exposure to a risk. It can also include the provision of specific training and supervision.

b.     Examples: introduce job rotation, implement a safe lifting policy, provide appropriate training, perform risk assessments

c.      Use personal protective equipment

d.     Provide personal protective equipment

e.     Examples: wearing gloves protects the worker from bodily fluids and chemicals.

Professional notes

• scenario → choose aid + pattern + rationale (case of Mr Brown highlighted as exemplar).

• Always relate answer to goals (stability, WB relief, confidence, energy, gait quality).

• Do not delegate transfer assistance to untrained family; only to trained carers after deliberate teaching.

• Patient may refuse transfer; physio must educate on risks of immobility (pressure injury, DVT, pneumonia, ↓ confidence) and obtain informed consent.

• Documentation & hand-over are part of duty of care and legal record.

Can you list at least 3 ways to engineer out a risk during a bed-to-chair transfer?

To engineer out a risk during a bed-to-chair transfer, you can implement:

1. Mechanical Hoists: Using a patient lift or hoist (e.g., standing hoist, ceiling hoist) to mechanically lift and transfer the patient, significantly reducing the manual effort required by staff.

2. Slide Boards/Transfer Boards: Employing a transfer board or slide sheet to bridge the gap between the bed and chair, allowing for a smooth lateral transfer with reduced friction.

3. Adjustable Beds and Chairs: Utilizing beds and chairs with adjustable heights to ensure they are at the same level during the transfer, minimizing vertical lifting and awkward postures.

4. Stand-Assist Aids: Implementing stand-assist aids (e.g., Sara Stedy) that help a patient pivot from a seated to a standing position, providing support and leverage during the transfer.

These methods fall under the "Engineering controls" in the Hierarchy of Risk Control, aiming to modify the work environment or equipment to reduce hazards.

What are the risks if a transfer is not performed?

If a transfer is not performed, the patient faces risks associated with immobility, including:

• Pressure injury

• Deep Vein Thrombosis (DVT)

• Pneumonia

• Decreased confidence