PS201 - Week 1 Cue Cards - Advanced Manual Handling

Acknowledgement of Country & Engagement

• Lecturer begins by acknowledging the Kaurna people of the Adelaide Plains as Traditional Custodians of the land and invites students to identify their own locations in the chat.

• Emphasises cultural respect and the importance of acknowledging Country at the start of professional gatherings.

Course Context & Objectives

• Lecture belongs to Physiotherapy Studies 201 (PS 201).

• Links directly to Course Objective 2 – “Demonstrate safe and effective manual handling.”
  and Course Objective 3 – “Demonstrate safe and effective assessment & management techniques for selected conditions across the lifespan & health settings.”

• “Across the lifespan” = newborn ➜ older adult; all health-care contexts (acute, rehab, community, private practice).

Lecture / Learning Objectives

1. Understand clinical reasoning & planning required for manual handling across the lifespan.

2. Apply manual-handling principles to transfers, physio sessions & ADLs.

3. Be introduced to self-reflection & evaluation skills.

4. Understand how manual handling will be taught & assessed in the course.

Why Manual Handling Matters

• Students asked to supply ≥ 8 reasons; collected answers emphasised:
  • Prevent injury to patient & practitioner.
  • Prolong practitioner career longevity.
  • Ensure patient safety & confidence.
  • Meet legal / registration thresholds (competency requirements).
  • Integral to all areas of physiotherapy, incl. documentation posture.

Where Manual Handling Occurs in Physio

• All sub-disciplines: musculoskeletal, neuro, cardioresp, paediatrics, sports, aged care, community, etc.

• Occurs with the patient (treatment, assessment, ADL assistance) and without the patient (moving equipment, setting up rooms, documentation ergonomics).

Registration & Employability Links

• Manual-handling competence is embedded in AHPRA Thresholds for Practice.

• Employers assume new-grad physiotherapists can handle patients & equipment safely.

Key Skills & Content To Be Learned This Year

• Safely perform and PLAN transfers (bed→chair→bed; repositioning; stairs).

• Prescribe & progress gait aids (frame, crutches, stick, rollator, gutter frame, etc.).

• Teach stair negotiation with gait aid.

• Reflect in, on & after action; document & hand-over to team.

Safety Fundamentals

• Consider safety of patient, physiotherapist, assistants & by-standers.

• Re-use first-year knowledge of biomechanics, gait aids, PS100 principles.

• “Assumed knowledge” = will NOT be re-taught in detail.

Definitions

• Manual Handling (SafeWork SA): “Any task that requires a person to lift, lower, push, pull, carry or otherwise move, hold or restrain any person, animal or thing.”

• Hazardous Manual Task adds:
  • Repetitive/sustained force.
  • Sudden force.
  • Repetitive movements.
  • Sustained / awkward postures.
  • Exposure to vibration.

Transfer Scope in PS 201

• Bed ⇄ chair / wheelchair (incl. supine→sitting →stand).

• Re-positioning in bed (up, across, rolling).

• Stair ascent / descent with gait aid.

The Risk-Management Framework (SafeWork SA)

1. Identify hazards (physical & psychological) – use all senses.

2. Assess the risk level.

3. Control the risk (apply hierarchy of controls).

4. Review & reflect (did controls work? what to change?).

Clinical Reasoning: Cues → Inferences → Hypotheses

• Cues = observable facts.

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

• Hypothesis = impact on physio management.

Patient Risk Assessment

Non-Negotiable Risk Factors

• Weight-bearing (WB) status.

• Attachments (IV, CVC, O₂, drains).

• Movement precautions (e.g.
  post-posterior-THR \big(\text{hip flex} > 90^{\circ},\ \text{adduction}, etc.).

• Splints / braces that must remain.

Subjective Questions (examples gathered in class)

• 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.

Objective “HALT” Screen (quick whole-body screen)

H – Head (flex/ext, rotation)
A – Arm (L)
L – Leg (L)
T – Trunk (flex/rot)

• repeat for opposite sid​e.
  • Check \le\text{ Grade 3} strength if limb is NWB, etc.

Additional Checks

• Respiratory status (SpO₂, breathing pattern).

• Wound integrity / ooze.

• Lines & attachments (locate patient‐end and wall/pump-end).

Therapist / Assistant Fitness for Practice

• Self-check: injuries, fatigue, correct clothing/footwear, infection control.

• When recruiting an assistant: confirm injury status, training, willingness to take your direction.

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 considerations (> 200\text{ kg}): weight-rated bed, chair, frame, hoist.

Hierarchy of Risk Control (SafeWork SA)

1. Eliminate (e.g.
   remove water spill).

2. Substitute (different transfer).

3. Engineering (equip, hoist, extra staff).

4. Administrative (rostering, time mgmt.).

5. PPE (gowns, gloves, N95).

Levels of Assistance (revisited)

• Stand-By Assist (SBA) = “Barbie arms” : elbows at sides, hands ready either side of pt.

• Light, Moderate, Heavy Assist – graded by amount of load you take.

• Verbal & tactile cues may overlay any level.

Executing the 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 23.5\text{ h}!).

Manual Handling During Physio Treatment

• Applies to assessment maneuvers (e.g.
  hamstring length, shoulder flexion) & therapeutic exercises.

• Example: Balance retraining requires pushing patient to edge of BOS → decide assist level that permits errors yet prevents falls.

Manual Handling in ADLs

• Physio may accompany pt to toilet, assist brushing teeth, dressing, kitchen tasks, etc.

• If pt is classified SBA for gait, remain SBA while they toilet / wash hands / brush teeth.

Demonstrated Clinical Scenarios

1. Confused Hx head injury + NWB arm in POP → move up bed.
   Consider: cognition, aggression potential, extra helper, protect NWB arm, avoid head-down tilt (↑ ICP).

2. Ward example: Patient says “going to toilet”; physio must escort or arrange trained staff – cannot leave pt unsupported.

Gait Aid Prescription

Reasons

• ↑ Stability, ↓ WB, conserve energy, ↑ confidence, maintain gait quality.

Decision Process

• Referral / pt request / own assessment / emergency need / equipment availability.

• Same 4-step risk framework → choose aid → fit & teach.

Gait Patterns (revision)

• 4-point, 3-point, 2-point, step-to, step-through, swing-through.

Relative Stability of Aids

(Most ➜ Least)

1. Pickup / rollator / gutter frames (larger BOS).

2. Axillary crutches (support trunk).

3. Elbow crutches.

4. Quad stick.

5. Single-point stick / absent aid.

Weight-Bearing Hierarchy

Least stable ➜ most stable:
\text{NWB} < \text{TWB} < \text{PWB} < \text{WBAT} < \text{FWB}.

Stability Quiz Outcomes

• Pickup frame more stable than axillary crutches (BOS).

• 4-wheel walker > single stick (BOS still larger even with wheels).

• Axillary > elbow crutch (supports trunk).

• Gutter frame > rollator (higher support).

Case Study – Mr Brown (Left POP Ankle, NWB 6 wks)

Key Cues & Inferences

• ED → acute, likely pain.

• Social tennis player → fit, good UE strength.

• NWB → needs large BOS, UE load, leg must be held off floor (POP heavy).

• Risk if no aid = hop/fall; risk with aid = balance, fatigue.

Decision

• Acceptable aids: Pickup frame or axillary crutches.

• Chosen in class: majority elected axillary crutches with SBA, 3-point or 2-step-through gait (depends on confidence).

• If unsteady ➜ fallback to pickup frame (engineering control ↑ stability).

Progression After 6 Weeks (WBAT)

• Maintain best gait quality; progress aid not gait pattern first.

• Options:
  • Axillary ➜ 1 crutch ➜ stick ➜ none.
  • Or frame ➜ crutches ➜ stick ➜ none.

• Physio may set temporary WB limits (e.g.
  WBAT) when med team gives FWB but pt not ready.

Transfers Likely to Require Gait Aids in PS 201

• Sit↔stand, bed↔chair, stair ambulation, indoor walking circuits.

Assessment Information & Exam Hints

• Practical OSCE: perform chosen transfer incl.
  gait aid & level of assist; assessor will ask for reasoning.

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

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

Ethical / Professional Notes

• 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.

Numbers & Statistics Mentioned

• 120\,355 serious workplace injury claims (2019–20).
  • 37\% due to body stressing.
  • 23\% due to slips / trips / falls.
  (Both over-represented in physiotherapy.)

Lecture Logistics & Student Feedback Points

• Live vs prerecorded debate; majority in chat preferred prerecorded with uploaded notes.

• All sessions recorded; links uploaded by course coordinator.

Self-Check Questions (as per slide)

• Can you describe & apply the SafeWork SA 4-stage framework?

• Can you rapidly screen a patient using HALT?

• Can you justify your gait-aid choice against the 5 original purposes?

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

• Can you outline how you would progress aids & patterns for a TWB → WBAT → FWB patient?

End of comprehensive notes for “Advanced Manual Handling & Transfers”.