Manual Handling Solutions for Complex Disabilities
Manual handling sounds simple enough given it is about supporting someone to move from one position to another. But it can become significantly more challenging in the context of severe or complex disability, when it involves balancing the needs and preferences of the individual with the safety of caregivers in a wide variety of environments.
In some cases, these issues mean specialised manual handling techniques are needed to ensure the safety, wellbeing and dignity of both the individuals receiving support and their caregivers.
Here, we look at some of the challenges associated with manual handling for individuals with complex disabilities, offer some practical advice and tips, and highlight the importance of taking an interdisciplinary approach.
Manual handling in disability services
People with complex or severe disability often need considerable support to move. According to figures from the Australian Bureau of Statistics, the greatest need for assistance among people with disability who have a profound limitation is for mobility, reported by 82.7% of these people.
In more than three-quarters of cases, this need is met by informal caregivers such as the individual’s partner, other family members or friends. Approximately 26% of people with disability receive assistance for mobility tasks from formal caregivers, such as disability support workers.
The challenges associated with manual handling tasks in disability contexts include:
1. Physical demands on caregivers
The physical effort needed to roll, lift, transfer, or reposition an individual with a significant mobility impairment can lead to caregiver fatigue, musculoskeletal injuries, and burnout.
Statistics from Safe Work Australia show that community and personal service workers have one of the highest rates of work-related injury and illness, accounting for 21.7% of all serious claims.
For example, a disability support worker who regularly repositions or transfers a person with a complex disability without adequate help from assistive devices may develop chronic back pain or an acute injury, necessitating time off work and medical treatment.
2. Risk of injury to the individual
Inappropriate manual handling techniques may result in manual handling injuries such as skin tears, or even fractures or dislocations, particularly in individuals with osteoporosis or joint instability.
For example, a person with osteogenesis imperfecta may suffer a fracture if mishandled during a transfer.
One recent study found that individuals with intellectual disability tend to develop osteoporosis between 15 and 30 years earlier than people without intellectual disability and have a significantly higher rate of fracture (especially hip fracture), highlighting the importance of safe manual handling in these individuals.
3. Communication barriers
Individuals with severe disabilities may have limited or no ability to communicate their needs, preferences, discomfort, or pain, complicating the handling process. Communication barriers may lead to anxiety, frustration, and the potential for misunderstanding or harm to the individual.
For example, an individual with cerebral palsy who is non-verbal may not be able to express discomfort during a transfer or repositioning manoeuvre, resulting in an awkward or painful movement or position the caregiver is not aware of.
4. Behavioural challenges
Some individuals may exhibit behaviours that increase the challenge of manual handling procedures, such as resistance. For example, an individual with autism who experiences sensory overload during transfers might demonstrate resistive or aggressive behaviours, making the handling process more challenging and potentially hazardous to themselves and their caregivers.
5. Environmental restrictions
The physical environment where care is provided can pose additional challenges. Things such as limited space, inadequate equipment, and clutter can hinder safe manual handling practices.
For example, a caregiver working in a small, cluttered room may struggle to manoeuvre a wheelchair or use a mechanical lift effectively, potentially increasing the risk of injury to both the caregiver and the individual.
6. Lack of training or support
Inadequate training and support for caregivers can lead to unsafe manual handling methods. For example, a caregiver who has not received appropriate training in how to use a transfer board with someone who has a spinal cord injury might use one incorrectly, leading to increased physical strain and potential harm to themselves and the individual they are supporting.
Strategies and solutions for effective manual handling
Caregivers and allied health professionals such as physiotherapists can implement several strategies to help ensure manual handling is safe, effective and tailored to the needs and preferences of the individuals they are supporting.
Comprehensive assessment and planning
Effective manual handling in disability always begins with a thorough assessment. This should include an evaluation of:
- medical history and diagnosis – to help identify any conditions that could impact mobility, strength, coordination, or communication.
- physical abilities and limitations – such as muscle strength, range of motion, joint stability, balance and coordination to help determine the level of support needed and the individual’s ability to assist in transfers and movements.
- the individual’s ability to perform activities of daily living (ADLs) such as sitting, standing, walking, and transferring, and observation of how they move in their current environment.
- pain and discomfort – including identification of any areas where these may be experienced during movement or handling.
- behaviours that may affect manual handling, such as resistance, aggression, or anxiety.
- communication abilities – including verbal and non-verbal communication methods and identification of preferred communication techniques and aids (e.g. picture boards, communication devices).
- sensory considerations – such as heightened sensitivity to touch, sound, or light.
- the physical environment where care is provided, including space constraints, lighting, and accessibility.
- risk factors – such as skin integrity issues, fall risks, and the likelihood of injury to the caregiver or individual.
- review of any current assistive devices and their appropriateness for the individual’s needs.
- the individual’s preferences and goals for handling and movement.
- caregiver capabilities – including their knowledge and skills related to manual handling techniques and the use of assistive devices.
This assessment should ideally include input from a team of health professionals. Depending on the needs and goals of the individual, this may include:
- physiotherapists – to assess things like range of motion, mobility, balance, and muscle strength and tone
- occupational therapists – to review ADLs and functional capacity
- nurses – to assess skin integrity and risk of pressure injury
- speech therapists – to evaluate communication abilities
- behaviour support practitioners – to assess behaviours that may impact manual handling tasks.
Input should also be sought from formal and informal caregivers who are supporting the individual. They will have significant insight into the issues that may impact the success of manual handling on a day-to-day basis, as well as anything that concerns them.
A manual handling assessment should consider the needs of the individual and their support people.
The healthcare team can work together with caregivers and the individual to create a care plan that outlines appropriate handling techniques, equipment needs, and safety precautions.
This plan should be reviewed regularly and adjusted to reflect any changes in the individual’s condition or needs over time.
Tailored handling techniques
Each individual with complex or severe disability has unique needs, goals and abilities. Techniques can be adapted for each individual to help enhance safety and comfort.
For example, you might take a slow, gentle and controlled approach to repositioning an individual with Parkinson’s disease in bed to help minimise the likelihood of muscle spasms or discomfort.
Assistive devices
Assistive devices can reduce manual handling risks and facilitate safe manual handling, helping to reduce the physical strain on caregivers and the risk of injury to both parties. Examples of manual handling equipment include:
- mechanical lifts or hoists
- adjustable beds
- slide sheets
- transfer boards.
For example, a hoist might be the most appropriate device for transferring an individual with severe movement limitation from a wheelchair, eliminating the need for manual lifting and ensuring a controlled and safe transfer.
Training and education
Proper manual handling training and education are essential for safe manual handling. Physiotherapists and other health professionals may be involved in training caregivers with aspects of manual handling such as:
- how to use assistive devices
- ergonomic principles such as good body alignment and posture
- specific techniques for handling individuals with complex disabilities.
Ongoing education can help to maintain high standards of care.
For example, a physiotherapist may train caregivers to use slide sheets to facilitate smoother transfers and repositioning of an individual who has motor neuron disease in bed, thereby reducing friction and the risk of skin injuries.
Use of ergonomic principles
Following ergonomic principles is one way to encourage the use of safe manual handling techniques and reduce the risk of caregiver injuries. Examples include:
A caregiver uses a hoist to assist a person with disability out of his motorised wheelchair to a standing position in the kitchen.
- maintaining proper body mechanics – such as good spinal alignment, bent knees and avoidance of twisting movements
- using leverage and momentum effectively
- ensuring the caregiver is positioned closely to the individual being handled.
When supporting an individual to stand, for example, caregivers should bend their knees, keep their back straight, and use their leg muscles rather than their back to provide assistance.
Communication and behavioural strategies
Effective communication is crucial for successful manual handling. When supporting individuals who have limited verbal abilities, health professionals and caregivers can use alternative communication methods (such as picture boards, gestures, or technology-assisted communication devices) to explain the handling process and encourage individuals to express their needs, concerns and preferences.
Behavioural strategies can also be employed to manage resistance or anxiety during handling tasks.
For example, if an individual becomes anxious during transfers, caregivers can use a picture board to explain each step of the process and provide reassurance, helping to ease their concerns and increase cooperation.
Environmental modification
In some cases, it may be helpful to modify the environment to facilitate safe and effective manual handling. For example, it may be necessary to rearrange furniture to allow adequate space for a mechanical lifting device, or to remove clutter to improve wheelchair accessibility.
Regular review and plan updates
An individual’s needs often change over time. The manual handling plan should be reviewed regularly to ensure it is still working effectively and updated as needed. Caregivers should be encouraged to advise a member of their health professional team if they have any concerns about the manual handling plan.
Expert support for complex manual handling needs
Providing manual handling for individuals with complex or severe disabilities requires a multifaceted approach that takes the unique circumstances and risks into account. The team at Active Ability has significant experience working with individuals with severe and complex disability, including those with autism, neurological conditions, and intellectual disability. We can support you to develop and implement effective and safe manual handling plans, prescribe assistive devices, and provide caregiver education and training. To learn more, contact our friendly team on (02) 8678 7874, hello@activeability.com.au or via our contact form.Get in touch
hidden
Follow Us