Difficulties in ambulating is the most common deficit that leads to referrals for outpatient rehabilitation at the SPD Rehabilitation Centre (RC), and an improved walking function is the most common goal set for clients. We take a look at how the ceiling hoist can be used during physical therapy to improve walking.
Being Independent in the Community
Mr Tan Chuan Hoe was diagnosed with T6/T7 spinal cord compression that causes numbness and lower limb weaknesses, which affected his balance and walking.
The 71-year-old has difficulties moving about independently, including walking long distances, taking public transport as well as negotiating curbs, steps and crowd. Even though he uses a motorised scooter, Mr Tan looks forward to eventually going out without depending on it.
One common rehabilitation goal for clients who experience limb weakness, or those with temporary paralysis, is to learn to walk again and be independent in the community. However, concerns of falling due to the lack of balance sometimes delays the progress. It is therefore important for them to build up confidence along with their balance and muscle strength.
A Device for the Right Support
The use of the right ceiling hoist and walking sling can be a very useful addition during the clients’ recovery programme. They offer comfort and support that the clients need, and also ensured safety for both the clients and the staff as the former is being strapped during the activity. Depending on the layout of the rehabilitation area, a ceiling hoist can be installed to provide users with easy access to other equipment, such as walking bars and treadmills.
At our RC, the ceiling hoist is used during balance and walking training for client with higher fall risks. As they are designed to hold significant weight, ceiling hoists are able to hold clients aloft and that gives them the confidence to practice natural movement without any unnecessary pain, discomfort, or risk.
Working On Practical Skills
Mr Tan’s physiotherapist Sarah Lim is using the ceiling hoist with him for the first time during his therapy session. “With the ceiling hoist, I would be able to challenge Mr Tan more. My main focus would be on dynamic standing balance training, dual task training and limbs co-ordination. These are abilities that he has work on if he is looking to be independent in the community as they help him walk better, navigate the crowds and go up and down a bus.”
Hooked up to the hoist, Mr Tan started off with balance and gait training by walking and doing step ups on a board. They then went on to tandem stand, progressing to tandem walk and then backward tandem walk. This would have taken more support from his physiotherapist at his side and taking a longer time.
They then went on to bounce and catch a basketball with alternate hands in standing position, and thereafter progressing to walking and bouncing, throwing and catching the ball to train his co-ordination and dual tasking. Even though Sarah was standing away from him and not in the best position to prevent any falls or loss of balance, the ceiling hoist helped Mr Tan to regain his footing and continue with his activities. We saw flashes of Mr Tan’s days of playing basketball previously, and that youthful twinkle in his eyes, as he displayed increasing comfort and confidence in his movements during the 45-minute session.
Although evidence of using partial body weight supported gait training, such as with the use of the ceiling hoist, is not conclusive in increasing the chances of walking independently compared to other physiotherapy interventions, it has been used to treat people with spinal cord injuries and hemiplegia as it allows for task-specific training of complete gait cycles. It also enables the therapist to mobilise their clients who do not yet have adequate truncal balance to sit unsupported, gives a sense of security, and allows the user to focus on the tasks rather than on maintaining balance.
The ceiling hoist and harness offer the option to explore higher level and more dynamic standing and walking tasks whilst ensuring the safety of the therapists and clients.
This article was written with inputs from SPD senior physiotherapist Nadiah Binte Muhamed Amin and physiotherapist Sarah Lim.