LECTURE # 17 BY DR USMAN IQBAL JANJUA

KinesiologyM Farrukh ShahzadBSPT, PPDPTFaculty of Rehabilitation Sciences

Lesson

Suspension TherapyreviewSling Sling typeType of suspension Suspension for the lower extremityAbduction and adduction of hipFlexion and extension of hipFlexion and extension of kneeThe ankleAbduction and adduction of shoulderFlexion and extension of shoulderShoulder internal and external rotationFlexion and extension of elbowFlexion and extension of wristFlexion and extension of arm

Slings

Single SlingsSingle slings are made of canvas bound with soft webbing and with a D ring at each end They are used open to support the limbs, or folded in two and as a figure of eight to support the hand or foot They measure 68 cm long by 17 cm wide.

Double Slings

Double slings are broad slings measuring 68 cm long by 29 cm wide with D rings at each end Double slings are used to support the pelvis or thorax or the thighs together, especially when the knees are to be kept straight.

Three-ring Slings

Three ring slings are webbing slings 71 cm long by 34 cm wide with three D rings, one D ring fastened at each end and one free in the middle. The centre ring is for attachment to the dog clip The webbing is slipped through the end D rings to make two loops These slings are used to support the wrist and hand or ankle and foot

Head Sling.

A head sling is a short, split sling with its two halves stitched together at an angle to create a central slit This allows the head to rest supported at the back under the lower and upper parts of the skull, or in the side lying position leaves the ear free.

Types of Suspension

Vertical Fixation (suspension)Axial Fixation (suspension)

Vertical Fixation

In using vertical fixation the rope is fixed so that it hangs vertically above the centre of gravity of the part to be suspended.The centre of gravity of each part of the body is, on the whole, at the junction of the upper and middle third. Vertical suspension is used for support as it tends to limit the movement of the part to a small-range pendular movement

Vertical Fixation

Vertical fixation is used primarily to support, e.g. the abducted upper limb when the elbow is to be moved is supported from above the centre of gravity of the arm and axial fixation is used over the elbow for forearm movement

Axial Fixation

This occurs when all the ropes supporting a part are attached to one 'S' hook which is fixed to a point immediately above the centre of the joint which is to be moved,e.g. if the lower limb is to be moved at the hip joint, two ropes, one to the foot and one to the area of the knee, will be used and fixed at a point immediately over the axis of the hip joint When such fixation is set up the movement of thelimb will be on a flat plane level with the floor. In this way pure angular movements are obtained

Axial Fixation

If some resistance to the muscle work is required, then the whole fixed point is moved away from the muscles which require resistance.If abduction is to be resisted the fixed point is moved towards the adductors and the limb then falls towards that side, i.e. into adduction. On effort the limb will now rise into abduction brought about by isotonic shortening of the abductors, resistance being offered by gravity. Slow lowering into the resting position is controlled by isotonic lengthening of the abductors, with the movement assisted by the pull of gravity, and if at any time the abductors relax, the leg will drop into adduction.Safe Sling Selection & UseSling SelectionSling Insertion/PlacementSling AttachmentSling Removal

Sling SelectionChoosing the Appropriate SlingPatient handling taskPatient characteristicsLifting deviceUse Patient Handling Care Plan (Algorithms)

Sling Insertion/PlacementMethod ConsiderationsPosition of PatientPatient medical condition/sPatient ability to help

Safety ConsiderationsPatient comfortSheer forcesCaregiver safetyBarriers to Consistent & Safe Sling UseKnowledge GapsAwareness of sling types and designsTechnical knowledge regarding facility slings Sizes, types, weight limits, corresponding liftsProper sling selection guidelinesImportance of sling safetySling application processSafe sling use protocol and policy

Barriers to Consistent & Safe Sling UseSkill NeedsSling inspectionSling insertion and placementSling attachmentAssessing patient comfortMaintaining patient dignitySling removal

Suspension for the lower extremityThe HipAbduction and AdductionThe starting position is lying with the opposite leg abducted to its limit

The fixation point is immediately above the hip joint

abduction and adduction of hipOne sling is put under the lower thigh and one three-ring sling on the foot and ankle; each is attached to a rope hung from the fixation point May be utilized for the mobility or facilitation of abduction and adduction or resistance can be given manually of by shifting the point of fixation

The Hip for Abduction & Adduction

Hip Flexion Extension The starting position is side lying with the underneath leg flexed as far as possible

The fixation point and sling arrangements are as above, with the limb lifted until it is horizontal.Hip Flexion Extension If the movement of flexion is to be mobilized the knee and hip must be flexed together to overcome the passive insufficiency of the hamstrings

Equally, when mobilizing extension the knee should be extended to overcome active insufficiency of the hamstrings

Flexion and Extension of hip.

FLEXION AND EXTENSION of kneeThe starting position is side lying with one or two pillows between the slightly flexed thighs

One three-ring sling is applied to the foot and ankle and one rope attached to a fixation point above the knee joint.

Knee flexion and extensionBy keeping the hip slightly flexed on the trunk the foot can be seen each time the knee is extended and part of the arc of movement is thus observed by the patient. This position may be used to mobilize the knee joint or to work the flexors or extensors of the kneeKnee Flexion Extension

The Ankle

It is rarely necessary to use suspension as in this case it is easier to perform supported movements by using a polished board.

Suspension For Upper Extremity The shoulder joint ABDUCTION & ADDUCTION The starting position is lying, quarter turned towards the arm which is to be moved This allows the normal anatomical movement to be performed in the plane of the scapula.Abduction & Adduction of shoulder Alternatively, the starting position is prone lying, quarter turned towards side lying with a pillow under the trunk on the side of the arm which is to be moved The advantage of prone lying is that the therapist can see the movements of the scapula as well as those of the arm

Abduction & Adduction of shoulderTwo single ropes are required, one attached to a single sling under the elbow and one to a three-ring sling applied to the wrist and hand. The fixation point is over the shoulder joint.Glenohumeral rhythm may be re-educated and all the muscles performing shoulder girdle movements may be worked.Abduction & Adduction of shoulder

Flexion & Extension of shoulderThe starting position is side lying on pillows and quarter turned to the back. Female patients need two pillows under the head and one under the shoulder to allow the forearm to clear their wider pelvis. The slings and ropes are arranged as described above and again the movement may be limited to the glenohumeral joint and the muscles working over it, or movements of the shoulder girdle may be included.Shoulder External Rotation & internal Rotation If it is desired to perform rotation of the glenohumeral joint, Then only one sling should be used at the level of the elbow and a single pulley rope should be attached to the fixed point above the shoulder. The ends of the sling are attached to each end of the pulley circuit and it will then be possible to perform medial or lateral rotation with two angular movements

Flexion and extension of elbowBecause of the carrying angle of the forearm it is easier to perform these movements when the arm is suspended in abduction. The starting position is sitting on a low-backed chair. A single sling and rope supports the arm in vertical fixation, and a three-ring sling and single rope are fixed to a point above the elbow joint. The therapist should stand behind as she may need to give additional support by holding the arm with a grasp inside the sling, which will allow palpation of the flexors and extensors which are covered by the supporting sling.

Flexion and Extension of elbow

flexion and extension of wrist

This is more usually and conveniently performed on a polished board or table.

Flexion and Extension of Arm

As a functional movement this may be performed with the patient in the sitting position, e.g. practising taking the hand to the mouth may be done by using two single slings attached to two single pulley rope circuits.

Flexion and Extension of ArmOne sling is placed round the arm and one round the forearm. If the ropes are sufficiently tightened the patient can grasp, supinate and flex the elbow and shoulder while adducting and laterally rotating

Utilized for patients having problem in performing personal feeding, turning pages of book at eye level

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