Choosing an Overhead Hoist

Private Occupational Therapists

Occupational therapists in private practice can carry out assessments in the home or workplace, and if home modifications are being considered, provide a report detailing the recommendations. It is important to ensure the therapist is experienced in relation to your particular needs. Make sure to discuss fees before engaging anyone’s services, and also check what the assessment fee includes (or does not include). The profession’s representative body, the Association of Occupational Therapists in Ireland (AOTI), keeps a list of contact details of member occupational therapists working in private practice in Ireland. This list is available from the AOTI (see Useful Addresses).

Private Physiotherapists

Physiotherapists can assess for movement, strength and balance training equipment, walking aids and exercise devices and recommend accordingly. If you wish to consult a physiotherapist you can go directly to your local chartered physiotherapist or ask your GP to refer you. It is important to ensure the therapist you consult is experienced in relation to your particular needs. Chartered physiotherapists work in hospitals and in the community where treatment is covered under the public health service. They also work in private practice and can be contacted through the profession’s representative body, the Irish Society of Chartered Physiotherapists (see Useful Addresses), or through the Golden Pages.

If you decide to buy equipment privately it is strongly recommended to seek the advice of an appropriate therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.

You can arrange to visit a supplier’s showroom (if they have one). Contact details of suppliers can be found under ‘Disabled Persons Products & Services’ in the Golden Pages and some may have a website with details of their products and services which you can view online. Another source of information on suppliers of assistive technology, aids and appliances is the Access Directory. This directory is produced commercially each year and copies are widely available (see Useful Addresses).

Sometimes suppliers organise exhibitions of different types of equipment in various locations around the country allowing people to see and try equipment. These exhibitions are often advertised in the local paper or on local radio. You can also request to be put on a supplier’s mailing list so you will be notified if there is an event being held in your area.

Some companies will give equipment for a try-out period before purchase. Enquiries should also be made about maintenance (if it will be required), maintenance contracts (if relevant) and whether a user manual is provided with the equipment (essential).

When purchasing from any supplier, it is important to remember that it is their business to sell. There may be several suppliers of that particular piece of equipment or different manufacturers of the same type of equipment, so always shop around.

Free-hanging curly cable

Power is provided from the mains by a loop of curly cable that is connected to the hoist. The cable moves and stretches as the hoist moves along the track. However, the curls in the cable over stretch eventually and can hang down which may be hazardous.

Cable along the track

The cable providing the power from the mains is looped along inside the track so there is no cable hanging down.

Conducted through the track

This type has no power cables but has a power conductor rail built into the aluminium track. This carries the power and transfers it to the hoist via a specially designed trolley. This eliminates the need for travelling cables and is therefore suitable for longer length tracks.

Rechargeable battery

A rechargeable battery eliminates the need for travelling cables and is another alternative for longer length tracks. The battery is built into the hoist. It is essential that the battery be recharged regularly, by returning the hoist to the end of the track to make good contact with the battery charger. Unfortunately, this is easily overlooked and the batteries may fail. In the event of a mains power failure, if the batteries are well charged, the hoist should still have enough power to complete the existing manoeuvre and several others.

Straight track

This carries the hoist from one place or room to another in a straight line. Pick up points for the person being transferred are limited to anywhere below the track.

Angled track

Different track angles enable the hoist to go round corners, bends etc. However 90° angles may be difficult to negotiate.

Turntables

A turntable enables a person who is moving along the track to turn through 90° without having to negotiate a tight angled track. The person and the hoist move onto the turntable. By pushing a button or using pull cords, a mechanism is released and the straight piece of track on the turntable swivels through 90°. The hoist user can then move onto a track running in a different direction.

X-Y tracking system or H tracking

Some companies can now install manual and/or powered X-Y systems which enable a person to be lifted from practically anywhere in a room. This is achieved by installing two parallel tracks on each side of the room either on the ceiling or on opposite walls. A moving section of track up to 5m in length runs between the parallel tracks. However, this type of track can only be used within one room or area.

Gantry frames

These are floor-standing frames, which can be used with a mains powered permanently attached hoist unit or a battery powered portable hoist unit. They usually stand over a bed and are useful for:

• people who are terminally ill,
• people who are going to be moving, re-housed etc,
• people who do not want or can not have a permanent hoist fitted in their home.

Some are heavy and awkward to set up and do not always feel very stable during transfers. Lightweight versions are available which are much easier to set up and dismantle.

Wall-fixed hoists

These have support frames, which need to be permanently fixed to the wall. There are two main types.

• Swinging hoist - These are mains powered hoists which can be swung through 90° or more and are controlled by a hand-held control.
• Swinging frame with portable battery-operated hoist attached - Portable battery operated hoist units can be hooked onto wall attached booms which will swing through 180°.

These can be particularly useful in a nursing or residential home, where hoist use is constantly changing so that it may be worth putting a swinging frame in every room and attaching the portable hoist whenever it is needed.

Free-standing hoists

These have a floor standing frame - similar to a lifting pole - with a boom and spreader bar that swings through 90° or 180°.

These hoists can be used:

• for transferring short distances, eg bed to chair or wheelchair, wheelchair to toilet,
• when lack of space makes the use of a mobile hoist impossible,
• when client preference or the structure of the building makes the use of an overhead hoist on a track or gantry impossible.

They are useful in similar situations to gantry frames.

Manual traversing

This requires the carer to move the person, in the sling, along the track. The design of the wheels on the hoist motor trolley makes this easy to do. However, it obviously still requires more effort than a powered traversing mechanism, and may pose an increased risk of back injury to the carer. Benefits include:

• the carer is able to control the speed at which the person is moved along the track,
• manual traversing tends to produce a smoother start than powered traversing.

Powered traversing

This enables the person to move along the track independently or the carer to move him/her with minimum effort.

• The carer is unable to control the speed at which the person is moved which may be a disadvantage.
• Powered traversing tends to produce a jerky start to which both the person being moved and the carer may take some time to become accustomed.

Powered lifting mechanism

All overhead hoists have a powered lifting mechanism which will reduce the risk of back injury to the carer.

Weight capacity of hoist

Check that the weight of the person does not exceed the capacity that the hoist has been designed to work at safely.

Lifting range

Powered traversing tends to produce a jerky start to which both the person being moved and the carer may take some time to become accustomed.

Emergency lowering

Most overhead hoists have a system to lower the person in an emergency. Either there is a battery powered back-up for lowering or the hoist is wound down.

Emergency traversing

Hoists powered by an in-built rechargeable battery store power and work for a limited period regardless of the mains electricity. Mains connected hoists do not usually have an alternative emergency power source for traversing.

Automatic cut out switch

This will enable the carer to stop the hoist immediately if there is an emergency.

Controls

There are various different types:

• Handset - the carer can operate the controls while standing close to the person so that he/she can provide assistance and support during the manoeuvre. Controls should be clearly labelled; otherwise they are often used upside-down, and the person will be moved in the wrong direction.
• Splash proof - enables the hoist to be used safely in the bathroom where the handset can be used in or near the bath or shower.
• Pull-cord mechanism - works on a two-way, pull-cord system.
• Infra-red - this has an infra-red sensor on the hoist. It enables the person to use a remote control to move the hoist out of the way along the track when not in use and bring it back into position when required.

FACTORS TO CONSIDER WHEN CHOOSING A SLING

The choice of hoist sling will depend on:

• the amount of support required,
• tasks which need to be undertaken,
• the comfort of the person being lifted,
• the ability of the person being lifted, especially if he/she is moving independently,
• the ability of the carer.

Consider the following:

• Sizes - slings always come in a range of sizes but beware, corresponding sizes will vary from one company to another, in the way that shoe sizes often vary. It is very important that the person always uses the correct size of sling, even if this means changing it if he/she gains or loses weight.
• Colour coding of slings - although many manufacturers colour code their slings for size, at the moment there is no consistency between the companies which can prove very confusing.
• Loops on the slings - these are for positioning the person correctly in the sling, not for trying to make a sling that is too big or too small fit him/her. It may take several attempts to successfully position the person so that he/she is comfortable. Once this has been achieved, it is worth marking the loops agreed to avoid wasting time in the future.
• Amount of fabric - the more fabric there is in a sling, the more support it will offer and the larger the area over which the persons weight will be spread. Hence, hammock slings, which have more fabric, cause less pressure and are therefore usually more comfortable than toileting slings. This is particularly important for people who are susceptible to pain.
• Points of suspension - the more points of suspension for the sling on the spreader bar, the less scrunched up the person will be. Two points of suspension are standard, although some have three or four. Others can be converted to four using side hanger attachments. Again, this is an important consideration for people who are susceptible to pain.
• Sling fabrics and linings - a range of different sling fabrics and linings is available. Padded and lined leg pieces tend to be more comfortable and easier to put on, mesh slings are easier to use in the bath and, if the person is sitting in a tightly moulded seat, an easy slide sling is easier to use.
• Compatibility of slings – some manufacturers stipulate that only their own slings can be used on their hoists. This is to ensure the sling connections are correct and users have clear instructions how to use the sling and hoist. It also because of liability in the case of an accident. Sometimes slings have to be used on hoists manufactured by other companies. It is essential that sling and hoist are compatible and advisable to get written permission from both the hoist and sling company.
• Specials - the majority of manufacturers will adapt and produce special slings to accommodate the specific needs of a person and some companies produce made-to-measure slings for most makes of hoist. However, a sling can take up to eight weeks to make and can be expensive. In addition, there is no guarantee that it will solve the problem, as there is no way of trying it before it is made. Always ensure that there is not an off-the-shelf sling available that would be suitable before ordering a special. Try out different styles and sizes.

When putting on slings in bed, try to raise the height of the bed to a position that is comfortable for the carer to work at.

When putting on slings in a wheelchair, commode or armchair, remember the following:

• Leave the leg/footrests on the chair as this makes it easier to get the slings under the thighs.
• The carer should NOT stand up and bend over to lift one or both of the legs to position the sling underneath.

Remember that, when trying out new slings, it may take a few attempts to find the most comfortable position, and that the first sling that is tried may not be the correct size and/or shape.

Advantages

• Can be put on and taken off easily in most positions: sitting, lying, on the floor etc.
• The person may be able to put it on independently.
• Provides good access for toileting/washing.
• Provides a choice of leg positions.
• With the leg bands in the crossed position and with the correct sized sling, it is virtually impossible for the user to fall out.
• No user co-operation is required.

Disadvantages

• Need to remove clothes for toileting before hoisting which may involve first transferring onto a bed.
• Leg pieces may be uncomfortable (see below).
• With both leg bands under both legs, the person may, if he goes into extensor spasm, slide out of the sling.

Comfort

• Adequate support will not be provided if the leg pieces are too narrow, or they are not positioned under the mid thighs.
• Padded or lined leg pieces are less likely to crumple when used in the crossed position and will therefore be more comfortable.
• Some companies have a loop system, which holds the leg pieces together without having to cross them over. Therefore, they will not crumple at all.

Advantages

• Can be put on in most positions: sitting, lying, on the floor etc.
• The person may be able to put it on independently.
• Provides good access for toileting/washing etc.

Disadvantages

• It does not provide enough support for everyone. Those with little or no muscle tone in their legs may slip through the sling.
• Although it is available with head support, most people who do not have head control will rarely have the necessary trunk control and the sling will not be suitable for them.
• The thoracic/waist band may feel restricting although it does not have to be done up tightly.
• It requires the co-operation of the person as he/she could slip through the sling if he/she raises the arms above the head.

Comfort

• Padded or lined leg pieces are more comfortable and do not crumple.
• A loop system to keep the legs together rather than crossing over the leg pieces is more comfortable and easier for the carer.
• The leg pieces should be positioned under the mid-thigh so that adequate support is provided.

Advantages

• Many people find them very comfortable as the bodyweight is supported over a large area of material and therefore pressure areas are unlikely to form.
• No user co-operation is required.
• It provides very good support.

Disadvantages

• The sling is not easy to take on and off. The person usually needs to be rolled onto it in a lying position.
• The person is not able to put the sling on independently.
• Provides little or no access for toileting/washing.
• When a commode aperture is present, it may be difficult to line it up accurately.
• If the person is being transferred into a chair or wheelchair, he/she may have to remain sitting on the sling as it will be difficult to re-position it when the time comes to get out of the chair.
• If the sling is fitted incorrectly and the person goes into an extensor spasm, it is possible that he/she could slide out of the sling.
• If being used for bathing, for example, clothes must be removed before hoisting and then he/she will have to return to the bed to get dressed again.

Comfort

• Can be comfortable for people with widespread pain, such as with rheumatoid arthritis, as it provides full body support.
• If used in conjunction with coathanger spreader bars, the person will be less scrunched up and therefore even more comfortable.