1. Riverview IU6 Presents… Back Safety and Lifting Strategies in the School Setting. IU6 PT/OT Deptartment Fall 2011

2. Staff Introductions… Jill Shull, DPT –PT Jill Shull, DPT –PT Mariam Bankovich, PT Mariam Bankovich, PT Jennifer Hindman, DPT Jennifer Hindman, DPT Kathy Walton, MS OTR/L Kathy Walton, MS OTR/L Lisa Ryver, OTR/L Lisa Ryver, OTR/L Julie Hovis, MS OTR/L Julie Hovis, MS OTR/L KeLeigh Rice, COTA/L KeLeigh Rice, COTA/L Lacretia D. Lachnicht, OTR/L Lacretia D. Lachnicht, OTR/L Toni Riskus, COTA/L Toni Riskus, COTA/L

3. In-Service Objectives Discuss work-related injuries and symptoms Discuss work-related injuries and symptoms Educate participants on normal spine alignment, posture, and back safety Educate participants on normal spine alignment, posture, and back safety Educate participants on rules for lifting. Educate participants on rules for lifting.

4. Work-Related Injuries

5. 2009 Pennsylvania Department of Labor and Industry Injury Statistics Total recordable nonfatal injuries and illness for private illnesses was 3,277,700. Total recordable nonfatal injuries and illness for private illnesses was 3,277,700. Cases involving missed days of work was 965,000. Cases involving missed days of work was 965,000. Sprain and strain injuries cases totaled 379,340. Sprain and strain injuries cases totaled 379,340. Cases involving injuries to the back was 195,150. Cases involving injuries to the back was 195,150. Cases involving falls was 212,760. Cases involving falls was 212,760.

6. Common Work-Related Musculoskeletal Injuries Musculoskeletal injuries involve the nerves, tendons, muscles and supporting structures (i.e. intervertebral discs) Carpal Tunnel Syndrome Carpal Tunnel Syndrome Tenosynovitis, Tenosynovitis, Neck Tension Syndrome Neck Tension Syndrome Low Back Pain Low Back Pain

7. Common Symptoms Of Work- Related Musculoskeletal Disorders PainNumbnessTingling Muscle weakness Difficulty moving/walking Difficulty performing ADLs. Reduced worker productivity Lost time from work Temporary or permanent disability Inability to perform job tasks Increase in workers compensation costs

8. SAVE YOUR BACK!!!

9. Anatomy of the Spine Anatomy of the Spine… 7 Cervical Vertebrae 7 Cervical Vertebrae 12 Thoracic Vertebrae 12 Thoracic Vertebrae 5 Lumbar Vertebrae 5 Lumbar Vertebrae 5 Fused Vertebrae 5 Fused Vertebrae Disks- between vertebrae acting as shock absorbers Disks- between vertebrae acting as shock absorbers Curves of spine should be maintained for correct posture, body mechanics and safe lifting Curves of spine should be maintained for correct posture, body mechanics and safe lifting

10. Radiograph of Normal Cervical Spine

11. Radiograph of Cervical Spine with Pathology

12. Radiograph of Normal Thoracic Spine

13. Radiograph of Normal Lumbar Spine

14. Back Safety Tips

15. Identifying Poor Posture and Risks Prolonged sitting is the enemy (>20 min without position change is harmful) Prolonged sitting is the enemy (>20 min without position change is harmful) Avoid slouched posture or rounded back and forward head Avoid slouched posture or rounded back and forward head Frequent or repetitive stretching at end Range of Motion Frequent or repetitive stretching at end Range of Motion Heavy loads offer greater risks Heavy loads offer greater risks Repetitive, forceful, or prolonged exertions, or frequent heavy lifting, pushing, pulling or carrying of heavy objects Prolonged awkward postures Avoid bending at the waist or neck Avoid repetitive twisting

16. Sitting Tips  NO SLOUCHING!!!  Sit upright with shoulders and hip in alignment  Hips, knees, and ankles at a 90 degree ankle  Feet flat on the floor  Arm rest with 90 degrees at elbows

17. Computer Position Keyboard- 25-26 inches above floor = elbow height. Keyboard- 25-26 inches above floor = elbow height. Monitor height- 23-33 inches above floor = top of print level with level of eyes. Monitor height- 23-33 inches above floor = top of print level with level of eyes. Monitor- tilt to decrease glare and do not place near window. Monitor- tilt to decrease glare and do not place near window. Frequently used items should be within 14 inches from front of desk. Frequently used items should be within 14 inches from front of desk.

18. Decrease Strain On Body The following may be needed in order to ensure proper body alignment- The following may be needed in order to ensure proper body alignment- Foot rest Foot rest Wrist rest Wrist rest Swivel chair Swivel chair Document holder Document holder Proper Lighting (overhead and task oriented) Proper Lighting (overhead and task oriented)

19. Prevent Upper Body Fatigue Keep upper arms straight up and down in line with your body. Keep upper arms straight up and down in line with your body. Maintain elbows at 90 degrees. Maintain elbows at 90 degrees. Keep wrist in neutral- wrist should be straight when fingers are on home row of keyboard. Keep wrist in neutral- wrist should be straight when fingers are on home row of keyboard. Utilize wrist rests or arm rests. Utilize wrist rests or arm rests.

20. Standing Tips

21. Stand upright to ensure that a vertical line goes from the ear, to shoulder, hip and ankle (this position puts less stress on neck and back muscles) Stand upright to ensure that a vertical line goes from the ear, to shoulder, hip and ankle (this position puts less stress on neck and back muscles) Have work surface at elbow height Have work surface at elbow height Take breaks in between tasks and change positions!!!!!! Take breaks in between tasks and change positions!!!!!! Put frequently used items with in reach Put frequently used items with in reach Use a raised foot for one leg at a time Use a raised foot for one leg at a time

22. Standing Workstation Utilize a rubberized cushion or anti-fatigue mat. Utilize a rubberized cushion or anti-fatigue mat. Utilize a foot rest or stool to assist in changing position. Utilize a foot rest or stool to assist in changing position. Do not twist!...take an extra step. Do not twist!...take an extra step.

23. Lifting Tips…… Lift using your legs and keep your back in a vertical position Keep objects close to your body Do not bend at the back or neck Wide Base of Support Move your feet…do not twist.

24. GET HELP WHEN YOUR NEED IT! Always have a second person to assist you with any lift over 50 lbs Always have a second person to assist you with any lift over 50 lbs

25. Push, Don’t Pull Objects…

26. Adaptive Equipment in the School Setting

27. Equipment Power and Manual Wheelchairs Power and Manual Wheelchairs Hi/Lo Tables Hi/Lo Tables Walking Aides (Walker, Crutches, Cane) Walking Aides (Walker, Crutches, Cane) Mechanical Lifts Mechanical Lifts Adaptive Chairs Adaptive Chairs Slant Boards for Writing, etc. Adaptive Writing Utensils Adaptive Scissors Adaptive Feeding Equipment

28. Wheelchair Safety Always lock wheelchair brakes before placing a student in or removing him/her from a wheelchair. Always lock wheelchair brakes before placing a student in or removing him/her from a wheelchair. Place students in a wheelchair with his/her bottom as far back in the seat as possible to encourage upright posture. Place students in a wheelchair with his/her bottom as far back in the seat as possible to encourage upright posture. fasten hip or seat belts fasten hip or seat belts

29. Wheelchair Safety (Cont.) Check feet to make sure they are in the foot rests before fastening straps. Check feet to make sure they are in the foot rests before fastening straps. Always discuss the destination if you are escorting or pushing a student using a wheelchair. Do this regardless of the students level of assistance. Always discuss the destination if you are escorting or pushing a student using a wheelchair. Do this regardless of the students level of assistance. Always lock the brakes if you are coming to a stop, even if it’s for a few seconds. Always lock the brakes if you are coming to a stop, even if it’s for a few seconds.

30. Wheelchair Safety (Cont.) When outdoors turn the chair around and go backwards down short inclines and over curbs. When outdoors turn the chair around and go backwards down short inclines and over curbs. Watch for cracks in sidewalks so front wheels do not fall into and cause the chair to tip. Watch for cracks in sidewalks so front wheels do not fall into and cause the chair to tip.

31. Hoyer Lift

32. Indications for Using a Hoyer Lift Must be trained in proper use of equipment- all lifts are different Must be trained in proper use of equipment- all lifts are different If a student is dependent, assistance of 2 people is necessary to perform the transfer using a Hoyer lift If a student is dependent, assistance of 2 people is necessary to perform the transfer using a Hoyer lift Indicated for students who are unable to walk or bear weight through their legs without support Indicated for students who are unable to walk or bear weight through their legs without support Used to move students on/off of mats, chairs, wheelchairs and toilets Used to move students on/off of mats, chairs, wheelchairs and toilets YOU SHOULD BE TRAINED BY A PT OR OT IN THE SCHOOL SETTING BEFORE ATTEMPTING ANY TYPE OF TRANSFER YOU SHOULD BE TRAINED BY A PT OR OT IN THE SCHOOL SETTING BEFORE ATTEMPTING ANY TYPE OF TRANSFER

33. Transfer Tips for Moving Students Contact the PT/OT staff assigned to your district for child specific training Contact the PT/OT staff assigned to your district for child specific training Prepare the area for transfers-be as close as possible Prepare the area for transfers-be as close as possible Educate the student on what is about to occur Educate the student on what is about to occur Never grab a student by the arm to assist them Be sure the wheelchair is prepared (i.e. brakes locked, leg rests out of the way, and seat belt unbuckled) ALWAYS USE A GAIT BELT WHEN LIFTING

34. Safety Tips Always have a clear path Always have a clear path Make sure you can see Make sure you can see Assess the size of the load Assess the size of the load Do not hold your breath Do not hold your breath Allow time between lifting activities Allow time between lifting activities Push not pull Push not pull Face your work Face your work Take a movement break Take a movement break

35. If A Student Falls… Do Not Move The Student! Do Not Move The Student! First assess for injury and level of pain. First assess for injury and level of pain. If a fall occurred notify the nurse for an assessment and documentation. If a fall occurred notify the nurse for an assessment and documentation. Maintain the position of fall but make them comfortable and safe until the nurse completes the assessment. Maintain the position of fall but make them comfortable and safe until the nurse completes the assessment. Complete IU6 incident report form and notify your supervisor. Complete IU6 incident report form and notify your supervisor.

36. Prevention Proper posture and alignment Proper posture and alignment Good body mechanics Good body mechanics Good physical health and exercise Good physical health and exercise Rest Rest

37. Preventative Exercises

39. QUESTIONS?????

40. Quiz Time!!! Name a work injury__________________________ Name a work injury__________________________ Which is not a risk factor for a back injury? Which is not a risk factor for a back injury? Poor posture Poor body mechanics Poor posture Poor body mechanics Stressful living Decline in physical fitness Stressful living Decline in physical fitness Work Habits Type of shoes worn Work Habits Type of shoes worn Rest is a prevention for injury? T or F Rest is a prevention for injury? T or F Keep the curve in your’ lower back? T or F Keep the curve in your’ lower back? T or F Weight close to body weighs more? T or F Weight close to body weighs more? T or F Push don’t pull? T or F Push don’t pull? T or F Name a safety tip_______________________________ Name a safety tip_______________________________

41. THANK YOU & Have a great year!