Friday, December 2, 2011
Devices for Helping to Transfer a Person with ALS
by Shelly Lewis, Physical Therapist
and Scott Rushanan, Occupational Therapist
ALS Center at Pennsylvania Hospital
A few Pennsylvania Hospital ALS clinic team members recently attended in-services on two standing lift devices--the EZ pivot and molift models. The instruction we received at these lectures confirmed that these devices are not the best option for most PALS (Persons with ALS).
One drawback of these devices is that they can only be used once the PALS is already in a seated position. The straps that are used to operate the device have to be donned while the person is already sitting in a chair or sitting at the edge of a bed. These devices cannot safely be used for moving PALS from a lying position in the bed to a seated position at the side of the bed. This activity can be very difficult for PALS who have significant weakness.
Even if the person being transported is able to move from a lying position in the bed to a seated position at the side of the bed, the straps on any of these lifting devices are difficult to don while seated. The straps have to be wrapped around the trunk, legs, and, in the case of the EZ pivot, buttocks of the person being transferred. Any PALS with decreased strength in the trunk and arms may find it difficult to maintain his or her sitting balance at the edge of the bed while a caregiver places these straps around them.
Another problem with these devices is that they are not made to be used with someone who has significant progressive weakness in the legs. They are designed to be used with individuals who have moderate weakness in cases where strength is either stable or expected to be regained. These devices will not work properly if the person being lifted is unable to stand partially or bear weight through his or her legs. As a matter of fact, the vendor of the molift said the product was not appropriate to use on persons who cannot or should not stand on their own, without the lift. There is the potential for injury if a person who is unable to bear any weight through his or her legs uses one of these lifts.
In addition, none of the vendors we spoke to were able to get their devices paid for by insurance. These are costly items and it is rare to find a company that will rent them to you. In some cases, insurance will give you an allowance for a lift device, but you would still be left with a bill of several thousand dollars after the allowance. Most vendors will make you pay the cost of the entire device upfront and then have you haggle for the partial reimbursement with your insurance.
The EZ pivot had a few additional issues that would make it difficult to use - it requires much effort for the caregivers when lifting PALS, as it is not hydraulic. Also, it puts the person being lifted in a position that closes off his or her chest and diaphragm (which could be a problem for PALS with respiratory
difficulties). In addition, the EZ pivot straps would be extremely difficult to put on a person who had poor trunk control even if they were seated in a supportive wheelchair. A PALS who trialed the EZ pivot in his home for a few weeks said it was just too cumbersome for his wife to strap him in it so he returned the device.
There are a few positive things about these machines. They are less physically taxing than a dependent lift for the caregiver when going from chair to chair. They also give easy access for hygiene with toileting. However, these benefits do not seem to outweigh the drawbacks.
If you need a mechanical lift to assist with transfers, a hoyer lift is usually more appropriate. Use of the hoyer lift involves placing a sling-like piece of fabric under the PALS. The sling and person are raised using a hydraulic lift. The person is then pushed over to the next surface and lowered down. With a little practice, the lift can easily be used with the assistance of only one caregiver. This type of lift is almost always covered by insurance. In addition, this lift assists with moving between a lying down and seated position. Plus, the sling is much easier to put under the PALS than any of the standing lift devices. The actual space the hoyer takes up is very similar to the standing lifts.