KINESIOLOGY

Lesson
Suspension Therapy

M Farrukh Shahzad
BSPT, PPDPT

Faculty of Rehabilitation Sciences

review
Sling
Sling type
Type of suspension

Suspension for the lower extremity

Abduction and adduction of hip
Flexion and extension of hip
Flexion and extension of knee
The ankle
Abduction and adduction of shoulder
Flexion and extension of shoulder
Shoulder internal and external rotation
Flexion and extension of elbow
Flexion and extension of wrist
Flexion and extension of arm

Slings

Single Slings
Single 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
the
limb 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 & Use

Sling Selection
Sling Insertion/Placement
Sling Attachment
Sling Removal

Sling Selection
Choosing the Appropriate Sling
Patient handling task
Patient characteristics
Lifting device
Use Patient Handling Care Plan

(Algorithms)

Sling Insertion/Placement
Method Considerations
Position of Patient
Patient medical condition/s
Patient ability to help

Safety Considerations
Patient comfort
Sheer forces
Caregiver safety

Barriers to Consistent & Safe Sling Use

Knowledge Gaps
Awareness of sling types and designs
Technical knowledge regarding facility slings

Sizes, types, weight limits, corresponding lifts

Proper sling selection guidelines
Importance of sling safety
Sling application process
Safe sling use protocol and policy

Barriers to Consistent & Safe Sling Use

Skill Needs

Sling inspection
Sling insertion and placement
Sling attachment
Assessing patient comfort
Maintaining patient dignity
Sling removal

Suspension for the lower extremity

The Hip
Abduction and Adduction
The 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 hip

One 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 knee

The 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 extension

By 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 knee

Knee 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 shoulder

Two 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 shoulder

The 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 elbow

Because 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

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 Arm

One 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

TOPIC