Draft factsheet for reader feedback
Choosing equipment for the heavier person
Choosing equipment for the heavier person
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Choosing equipment for heavy duty use
- EQUIPMENT HIRE5
- WHERE TO GET HELP AND ADVICE5
- CONSIDERATIONS BEFORE BUYING EQUIPMENT6
- MOVING AND HANDLING EQUIPMENT8
- MOBILITY AND WALKING8
- WHEELCHAIRS AND SCOTERS10
- PERSONAL CARE11
- CLOTHING AND FOOTWEAR15
- SMALL HANDLING AIDS16
- HOIST AND SLINGS18
- USEFUL ORGANISATIONS22
- FURTHER INFORMATION23
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Disabled Living Foundation, 4th Floor, Jessica House, Red Lion Square, 191 Wandsworth High Street, London, SW18 4LS, Tel: 020 7289 6111, Fax: 020 7266 2922, Helpline: 0300 999 0004 10.00am-4.00pm, Email: firstname.lastname@example.org, Website: www.dlf.org.uk
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The aim of this factsheet is to provide an overview of equipment that is designed to enhance independence and comfort for the heavier person.
There is now a wide range of equipment available to enable independence.
While some of the products discussed in the factsheet will can be used independently by the heavier person some equipment will need to be used by carers. The changes in the body dynamics of a heavier person can contribute to risk of injury to both the person and the carer(s) during moving and handling tasks. Training in the correct use of equipment is essential and purchases of certain products (e.g. a hoist) should follow an assessment and recommendation by a professional person (occupational therapist, moving and handling practitioner) to ensure the safety of the user and carer(s).
When you are looking at products you may find different terms in use;
- a heavier person may also be described as a bariatric person or plus sized person
- equipment may be described as bariatric equipment, heavy duty equipment, moving and handling aid
- equipment and product are the same
- weight limit, Safe Working Load (SWL), weight capacity, load capacity all mean the same
bespoke equipment – equipment tailored to the individual persons needs
Assessment of the environment is essential before making choices.
Choice of equipment will be affected by the changing weight, size and shape of the heavier person.
Equipment must fit through doorways and should not cause an obstruction within the room it is to be used in. If it is to be used on an upstairs floor, a safe method of moving the equipment between floors as well as the load capacity of floors and ceilings must be determined by a structural engineers or other suitable qualified person.
While some equipment suppliers have a range of ‘heavy-duty’ off the shelf products, there are manufacturers that specialise in manufacturing bespoke equipment.
Many suppliers offer a hire service. Contact the Disabled Living Foundation Helpline for contact details.
WHERE TO GET HELP AND ADVICE
For up-to-date product and supplier information, please contact our equipment helpline, open Tuesday to Thursday 10am-4.30pm, tel: 0300 999 0004 (calls charged at local rate); or if you use a mobile it's cheaper to ring: (020) 7432 8018 (calls charged at standard rate). Alternatively, you can write to our letter enquiry service or contact us via email at email@example.com To help us give you a concise and informative reply, please provide us with as much detail as possible including information on the difficulties you are having and any solutions you have considered, including equipment you already have any ideas you have.
If further help is required contact your local social services for a community care assessment. The assessor will consider personal needs – whether they are simple or complex; whether they are many or few; and whether they are essential to independence and quality of life. If the client qualifies for help their needs will be more fully assessed to identify hazards with moving and handling the heavier person.
Help may be provided by providing extra carers; and/or equipment that will make managing tasks at home easier.
People don’t have to accept the service or equipment offered by social services. Instead, they are entitled to ask for a direct payment that is a cash alternative, equivalent in value to the service/equipment they would have received. This money must then be used to independently organise relevant services or to buy appropriate equipment. Social services, using Government guidelines, will make a decision on an individual’s capabilities to organise their own services when deciding on whether a direct payment will be appropriate.
Funding equipment Charitable trusts may sometimes provide funding for equipment. A useful resource is www.turn2us.org.uk , a website that allows you to search for organisations that give grants, including for equipment and other services. You can refine / filter your search by specific health issues such as 'physical disability', 'ageing' or 'rheumatism'. If you're over 60, Charity Search is a free service to help you find a grant-giving charity www.charitysearch.org.uk
Charities will only give awards in accordance with a predetermined criteria, so it is important that you carefully select the trusts you apply to.
Most libraries hold directories of suitable funders in their reference section, such as the The Directory of Grant Making Trusts The Grants for Individuals website is run by the Directory of Social Change and lets subscribers search for grants but is intended for organisations searching for funding for individuals. http://www.grantsforindividuals.org.uk
Try equipment before you buy If you decide to buy equipment privately it is best to try and compare the different ranges first. You may have an equipment demonstration centre near you where you can visit to view and try out ranges of equipment. You will receive impartial advice to help you choose appropriately. However, centres may not display examples of all the equipment in this factsheet. You will need to contact your nearest centre to find out what they have and to book an appointment. Contact details for your nearest Equipment Demonstration Centre can be found on the Disabled Living Foundation's web page Equipment Demonstration Centres in the UK.
Be cautious of sales people who try to persuade you to buy equipment that may not meet your needs fully or is over-priced. Buying from a company that belongs to a trade association, such as the British Healthcare Trades Association (BHTA) may give you some reassurance. BHTA members have signed up to a code of practice governing standards of customer service (see Useful organisations).
You don't have to pay VAT on products designed for disabled people if you have a long term illness or disability, or are terminally ill. Mobility shops may automatically sell you equipment without charging you VAT, but you may have to ask. Individuals with a temporary injury such as a broken arm or hip do not qualify for VAT relief. For more information, and to check for any changes in the regulations visit the GOV.UK, VAT relief on products and services for disabled people or the HM Revenue & Customs reduced rate VAT webpage (their Charities Helpline covers VAT relief for disabled people: Telephone: 0300 123 1073)
CONSIDERATIONS BEFORE BUYING EQUIPMENT
The expertise of a professional person (physiotherapist, occupational therapist or a Moving & Handling Practitioner) who has specialised knowledge of moving and handling equipment can help when choosing equipment. Heavier people often have other complex needs, which must be considered and a professional assessment will ensure all these factors are considered to recommend the right type of product. You can contact your local social services and ask about an assessment. GOV.UK website
Private physiotherapist If you wish to request a private appointment with a physiotherapist then you can obtain a list of local physiotherapists who offer private services from the Chartered Society of Physiotherapists at www.csp.org.uk or tel: 020 7306 6666 or Physio First www.physiofirst.org.uk/
Private occupational therapist If you wish to request a private appointment with an occupational therapist then you can obtain details of local private occupational therapists from the 'College of Occupational Therapists Specialist Section Independent practice' (COTSS-IP) website. www.cotss-ip.org.uk or phone their enquiry Line: 020 7989 0681.
If you do contact a private physiotherapist, or occupational therapist, make sure they are registered with the Health and Care Professions Council (HCPC). The HCPC is responsible for the conduct, performance and ethical behaviour of its registrants. Health care professionals who do not meet the standards of practice, conduct and behaviour required by the HCPC are removed ('struck off') from the register. Visit the HCPC website to check the registration status of a physio or occupational therapist.
To provide you with some helpful hints, consider: -
Capacity of equipment (Safe Working Load SWL)
The equipment must be strong enough to support the heavier person’s weight (and reflect possible changes in the person’s weight and size e.g. increase or decrease) and must not exceed the product’s SWL.
Ability of the heavier person
A person’s ability may change over time and due to changing health needs: which may include: -
- Muscle weakness;
- Restricted movement caused by size;
- Pain from over-stressed joints;
- Pressure ulcers.
Ability of the carer(s)
Any person expected to use equipment must have received training prior to its use. This should be facilitated by a professional trainer or attending a relevant course e.g. those organised by DLF. Make sure you discuss the level of training provided by suppliers; more complex equipment will require more detailed training.
This is a very important aspect to consider when purchasing equipment for your home, common restrictions include:-
- Layout of the home e.g. bedroom toilet/bathroom and living room;
- Size of rooms;
- Doorway widths - the average door opening may not be wide enough for larger equipment;
- Thresholds and changes in floor surface limiting movement of wheeled equipment;
- Space for free movement of equipment and the carers;
- Moving heavier equipment up/downstairs;
- The Load bearing capacity* of the floor or ceiling;
- Height of ceiling;
- Storage spaces for equipment e.g. hoist.
* A structural engineer (council or private) can advise on these issues
Weighing the heavier person
It is important for the heavier person and for that managing their care needs to know their weight. The weight of the person is essential to ensure the correct and safe choice of equipment. Domestic weighing scales will have a limited weight capacity but are readily available from high street stores.
Larger capacity scales are available with a standing platform, a chair or a ramped platform to take the person in their wheelchair.
Some hoists have the option of a weighing scale attachment.
Beds are also available with integral weigh scales.
Many suppliers offer a weighing service, which may have a cost implication.
MOVING AND HANDLING EQUIPMENT
Mobility and Walking
It is not advisable for a carer to assist a heavier person to walk because of the risk of injury to both the person and the carer if the person being assisted falls down.
Walking aids can provide support: walking sticks, crutches and frames are available for the heavier person from a range of suppliers.
Walking frames are designed to provide additional support during walking. Not all frames will accommodate the larger person. Before considering the purchase of any walking aid seek professional advice to ensure that the equipment is suited to individual needs, environment etc.
Walking frames should not be used to assist standing but can be useful if positioned nearby so the person standing can hold on to them for support once standing. Frames can also be useful to provide steadying support whilst a carer assists with dressing.
Wheeled walking frames are pushed forwards rather than lifted and can be less cumbersome to manoeuvre in certain environments. However some floor surfaces and environments may not be suitable. Some have a tray or basket attachment making it easier when moving items from one area to another.
Overhead hoists and some mobile hoists can be used to support a person in standing. The person’s body weight is partly supported in a walking harness. Whilst this procedure is more commonly used as part of a rehabilitation programme it may be used at home in certain situations.
Getting up and down stairs
Ideally all facilities would be provided on the same level e.g. bathroom/toilet, bedroom, living room and kitchen – but this is not always possible.
A second stair rail can help to move up and downstairs, the rail must be securely fixed and provides additional support for the larger person.
It is possible to install a stair lift in some properties for the heavier person.
Professional advice from a structural engineer must be sought before adaptations to a property are made.
Use of a manual wheelchair has limitations for both the heavier person and their carer(s).
Wider wheelchairs are difficult for a single carer to manoeuvre over any distance or restricted environments.
Advice should be sought when considering purchase of a wheelchair to ensure the correct design is identified.
Wheelchairs should be fitted with a cushion that corresponds in size to the wheelchair seat and which is suitable for the person’s weight. The cushion should be ordered at the time of the wheelchair.
Powered wheelchairs & scooters
A range of powered wheelchairs and scooters are available to aid independent living. Their size and level of manoeuvrability can make it difficult to use them in the average home; however, they can provide independent outdoor mobility. Not all scooters are capable of climbing kerbs and so consider the environments in which you might want to use this type of product.
Both powered wheelchairs and scooters can be driven forwards and in reverse, and although reverse may not be used that often, it is needed for tight manoeuvring in smaller spaces. If the driver has difficulty turning to see behind them, wing mirrors might help.
Certain models have detachable armrests that make it possible to transfer into the seat from the side or using a hoist.
The controls for wheelchairs are either positioned on the armrest or at the back to enable a carer to take control.
Some scooters have a swivel seat to help when getting on and off: often the armrests can be flipped back to improve access. Armrests when in use (down) provide a hand-hold support when sitting or standing up, but may restrict the width within the seat and ease of movement/repositioning. Scooter controls are mounted on a tiller that is turned left and right to steer. It is important to check the space between the seat and the tiller to ensure that controls can be easily reached.
Both powered wheelchairs and scooters need to be stored in a secure place and with larger vehicles a garage or shed is often required. Batteries must be charged up regularly using a charger that plugs into the mains. The position of the charging point on the vehicle will affect how easily the operator can manage this independently.
The bathroom environment in most homes is small making it particularly difficult for larger people to access and use standard features e.g. bath or lavatory. This situation is made more difficult and restricting if additional equipment and/or carer(s) are required to assist. Potentially more space can be created by: -
- Removing the wall separating the toilet and bathroom (if the two are adjacent to one another);
- Changing an inward swinging door to an outward swinging / sliding door to improve access and be less restricting within the bathroom;
- Removing the bath and exchanging it for a level access shower;
- Conversion of the bathroom into a wet room.
Ensure you contact a structural engineer to discuss options before proceeding with any work to your home.
Generally bathing is not an option for the larger person; personal care is most often a:
- Strip wash at a wash basin;
- Assisted shower.
Assistive equipment is available to enable as much independent personal care as possible from long handled brushes to shower chairs and grab handles.
A heavy duty perching stool can be used to rest on whilst washing at the wash basin. Armrests on the stool provide some sideways security and a handhold to push on when standing up.
Whilst showering provides a more satisfactory alternative to bathing, the needs of other household members should be considered, the usual option is to replace the bath with a shower, or convert the bathroom into a wet room.
Half doors across the front of a shower cubicle or to section off a shower area will be less restricting than a completely enclosed shower, reduce water spillage out of the area and can help to keep the carer dry.
Professional advice from a structural engineer must be sought before adaptations to the property are made and considerations are:
- Weight limit of shower tray;
- Weight distribution of the shower chair;
- Porcelain or acrylic shower trays;
- Level access height and design of shower controls;
- Position of grab rails.
Where mobile shower chairs are to be used - check the thresholds and floor surfaces to ensure movement of the shower chair will not be impeded and that it can be turned within the bathroom and manoeuvred within the shower. Brakes are essential to keep the chair stationary during transfers and when in use
People, who spend the majority of time in bed, may be able to transfer onto a
mobile shower chair/shower table using a hoist. If this is not possible a bed bath would be the only option, so an electric profiling bed is essential for the carers and access to both sides of the bed would be required.
Whilst the safe working load of the toilet is important to consider, just as important is the way in which this is to be mounted - a wall mounted toilet will generally have a lower weight limit. Seek professional advice to identify the safe working limit if considering this type of option.
A standard sized toilet seat is often inadequate and causes pinching. Toilets are available for the larger person: providing a wider deeper seat and higher weight limit. For certain designs the size of the aperture remains similar to a standard toilet (so it can safely be used by children).
A standard toilet can be adapted in a variety of ways to make it more comfortable and to provide better support, although space around the toilet can limit any adaptation.
A raised toilet seat can give a higher sitting position but seat size is similar to a standard toilet. The seat must be firmly secured and it is generally safer to choose a design which replaces the existing toilet seat and uses the bolt-holes at the back of the pedestal to secure it.
When cleaning oneself it is easier if there is a substantial cut-away at the front of the seat.
Grab rails on the wall can provide a handhold to assist standing. If wall-fixing alone is not adequate, some drop-down rails can have an extra support leg, distributing some of the load through the floor. These need to be mounted on the wall behind the toilet.
Another option is a floor to ceiling rail that is secured with screws at both ends, and can also have a separate horizontal rail attached to the side wall.
A raised toilet seat frame combines a raised seat on a frame, and can be adjusted in height to suit the stature of the heavier person. Some styles have a squarer seat giving a larger area to sit on. Frames can be bolted to the floor to prevent tipping.
When considering purchase or installation - check that there is room either side of the toilet and plumbing to accommodate the frame. Toilet chairs are also available that include a backrest to increase comfort and stability. Check that the chair backrest doesn’t obscure the toilet flush.
Some toilet chairs are mobile so they can be positioned over the toilet (space permitting), and as with the mobile shower chairs, the person can transfer into the chair in another room (e.g bedroom, using a hoist if necessary).
Over-toilet chairs usually have a fitting to accommodate a commode pan. If there are occasions when the heavier person has restricted movement; the commode option can be used.
Combining a shower and a toilet chair will cut down on the amount of equipment in the home, and the number of transfers.
If access to the toilet is not possible, or the person is unable to move any distance, a commode will be required. A range of static commodes are available with features such as:
- Lightweight metal frame;
- Wide seat with different widths and depths of seat;
- Removable armrests;
- Removable backrest, (to make positioning on the commode easier if transfers are via a hoist);
- Height adjustment.
Check how the commode pan is positioned – some slide in from the back and this might present problems if the commode is placed with its back to a wall.
A mobile commode gives the opportunity to bring the commode to the person when the need arises, but then taken away and stored elsewhere.
Urinals are useful for people who are very immobile and also for emergencies when there’s not enough time to transfer to a commode or toilet.
Versions are available for both men and women, but are easier for men to use than women. A perching or sitting position is best although some designs can be used with the person lying down.
For women, it may be difficult to position the urinal and therefore some are designed to fit the female anatomy, those with a wider necked receptacle may be more useful.
Some people may suffer stress incontinence and will require extra padding. Please seek professional advice.
CLOTHING & FOOTWEAR
The design of clothing can influence how quickly it can be removed for toileting or personnel care.
Loose fitting clothing may be easier to manage and more comfortable for some larger people.
Avoiding clothing styles that could cause restriction to blood flow or irritation such as tight straps, waistbands, collars, cuffs and sock/stocking tops is an important consideration.
Clothing should be considered for ease of wear and laundering. Front fastenings are better for independent dressing. Small fastening will be difficult for large or oedematous fingers to manipulate. Velcro can be used to replace buttons, but be sure that the garment is generous in size or Velcro will part under strain.
For men, trousers with a long length fly zip helps when positioning a urinal. Edgware braces or pant locks stop trousers falling down when they are dropped to sit on the toilet (contact Disabled Living Foundation Helpline for further information).
For women, fuller skirts and dresses are easier to adjust when using the WC. It’s generally easier to pull up the bottom layer than pull it down. Wrap over designs can help by being easier to put on and because the overlap can be pulled open.
It can be difficult for women to find under-garments comfortable to wear. Wide-legged French knickers are less likely to restrict, and if lose enough can be pulled to one side to use a urinal. Bra straps can be made more comfortable by fixing a padded guard to the shoulder strap, and the back can be lengthened by using an extender that hooks onto the existing back fastening.
The Disabled Living Foundation Helpline can supply addresses of mail order suppliers for the larger person.
For some people swollen feet and joints can be particularly painful. The arches of the foot may have fallen and may need support within the footwear.
People with poor circulation and reduced sensation may have difficulty keeping their feet warm. Thicker soles give more heat insulation. Fleece-lined slippers can be worn when at rest.
Footwear that opens to the toe is easier to wear. Extra width and depth can accommodate swollen feet. Supportive insoles can make weight bearing more comfortable. Soft leather and cushioning can protect the skin against pressure ulcers.
A long handled shoe horn can help to put shoes on. Reaching down to do fastenings may be difficult. Velcro is easy and can also be adjusted if swelling varies throughout the day.
If off-the-shelf footwear is not suitable, footwear can be made-to-measure. This is sometimes available through a local hospital or via a G.P. referral; alternatively it can be bought privately.
The British Footwear Association has information on suppliers of ‘hard to find footwear’ on their web site www.britishfootwearassociation.co.uk or contact the Disabled Living Foundation Helpline information.
Small Handling Aids
There are transfer boards with a greater SWL for heavier people.
Transfer boards are predominantly designed for independent use and are used to bridge the gap between two surfaces (e.g. bed and wheelchair) to enable a person who is unable to stand to transfer.
There are risks associated with assisting in the use of transfer boards for the heavier person and their use is not suitable for all people; their use should only be implemented following a professional assessment.
The user must have sufficient strength in their arms to assist themselves during the transfer.
Slide sheets (flat, tunnel, roller)
These are products used as repositioning aids by the user or carer(s). Use of the slide sheet (or equivalent) may require additional carer(s): they should only be used after appropriate assessment and training in their use.
This type of product is available from a range of suppliers in different sizes.
Assisting a heavier person from the floor
If a heavier person falls on the floor – it is important to assess for injury first. If there is cause for concern, call the emergency services ASAP.
Should the need arise to assist a heavier person from the floor hoisting may be one option.
Another solution is the use of a lifting cushion of which there are a limited numbers of designs for the larger person.
A chair should provide comfort and support for activities such as reading and watching TV. To provide support and comfort the following should be considered: -
- Chair dimensions;
- Straight or tilted back;
- Safe Working Load;
- Height of the seat;
- Whether an inclined backrest is necessary;
- How much time is spent in the chair;
- Purpose of the chair (sleeping or recreation);
- Position within the room;
- Other equipment the chair is to be used with e.g. hoist, cantilever table;
- The requirement of a pressure relieving cushion.
- Armrests should provide a firm surface to push up from and should extend at least to the front of the seat. Detachable/drop down armrests can help positioning of slings should the person require hoisting.
Riser recliner chairs
People who have difficulty standing from the sitting position can be assisted if they use an electrically powered riser recliner chair. There are different designs available; the seat unit or the entire chair rises and tilts to help bring the person up to a standing position and they must have sufficient strength in their legs to rise up from sitting.
People who have difficulty transferring may spend the majority of their time (day and night), in their chair and consequently a powered riser recliner, may best meet their needs and allow easier repositioning.
Some people may choose to sleep in their chair - finding lying flat difficult and uncomfortable; a powered riser recliner chair may help provide a semi-reclined position with legs raised.
Certain powered chairs allow the person to adjust independently the leg and backrest giving the person more choice of position.
Sitting with legs raised for periods can help reduce swelling of the lower limbs
Certain chairs feature integral pressure relieving cushions.
Hoists are used to lift and transfer people who are unable to take their weight through their legs. There are a number of suppliers with designs from mobile battery powered versions to electrically powered hoists which may be permanently or temporarily installed.
There are different designs of hoist available for different transfers; their use should only be implemented after assessment and training.
Fitting the sling and transferring the heavier person can require considerable assistance by carers.
Considerations when choosing a hoist are: -
- Ability of the person - how much the person can assist the carers
- Weight of the person*;
- SWL of the hoist and slings*;
- Types of transfer required;
- Number of carers;
- Required distance of travel
SWL must be considered allowing for changes in the persons weight*
Mobile hoists are used to transfer a person over a short distance e.g. bed to chair. The person is lifted in a sling attached to the hoist.
Overhead hoists may be the preferred option where there is limited space for carers, free movement and the type of transfer required. Overhead hoists run on tracking that can be fixed to:
- The ceiling;
- From wall-to-wall, spanning the room from one side to the other;
- Free-standing gantry.
Assessment of the strength and capacity of the ceiling or walls will determine whether tracking can be fitted (advice from a structural engineer will be required). If tracking cannot be installed then the option is to use a free standing gantry frame hoist design. Gantry hoists are simple to install as they require no permanent fixing.
- Floor surfaces;
- Loading capacity of ceiling/floor/walls;
- The range of lifting height of the hoist (to ensure clearance when lifting off a bed, from the floor);
- Space around and underneath furniture (if considering a mobile hoist)
Slings support the person during the transfer and there is a wide range of available including those for people with sensitive skin. Bespoke slings are also available from certain suppliers.
The choice of the right sling for an individual requires expert assessment and knowledge.
A bed should provide comfort and support for the individual and allow sufficient room for repositioning – this is especially important for the larger person.
Different designs of profiling beds and mattress are available with a range of functions. It is recommended that professional advice is sought prior to purchasing and bed.
To ensure the selection of the best bed, the following should be considered: -
- The size and design of the bed
- The position of the bed within the
- Transfers on and off the bed;
- Changing position in the bed;
- Providing access around the bed;
- The position of fixtures and fitting within the room e.g. power points, windows;
- Other equipment;
- Number of carers.
A powered profiling bed is essential for the heavier person. The ability to adjust the height of the bed is critical for both independent transfers and those involving carer(s) and equipment e.g hoists.
Equipment that can help with independent bed transfers includes:
- Bed blocks positioned under the legs of a normal divan bed to raise it up;
- A bed lever - a handle that fits between the mattress and the bed base to provide a handhold when pushing-up, to stand from sitting;
- A leg lifter - a powered device that lifts / lowers the legs up level with the mattress;
- A sliding sheet: slippery fabric that can help to reposition the person in the bed.
There are certain beds which have a greater profiling range, which can be used to assist a person from lying through sitting to standing. With the lower limbs down this makes it possible to transfer from the end of the bed more easily.
Repositioning in bed
The heavier person may need a wider bed to enable them to turn safely. A wider bed will require carers to reach across a wider area.
If the person requires further assistance beds and mattresses are available to assist turning them. Slide sheets may help carers to achieve this more easily.
The design of the mattress is critical for providing support and comfort for the person.
Released April 2014, to be reviewed by April 2017, Version 1.1
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Hignett, S., Chipchase, S., Tetley, A. and Griffiths, P. (2007) Risk assessment and process planning for bariatric patient handling pathways. HSE, Loughborough University: Leicestershire
Baptiste, A. (2007) Safe Bariatric Patient Handling Toolkit. Bariatric Nursing and Surgical Patient Care. Vol.2(1) p17-46 http://online.liebertpub.com/doi/pdf/10.1089/bar.2006.9996
Bakewell, J. (2007) Bariatric furniture: Considerations for use. International Journal of Therapy and Rehabilitation. Vol.14(7) p329 - 333
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