The prevalence of STS weakness as well as the correlating risk of falling are core triggers to employ services of nursing staff. 16.9% of the people in outpatient care compared to 43.8%
of elderly living in nursing homes had deficits with the motion sequence STS as was found in the studyLEILA75+. Etiological factors of course are that people living in nursing homes are often much more fragile and less independent than those able to live at home (Wilms et al., 2001, p. 353 f.). This frailness partially originates from an “accustomed dependency” through which passive behavior of elderly is indirectly encouraged since active participation is rarely appealed with positive response. Influencing factors such as time pressure play a key role in the promotion of active participation of elderly. Passive participation, however, results in the continued degeneration of muscle tissue, thereby increasing the dependency during STS movement and in turn decreasing the independence of elderly (Heidenblut and Zank, 2015, p. 322).
Another negatively influencing factor are psychotropic drugs. “In dem Bemühen, Stürze in Krankenhäusern und Pflegeeinrichtunen zu verhindern, versuchen Fachkräfte in Gesund-heitssituationen nach wie vor, Patienten oder Bewohner durch Einschränkung ihrer Mobilität vor Stürzen zu bewahren. Dafür bleibt ihnen häufig nichts anderes übrig, als auf Fixierungs-maßnahmen und Psychopharmaka zurückgreifen.” (Tideiksaar, 2008, p. 16) (Nursing staff try to limit the mobility of patients in certain health situations in an effort to protect patients from falling in hospitals and nursing homes. Often the only choice that remains is to resort to fixation measures and the utilization of psychotropic drugs.). Despite the questioned effects of psychotropic drugs to lower the risk of falling (Tideiksaar, 2008, p. 16) has mentioned
chological state of the patient, thereby decreasing the active mobility and increasing care dependency.
Nursing staff stand in the middle of a major economical conflict. Providing carefully planned and coordinated care and welfare for those in need of care on the one hand and complying with the continuously rising economical challenges of health care on the other side has be-come a rising concern to health care specialists. This conflict of aims at this point are only met by strictly regulating and standardizing care procedures resulting in higher physical and psychological stress for nursing staff ((Rabe-Kleberg et al., 1991) in (Stagge, 2014, p. 91)).
Maintaining such standards has proven to be counterproductive as the increase in workload over decreasing time frames can have extreme consequences on physical and psychological health (Zimber, 1998, p. 418). Therefore nursing staff suffer from a much higher risk of work related injuries as well as suffering from the so-called ‘burnout syndrome’. In particular, nurs-ing staff are said to be six-times more likely to incur a lumbar disc herniation or other forms of lumbosciatica compared to employees of other physically demanding industries (Cohen-Mansfield et al., 1996; Leiter and Harvie, 1996, p. 98 f.).
Loss of Mobility due to Age-Related Changes
Increased Difficulties with Sit-to-Stand Movement
Increased Risk of Falling
Care Dependency
Conflict of Aims within Nursing Care
Additional Reduction of Muscle Activity Demographic Change
Figure 3The downward spiral of mobility
Bio-Kinematic Design of Individualized Lift-Assist Chairs for the Support of Sit-to-Stand Movement 9
TNS Infratestreleased results of a study in 2009 where only 26% of the staff in nursing homes haven’t changed their jobs compared to 39% in 1997 (TNS Infratest Sozialforschung, 2011).
Furthermore it was observed that nursing staff remain an average time of 8.4 years in their work profession only (Hackmann, 2010). Thus the congestion of work for nurses is expected to dramatically increase upon major economical establishments such as a continued high demand for professionally trained nursing staff and an increasing shift of full-time to part-time positions due to cost-cutting measures (Simon, 2012, p. 53; Stagge, 2014, p.83)
All these factors that influence STS movement are mostly interconnected as seen in Fig.
3. The ‘Loss of Mobility due to Age-Related Changes’ is responsible for a decreased inde-pendence and thus ‘Increased Difficulties with STS Movement’ which in turn is accountable for an ‘Increased Risk of Falling’. At some point it becomes inevitable to support ADL via nursing staff. However, the aforementioned ‘Conflict of Aims within Nursing Care’ leads to a considerable neglect ion of personal mobility and therefore in turn is responsible for the continued ‘Loss of Mobility due to Age-Related Changes’. This downward spiral of mobility is accelerated due to the socio-economical challenge of demographical change.
3. Background and State-of-the-Art
Sitting down and standing up is a transfer motion is a fundamental movement that is car-ried out countless times during the day to conduct other ADL. It is a prerequisite at home as well as in nursing homes to live an independent life and therefore also influences social interactions with others. Numerous technological solutions exist as will be discussed in this section that assist in the STS transfer motion. The right choice of device ought to be chosen on the degree of disability and independence and should always try to rehabilitate normal STS movement. The state-of-the-art is split into three distinct sections. The first sections will discuss the ubiquitous manual transfer as carried out from person to person. This is followed by technological solutions as well as patents that exist on the market. Last but not least technological research and development in this field will be analyzed. The following Fig. 4 represents the most distinct technological solutions which try to intervene with the downward spiral of mobility.
Loss of Mobility due to Age-Related Changes
Increased Difficulties with Sit-to-Stand Movement
Increased Risk of Falling
Care Dependency
Conflict of Aims within Nursing Care
Additional Reduction of Muscle Activity Lifting Cushions, Transfer Rails
Wheelchairs, Walk-ers, Exoskeleton Robots
Manual Transfer, Trans-fer Lifters, Lifting Belts
Figure 4Intervention of technological solutions to impede the downward spiral of mobility
Bio-Kinematic Design of Individualized Lift-Assist Chairs for the Support of Sit-to-Stand Movement 11