Restrictive Intervention and a Chair for the Intervention

The present invention relates to a chair, to a method for feeding a patient and to an intervention used in this method . The invention relates particularly, but not exclusively, to a chair used to feed a patient through a nasogastric tube where a restrictive intervention is required .

Nasogastric tube feeding (NG feeding) is the practice of passing a narrow tube down a patient ' s nasal cavity, through the oesophagus and into the patient ' s stomach . This ensures vital nutrients and medicines can be adequately administered through the tube to the patient directly into their stomach . This method is mainly used when a patient is having di f ficulty swallowing or unable to eat or drink . Even in non-resistive patients the natural reflex caused by a tube being inserted into a patient ' s nasal passage and throat can cause the patient discomfort and distress .

However, there are a small number a patient ' s who urgently require nasogastric tube feeding but due to suf fering from eating disorders are unwilling to have such a procedure untaken . In these cases , a respectful method of restrictive intervention is required to handle the patient and administer the necessary care .

In an existing technique i f a patient is resisting, they are placed in a sitting position whilst a member of staf f sits beside , positioned higher than the patient , and holds them whilst a clinician inserts the tube . With the additional trauma and discomfort of the nasogastric tube being inserted, this method does not address the physical demands and postural stress placed on the staf f members during extended periods of intervention . Furthermore , there is a potential risk-of-inj ury to the patient and staf f members involved during the insertion of the nasogastric tube , whilst extending the increase of emotional and mental impact on the patient .

Preferred embodiments of the present invention seek to overcome or alleviate the above-described disadvantages of the prior art .

According to an aspect of the present invention there is provided a restrictive intervention chair comprising : an inclined back support portion; a thigh support portion less than perpendicular to said back support portion .

When a patient is sitting in the chair the patient ' s back rests on the back support and their thighs lie along the thigh support portion . With the back support portion at an incline the patient ' s torso is angled such that their weight is concentrated through their back . Along with this , and the angle between the patient ' s hip and spine being less than perpendicular, the patient is manipulated such that their knees are higher than their hips . These features reduce movement in the patient ' s legs , torso and calves and decreases the muscle power of the individual sitting in the chair . This also has the ef fect of sitting the pelvis down and stops the user bringing their torso forward .

In addition, whilst the patient is in the chair care workers are able to restrict free movement of the patient ' s arms and head . The care workers achieve this by standing behind the back support and holding their arms and holding their head against the back support portion, this increases the safety of the care workers and due to the patient ' s reduce movement decreases the amount of force and strain needed to intervene with the patient . This reduced strain allows care workers to carefully maintain the patient ' s position over a longer period of time without causing any discomfort to themselves or the patient . Furthermore, with the care workers being situated behind the patient another member of staff is able to position themselves in front of the patient to insert the nasogastric tube.

Additionally, the inclined back support allows the member of staff to insert the nasogastric tube at an angle making insertion of the tube easier.

The chair may further comprise a calf support portion.

The calf support portion reduces movement in the patient's calves, by lifting their calves and reducing the power in the quad muscles. This also lowers the ability of the patient to kick out decreasing a potential risk-of-inj ury to any members of staff.

In preferred embodiment the thigh support portion is between 70° and 30°, preferably between 60° and 40° and ideally at substantially 50° relative to the back support portion.

As the angle between the hips and spine becomes more acute the patient finds it harder to lean forward to get out of the chair and less muscle power can be directed through the thighs.

In a further preferred embodiment, the back support portion is between 70° and 30°, preferably between 60° and 40° and ideally at substantially 50°.

Having the torso angled at 50° is the preferred angle from a nasogastric tube to be inserted easily through the nasal cavity and into the stomach.

In another preferred embodiment there is a gap is located between said back support portion and said thigh support portion .

Having a gap where the patient's buttocks would be situated increases the difficulty for a patient to support themselves and therefore remove themselves from the chair. In an additional preferred embodiment , the chair further comprises at least one leg .

In a further preferred embodiment , the chair further comprises a thigh support extension portion .

The thigh support extension portion is used for patients who have longer legs .

In another preferred embodiment the cal f support is moveable relative to said thigh support portion .

Having the cal f support moveable allows adequate placement of the cal f support for patients with longer or shorter legs .

According to another aspect of the present invention there is provided a method of restrictive intervention for a patient comprising positioning the patient on a chair wherein, the patient ' s back is resting on an inclined back support portion and their thighs are resting on a thigh support portion such that the patient ' s knees are above their hips and that the angle between the patient ' s thighs and spine is less than perpendicular .

In another preferred embodiment o f the present invention the patient ' s buttocks are unsupported .

In a further preferred embodiment of the present invention the back support portion is inclined between 70 ° and 30 ° , preferably inclined between 60 ° and 40 ° and ideally inclined and 50 ° relative to the ground .

The method may further comprise a restrictive intervention with said patient by holding their arms ; and moving the patient relative to said chair such that said chair engages the back of the patient ' s knees .

Having the chair moveable behind the patient allows for an easier transition of the patient into the chair . According to a further aspect of the present invention there is provided a method of feeding a patient comprising : intervening with a patient according to the method set out above ; inserting a nasogastric tube ; and feeding the patient through said nasogastric tube .

Preferred embodiments of the present invention will now be described, by way of example only, and not in any limitative sense with reference to the accompanying drawings in which

Figure 1 is a perspective view of a restrictive intervention chair of a first embodiment of the present invention;

Figure 2 is a perspective view of the back of the chair of figure 1 ;

Figure 3 is a side view of the chair of figure 1 ;

Figure 4a and Figure 4b are side and perspective views of a portion of the chair of figure 1 ;

Figure 5 is a side view of another portion of the chair of figure 1 ; and

Figure 6 is a side view of a person sitting in a chair of the present invention .

Referring initially to figures 1 , 2 and 3 , a restrictive intervention chair 10 includes a back support portion 12 , a thigh support portion 14 and a cal f support portion 16 .

The back support portion 12 includes a first surface 18 , a second surface 20 and a headrest portion 22 . The first surface 18 is located at the front of the back support portion 12 , where a patient would rest their back, whereas the second surface 20 is located at the back of the back support portion 12 . The first surface 18 is wide enough to accommodate a patient ' s back and arms when they are resting on the back support portion 12 , whilst the headrest 22 is where the patient ' s head would lie . In between the first and second surface is a foam layer (not shown) , located adj acent the first surface 18 and a structural wooden board (not shown) adj acent the second surface 20 . The second surface 20 is also connected to a series of support bars that supports the back support portion 12 and secures it in an inclined position . A main support bar 24 is located longitudinally along the midline of the second surface 20 . This main support bar 24 has a plurality of laterally placed support bars that intersect perpendicularly . The first lateral support bar 26 is situated adj acent the head rest 22 and the second lateral support bar 28 is situated near the base of the back support portion 12 , adj acent the floor . At each end of the first and second lateral bars is a bolt 30 . These bolts 30 are used to secure the support bars to the back support portion 12 by drilling into the wooden board located within . At the intersection of the first main bar 24 and the first lateral bar 26 is located a first leg support bar 32 . This extends from the intersection to a first floor support bar 34 , located on the floor . A second leg 36 support bar also extends from the intersection of the main support bar and the second lateral support bar 28 towards the first floor support bar 34 . To maintain the incline of the back support portion 12 the first leg support bar 32 is longer in length than the second leg support bar 36 . Both the first and second surface of the back support portion 12 is covered in a coating of industrial standard Dartex® .

Referring additionally to figures 4 and 5 , the thigh support portion 14 is located in line with the back support portion 12 with a gap therebetween . The thigh support portion 14 is inclined relative to the back support portion and includes a third surface 38 and a fourth surface 40 . The third surface 38 is where the patient ' s thighs are supported when they are positioned in the chair 10 . In between the third and fourth surface is a foam layer (not shown) , located adj acent the third surface 38 and a structural wooden board (not shown) adj acent the fourth surface 40 . The fourth surface 40 also has a metal plate 42 attached via bolts 30 and a third leg bar 44 extending from the bottom of the metal plate towards the first floor support bar 34 . The third leg bar 44 lies parallel with the inclined thigh support portion 14 until it reaches the bottom of the thigh support portion . At this point the bar bends such that it is perpendicular with the first floor support bar 34 , creating a stable and strong support for the thigh support portion 14 . Both the third and fourth surface of the thigh support portion are covered in a coating of industrial standard Dartex® .

The cal f support portion 16 includes a fi fth surface 46 and sixth surface 48 . In between the fi fth and sixth surface is a foam layer (not shown) , located adj acent the fi fth surface 46 and a structural wooden board (not shown) adj acent the sixth surface 48 . When the patient is positioned in the chair 10 the patient ' s calves are supported by the fi fth surface 46 . The sixth surface 48 also has a third lateral support bar bolted to it and a fourth leg support bar extending from the middle of the third lateral support bar 50 towards a second floor support bar 52 . This cal f support portion is also inclined relative to the floor and the thigh support portion 14 . Both the fi fth and sixth surface of the cal f support portion are covered in a coating of industrial standard Dartex® .

The first and second floor support bars , 34 and 52 , are located at the base of the chair and engage the floor . The first floor support bar 34 further includes a first pair of feet and second pair of feet extending from therein, further reinforcing the stability of the chair 10 . The first pair of feet 54 are located at the end of the first floor support bar 34 adj acent the back support portion 12 . One end of each foot is connected to the first floor support bar 34 and extend at an angle greater than 90 ° away from the first floor support bar 34 , whilst the other end of each foot has a wheel 55 situated thereon . The second pair of feet 56 are located distal the first pair of feet 54 adj acent the thigh support portion 14 with one end of each foot perpendicularly connected to the first floor support bar 34 and the other end having a plastic end cap attached . The second floor support bar 52 also includes a third pair of feet 58 located at the end of the second floor support bar adj acent the fi fth surface of the cal f support . One end of each foot being perpendicularly connected to the second floor support bar 52 and the other end of each foot having a plastic end cap attached . Additionally connected in the middle , between the third pair of feet is a handlebar 60 . The chair 10 can be li fted from the front at the third pair of feet 58 using the handlebar 60 . Once li fted the chair 10 can be rolled on its wheels ( located on the first pair feet 54 ) using a 'wheelbarrow' like motion, making it easier to move the chair when required .

Referring now to figure 3 the back support portion 12 is inclined by angle A relative to the ground between 70 ° and 30 ° , preferably between 60 ° and 40 ° and ideally at 50 ° . At 50 ° the patient ' s torso is angled in such a way that insertion of the nasogastric tube is easier and more comfortable . The thigh support portion 14 is also incline by angle B between 70 ° and 30 ° , preferably between 60 ° and 40 ° and ideally at 50 ° relative to the back support portion 12 . When the patient is sat with their back resting on the first surface 20 of the back support portion 12 and their thighs resting on the third surface 38 of the thigh support portion, they slightly sink into the foam inserts resulting in the angle between their spine and thighs being substantially 45 ° . Figure 3 also shows the height H from the bottom of the thigh support portion to the ground is 290 mm . It is required to have the back support portion 12 close to the ground to allow a patient to be lifted easily into the chair 10 . It should also be noted that the angle between the thigh support portion and the cal f support portion is at an angle C 40 ° . This acute angle places the knees below 90 ° when the patient is sat in the chair 10 with their calves resting on the cal f support 16 .

Referring now to figure 4a and figure 4b the thigh support portion 14 further includes a thigh extension portion 62 . The thigh extension portion includes a foam insert at the front end wooden board (not shown) at the back . The thigh extension portion 62 is a removable extension and when in place is located at the top of the thigh support portion 14 , where the back of the patient ' s knees are positioned when seated . The metal plate 42 , located on the fourth surface 40 of the thigh support portion 14 further includes a first recess (not shown) for receiving an insert 66 . The insert 66 is located on the back of the thigh extension portion 62 and extends further than the base of the extension portion to align with the first recess . When a patient with a longer thigh length than the thigh support portion 14 is to use the chair, the insert 66 is slotted into the first recess 64 positioning the extension on top of the thigh support portion, resulting in a lengthened thigh support portion .

Referring now to figure 5 a first extender portion 68 and a second extender portion 70 are located between the thigh support portion 14 and the cal f support portion 16 . The first extender portion 68 is connected to the back of the second leg support bar 34 adj acent the fourth surface 40 of the thigh support portion 14 and includes a second recess (not shown) that matches the shape of the second extender portion 70 . With the length of the second recess being slightly longer than the length of the second extender portion 68 . The second extender portion 70 is connected to the back of the third leg support bar 44 adj acent the sixth surface 48 of the cal f support portion 16 . The second extender portion 68 is the same shape as the second recess and therefore can slot into and out of the second recess , permitted by a sliding motion . Inside the first and second extension portions is a plurality of sprung loaded pins (not shown) . These allow speci fic positions of the extension portions to be secured and reduce movement once the patient is seated on the chair . I f the distance between the cal f support portion 116 and the thigh support portion 14 needs to be decreased the second extender portion 70 can be positioned further into the second recess and secured with the sprung loaded pin, bringing the cal f support portion 16 closer to the thigh support portion 14 .

Referring now to figure 6 , the method of using the chair 10 will now be described . A patient will initially be stood with their back facing the front of the chair 10 , with the fi fth surface 46 of the cal f support portion 16 facing towards the back of their knees . The length of their legs are taken into account such that i f their thighs are long the thigh extension portion 62 is added to the thigh support portion 14 and i f their calves are long the second extender portion is moved further from the thigh support portion 14 . When the chair 10 is positioned correctly with regards to the patient , two members of staf f will each hold an arm of the patient and reverse the patient towards the cal f and thigh support portions . As the back of the patient ' s knees contact the cal f support their legs bend over the cal f and thigh supports . The patient is then lowered into the chair 10 ensuring that their back is resting on the back support portion 12 , their thighs are resting on the thigh support portion 14 and their calves are supported by the cal f support portion 16 with their buttocks unsupported by the gap between the thigh and back support portions . Once seated the patients head is restrained on the headrest 22 by a third member of staf f whilst their arms are also restrained . The angle of the patient ' s torso is ideally at 50 ° to the ground, enabling easier insertion of the tube , whilst the angle between their spine and thighs is also around 45 ° . Their calves are also supported at an acute angle 40 ° . Once it is established that the patient ' s movement has been restricted in the chair and unable to manoeuvre out of the chair a clinician approaches the patient and carefully inserts the nasogastric tube through the nose and into their stomach . Once inserted, food can be delivered through the tube .

It will be appreciated by persons skilled in the art that the above embodiments have been described by way of example only and not in any limitative sense , and that various alterations and modi fications are possible without departure from the scope of the protection which is defined by the appended claims . For example , the industrial standard Dartex® could be replaced with any material that is safe and easily cleaned such as , polyurethane or rubber .

A further example , attachment of the thigh extender portion could be achieved by using a hinge mechanism between the thigh support portion and the thigh extender portion .