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Back Safety, Safe Patient Handling,

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Back Safety, Safe Patient Handling, & Assisted Mobility Skills Finger Lakes DDSO New Employee Orientation April 2012 Soft Goods Maintenance & Care Soft Goods ... – PowerPoint PPT presentation

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Title: Back Safety, Safe Patient Handling,


1
Back Safety,Safe Patient Handling, Assisted
Mobility Skills
  • Finger Lakes DDSO
  • New Employee Orientation
  • April 2012

2
What is Back Safety/Safe Patient Handling(SPH)?1
  • A set of policies and programs designed to
    decrease the strain and injury on staff while
    they move and care for consumers
  • Focuses on minimizing and eliminating manual
    lifting by using equipment instead of the
    caregivers body
  • Legislation in NYS is passed in the Assembly and
    is pending in the Senate to make SPH mandatory in
    all healthcare facilities.

3
Why is Back Safety/Safe Patient Handling
important?
  • Healthcare work is among the most hazardous
    occupations in NYS2
  • Back injury is the 2nd leading occupational
    injury3
  • Back injuries are expensive2
  • Cost of medical care
  • Cost to pay overtime coverage
  • Significant time is lost with injury
  • Mandated overtime, training new staff
  • Safe body mechanics are not enough to prevent
    injury3,5
  • Prior to SPH, stand pivot transfers were the 1
    way FLDDSO staff were injured when caring for
    consumers

4
Benefits to Staff2
  • Decreases Injuries
  • Decreases Pain and Muscle Fatigue
  • Decreases Lost Work Days
  • Decreases Overtime
  • Increases Morale
  • Increases Job Satisfaction
  • My company/supervisor/worksite cares about me!
  • SPH is an investment in the employee

5
Consumer Benefits of SPH2
  • Improves quality of life
  • Lowers levels of depression and behaviors
  • Consumers feel more secure and less anxious when
    being transferred in a consistent manner
  • Improves urinary continence
  • Increases consumer participation in activities
  • Increases level of daytime alertness
  • Increases/maintains upper extremity ROM
  • Decreases fall risk
  • Decreases in fractures (spiral, compression)
  • Decreases skin tears and bruising

6
What About the Consumers?
  • Bottom line
  • We can not provide safe care for the consumers if
    we do not take care of ourselves!

7
Back Safety
  • Injuries
  • Risk Factors
  • Proper Lifting

8
Healthy Spine
Image from http//www.orlandocaraccidentlawyerblog
.com/2009/08/
Image from www.squidoo.com
9
Posture
  • Purpose of the spine
  • Protects the spinal nerve
  • Demo posture/curves
  • Muscles support the spine
  • Back muscles tend to be small in size
  • Lifting muscles are larger? quads and gluts
  • Good posture relies on flexibility core
    strength
  • Stretch your low back into extension
  • Strengthen your abs

Image from http//davidsalse.files.wordpress.com/
2011/06/posturesitting.jpg
10
Risk Factors2,3,6,7,8,9
  • Lack of exercise
  • Lack of social support
  • Low job satisfaction
  • Age
  • Lifting more than 35lbs
  • NIOSH safe weight limit
  • Lack of sleep
  • Less than 8 hours
  • Smoking
  • Decreases bodys ability to heal
  • Poor posture
  • Stretches weakens key muscles
  • Examples car seating, brushing teeth, washing
    dishes
  • Frequency of forward flexion
  • Typically 3,000-5,000 times/day
  • Previous injury
  • Known or unknown

11
Microtraumas Unknown Injuries
  • Mechanical processes
  • Compression
  • Shear
  • Rotation/Twist
  • Awkward Postures

Image from http//www.sandiego-spine.com/2010/dege
nerative-spine.png
12
Common Injury in Spine
  • Disc Herniation
  • Over time the outer layer of the disc weakens
    from repeated microtraumas
  • The inner jelly of the disc bulges out of
    position, usually toward the back where it can
    put
  • pressure on the nerve

Image from http//www.backpainhelptoday.com/wp-con
tent/uploads/2010/12/Hdisc1.jpg
13
Other Common Injuries
  • Muscle Strain
  • Tear in muscle fibers
  • Pain
  • Inflammation
  • Tightness
  • Tendinopathy
  • Pain
  • Tenderness
  • Related to gradual wear tear
  • Compression Fracture
  • Directly related to disc health
  • Various Locations
  • Shoulder
  • Rotator cuff, impingement
  • Knees
  • Torn cartilage, ligament issues
  • Neck
  • Nerve problems radiating down arm, stiffness

14
Body Mechanics
  • DO NOT
  • DO
  • Get in the ready position
  • Wide base of support
  • One foot slightly forward
  • Firmly plant your feet
  • Soften your knees
  • Wear appropriate clothing and footwear
  • Per DDSO dress code, shoes must cover toes and
    have flat contact with ground
  • Make quick and jerky movements
  • Causes strain on back muscles
  • Twist when lifting
  • Keep nose and toes pointed in the same
    direction
  • Wear clothing that interferes with safe patient
    care
  • Large jewelry
  • Shoes with high heels, flip-flops

15
Body Mechanics / Lifting
  • Assess the situation
  • Know your limitations
  • Is there equipment available to make this safer?
  • Plan ahead and prepare the environment
  • Clear pathway
  • Hold the load close and firm
  • Hips shoulders square to load
  • If hold is not firm- start over!
  • With heavy objects, break up the load
  • Communicate with other staff member and consumer

16
Chores Challenge
  • Laundry
  • Top loading washer front loading dryer
  • Making beds
  • Shoveling snow
  • Push, squat, do not toss over shoulder
  • Yard work
  • Use wheelbarrows, kneel on knee pads
  • Carrying groceries supplies
  • Divide up loads, use carts on wheels

17
SPH Assisted Mobility Skills

18
Course Objectives
  • Given direction by a licensed physical or
    occupational therapy staff, the FLDDSO new
    employee/trainee will demonstrate their knowledge
    by performing the following
  • General concepts for joint range of motion (not
    specific to a consumer)
  • General concepts to prevent and manage decubiti
    (pressure sores)
  • Safe and effective transferring and handling
    techniques including use of non-friction devices,
    rolling devices, mechanical floor lifts,
    sit/stand lifts and gait belts
  • Safe and effective positioning of consumers on
    support surfaces (wheelchairs, beds)

19
Competencies
  • 4.17 Lifting Transferring
  • 4.19 Range of Motion
  • 3.5 Blind Trailing-Mobility Techniques for
    consumers with Visual Deficits
  • Competencies get officially signed at the
    worksite. This class will give you the basics and
    will result in signature in the Comments
    section of these 3 competencies.

20
Range of Motion (ROM) The available movement
at a joint
  • ROM deficits are commonly seen in
  • Consumers with cerebral palsy (high tone)
  • Consumers who have had a stroke (high tone)
  • Consumers with arthritis (cartilage less pliable)
  • Benefits of Joint Movement
  • Increased comfort and flexibility
  • Increased circulation and nutrition to joint
  • Maintenance of ADLs (dressing, bathing, etc.)
  • Greater ease for staff to perform skin/hygiene
    care

21
ROM Programs
  • ROM is performed by staff when muscle and/or
    joint tightness
  • Interferes with cleanliness and hygiene care
  • Interferes with dressing
  • Causes pain and discomfort
  • Formal programs may be provided by OT/PT
  • Found in the IPOP
  • Require further consumer specific training by the
    therapist

22
Keys to Remember
  • Your approach matters
  • Quiet voice, dim lights, firm, but gentle touch,
    after a warm bath/shower
  • Always tell the consumer what you are doing
  • Surround the joint
  • One hand on each side of the joint
  • Only range one joint at a time
  • Full hand control
  • Keep fingers together, flat surface
  • Fingertips can bruise avoid claw hands
  • Smooth and controlled
  • Never push into restrictions
  • Never bounce
  • Move slowly fast jerks can increase tone and
    cause injury

23
ROM Terms to Know
  • Adduction
  • Moving the body part towards midline
  • ADDing to the body
  • Internal Rotation
  • Rotation towards the center of the body
  • External Rotation
  • Rotation away from the center of the body
  • Flexion
  • To bend
  • Extension
  • To straighten
  • Abduction
  • Moving the body part away from midline
  • Abduct means to take away!

24
  • Flexion
  • Extension

Images from HEP2go.com
25
  • Abduction
  • Adduction

Images from HEP2go.com
26
  • Internal Rotation
  • External Rotation

Images from HEP2go.com
27
Decubitus UlcersPressure Ulcers Bed Sores
  • Risk factors
  • Boney areas of the body
  • Tail bone, heel, ankle, hip, elbow, back
  • Prolonged pressure
  • Healthcare best practice requires repositioning
    at least every two hours!
  • Fragile skin
  • Decreased circulation
  • Diabetes, other vascular diseases
  • Poor nutrition
  • May have adequate intake, but poor absorption

28
Decubitus Ulcers
  • Risk Factors continued
  • Friction
  • Repeated movement across a surface
  • Shearing
  • Body tissue moves over top the skin which has
    adhered to the support surface
  • Example bare legs on a vinyl car seat on a hot
    day
  • Moisture heat
  • Sweat
  • Incontinence
  • Bowel and bladder
  • Caustic to skin

29
Decubitus Ulcers
  • Most are preventable by
  • Keeping the skin clean and dry
  • Changing position at least every 2 hours
  • Properly using support surfaces that relieve
    pressure
  • seat cushions, mattresses
  • Assuring clothing is not a risk factor
  • avoid jeans, avoid nylon pants, ensure footwear
    is ON when in wheelchair

30
Discussion points on seating demo
  • Tell us about how you feel after being on
    improper seating during the short discussion
  • Remember that consumers sit in positions for up
    to two hours at a time
  • Make sure consumers are seated appropriately!
  • Fragility of consumer skin even before seating
    concerns

31
Cushion 101
  • Used for pressure relief, comfort, and
    positioning
  • Positioning cushions have
  • Bump in front to separate legs
  • Soft well in the back for tailbone
  • Check to make sure they are in properly
  • Hand sweep to check front and back
  • Check the labels
  • Often labeled front and back
  • Do not assume the cover is on the cushion
    correctly

32
Wheelchair parts
Pelvic Positioning Belt
Hand Rim
Rear Anti-Tippers
Front Castor
33
All WCs used by consumers at the FLDDSO must
have
  • 2 working brakes (wheel locks)
  • Pelvic positioning belt (seat belt)
  • Rear anti-tippers
  • Arm rests
  • Foot rests
  • may be removed inside buildings for people who
    foot propel, must be replaced prior to
    transportation
  • Tilt chairs must have headrests
  • Any exceptions are found in the IPOP

34
Wheelchair Maintenance Care
  • Frequent cleaning necessary for function
  • Not just for night shift
  • Cleaning should occur as chair gets soiled
  • Especially following meals
  • Upholstery should be wiped down
  • More to come with Personal Care Skills course
  • If the wheelchair is broken or missing parts, DO
    NOT bring consumer to day program or outings
  • Cannot be transported in that condition
  • Immediately contact OT, PT, house or program
    managers

35
Soft Goods Maintenance Care
  • Soft Goods include
  • Wheelchair Cushion Covers
  • Canvas and Mesh Slings
  • Non-friction sheets for bed repositioning
  • One-way (anti-slip) devices
  • Gait belts
  • Washing
  • Hand wash
  • Machine wash lukewarm water detergent
  • Garment bag may be used
  • DO NOT USE BLEACH
  • Drying
  • All soft goods MUST be hung or laid flat to dry
  • DO NOT PUT IN THE DRYER

36
Bed Mobilityand Positioning
37
Keys to Bed Mobility and Positioning
  • COMMUNICATION
  • Always talk to the consumer to tell them what you
    are doing ask them to help if they can assist
  • Always talk to the other staff person
  • Dont forget good body mechanics
  • If the task is unsafe or difficult, is there
    equipment that would make it safer and easier? If
    you arent sure, ask a PT or OT!

38
Supine positioning
  • Body position
  • laying on their
  • back
  • Pressure points
  • Back, tail bone, heels, back of head, elbows
  • Use bed controls for positioning
  • Pillow/support placement
  • Under head
  • Under knees
  • Behind calves
  • Heels floating

Image from http//www.me-jaa.com/mejaa21Mar2009/pr
essureulcer-pt2-fig1.gif
39
Side-lying positioning
  • Body position
  • Head, neck, trunk, and hip aligned
  • Both legs bent at hips and knees
  • Pressure points
  • Shoulder, hip, knees, ankles
  • Pillow/support placement
  • Under head
  • Between knees
  • Supporting top arm
  • Behind back

Image from http//lifecenter.ric.org
Image from http//www.me-jaa.com/mejaa21Mar2009/pr
essureulcer-pt2-fig1.gif
40
SPH Rolling
  • Communicate with the consumer and other staff
  • Equipment possibilities include
  • Non-friction sheets
  • Positioning devices (Tri-turner, full body, split
    sheet)
  • Grab bars (side rails, bed assist bars)
  • Position the person for best mechanical advantage
  • Bend knee opposite the direction of the roll or
    cross leg over towards roll
  • Ensure their arms are out of the way

41
Rolling With SPH Techniques Devices
  • Top Sheet (Split Sheet)
  • Used with mechanical lifts
  • Used for wound care, pressure relief
  • Can be used with 1 or 2 staff members because it
    is for positioning is not a transfer out of bed
  • Must be left on bed
  • Make the bed with the Top-Sheet on

Images from romedic.com/usa
42
More SPH Techniques Devices
  • Non-Friction Sheets
  • Use Repositioning up/down, side/side in bed,
    rolling for care in sidelying
  • Closed end of tube in the direction you are
    moving the consumer
  • Head?foot for up/down positioning
  • Side?side for lateral shift or rolling
  • Must be used with two staff
  • Must hold and use secondary sheet (draw
    sheet/cloth chux) atop NF sheet
  • Rules for Non-Friction Sheets
  • Hands are never on the NF sheet after it is under
    the person
  • Hands are driving DOWNWARD into the bed
  • Lunge/step to move, square body towards direction
    you are going
  • Arms/legs/trunk move as ONE unit
  • Place and remove without turning or rolling
    consumer
  • Tuck method in demo lab
  • Does NOT stay on bed

Images from romedic.com/usa
43
Transfers
44
Gait belts
  • Why
  • Consistent, firm grasping surface for staff
  • Provides a sense of security to the consumer
  • Protects both parties from injury when
    transferring or ambulating
  • When
  • Consumer requires assistance to maintain balance
    standing or ambulating as determined by PT/OT/RN
    with input from staff
  • Remember
  • NOT a lifting belt
  • Consumer must have good sitting balance
  • Consumer must be able to move their feet
  • Should not require lifting to maintain standing
    position
  • Not intended to prevent most falls
  • Always hold at the handle
  • Make sure belt is snug but not restrictive
  • Be aware of location of medical concerns (tubes)

Image from romedic.com/usa
45
Assistance Levels
  • Contact Guard
  • Gait belt required
  • Hands on the gait belt
  • Used when consumer requires physical and/or
    directional guidance and verbal cueing
  • Stand-By Guard
  • Gait belt frequently required
  • Within an arms reach of the consumer, prepared to
    assist if needed
  • Used when consumer only needs occasional balance
    assistance or guidance
  • Range of Scanning
  • Visual supervision
  • Level of assistance determined by PT/OT/RN
  • Documented in IPOP

46
Keys to Transfers with Mechanical Devices
  • COMMUNICATION
  • Always talk to the consumer to tell them what you
    are doing ask them to help if they can assist
  • Always talk to the other staff person
  • Dont forget good body mechanics
  • If the task is unsafe or difficult, is there
    equipment that would make it safer and easier?
  • If you arent sure, ask a PT or OT!

47
Lifting Sling Sizing and Materials
  • Sizing
  • Height
  • Mid-head to mid-buttock for full coverage
  • Width
  • 2-3 finger-width of material on either side of
    body
  • Weight
  • Slings will have weight as well as sizing
    restrictions
  • Check label
  • Color Coded (most)
  • Small red, Medium yellow, Large green, XLarge
    blue
  • Materials
  • Canvas/Quilted
  • Dry transfers only (not for bathing)
  • Not left under consumer
  • Mesh
  • ANY transfer, including bathing
  • Typically best if IPOP requires sling to stay
    under consumer
  • Dries fastest

48
Lifting Sling Check
  • When to NOT use sling
  • Frayed material on loops (even if its not the
    loop you will be using)
  • Holes in any portion of sling
  • Cut-off loops
  • Evidence of previous repair (sewn)
  • Evidence of being shrunk in washer
  • Dusty residue from previous bleaching
  • Report to supervisor if you take sling out of
    use, clearly label concern on sling
  • Contact OT/PT

49
Lifting Sling Types
  • Split Leg Sling
  • Has full trunk and separate leg extensions to
    support each leg
  • Available with or without head support
  • Can be placed removed with consumer in chair

Images from Romedic.com/usa and
http//www.a3bs.com/imagelibrary/W49825M/W49825M_0
1_Universal-Mesh-Sling-Split-Leg-Medium.jpg
50
Lifting Sling Types
  • Full Body Sling
  • Must stay under consumer
  • Ideally, it should be mesh
  • Head control
  • No separate pieces for legs

Image from http//www.a3bs.com
51
Lifting Sling Types
  • Split Leg Hammock Sling
  • Head control
  • Leg straps to support each leg
  • Cross-through method for majority of people
  • Cradle method for amputees or full leg coverage

Images from Romedic.com/usa and
http//www.hmebc.com
52
Lifting Sling Types
  • Hygiene/Toileting Sling
  • Has wide support belt around trunk and/or waist
    with leg supports
  • Allows access for hygiene care and toileting
  • Can also be used for other seated transfers
  • Consumer must have adequate head and neck control

Images from Romedic.com/usa and
http//www.hmebc.com
53
Lifting Sling Types
  • Limb Strap
  • Secures limbs for positioning, wound care,
    hygiene care, dressing, bathing
  • Can also be used for ROM and exercising
  • Can be used in combination with other slings for
    optimal positioning

Image from http//www.angelsolutions.com/
54
Lifting Sling Types
  • Stand Assist Harness
  • Trunk/waist support belt
  • Used with sit-stand mechanical lifts
  • Walking Harness Sling
  • Has body support with pelvic/leg straps
  • Used with mobile base floor lifts or ceiling
    track lifts for assisted walking

Images from Romedic.com/usa
55
Mechanical Lifts
  • Sit-Stand Lift
  • Rolls on floor
  • Used for transfers from seated position to seated
    position (toileting, bathing)
  • Potential use in therapy
  • Removable footplates for ambulation

Image from spin-life.com
56
Sit-Stand Lift
  • Consumer Requirements
  • Independent sitting (on edge of bed OR supported
    sitting in chair)
  • Bears some weight through one or both legs
  • Holds on with at least one hand
  • Is an active participant in the lifting,
    familiar with the process
  • May require training for consumer comfort and
    cooperation

Image from http//www.accessibilityservices.net/im
age/Floor20lift206-sit20to20stand.jpg
57
Sit-Stand Lift Procedure
  • Always use TWO staff for transfers
  • Assess environment
  • Clear path to transferring area
  • Minimal space between transfer surfaces
  • Prepare equipment
  • Place harness snugly around the low back region
    of the consumer
  • Attach designated straps to lift
  • Instruct/Assist the consumer to put their feet on
    the foot plates
  • Instruct the consumer to grasp the handles on the
    lift

58
Sit-Stand Lift Procedure (cont)
  • Sit-Stand lift brakes OFF /wheelchair brakes ON
  • Allows consumers weight to center itself within
    supports
  • Raise the consumer using remote
  • Maintain contact guard while lifting and moving
  • Staff stand on either side of consumer in lift
  • Transfer to desired location
  • Move the lift, do not push consumer
  • Lower the consumer onto destination seat
  • Buckle pelvic belt if present
  • Remove lift harness
  • Reposition as necessary

59
Mechanical Lifts
  • Mobile Base Floor Lift
  • Rolls on floor
  • Hoyer is one brand, we typically use Invacare
    Reliant 450 lifts

Image from spin-life.com
  • Ceiling Track Lift
  • Includes ceiling mount, wall-to-wall mount, free
    standing frame, tension-mount
  • Best for small rooms like bathrooms and bedrooms

Image from Romedic.com/usa
60
Mobile Base Floor Lift / Ceiling Track Lift
  • Consumer Requirements
  • Most universal lift available, can be used on
    vast majority of consumers
  • May have poor sitting balance and poor head
    control
  • May have seizure disorder, osteoporosis
  • Unable to meet requirements for Sit-Stand Lift

61
Mobile Base Floor Lift / Ceiling Track Lift
Procedure
  • Always uses TWO staff for transfers
  • Assess environment
  • Clear path to transferring area
  • Minimal space between transfer surfaces
  • Prepare equipment
  • Ensure sling is in the proper position under
    consumer
  • Determine and attach appropriate sling loops
  • Mobile base floor lift brakes OFF
  • Allows consumers weight to center itself within
    lift supports
  • Raise the consumer using the remote

62
Mobile Base Floor Lift / Ceiling Track Lift
Procedure (cont)
  • Maintain contact guard while lifting and moving
  • Protect the head and legs
  • Transfer consumer to desired location
  • Move the lift, do not push the consumer in sling
  • Lower the consumer onto destination support
    surface
  • Buckle pelvic belt if present
  • Remove sling unless otherwise indicated in IPOP
  • Reposition as necessary

63
SPH Decision Tree
  • Full Mechanical Lift
  • (Floor or Ceiling)
  • Sit to Stand Mechanical Lift
  • One Person Transfer with Gait Belt
  • Independent

64
Additional Discussion Demos
  • One-way devices
  • Turning discs (cloth for seated, hard plastic for
    standing)
  • Compression stocking donner / bag
  • RoMedic Easy-Glide for sling placement and removal

65
References
  1. American Nurses Association. Safe patient
    handling. Accessed February 28 2012. Available
    at http//www.anasafepatienthandling.org/Main-Menu
    /SPH-Background.aspx.
  2. NYS Zero Lift Task Force. Accessed February 27,
    2012. Available at www.zeroliftforny.org.
  3. Edlich RF, Winters KL, Hudson MA, Britt LD, Long
    WB. Prevention of disabling back injuries in
    nurses by the use of mechanical patient lift
    system. Journal of Long Term Effects of Medical
    Implants. 200414(6)521-533.
  4. Finger Lakes Developmental Disability Services
    Office. Injury reports. Last updated February
    2012.
  5. Hignett S. Intervention strategies to reduce
    musculoskeletal injuries associated with handling
    patient a systematic review.Occup Environ Med.
    200360(9). Available at http//www.ncbi.nlm.nih.g
    ov/pmc/articles/PMC1740617/
  6. Bidassie B, McGlothlin JD, Mena I, Duffy VG,
    Barany JW. Evaluation of lifestyle risk factors
    and job status associated with back injuries
    among employees at a mid-western university.
    Applied Ergonomics. 201041106-114.
  7. http//www.newyorkbackinjury.com/2010/12/15/new-yo
    rk-back-injury--risk-factors-of-back-pain/
  8. Hoogendoorn WE, van Poppel MNM, Bongers PM, Koes
    BW, Bouter LM. Systematic review of psychosocial
    factors at work and private life as risk factors
    for back pain. Spine. 20025(16)2114-2125.
  9. Waters T. When is it safe to manually lift a
    patient? AJN. 2007107(8)53-58. Available at
    http//safeliftingportal.com/safeliftinglibrary/do
    cuments/Tom20Waters20article-20when20is20it2
    0safe20to20manually20lift20a20patient.pdf
  10.  Nelson, A., Baptiste, A. Evidence-based
    practices for safe patient handling and movement.
    Online Journal of Issues in Nursing. 20049(3).
    Available www.nursingworld.org/MainMenuCategories
    /ANAMarketplace/ANAPeriodicals/OJIN/TableofContent
    s/Volume92004/No3Sept04/EvidenceBasedPractices.asp
    x
  11. Tseng CN, Chen CCH, Wu SC, Lin LC. Effects of
    range-of-motion exercise programme.
  12. Pless. A closer look at the pivot transfer.
    Caring for the Ages. December 2005. Available at
    www.amda.com.

66
Images
  • www.HEP2go.com
  • www.squidoo.com
  • www.quickie-wheelchairs.com
  • www.romedic.com/usa
  • http//www.orlandocaraccidentlawyerblog.com/2009/0
    8/
  • http//login.npwebsiteservices.com/Tarlov_Cyst_Dis
    ease_FoundaAYSCXT//OurLibrary.asp
  • http//www.streetsie.com/manual-wheelchair-design-
    production/
  • http//lifecenter.ric.org
  • www.spin-life.com
  • www.veteransmedicalequipmentsales.com
  • http//www.a3bs.com
  • http//www.backpainhelptoday.com
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