Chapter 11 Exam 3 manual lateral transfers Flashcards

1
Q

General procedures for manual transfers

first 6 steps

A
  1. Gather items needed for moving, draping and positioning the patient
  2. Non-slip footwear
  3. Organize the management of equipment
  4. Postition transfer surfaces close together.
  5. Prepare surface you’re moving toward (place drawsheet)
  6. Secure both surfaces with equipment locks
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2
Q

General procedures for manual transfers

Next 7 steps

A
  1. apply gait belt
  2. Communicate appropriatly and engage the patient in the proceedure.
  3. Coordinate with other people who may be assisting.
  4. Establish a secure hold on gait belt
  5. Use good body mechanics
  6. Position the patient safely at the end of the transfer. Raise upper rails - footplates, armrests.
  7. Insure important items are within reach (call light, glassses, remote, telephone)
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2
Q

Underlying Assumptions for a dependent Transfer with One Clinician

A
  • Clinician is physically able to control and support the load
  • clinician is able to manage any lines and tubes or leads.
  • the equipment is functioning properly
  • Patient is not resisting transfer
  • patient has some voluntary head control and the ability to bear at least some of the weight.
  • the transfer will not violate movement precautions.
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3
Q

Gait belt

A

transfer belt or walking belt.
safety device.
support to prevent fall.
2 inches wide - 54-60 inches long
bariatric 71 inches long

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4
Q

gait belt placement

A

narrow part of waist, just above the pelvis.

-
Extra care if: back or abdominal surgery. Ostomies or feeding tubes.

-
place above vunerable site.

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5
Q

How to apply a gait belt

A
  1. Communicate with patient
  2. place belt arround waist with buckle in front and slightly to side. Over clothing. Teath to the front and metal flap on the side closer to patient
  3. Pass the metal-tipped end through the teeth and buckle
  4. Pull the belt snug, but not uncomfortably tight. Two fingers
  5. Lift far metal loop causing the teeth to grip
  6. Readjust the belt as needed
  7. tuck any excess length.
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6
Q

How to grip a gait belt

A

supinated or underhand grip.

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7
Q

How to remove a gait belt

A

patient seated:
1. unbuckle the belt and have patient lean forward.
2. must be cleaned after each use.

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8
Q

Wheelchair to bed lift transfer. - two people - first 3 steps

A
  1. position the chair beside bed with legrests and armrest removed bed height same or lower than chair. wheels locked on both.
    2.Taller stronger technician behind patient. wide BoS Stradle the drive wheels.
    3.Second clinician in front - squats or half-kneels perpendicular to patient’s legs, facing the bed.
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9
Q

Wheelchair to bed lift transfer. - two people - second 3 steps

A

4 Hold patient securly
* fold pts arms accross chest.
* clinician behind reaches under patient’s upper arms and with forearms pronated, grasps the patient’s forearms just proximal to writs.
* clinician in front reaches under pt’s legs so legs are resting on forearms. closer to hips provide greater control.
5 Lift shift and lower
* Lift: clinician in front can see pt’s face so they count. on 3 both clinicians lift upward enough to clear lateral barriers.
* Shift. to create lateral movement, the clinician behind the pt shifts laterally. at the same time the clinician in front steps forward.
* Lower. Once pt is over bed lower gently. Bend from knees.
6 Reposition as necessary, recheck any lines leads or tubes.

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10
Q

Wheelchair to bed lift transfer

If you are the clinician in front

A
  • Decrease the moment arm, by supporting the legs closer to the hips
  • Getting closer to the line of action of gravity on the head arms and trunk
  • participating more in upward portion of the lift.
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11
Q

Opposite of wheelchair to bed

Bed to wheelchair dependint lift transfers

A
  • patient in a sitting position so clinician can reach around upper body from behind
  • bed position so compressed mattress is the same or slightly higher than the chair’s seating surface
  • Clinician supporting the LEs moves backward so create a clear path
  • when lowering the pt, situate hips back in chair.
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12
Q

Full flexion Transfer - alternate depedent lift.

A
  1. the ready position: pt scooted forward with feet beneath them. Armes crossed and hips flexed forward head over knees. Clinician leans over the patient and reaches under their hips while maintaining good body mechanics.
  2. Clinician leans backward slightly, lifting the patient’s hips just enough to clear the chair as they pivot.
  3. In one continuous movement, the clinician pivots the patient and lowers them to bed or mat.
  4. Clinician maintains a guarding position as he ensures the patient’s stability in sitting.
    * Not the best movement pattern to practice on the way to becoming more independent in transfers.
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13
Q

dependent repositioning in a chair (scooting pt’s hips back for instance.)

A

wide BoS from behind chair.
uses same arm position as lifting the patient
Count of 3 lifts the patients hips up and back

2nd clinician can help by grasping lateral aspects of gait belt or reaching under the buttocks and blocking knees.

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14
Q

Transfer board

A

sliding or slide board. allows transfer without having to bear weight through LE.

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15
Q

Steps 1-3

Independent Lateral Seated Transfer with Transfer Board: Bed to wheelchair

A
  1. adjust bed height to same or slightly higher than chair with compressed mattress. Remove right armrest of chair and place right side of chair close to the bed. Secure both surface. Locks.
  2. Lean trunk away from transfer, lifting the hip up off the bed, and place slide board weell beneath hip, under the iscial tuberosicty.
  3. Position the board in front of the wheelchair’s drive wheel, aimed toward the chair seat.
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16
Q

Steps 4-6

Independent Lateral Seated Transfer with Transfer Board: Bed to wheelchair

A
  1. Lean slightly to left, toward the chair, and place open left hand far enough out to allow room for hips to move toward it. right hand directly under axilla. Lean forward slightly. depress the shoulders and push down with borth arms to lift the body up and sideways on the board. Repeat hand placement and sideways movement until on wheelchair seet.
  2. Lean away from bed and remove the transfer board
  3. Replace wheelchair armrest and legrest and adjust the sitting position as needed.
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17
Q

Steps 1-4

Independependent Lateral Seated Transfer with Transfer Board: wheelchair to Bed

A
  1. approach bed and remove right armrest and legrest.
  2. Position the right side of chair as close as possible to bed. Angled slightly to prevent drive wheel from hindering transfer. Secure both surfaces. (bed and wheelchair locks)
  3. Lean trunk to the left, lifting the right hip up off the seat. Place end of transfer board beneath right hip. May need to be moved side to side to correctly position.
  4. position the board in front of drive wheel and aimed toward the mat (bed)
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18
Q

Steps 5-7

Independependent Lateral Seated Transfer with Transfer Board: wheelchair to Bed

A

5 Lean slightly to the right, toward the mat, and place open right hand far out on the board. Allow room for the hips to move laterally. Place left hand on wheelchair armrest or seat, directly beneath axilla.
6 Lean slightly forward. depress shoulders and push down with both arms to lift the body up and sideways on the board. Repeat hand placement and lateral movement until positioned securly on the mat.
7 Lean to the right, away from the wheelchair and remove the transfer board. Replace the armrest and legrest.

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19
Q

Clinician Assistance for lateral Seated Transfer with Transfer Board

A

Second person can assist from behind, helping lift the patient’s torso as in the dependent lateral shift. CCDD

Guard from the front. both hands at shoulders or shoulder and one on gait belt.

knees ready to block any unwanted forward sliding.

There are hand holds in transfer boards - don’t let patient use them for transfers as fingers can get caught.

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20
Q

Clinician Assistance for lateral Seated Transfer with Transfer Board

Safe hand placement.

A

There are hand holds in transfer boards - don’t let patient use them for transfers as fingers can get caught.

Don’t put fingers under end of slide board as fingers could get crushed.

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21
Q

Steps 1-3

Assisting in a lateral transfer using a transfer boardL: Bed to Wheelchair

A
  1. Remove the wheelchair’s right armrest and legrest and postion the right side of the wheelchair at a slight angle to the mat. secure both surfaces.
  2. postition self in front with wide BoS. Be prepared to block knees. Place gait belt around patient.
  3. Lean patients trunk to the right, lifting left hip off the bed to place the transfer board. Aim transfer board toward the seat of wheelchair, but in front of the drive wheel.
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22
Q

Steps 4-6

Assisting in a lateral transfer using a transfer boardL: Bed to Wheelchair

A

4- Patient leans toard the chair, places hand far enough toward the chair to allow lateral movement. Other hand below axilla
5- Grasp lateral aspects of gait belt or use shoulder and pelvis depending on level of control needed. Count of three, pt depresses shoulders, pushes down with both arms, and transfers laterally with assistance. Repeat until in chair.
6 - Lean patient to the left and remove the transfer board from underneath the hip. Remove gait belt. Replace wheelchair armrest and legrest and adjust the sitting position for comfort and safety. Provide call button or cell phone.

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23
Q

Assisting in a lateral transfer using a transfer board: wheelchair to bed

A

similar to bed to wheelchair but in oposite direction.
If the patient is wearing a hospital gown. powdering board or placing a towl or pillowcase over the board may help.
Encourage patient to lift rather than slide.
environment may pose challenges to positioning slide board.

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24
Q

Standard slide boards

A

support 300 to 400 lbs.

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25
Q

Bariatric slide boards

A

500 lbs.

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26
Q

Steps 1-3

Independent Lateral Seated Transfer without transfer board: Wheelchair to Mat to the left.

A
  1. Approach transfer site and remove the wheelchair’s armrest and legrest on the transfer side
  2. position left side of chair as close as possible to the mat. Angle the chair slightly to prevent the drive wheel from hindering the transfer. Engage locks. secure both surfaces.
  3. lean left toward the mat. A slight shift of the body toward the edge of the seat may be necessary. Place left hand on mat, just beyond the destined location of the hips and the right hand on the armrest under tha axila.
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27
Q

Steps 1-3

Independent Lateral Seated Transfer without transfer board: Wheelchair to Mat to the left.

A

4- Depress the shoulders and push down with both arms, lift the body up, clear the wheel chair seat, and then move move over and down onto the surface of the mat.
5- Adjust the new sitting position as neded for comfort and safety.

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28
Q

Independent Lateral Seated Transfer without transfer board: reverse Mat to wheelchair.

A

process is the same as the opposite except patient rreaches for the far armrest of the chair before shifting. If the arm is too far away for safety, it may need to be done in a sequence of up and over shifts. Mind the gap.

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29
Q

Steps 1-3

Independent A-P Transfer: Bed to Wheelchair

A
  1. Adjust bed and chair as needed to minimize height difference between bed and chair. With legrests out of the way, bring chair to face the bed at right angle, inline with waist when you are lying supine. lock surfaces
  2. In long sitting, pivot in the bed so that your back is positioned directly in line with the chair. Scoot backward to EOB.
  3. Reach posteriorly to grasp both armrests of the chair or seat.
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30
Q

steps 4,5

Independent A-P Transfer: Bed to Wheelchair

A

4- Depressing the shoulders and pusing down with the arms, lift the body up and back, positioning the hips at the back of the seat.
5- Unlock the wheelchair and back away from the bed, positioning the LEs on legrests as appropriate.

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31
Q

steps 1-3

Independent A-P Transfer: Wheelchair to Bed

A

exits chair facing forward
1. adjust bed/chair as needed to minimize the height difference. with legrests out of the way, position chair at right angle to bed, leaving enough room to manuver LEs.
2. Place both feet and lower legs up on bed with knees extended.
3. Place both hands on the armrests of the chair, chair seat or drive wheels, directly below the axilla.

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32
Q

steps 4,5

Independent A-P Transfer: Wheelchair to Bed

A

4- Lift the body up and slide it forward onto bed, repositioning LEs as needed
5- Once fully and safely on the bed, pivot to realign yourself on the bed.

Most common piece of equipment to assist is a trapeze bar

Transfer boards placed under the patient in long sitting can be used to bridge the surfaces from the chair to the bed after the patient gets their legs onto the bed/chair

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33
Q

Stand pivot transfer from bed to chair with total hip arthroplasty posterolateral approach on the right side things to consider:

A

Chair placed on patient’s left side, so lead with unaffected leg and prevent adduction on right side.

right foot forward when standing up rather than under pt to prevent hip flexion past 90 degrees.

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34
Q

Stand pivot transfer definition

A

when a patient stands erect, turns ans sits.

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35
Q

squat pivot transfer definition

A

patient achieves a partially erect posture durring turn and sit.

36
Q

Preparing the environment for stand and pivot transfer

A

place both seating surfaces close to one another.
remove legrests or fold them out of the way if they aren’t removable.
secure both surfaces (locks)

Patient should be wearing footwear.

37
Q

for stand and pivot transfer

Moving forward on the chair

A

hips need to forward on the seating surface.
Up and forward shift
or alternat weight shifting
forward hip slide

38
Q

for stand and pivot transfer

Up and forward shift to move forward in chair

A

The patient leans forward and pushes down through arms and/or legs, and lifts the hips up to clear the seating surface and then forward.

39
Q

for stand and pivot transfer

Alternate weight shifting to move forward in chair

A

Shifts the hips forward in reciprocal manner.
Leans body to one side then other
contralateral hip moved forward and then the other.
Can be helped by reaching behind patient’s hips and lifting up and forward with the patient.
Hands near SI joint.
clinician should squat or half kneel when doing this.

40
Q

for stand and pivot transfer

Forward hip slide to move forward in chair

A

Patient leans trunk back against the back of the chair, and using the trunk extension as leverage to slide the hips forward. (force couple)

However, to complete, the patient’s upper body must be brought forward against gravity, using significant abdominal muscles.

41
Q

for stand and pivot transfer

Foot postion

A
  • As far back as possible
  • flat on floor
  • shoulder-width apart unless both knees are blocked, then closer together
  • Lead foot slightly forward (foot nearest target surface)
  • Not too far forward or BoS will be anterior to the COM.
  • can be done on one foot. extend knee of the onvolved LE, moving foot forward.
42
Q

for stand and pivot transfer

Forward Trunk lean

A
  • CoM over BoS - moving mass of the trunk forward over BoS created by pts foot placement
  • “bring your nose over your toes.”
  • “make your head touch my hand”
  • Maintained during the initial rise in a stand and pivot.
  • may trigger fear of falling for some patients
  • May have to have patient slide a hand down shin to achieve trunk position
43
Q

for stand and pivot transfer

Use a gait belt

A
    • for patients that require close guarding or physical assistence.
  • also to privide clinician with a contact point for control of the patient’s movement. along with blocking knee-better mechanical advantage.
  • Belt can help prevent falls.
  • almost always for patients with maximum to Mod assist.
44
Q

for stand and pivot transfer

Arm and Hand placement

A
  • assist in transfer by pushing down on armrests of chair or surface.
  • pts hands should be posterior to flexed trunk.
  • Leading hand ready to reach the far edge or armrest of destination.
  • One option is to have the patient hold on tto the clinician’s forearms or hips.
  • Don’t let them grab the kneck. - grabbing back may invite them to slide up to kneck.
  • Don’t let patient lock elbows, especially on reaching.
45
Q

for stand and pivot transfer

Clinician Position

A
  • In front of patient with hips and knees flexed.
  • wide BoS
  • Staggard feet to mimic pts feet.
  • hands grasp gait belt on either side of patient’s lumbar spine.
  • Some clinicians place hands beneath the patient’s hips.
46
Q

for stand and pivot transfer

Performing the pivot transfer

A

Ability determines wheather it will be a squat pivot or standing pivot transfer.
Dependent pivot transfers require careful guarding.
Rising, pivoting and sitting.
“on the count of 3”
In stand and pivot, there may be pauses between the components.
In squat and pivot, one continous movement
squat and pivot normally require more assistance.
Blocking pts knees is very important on squat and pivot.

47
Q

for stand and pivot transfer

Blocking the pts. Knees

A
  • needs to be able support weight on at least one LE
  • pts tibias will keep moving forward without a counterforce
  • blocking the knee helps because the quadricepts wont have to work so hard to prevent tibias from moving forward.
  • If one leg is reliable - block unreliable leg
  • If both legs are partially reliable - block both legs
  • If both legs are partially reliable - block stronger leg or both legs
  • If both legs are less than partially reliable - block both.
  • one method is to use two LE to block one of pts knees.
  • pts who require squat pivot often require both knees blocked.
  • clinician’s tibia crossing the patients tibia is one to one method
48
Q

Knee block

Placement for two to one knee block

A
  • Clinician stands with hips flexed and internally rotated
  • knees flexed
  • medial aspects of both knees on either side of the pts tibial tuberosities, creating a wedge block against tibial tuberosity.
  • Don’t place too far laterally, “sandwiching.”
49
Q

Knee block

Placement for a two to two knee block

A
  • place the pt’s feet together and slightly staggared.
  • Place medial aspects of clinician’s knees against anterolateral aspects of the pt’s knees as close to the midline as possible.
  • avoid pt’s knees slipping forward through the clinician’s knees
50
Q

knee block

Placement for a one-to-One cross tibia block

A
  • height differences can make two to two or two to one block difficult.
  • Clinician flexes at the hips and knees
  • positions the medial aspect of foot against the medial aspect of pt’s foot.
  • This shifts the clinician’s position slightly to the side allowing for great pt trunk flexion
  • Variation: lateral placement but crosses medially. Helps when a pt’s knees buckle.
51
Q

for stand and pivot transfer

Rising

A
  • pt pushes down through feet and hands
  • clinician leans posteriorly to accomodate pt leaning forward.
  • Use clinician’s lean and grip on gait belt to assit in maintaining adequate trunk flexion.
  • Assist by providing an extension mement at the patient’s knees around the fulcrum point of knee contact.
  • Be prepared to lower patient back to chair if rising fails.
52
Q

for stand and pivot transfer

Pivoting

A
  • After rising, pivot on foot or feet.
  • Move hips toward the target surface
  • clinician pivots their feet with the pt’s feet
  • pt may need to perform a series of small movements, lifting heel and pivoting on the ball of the foot.
  • Do not allow descent until pt is directly in front of the seating surface.
53
Q

for stand and pivot transfer

Sitting

A
  • Requires flexion similar to rising.
  • May need to be encouraged to flex at the hips
  • If they don’t flex, they will sit rappidly and put a huge strain on clinician’s back.
  • With the trunk flexed, they are better able to reach back to support themselves.
  • If no armrests are availabe, the pt should reach for the target seating surface if possible.
  • If the patient extends hips too early during the descent, the initial contact may be upper back against upper back of chair. This causes hips to rest forward in the seat.
  • Cliinician may have to use leverage to control the pt’s descent. body weight against knees.
54
Q

Steps 1-4

Assisted Suquat and Pivot from Supine in bed to sitting in chair

A
  1. Prepare the pt - explain activity - don non slip footwear - clothing -
  2. Bring chair close - Bring chair close to bed, but not it’s final position (allowing enough room for pt’s legs to move off eob) Remove armrest and legrest - apply locks on bed - Lower bed to the approximate level of the chair or slightly higher.
  3. Move pt from supine to sitting on EOB
  4. Position the pt and chair for transfer
    • position chair adjacent to the bed and lock weels
    • move the pt close to EOB to minimise the transfer distance
    • place pt’s feet weel under the body and in full, or near full, contact with the floor.
    • pt. lean forward. If needed assist with forward lean from scapular area
    • Grasp gait belt behind the patient. Hands should almost meet at middle of back. arms can provide additional trunk support
    • Stabilize your trunk and bend knees, blocking pt’s knees as needed.
55
Q

Steps 5-7

Assisted Suquat and Pivot from Supine in bed to sitting in chair

A

5 - pivot
* Begin the pivot by leaning back as the pt. leans forward
* The combined CoM of the pt and clinician should be above the clinician’s feet
* have pt reach for the target surface
* clinician pivots on feet, turning with the pt’s as a single unit until the pt is directly in front of the chair.
6 - Lower the pt. into chair
* Maintain a neutral spine and lean forward and slowly lower pt into the chair
* Place pt’s hips well back in the chair
7 - Reposition the pt as needed
* Replace the wheelchair armrest and legrest
* ensure hips are fully back and legs and arms are supported
* Remove the transfer or gait belt.

56
Q

reverse of bed to chair Steps 1-3

Assisted Squat to Pivot From Chair to Bed

A
  1. As clinician assists pt up from chair, pt may be able to push down with one hand on the far armrest while reaching for the bed with the other. If pt is afraid and grips armrest, it may be preferable to have pt grip clinician’s forearms or cross arms on chest
  2. When lowering pt onto bed, position toward the HOB to reduce repositioning.
  3. make sure pt. is securely on EOB. On the edge it will compress and create a slope. Do not release knee block until pt is securely on EOB. If necessarary , have patient flex at hips and push through the knees and femurs with an aditional lift of hips to ensure the pt is well positioned on EOB
57
Q

reverse of bed to chair Steps 4,5

Assisted Squat to Pivot From Chair to Bed

A

4- Before moving into supine, check position on the bed. It’s easier to scoot sidewise from sitting.

5- Remove gait belt and assist the patient into a sidelying position and then into supine.

58
Q

steps 1-3

Independent Stand-Pivot Transfer.

A
  1. Bring the hips forward to the edge of the chair. Place both feet back with the near fooot slightly forward. Place both hands on armrests.
  2. Leaning forward, push down through the LEs and hands, pushing the body up to full standing position. Release the armrests as a full upright posture is attained.
  3. Pivot on the balls of the feet or with small pivoting steps, until the body is postioned in front of the target seating surface
59
Q

steps 4-6

Independent Stand-Pivot Transfer.

A

4- Lean the trunk slightly forward and reach back with both hands, usually first one and then the other, to the armrests of the chair for support and guidance
5- Slowly lower the body onto the seating surface, maintaining a partially flexed hip position and controlling the descent with LEs and with UEs as needed
6- Adjust postion as needed

60
Q

steps 1-4

Assisted Chair to Mat stand-pivot transfer

A
  1. explain activity to the patient, demonstrate if needed and place gait belt.
  2. Position the char angled close to the mat. A gap may be necessary to give clinician room. secure the wheelchair locks.
  3. Bring the patient’s hips forward to edge of chair. place both feet back. near foot slightly forward. both hands on armrests.
  4. Pt leans forward and pushdown through LE and hands. Patient releases the armrests as the body moves to aa erect standing position
61
Q

steps 5-9

Assisted Chair to Mat stand-pivot transfer

A

5- It’s helpful to pause on intial standing. check for indications of diazziness and snug up the gait belt. get pt to focus on next steps
6- Together, the patient and clinician pivot on the balls of the feet with small pivoting steps until the patient’s body is postitioned in front of the target seating surface
7- Have the patient flex the hips slightly and reach back with both hands, usually first one and then the other, to the mat.
8- Slowly lower the body to the mat, encouraging the pt forward leaning trunk position. block knee as needed. controll descent.
9- Adjust the pt’s postition as needed.

62
Q

Completeing the transfer

A

replace wheelchair armrests and legrests. Place pt’s feet on footplates.

Make sure pt has access to important items.

A way to call for help.

63
Q

Using walkers for stand and pivot

A

can provide stability and support during a stand-pivot transfer. Pt turns walker sligthly and then presses down on haldles of walker to pivot feet, decreasing the forces transmitted through the LE.

64
Q

Pivot disks

A

by placing a pivot disc under feet, it minimizes the force necessary to pivot. More common for mod to max assist patients.
Can also be used by min assist patients
clinician may have to anchor the disk with the ball of a foot while the pt is rising.
both of pt’s feet are on the pivot disk.

65
Q

Pivot poles

A

provide stabilitiy during the pivot phase of the transfer.
floor to ceiling pole with optional pivoting handle.
helps with independence.

66
Q

Unilateral Restricted weight-bearing

A

must be able to put at least partial WB on restricted LE to complete normal pivot transfer.

NWB transfer on involved LE if they can’t bear weight. NWB modifactions for pivot transfer:
* Slides the involved LE forward rather than having it under CoM at begining of transfer
* Pt holds involved foot slightly off the ground during the pivot section. Hops.
* While decesnding, slides involved foot forward.
* if patient has difficulty maintaining WB precautions, a squat or slide board transfer may be better.

67
Q

Hemiparesis

A
  • Weakness on one side of the bodfy
  • Strength and motor control will determine optimal method of moving hips forward to transfer
  • if using forward hip slide, may need to pull on armrest with the strong arm to bring the truck upright before attempting to stand.
  • May need to use stronger leg to move weaker foot into position or use stronger arm to do this.
  • May resemble unilateral transfer in that the patient seems to hop to pivot.
  • controls descent by maintaining forward lean, knee and hip flexion and strong arm on armrest.
  • Blocking knees as needed.
  • flacid arm should not be allowed to hang by the pt’s side.
  • hold the involved arm close to chest.
68
Q

THA

A
  • Often have LE precautions.
  • Review - hip flex, hip adduction, hip internal rotation - restrictions
  • Forward hip slide to scoot forward or a hybrid menuver where the pt leans back and lifts and moves forward to edge.
  • Foot of the uninvovled leg under CoM, involved leg forward
  • Often require physical assistance AND a walker to do pivot transfer
  • Several small steps for pivot.
  • If pivoting away from the involved side, the trunk rotation will cause internal rotation of hip on the involved side. Must turn feet before turning trunk to prevent internal rotation.
  • Either direction - move feet before trunk to avoid internal rotation - away from involved side is perfered however.
  • Reaching back with the uninvolved side when sitting helps prevent internal rotation.
  • Sliding the involved leg forward before sitting minimizes hip flexion
69
Q

Spinal Cord Injury And Sitting Pivot Transfer

A

Most WB is through the arms.
powered by UE and momentum from head and neck.
Continous movement.

70
Q

steps 1-4

Spinal Cord Injury And Sitting Pivot Transfer from chair to surface

A
  1. Position wheelcair close to the target surface and at an able of approximatly 20 to 45 degrees. apply the locks
  2. Position the feet on the floor slightly posterior to the knees while maintaining full or nearly full, foot contact with the floor
  3. Place the leading hand on, or as close as possible to the target surface.
  4. Place the trailing hand on the seat next to the upper thigh of the ipsilateral leg.
71
Q

steps 5-8

Spinal Cord Injury And Sitting Pivot Transfer from chair to surface

A

5- Flex the neck and hips, bringing CoM forward over the feet.
6- Use the arms to lift the buttocks sufficiently to clear the seat and immediatly pivot the hips toward the target surface, turning the head and shoulders in the oposite direction.
7- Immediatly lower the hips onto the target surface
8- Adjust position as needed.

72
Q

While learning sitting pivot transfer

A
  • Clinician may need to be in front guarding against loss of balance.
  • Special attention to guarding the trunk, because of SCI
  • Verify no tissue damage is occuring - pt may not be able to tell.
73
Q

Toilet transfer and pants for stand-pivot

A

the perineal earea is typically exposed after the transfer to toilet but before sitting down.

74
Q

Toilet transfer and seated tranfers

A

A commode transfer board with a cutout for drive wheel and for the comode opening can make the process safer and easier

75
Q

Steps 1-6

Toilet Transfer with Clinician Assistance

A
  1. Prepare patients by informing them wwat will be happening and how they can assist.
  2. Position the chair as idicated by the person and environment
  3. Adjust the cheair as needed. (remove armrests, legrests and apply locks)
  4. Apply the gait belt as needed
  5. Don gloves and assist with removal of pants and underwear
  6. Position the patient for transfer: scooted forward in the chair with feet flat on the floor.
76
Q

Steps 7-11

Toilet Transfer with Clinician Assistance

A

7- Perform squat-pivot or stand pivot technique, using knee blocks as needed
8- Lower patient to the toilet
9- Reposition the patient as needed
10- Assist with hygeiene and cloting as needed
11- Reverse the transfer process to teturn to the chair

77
Q

Bathtub Bench Transfers unique considerations:

A
  • Protecting bare skin while in contact with bench and tub
  • Preventing slipping caused by wet
  • Setting and monitoring water temp
  • Having an adequate and accessible supply of towels, washcloths and other toiletries.
78
Q

Other considerations for Bathtub bench transfers

A

Keeping patient warm and protected and the patient’s dignity. If there is a dely in the transfer, consider draping.

79
Q

Step by step technique for chair to bathtub bench transfers

A

Similar to that for squat pivot or stand pivot with the following exceptions:

  • All clothing is removed before transfer.
  • Legrests and near armrests are moved out of the way and the wheelchair is positiioned against the tub, and locks applied
  • towel or soft pad placed on edge of tub to protect legs.
  • Legs are lifted up and over the tub before the transfer.
  • Patient performs a lateral transfer from the chair onto the seat in the tub, a grab bar on the far wall can be used for lateral scooting.
  • Clinician assistance, if needed, is provided either in front OR behind.
80
Q

Car transfers risks

A

falls are very likely exiting a vehicle

81
Q

steps 1-6

Independent Wheelchair to Car Transfer

A
  1. Slide the driver’s seat back as far as it goes and recline the backrest
  2. Remove the wheelchair armrest and the legrest nearer the car seat if possible
  3. Position the wheelchair facing forward between the open door and the car seat
  4. apply the wheel locks
  5. Scoot or lift the buttocks toward the front of the chair
  6. Position the feet in the same way as in other pivot transfers.
82
Q

steps 7-11

Independent Wheelchair to Car Transfer

A

7- Push or pull on a secure item in the car
8- Pivot in either a squat or a stand pivot while turning head away from the car seat. Flex the neck and upper trunk to clear the doorframe and prevent injury
9- Lower the hips onto the car seat
10- Bring the legs into the car
11- Adjust position as needed.

83
Q

Independent transfer from car to wheelchair

A
  • Almost the reverse of the process: exceptions:
  • Initiates with lift and a turn toward the wheelchair.
  • Must scoot farther toward the edge of the seat to get feet on ground.
84
Q

steps 1-5

Independent Wheelchair to car transfer using a Transfer baord

A
  1. Approach the car and open the passenger side car door as fully as possible
  2. Move the front passenger’s seat back as far as possible and recline the seat back slightly
  3. Remove the wheelcchair’s armrest and legrest
  4. Angle the wheelchair forward with the front the chair as close as possible to the front of the passenger’s seat. apply wheel locks
  5. Place the transfer board underneath the left hip and across onto the seat of the car
85
Q

steps 6-9

Independent Wheelchair to car transfer using a Transfer baord

A

6- Reach the hand out onto the board, allowing room for the hips to move laterally. To prevent injury to the fingers, do not grasp the end of the transfer board. Place the right hand on the wheelchair armrest or seat directly beneath the axilla

7- While depressing the shoulders and pushing down with both arms, lift the body up and sideways onto the board. Repeat the motion until the patient is positioned securely on the seat.

8- Lift the feet into the car

9- Remove the transfer board fromunderneath the hip. Adjust the new sitting position as needed for comfort and safety.

86
Q

Steps 1-5

Assisted Wheelchair to car Transfer

A
  1. Explain the activity to the patient
  2. Open the car door fully and slide the car seat back. apply the gait belt
  3. Remove the nearest legrest as well as the armrest if performing a squat pivot transfer
  4. Standing between the open door and the car seat, position the wheelchair beside the car and just behind the car door openeing and apply the locks.
  5. Assist the patient in scooting foraward to the front edge of the wheelchair seat
87
Q

Steps 6-10

Assisted Wheelchair to car Transfer

A

6- Have the patient lean forward to front edge of wheelchair seat. Assist patient in coming to full or partial standing position

7- For squat and pivot transfers, assist in pivoting to cart seat in continued forward trunk lean. For standing pivot, assist patient in standing and have the patient turn using multiple small steps. As the patient’s back turns toward the seat of the car, the clinician’s back turns away from the car

8- When the patient is positioned in front of the car seat, lower the hips to the seat. In a stand-pivot transfer, have the patient fles the hips to initiate the sitting process. The clinician typlcally uses one hand to guide the descent while placing the other hand over the patient’s head to prevent contract with the doorframe.

9- Once the patient is safely seated, remove the gait belt and assist the patient in placing the legs into the car while pivoting on the seat

10- Readjust the patient’s position and assist with the seatbelt as needed.