Transfers Flashcards
What are the different types of assisted transfers
- sit to stand w/no assistive device, 1 or 2 person assist
- stand pivot
- sliding board transfer/lateral scoot transfer
- squat pivot
- stand step transfer
- sit to stand w/axillary crutches and/or lofstrand crutches
- sit to stand with front wheel walker (FWW), rolling walker (RW), platform rolling walker
What are the different weight bearing statuses
- Non-weight bearing (NWB): foot doesn’t touch ground
- Toe touch/toe down weight bearing (TTWB): foot contacts ground for balance only up to 20% of body weight
- Partial weight bearing (PWB): usually 20% to 50% of body weight
- Weight bearing as tolerated (WBAT): limited only by patient tolerance (>50%)
- Full weight bearing (FWB): no restriction (100%)
Define independent
- No physical assistance or supervision needed from another person, done in a timely manner, consistent performance over time/reps
Define Mod independent
- requires an adaptive or assistive device, otherwise independent, timely, transfer board, bed rails, grab bars, furniture
Define supervision/stand by assistance (SBA)/close guarding
- Multimodal cues from another person, verbal, tactile, directions, but not touching for general safety
Define contact guard assist (CGA)
- Touching assist for safety, very likely patient will require additional protection
- example: hand on gait belt but not influencing the activity
Define Minimum assistance (Min A)
- patient does 75% or more of the activity, the therapist/caregiver assists with 25% or less assistance
- assistance is required to complete the activity
Define Moderate assistance (Mod A)
- patient does 50-74% of the activity, the therapist/caregiver does 26-50%
- assistance is required to complete the activity
Define Maximum assistance (Max A)
- patient does 25-49% of the activity, the therapist.caregiver does 51-75%
- assistance is required to complete the activity
Define dependent
- patient requires total physical assistance from one or more persons to accomplish the task safely
- the patient does 0-24% of the activity, the therapist/caregiver does 76-100%
- special equipment & devices are typically required
define unable/unsafe to attempt/perform
- contraindicated given the patient’s condition
Define mechanical lift
- 0% effort from the patient of the therapist/caregiver
Value of proper biomechanics
- decreased stress & strain
- decreased injury risk
- energy conservation
- safety
- promotes proper body control & balance increasing patient confidence
Cardinal rules of correct body mechanics
- assess & relassess the load & keep it close
- create an appropriate base of support for the type of lift to be performed
- use isometric muscle contractions of trunk muscles
- roll, push, pull, or slide vs lift if able
- lift with the legs/body in a slow deliberate matter
- avoid twisting motions or combined trunk motions
Describe valsalva maneuver
- it is the performance of forced expiration against a closed glottis
- essentially air is trapped in thorax, increases intrathoracic pressure which decreases venous return, thus decreasing cardiac output
Describe good body mechanics
- it maximizes the use of the core, hips, and lumbar spine
- sports the spine & pelvis during movement, maintains neutral pelvic alignment
Describe a deep squat lift
- hips lower below knees, feet straddle the object, UE are parallel, there is a vertical trunk position with lordosis & a slight anterior pelvic tilt
Describe a power lift
- same as the deep squat lift but only from the half squat position
- main technique used to get a patient out of a chair
Describe a straight leg lift
- deadlift technique
- knees slightly flexed or in full extension, trunk is vertical or horizontal
Describe one leg stance lift/ Golfer’s Pickup
- single limb stance on one LE with the opposite elevated as a counter balance
- reach down & pick up object like a golfer picks up a golf ball from the green
Describe half kneeling lift
- half kneeling position with load in between feet & close to the body
Describe traditional lift
- feet staggered stance to each other with load in between, lift arms initially then finish with the LE
Describe stoop lift
- partial hip & knee flexion to reach the load, the lower back is maintained in lordosis & vertical the entire lift
- compare to a Romanian dead life (RDL)
Example of a stand pivot transfer for a patient with different levels of assistance
- Max assist: dependent pivot holding over the back of the patient
- Mod assist: standing/assisted pivot with patient’s arms around your shoulders (normal)
- Min assist: standing with only gentle contact and PT can be standing, squatting, or sitting
- Min/Supervision: standing with an assistive device
What are the guidelines for dependent transfers
- perform a detailed chart review (know what you’re getting into)
- visualize & plan the transfer prior to performing it (consider the environment, pt status, goals of transfer, Pt & pt abilities, & available assistance/equipment
- preposition equipment with the end in mind
- determine if additional assistance is needed & acquire before the transfer is initiated
- select the safest technique & execute
- reassess after transfer to determine effectiveness or the technique
- evaluate pt response/complications & if goals of the transfer were met
- the transfer is not complete until the pt is safe & secure in the new position
What is the gait belt/transfer belt policy for TP1
- don gait belt prior to any transfer from one surface to another
- don gait belt during any upright functional activity
- there are no exceptions to these
What are the keys to an effective transfer
- explain what you are doing to the patient
- don’t overwhelm them
- provide cues as needed to maximize patient participation
- keep instructions simple & direct
- transfer person safely with good body mechanics
- assess for any adverse effects from the transfer
Different types of dependent transfers
- hoyer/mechanical lift
- sheet transfers w/2-3 people
- 3 person lift
- 2 person lift
- dependent squat pivot transfer
- lateral scooting transfer with/without sliding board
- sit to stand transfer with use of sheet
- sit to stand transfer with parallel bar support
What are the 3 scooting techniques to get a patient to the edge of their chair/bed
- depression lift
- R and L unweighting & scooting
- backwards lean
What is the goal of transfer training
- the goal is to progressively train the patient from a condition of dependence to a condition of independence
Safety for assisted transfers checklist
- gait belt
- footwear (non slip grip socks or shoes)
- medical status (vitals assessment)
- appropriate DME (durable medical equipment)
- communication (have pt recall technique and/or precautions
- cognition (is pt able to follow one or two step commands)
Typically what side of the patients do you transfers to
- transfer to the strong side/unimpaired side
What are the things to consider for initial conditions in transfer training
- posture
- ability to interact with the environment
- environmental context
What re the things to consider for preparation in transfer training
- stimulus identification
- response selection
- response programming
What are the things to consider for initiation in transfer training
- timing
- direction
- smoothness
What are the things to consider for execution in transfer training
- amplitude
- direction
- speed
- smoothness
What are the things to consider for termination in transfer training
- timing
- stability
- accuracy
Define motor control
- the ability to regulate or direct the mechanisms essential to movement
Define the mobility stage of motor control
- availability of ROM to assume a posture & the presence of sufficient motor unit activation to initiate a movement (mobility comes before stability)
Define the stability or static postural control stage of motor control
- it is the ability to maintain a static steady position in a weight bearing/antigravity posture (ex: prolonged holding of one position)
Define the controlled mobility or dynamic postural control stage of motor control
- it is the ability to maintain a dynamic posture/position in a weight bearing/antigravity posture (ex: standing or sitting weight shifts)
Define the skill stage of motor control
- mobility is superimposed on stability in non-weight bearing conditions
- requires a specific goal & a coordinated movement sequence to achieve the goal
Define the cognitive stage of motor learning
- attempting to understand task
- develop plan
- evaluate response
Define the associative stage of motor learning
- strategy selected
- refinement of skill
- less attention required
Define the autonomous stage of motor learning
- requires little to no attention
- can perform other tasks in connjunction
Describe the task analysis & task oriented approach
- gold standard to promote learning
- patients are helped to learn a variety of ways to solve the tsk goal rather than a single muscle activation
- adaptations to changes in the environmental context is a critical part of recovery of function
What are the phases of a sit to stand
1) weight shift/flexion momentum
2) bottom leaves the seat
3) lift/extension
4) stabilization
What are the common strategies used for a sit to stand
- momentum
- zero momentum/force control strategy
- arm rests
Practice conditions to train transfers
Constant vs Variable practice: same task repetitively or several different tasks
Mass vs Distributed: practice time is greater than rest time (mass) vs practice time is less than/equal to rest time
Random vs Blocked practice: A, C, B, E, D = Random; AAA, BBB, CCC, DDD = Blocked
Open vs Closed: open environment introduces external variables & closed environments allow for increases focus on the task itself
Part vs Whole practice
Feedback to train transfers
Intrinsic: feedback that comes from the individual simply through the various sensory systems as a result of normal production of the movement
Extrinsic: augments intrinsic feedback through cueing
Knowledge of performance: feedback relating to the movement pattern used to achieve a goal
Knowledge of results (form of extrinsic feedback): terminal feedback regarding the outcome of the movement
What needs to be included regarding transfers in an evaluation
- type of transfer performed
- level of assist
- patient limitations
- manual cues/contacts utilized for safe transfer
- time & consistency
Define this billing code: CPT code 97530
- used to bill for patient services that address improving functional mobility & independence
