Week 9: Transfer w/ a Device

assistive device

An assistive device is a gait aid used to assist a person with ambulation.  These include walkers, canes, and crutches.  Wheelchairs are not considered assistive devices, they are addressed separately as a propulsion aide.

adaptive equipment

Adaptive equipment are various devices and equipment used to assist a patient in achieving a task.  For example, a raised toilet seat to accomplish safe toilet transfers.  Grab bars to assist with safe transfers.  A tub bench/chair for safe bathing.  A reacher for picking objects up off the floor.  There are many different types of adaptive equipment and devices that can be used for mobility, bathing, dressing, eating, hygiene…

hand grip measurement

-Hand grips on all assistive devices should be measured to the height of the patient’s wrist crease.  Patient stands to their best height with arms at sides and the assistive device grip is measured to align at the base of the thumb or wrist crease to allow for a bend at the elbow of about 15-20 degrees when the patient then grasps the grip.  This elbow bend most importantly allows for leverage to assist in weight bearing relief of the involved lower limb, and for appropriate upper extremity (UE) and shoulder girdle stability, and for balance.    

-The best way to start your fitting is to check the patient’s chart for their height and then estimate the best fit prior to getting the patient up the first time.  Once up, you can then check to see if the fit is correct and explain to the patient why you fit the assistive device the way you did.  It is not uncommon for people to “borrow” someone else’s assistive device to save money, and that assistive device is not fit correctly for them.

-NOTE: When fitting assistive devices remember to consider the footwear and height of the sole of the shoes your patient will be wearing.

Sit<-> Stand Transfers with a Device

-Once we know a patient can ambulate (either with or without an assistive device) we no longer stand in front of them to facilitate sit<->stand.  The PT/PTA would facilitate from the side.  Hand placement on the patient and gait belt are critical and will be demonstrated in lab.  It is important to use the proper hand placements while also allowing the patient to push off and reach for their assistive device without you getting in the way.  NEVER have both hands behind the patient; if the patient loses their balance forward, it is hard to assist for recovery.  Instead, we will use a technique called a “box out” which allows the PT/PTA to have one arm in front and to the side of the patient while still allowing the patient to reach forward with their arm once they push off.

-Absolutes: Do not allow an assistive device to come between PT and patient as a barrier, i.e. DO NOT stand to the outside of the assistive device or in front of the assistive device and patient.  Except with canes and crutches, the patient is not to hold on to an assistive device while moving from sit to/from stand.  Patient should push up from the surface upon which they are currently sitting to stand; and reach back to check surface and control descent with sitting.

transferring to a wheelchair with a device

-PT stands on the involved side of the patient and assists them to standing.  The wheelchair is located on the patient’s uninvolved (stronger) side so they can transfer in that direction.  Eventually a patient may need to transfer both ways, however, it is typical to begin training by initiating movement to the uninvolved side.  The wheelchair should be located parallel to the bed/mat with enough distance from the bed/mat for the PT to move alongside the patient when assisting the patient to sitting.  The wheelchair should be close to the patient’s uninvolved lower extremity, so the patient does not need to take steps other than to step towards the wheelchair and then pivot with a half turn to prepare to sit.  If the patient needs to take steps, the wheelchair is too far away.