Quiz 2: Transfers

Preliminary Concepts

1. Be aware of client’s status: physical, cognitive, perceptual, behavioral, limitations

2. Be aware of your own status: physical limitations, ability to communicate clear, sequential instructions to client (or long term caregiver)

3. Know correct moving & lifting techniques!

Proper Body Mechanic Guidelines ✅

1. Get close to client, or move client close to you for stability & safety

2. Keep a square orientation to client

3. Bend at knees and hips - keep back straight. USE LARGE MUSCLES (hips, knees)

4. Keep neutral spine (not hunched/arched)

5. Maintain wide base of support

6. Keep your heels down

7. Don’t combine movements (avoid rotating & bending forward at same time)

8. Communicate w/ client 💬

Bed Mobility & Bridging - Help supine patient move upward on bed

1. Bridge & push w/ legs

2. Pull with arms on bedrails

3. Dependent / assisted slide

4. “Lay down/move down a little bit if needed. Can you show me from here how you’d get up normally from the side”

5. OT bends pt knees, holds the hips, has client stay in bridge position before going up bed

6. Two-person job: getting person out of bed with chux fabric

Adaptive devices for bed mobility

1. Leg lifter

2. Handrails to get off the bed

3. Pole - can be used at home to get out of bed, trapeze for patients with a lot of mobility issues for DME

Supine to Sit

1. Bend opposite knee

2. Client reaches across body w/ arm

3. OT assist w/ knee & shoulder as needed

4. Client pushes up onto elbow

5. Legs over edge of bed

6. Client pushes up to sitting

7. Assist at hip & shoulder

8. Client pushes up, we sweep the legs at the same time

9. “Today we’re gonna sit up” “On 3, use this arm and your elbow to sit up, kick off and up”

10. OT’s hand should be supporting client’s shoulder girdle and pulling down from side of knee for pt to sit up

Total Hip Precautions - Posterior Approach (depending on surgeon: 6-8 weeks) More like a sliding/sweeping motion because the patient can’t bend/roll. OT must facilitate them, tell them the precautions “Can’t bend hip, turn toe in, or bring foot over/crossing feet, we have to be careful getting out of bed.”

1. No hip flexion of postsurgical hip beyond 90 degrees/bending

2. No internal rotation of postsurgical hip beyond neutral

3. No adduction of postsurgical hip beyond neutral

4. *most at risk for dislocation when all 3 are combined

5. Sit up and scoot off, client moves pelvis at same time as her hip

6. Good to have a patient move their leg out straight when trying to get out of chair (the side that had the surgery. Never want two hands on walker when patients stand up!)

Total Hip Precautions - Anterior Approach (variable among surgeons)

1. Avoid hip extension

2. Avoid external rotation

3. Avoid adduction beyond neutral

(Standard) Sternal Precautions 💖 Patient must have hands crossing chest so they don’t use them! (PRL)

1. No pushing/pulling through the arms, can’t push off the bed.

2. No lifting more than 5-10 lbs

3. No reaching behind back

4. Don’t sleep w/ hands behind head, hug pillow to chest to not use arms/help w/ coughing

5. Restriction to using arms when moving from supine to sit, standing up

6. May include hugging a cushion to chest or “splinting” when coughing

7. Open heart surgery: sternum cut vertically to allow access to heart. Wires or plates used to hold the two sides of sternum together until incision is healed. Depending on surgeon: 4-12 weeks

Modified Sternal Precautions (Move in the Tube)

1. People are instructed to imagine a tube encasing their trunk and arms to keep arms close to body, “inside the tube” during loaded activities - rolling, pushing up to stand, lifting objects.

2. “In the tube” position limits the lever arm created by arm and hand, should decrease stress on sternum

3. Still need to hold cushion or cross arms when coughing

4. *Recommendation is to look at individual risk factors and taper restrictions as patient recovers.

5. Standard sternal precautions being questioned as being too restrictive in recent years, possibly contributing to negative outcomes

Lumbar Spine Surgery Precautions - Logrolling (approx 6-8 weeks): BLT! 🥪

1. No bending (hip flexion is allowed) in the back

2. No lifting objects weighing more than 5 lbs

3. No twisting. Rotation of the spine occurs when shoulders are not stacked directly over hips

4. Can someone bend over to tie shoes, pick up objects from the floor, lean over the sink when standing? NO!

TLSO Brace

1. Can be donned while supine, rolling side to side to place underneath

2. Helps maintain spinal precautions during supine to sit

Spinal Precautions: Logrolling to get in bed

1. Sit on side of bed toward top ⅓ 

2. Use arms to lower yourself onto your side while bringing your legs onto bed

3. Keep knees bent, roll onto your back

4. Slow, go down on elbow, kicking legs up, laying back. NO TWISTING!

Spinal Precautions: Logrolling to get out of bed

1. While lying on your back, bend your knees

2. Roll your hips & shoulders @ same time to turn onto your side

3. Push yourself up with your arms while lowering legs off side of bed

Considerations during transfers

1. Weight bearing (WB) status/other precautions

2. How has the patient accomplished this in the past? Assistive devices?

3. Strength, balance, endurance, cognition, footwear, tubes & wires

Stand-pivot transfer (don’t need arm rest off)

1. Secure transfer belt 

2. Remove leg rests

3. Position chair at 45 degrees

4. Lock brakes

5. Client scoots forward, positions feet (feet behind knees)

6. Client: nose over toes

7. Client pushes up from arm rests

8. Stand & gain balance. Pivot

9. Reach back for surface

10. OT leans client forward as they go down

11. Assisting weaker lower extremity (LE): assisted pivot w/ weaker knee stabilized by OT

12. Tips

    1. Weight shift, move forward: Leaning and moving

    2. Use hands to scoot up

    3. Client hands should be on their lap, but push up off the bed

    4. OT feet mirror her feet, staggered to pivot

    5. Client leans forward during up motion

    6. OT uses shoulder, not hands

Squat/Bent Pivot Transfer

1. Remove armrest, client scoots & leans forward

2. Position arms & legs (mirror their feet, staggered)

3. Bring client forward to shift weight 

4. Transfer weight forward & pivot over

5. Patient leaves opposite of way they’re going, try to use momentum to get them to go over

Sliding/Transfer Board* (for SCI patient, or can’t weightbear on feet at all)

1. Arm rest off. Gait belt on patient first

2. Put end of board under patient, may need to tilt them, “You’re gonna weightshift forward”

3. OT Knees on either side of their knees, have patient help you through process especially if they have good upper body strength 

4. Client uses arms and slides while pushing “1, 2, 3”, OTs are contact-guard assist.

5. Slide sideways, don’t lift

6. Pull end of board out, patient may need to tilt 

Quality Measures Codes

• 6: Independent = NO helper

• 5: Set up or clean up assistance = dependent, requires helper ⬇

• 4: Supervision or touching assistance

• 3: Partial/moderate assistance (>50%)

• 2: Substantial/maximal assistance (<50%)

• 1: Dependent

FIM Levels

• 7 = complete independence= no helper

• 6 = modified independence = no helper

• 5 = set-up/supervised = dependent, requires helper ⬇

• 4 = CGA/Min A (>75%)

• 3 = Mod A (50-74%)

• 2 = Max A (25-49%)

• 1 = Total A (<25%)

For walker

1. Walker in front of patient 

2. Sit on patient’s side, not in front of them 

3. Patient must be mobile enough, sit to stand principle (nose over toes, push up from bed, once standing put hands on walker) 

   1. Going to help her get balance, then ready to walk? Step and move over

4. Patient puts hand back while other hand on walker to stabilize for sitting in other chair

5. FWW = front wheel walker

THR (Posterior) Chair Transfer

1. If possible, sit in a firm high chair with arms.

2. Reach back for the arms of the chair, keep back upright, and lean back with the operated leg slid out in front.

3. To stand, reverse the steps.

4. Use this same posture for commode transfers.

Spinal Precautions Chair Transfer

1. Ensure chair’s behind you

2. Place 1 foot slightly behind the other

3. Tighten your stomach muscles. Bend forward from the hips, keeping your back straight.

4. Hold the armrests or sides of the seat for support.

5. Bend your knees. Use your leg muscles to lower yourself onto the seat.

6. Scoot back in the seat until you are comfortable

7. Reverse these steps to stand up.

Non weightbearing: what transfer is preferred?

Stand-step pivot: patient kicks leg out, OT on surgical side

Partial weightbearing: what should the patient do?

puts leg out to touch toe on ground, OT on surgical side