PE 2 Unit 2 Study Guide

Transfer

Safe and effective movement of a patient from one surface, position, or location to another (bed, chair, wheelchair, toilet)

Preparation

Assess patient ability (strength, cognition, balance, weight bearing status)

Safety

Lock brakes, remove obstacles, use gait belt, maintain wide base of support and neutral spine

Participation

Encourage maximal patient effort to promote independence 

Environment

Adjust surface height, position destination slightly lower than origin

Independent

The patient performs 100% of the activity safely and without physical help or cues

Patient does not require assistance, guarding, or supervision

Patient uses no assistive device

Safe and efficient movement

No risk of losing balance

Modified Independent

The patient performs the transfer independently, but requires:

An assistive device, more time, mild environmental modification ( uses a walker to stand and pivot, need grab bars, uses leg lifter)

Still no physical assistance from therapist

Standby Assist (Supervision)

The patient performs the activity with no physical contact but requires the therapist to be nearby for safety

Why? Slight safety risk, occasional cues, mild impulsivity, balance concerns

Therapist role: Positioned close, ready to intervene, may provide verbal cues only

Contact Guard Assist 

Therapist provides hands on light touch for balance or safety not to lift or support body weight 

Indications: patient has loss of balance potential, need tactile cueing, inconsistent stability 

Therapist role: Maintain hands on gait belt or trunk, ready to correct minor sway or slip 

Minimal Assistance

Patient performs > 75% of the movement

Therapist provides < 25% physical assistance

Why needed: Slight weakness, poor initiation, mild balance loss, needs help clearing hips, legs, or trunk

EX. Therapist helps guide one limb during transfer

Moderate Assistance

Patient performs 50-74% of the activity

Therapist provides 26/50% physical assistance

Typical: Patient needs large part of lifting effort, requires stabilization of trunk and legs, difficulty weight shifting

Therapist role: May need two hands, may assist multiple body regions, still allows patient to contribute meaningfully

Maximal Assistance

Patient performs 25-49% of the activity 

Therapist provides 51-75% assistance

Indications: patient cannot stand without major help, limited ability to support body weight, requires significant lifting from therapist, often needs two person assist for safety 

Dependent

Total assist

Patient Performs <25% of the movement or requires more than one person for safe performance

Includes: 1 person total assists, 2 person total assists, mechanical lift (Hoyer’s, sit to stand lift)

Why used: Patient unable to initiate or assist in transfer, very high fall risk, poor postural control or unconsciousness, severe weakness, SCI, end stage disease

Portable Lifts

Used when patients cannot assist or weight bear

Important: Verify weight capacity and stability of base legs before lifting, position sling to support head and trunk for dependent patients, communicate continuously with patient

EX. Manual (Hoyer) Lift, Powered Lift,Supine Lift/Slings

Manual (Hoyer) Lift

Hydraulic pump, requires 2 staff, legs out for stability used to transfer patients who cannot weight bear or assist during transfers.

Powered Lift

Battery operated, smoother motion, 1-2 staff assist

Supine Lift/Slings

Color coded straps ensure symmetry, check fit and skin integrity before/after use

For completely dependent or spinal precaution patients

Mounted (Ceiling) Lifts

Installed on overhead tracks in acute or rehab settings, allows mobility in bed area horizontal or multi direction movement

Bariatric versions have reinforced bars and wide slings to accommodate heavier patients, providing safe and efficient transfers without manual lifting.

Bar configurations: 2 bar (head/trunk + lower extremity straps) or 4 bar (supine use)

Color coded straps: ensure even support for symmetry

Sit to Stand Aids 

Used for patients with partial strength and good sitting balance to assist them in transferring from a seated position to a standing position, providing support and stability during the process.

EX. Manual (Sara Stedy), Powered Standers 

Manual (Sara Stedy) Aids

Patient holds bar, knees block pad, pads lower from sitting 

Assist with transitions between short sit to stand transfers

Contraindicated if non weight bearing or significant lower extremity weakness 

Powered Standers Sit-to-Stand Aids

Battery assisted, sling lifts patient upright

patient must tolerate partial weight bearing

Pre cautions: If patient slides in sling → use Hoyer lift instead

Gross Strength Assessment

Purpose: estimate overall motor control limb strength and endurance prior to transfer.

Perform bed level tests (bridging, rolling, leg lifts) to determine appropriate transfer type

Assess symmetry, effort, control

Identify areas needing support before mobility tasks

Standing Assisted Pivot Transfer

Used when patient can bear weight through at least one lower extremity

Setup: Feet under knees, trunk flexed forward

Therapist cues: Lean forward, push through legs, pivot toward chair

Key muscles: Hip/knee extensors, trunk stabilizers

Precautions: Watch for dizziness, orthostatic hypotension

Total Hip Replacement Precautions:

Keep surgical leg extended during stand

Avoid internal rotation, adduction, and flexion >90 degrees

Pivot on unaffected leg

Standing Dependent Transfers

Used when patient cannot initiate standing but can bear minimal weight 

Guard both knees (block both legs) 

Maintain close contact with patient’s pelvis/trunk 

Use count and team communication 

Transfer toward stronger side when possible 

Sliding Board Transfer

Used for Spinal cord injuries, amputation, or weak lower extremity patients

Remove armrest and footrest

Position board under hip angled toward destination

Cue push up, lift slightly, and slide toward chair 

Maintain head hips relationship, Head moves opposite to direction of transfer

Therapist guards at knees and pelvis

Maintain neutral wrist and shoulder to avoid impingement while assisting with the transfer. Ensure the board is secure and positioned properly to facilitate a smooth slide.

Variants: Scooting, Lateral swing, one person dependent lift 

Scooting: incremental hip lifts froward 

Lateral Swing: Requires upper extremity strength and trunk control 

One person Dependent Lift: Full therapist assist, short distances only 

Bed to Wheelchair Transfer

Position wheelchair 30-45 degrees angle to bed

Lock brakes and remove arm/foot rets

Move patient to bed edge, ensure feet flat

Cue forward lean and push through legs

Use gait belt for control

Total knee replacement: Support operative leg and avoid twisting the knee or rotation during pivot. Keep knee extended during stand, transfer toward stronger side

Drive Wheel

Large rear wheel used for propulsion, can be pneumatic or solid

Caster Wheel

Small front wheels for turning and maneuvering

Push Rim 

Outer ring used for manual propulsion

Front Rigging

Holds footrest and calf support at 60-70 degrees

Footplate and Calf Rest

Supports lower extremities can be swing away or elevating

Arm Rest

Fixed or removable for positioning and support

Back Upholstery

Supports spine, height adjustable 

Push Handles

Used by caregiver for propulsion

Tipping Lever and Anti Tippers

Lift casters over curbs, increases stability

Foam Wheelchair Cushion

Firm, lightweight, low cost

Indications: Low risk patients

Gel Wheelchair Cushion

Redistributes pressure via fluid displacement 

Indications: High risk for ulcers

Wedge/Positioning Wheelchair Cushion

Angled to prevent slouching or forward slide

Indications: Kyphosis, poor posture

ROHO (Air Cell)

Interconnected neoprene cells for dynamic pressure relief

Indications: Spinal Cord Injury, impaired sensation

Seat Width

+1 inch clearance each side

Issues:

Too wide: Poor alignment (asymmetry)

Too narrow: Skin shear (skin irritation)

Seat Depth

2-3 finger space behind knee to allow for adequate knee clearance and support.

Issues:

Too Long: Circulation issues

Too Short: Poor Support

Seat Height

Allow 2 in footplate clearance from the floor to prevent pressure on the feet.

Issues:

Too High: Difficulty propelling

Too Low: Pressure on thighs

Back Height

To inferior angle of scapula or shoulder level for support, depending on user's needs.

Issues:

Too High: Limits Motion 

Too Low: Reduces Support 

Armrest Height

Elbow 90 degree flexion

Issues:

Too High: Shoulder Elevation

Too Low: Leaning

Standard Wheelchair Type

<200 ponds, short term indoor use and a standard design suitable for most users.

Patients who use a wheelchair for temporary mobility, short term use

EX. Post surgical patients when cleared TKR, THR, Mild generalized weakness, Patients who ambulate but need a chair for community distances 

Sports Wheelchair Types

Lightweight, angled rear wheels for maneuverability

EX. Patients with paraplegia or long term spinal cord injury wo use wheelchair as primary mobility, very active community level wheelchair users

Externally Powered Wheelchair

Battery operated, joystick controlled 

Patients with poor upper extremity strength or endurance, those unable to propel a manual chair, long term mobility impairments, patients who need precise control of positioning, progressive neuromuscular diseases 

EX. High level spinal cord injury (C5-C6 or above), Muscular dystrophy, severe COPD or CHF limiting endurance 

Semi/Fully Reclining

Reclines 30-180 degrees, requires elevating leg rests

Patients who cannot tolerate upright sitting, those who frequently need to rest in reclined or supine positions, patients with poor trunk control, orthostatic hypotension, or pressure intolerance, People requiring elevating leg rest (edema, post op knee/hip conditions 

EX . Severe contractures preventing full upright seating, patient with poor trunk/head control 

Tilt in Space Wheelchair

Maintains hip angle, redistributes pressure without shear

Patients with significant postural instability, those at high risk of pressure ulcers needing pressure redistribution, patients with impaired head, neck, or trunk control, neurological disorders requiring position changes without hip flexion, users who cannot perform weight shifts independently 

EX. Patients with cerebral palsy. spinal cord injury with no ability to weight shift, individuals with TBI, poor balance, or minimal trunk control, complex seating positioning needs, patients with fixed kyphosis or pelvic obliquity 

Propulsion

Forward/backward turning via push rims

Ascending a Ramp

Patient leans forward and propels smoothly to counter gravity

Curb Negotiations

Caregiver uses tipping lever to raise casters before rolling over curb

Floor Recovery 

Use front, side, or back approach to return to chair after a fall 

Descending a Ramp

Patient leans back and controls speed with push rims

Wheelie

Skill used to lift front casters for curbs or obstacles, requires practice and supervision