Fundies Transfers

What is an "independent" level transfer?

patient performs ALL aspects of the transfer, including preparation, in a safe manner without transfer decided or assistance.

What is a "modified independent" level of transfer?

patient performs the transfer independently with transfer devices (cane, walker, etc)

What is "assisted" level of transfer?

patient actively participates, yet requires assistance.

What is "dependent" level of transfer?

patient doe not actively participate, or participates only minimally, and others perform all aspects of the transfer

What is "supervision" level of assistance/guarding?

therapist is near the patient and is able to provide verbal or physical assistance as appropriate; need for physical assistance is unlikely.

What is "contact guarding" level of assistance/guarding?

therapist is positioned close to patient, with hands on the patient/gait belt; likelihood of physical assistance being required is mod to high.

What is "minimal assistance (minA)" level of assistance/guarding?

patient is able to perform 75% ore more of an activity?

What is "moderate assistance (modA)" level of assistance/guarding?

patient is able to perform 25-74% of an activity.

What is "maximal assistance (maxA)" level of assistanc/guarding?

patient is able to perform 1-24% of an activity

What is the goal of transfer training?

to assist the patient to become independent or modified independent during transfer activities.

What does assistance include?

Assistance includes verbal cueing, monitoring of the environment, and physical assistance

What are steps for teaching transfers?

1. Use demonstrations of the transfer for patient and caregiver understanding

2. Break up the steps of the transfer for patient ease of learning

3. Educate patient, caregivers, and others assisting with the patient transfer on safe environment preparation prior to performing a transfer.

4. Consider skills that are similar among transfer activities for ease of learning; generalizability.

5. Consider the context of the learning environment or the environment in which the transfer occurs. Start teaching in a closed environment with few distractions and progress to more open environment with distractions and increased complexities as appropriate.

6. Practice using different types of equipment (varying chair heights, soft/hard seats, with/without armrests)

7. Encourage mental practice (visualizing the steps of the transfer sequence) to assist in learning.

What are proper body mechanics for transfers?

1. keep the patient close to you

2. maintain an appropriate large BOS

3. ensure that your BOS can move with you as you move

4. Maintain a static posture of the pelvis and spine to the greatest degree possible (engage core)

5. Lift using the large muscles of your legs rather than your back.

6. avoid crossing your feet or legs as you move (reduces fall risk and limits small BOS)

What can inappropriate use of a gait belt to pull pt to standing lead to?

Inappropriate use of a gait belt to pull a pt to standing leads to lack of pt upper body control and excessive lumbar trunk extension

What are tips for preparing the environment for a transfer?

-consider the direction in which the pt will be moving during the transfer (to the left or to the right)

-ensure movement will not be impeded by furniture or other equipment

-equipment that is needed should be within easy reach so you do not compromise pt safety

-avoid wearing jewelry that can become entangled with or scratch your pt

A transfer is not complete until:

1. Patient is secure in the new position

2. Manual contacts (therapist hands, gait belts, etc) are removed

3. Appropriate positioning and draping is completed

4. Necessary equipment is placed within pt's usable reach

5. patient confirms comfort in new position

What are the five transfers?

1. sliding transfer

2. hydraulic lift transfer

3. two-person lift transfer

4. standing pivot transfer

5. sliding board transfer

What is a sliding transfer used for?

used to transfer a patient between two treatment tables, a treatment table and a stretcher or a stretcher and a bed

What level of transfer is sliding transfer? How many people are needed for it?

Dependent transfer; three people are needed for an average sized adult

How do you perform a sliding transfer?

-position stretcher parallel to, and against, the treatment table or bed

-use a draw sheet to move the patient from original surface to new surface

-if patient cannot control extremity movement, wrap sheet around the patient

-lead therapist should lead count or verbal cues to synchronize the transfer between all participants

What level of transfer is a hydraulic lift transfer? How many people are needed for it?

used for dependent patient transfer. Only one person is required to perform the hydraulic lift transfer

How should sling and hooks be position to ensure pt is safe and comfortable.

-position sling so seams are on the outside, away from the patient, to avoid pressure areas

-attach chain hooks from the inside of the sling to the outside to reduce likelihood of pt being injured by the hooks.

What level of assistance is a two-person lift transfer? What is used for?

A dependent transfer requiring maximal assistance of two persons. Used to transfer a pt from two surfaces varying in height.

What position does pt have to be able to do and maintain in order to use a two-person lift transfer with that pt?

Patient must be able to maintain an upper extremity position of shoulder girdle depression, shoulder extension, adduction, internal rotation, and elbow flexion at approximately 90 deg for successful transfer

What level of transfer is a sliding board transfer? When is it used?

Assisted or independent transfer. Used when pt has enough strength to lift most of the weight of his/her buttocks and sufficient sitting balance to move in a sitting position, but are unable to perform a push-up transfer.

How is the sliding board transfer performed?

Performed using a series of mini "push-us" and sliding sideways along a sliding board from original surface to new surface. Patient should be able to place their palms flat on the sliding board, grasp the armrest or drive wheel of the w/c or make a fist and place the outside of the fist on the sliding board to achieve push-ups

What must the two surfaces be in order for a sliding board transfer to be successful?

Surfaces must be nearly level for this transfer to be successful

What level of assistance is a standing pivot transfer used for? When is it used?

Assisted or independent transfer requiring mod to min assistance of one person. Used when pt can sit, stand, pivot and bear full weight on at least one lower extremity, but have some weakness, paresis, paralysis, or loss of balance or sensation, which necessitates assistance to transfer safely.

In order to perform a standing pivot, patient must be able to do what?

patient must be able to bear some weight through their lower extremities

What does the therapist need to do during a standing pivot transfer to maintain extension in pt's lower extremity during transfer?

block lower extremities during transfer (block weak side or both if both are weak or unsure of which side is the weakest)

For a standing pivot transfer, it is easier to transfer to what side?

Generally, when patient has more involvement on one side than the other, transferring toward the stronger side is easier

NWB =

non-weight bearing

no weight at all

PWB =

partial weight bearing

(percentage or poundage stated by physician)

TTWB/TDWB =

toe touch weight bearing/touchdown weight bearing

(may only put their toe down for balance, no weight should be pressed through the limb)

WBTT =

weight bearing to tolerance

(the pt may put as much weight as they can tolerate through the limb)

FWB =

full weight bearing

(no limitation at all)