Transfers: ch 9

Transfer purpose

move pt from one place to another (or they move themselves)

Documentation

Should be clear and detailed

When documenting pt transfer

specify from what type of transfer and from what surface to what surface pt was transferred

4 levels of transfers

1. independent

2. Modified independent

3. Assisted

4. Dependent

Independent

Pt performed independently (I) without use of assistive devices (ADs)

Modified Independent

Pt performed (I) with ADs or there are some safety concerns

Assisted

Pt participates actively, but requires some level of assistance

Dependent

Minimal or no active participate of pt

7 levels of assistance

1. independent

2. Supervision

3. Contact guard

4. Minimal assistance

5. moderate assistance

6. Maximal assistance

7. Dependent

Independent (I)

Pt can perform safely and consistently with no assist and with no supervision (S)

Supervision (S)

PT or PTA is near the pt and may or may not be providing verbal cues but is NOT touching pt

Contact guard (CG)

Therapist has a hand on the pt or gait belt for balance, stability

Minimal assistance (min A)

Pt is able to perform 75% or more of activity

Moderate assistance (mod A)

Pt performed approx. 50% - 74% of activity

Maximal assistance (max A)

Pt performs 25% or less of work

Dependent

Pt is unable to participate and the therapist must provide all of the effort

Amount of assistance (2)

1. The number of persons needed to assist pt w/ completing transfer

2. Be specific in documentation and include level of assist w/ amount of assist

Types of assistance (3)

1. Verbal cueing (VC), tactile cues, visual cues

2. Monitoring equipment

3. Types of equipment used

What should be maintained close to the therapist to decrease stress on the back and upper extremities?

The patient (Pt)

What is the purpose of maintaining an appropriately large base of support (BOS)?

To increase balance and stability

Why is it important for your base of support (BOS) to move with you?

To maintain balance and stability while moving

What should be maintained in a static posture during body mechanics?

The pelvis and trunk

Which muscles should be used for lifting to promote proper body mechanics?

The large muscles of the legs

What should you avoid doing with your feet or legs while moving?

Crossing your feet or legs

During transfer (3)

1. Place one hand under buttocks/ hips for lifting or assisting pt

2. Loop your arm under pt's UE (do NOT pull on pt's UEs)

3. If using gait belt - one hand holds onto belt in the back of the pt

During amb

place one hand on lat aspect of pt's hip to indicate direction or movement or to provide assistance for balance

Gait belt

1. alternative method of providing control

2. Straps with buckles or hook and loop closures

Gait belt position

low on hips when sitting

When using gait belt

use belt to keep pt close to you at all times

Improper use of gait belt

Decreases safety

Preparing the environment

1. Consider which side pt will transfer

2. Avoid wearing jewelry

Side the pt should transfer

the good side

as pt gets stronger in transfers...

Encourage transfer on weak side

Commands and cues

pt should always be informed as to what is about to happen and how they should react

How commands should be said

slow, loud, and clear voice

When transfer is complete

pt is in safe new position

Dependent transfer

pt is unable to participate and the therapist must provide all of the effort

5 dependent transfer examples

1. cart to table transfer

2. 3 person carry

3. Hydraulic lift

4. 2 person w/c to floor transfer

5. Squat pivot transfer

cart position in transfer to treatment table

parallel to and against table

Number of people needed if pt cannot transfer on their own from cart to table

3 people

when 3 person carry is applicable

cart and treatment table cannot be arranged parallel

therapist position in three person carry

same side. one at head and upper trunk. one at midsection. one for LE

Hydraulic lift

provide a method for one person to transfer dependent pt

Hydraulic lift and w/c

lift base can be adjusted to fit around w/c

Hydraulic release valve

must be closed to raise pt and opened to lower pt

Pt position in hydraulic lift

rest on sling

how sling is attached to hydraulic lift

chains and hooks

Two person w/c to floor

Pt must have some UE and trunk control

Foot rests in 2 person w/c > floor

Swung away or removed

armrest in 2 person w/c > floor

Side pt is being moved towards in removed

Pt position for transfers

Edge of seat

w/c brakes for transfers

Always locked

2 ways to move pt to edge of chair

1. side to side weight shift

2. Pelvic slide

3 types of assisted transfers

1. SPT

2. Squat pivot transfer

3. sliding board transfer

w/c > floor transfers

1. forward lowering w/c to floor

2. Turn around w/c to floor

3. Forward hands and knees

Floor > w/c transfers

1. Turn around floor to w/c

2. Backward lift floor to w/c

w/c > floor transfers depend on pt...

strength, ROM, agility, and confidence