TRANSFERS

TRANSFER PRINCIPLES

a. Transfers are based on typical movement patterns

i. Notice the sequence and patterns of your movement.
ii. Notice the amount of trunk rotation, weight shift, and proximal control required
for distal function.
iii. Notice the placement of your hands and wrists during activities
b. Techniques should not be painful for therapist or patient
c. Patients need to be able to transfer to strong OR weak side to function in community
environments
1. Patients who are taught to move toward their weak side, put weight onto their weak leg, and
come forward without pulling up or pushing off, are potentially less fearful, need less
equipment, and eventually develop more normal patterns of movement.
2. Benefits of Proper Bed Positioning
a. Encourage weight bearing over the involved side to help decrease fear and increase
awareness.
b. Encourage trunk rotation for dissociation of pelvis and shoulder girdles and to facilitate
more normal movement.
c. Encourage elongation of the trunk and gently put muscles on length in order to prevent
tightness.
d. Encourage scapular protraction to prevent shoulder pain and inhibit flexor tone of the
upper extremity. If you are working with patients who are longer-term post stroke, they
can still benefit from these guidelines. However, if orthopedic limitations have already
begun, you may need to make modifications. Work from proximal to distal when making
modifications.
  TYPES OF TRANSFERS
 SLIDING TRANSFER

 A draw sheet is placed under the patient.

 The portion of the sheet to the patient’s sides is rolled and grasped close to the patient.

 The therapist at the patients head should be on the side to which the patient is moving. And he
is responsible for coordinating the transfer.

 When patients are unable to control the head and neck, the therapist at the patient’s head
supports the patients head by placing one arm under the patient’s shoulders while cradling the
patients head.

 When patient’s extraneous movements cannot be controlled during a transfer, or if a patient is

agitated, a sheet may be wrapped around the patient to provide control of the patient’s
extremities.

 Two people stand on the side to which the patient is to be moved and grasps the sheet close to
the patient. One assistant stands on the other side and grasps the sheet with one hand at the
patients shoulder and the other hand at the patient’s hip.

 When the two people on the side to which the patient is to be moved cannot reach across the
table to lift the patient, they may kneel on the treatment table.

 The patient is lifted and moved part of the way from the cart onto the treatment table upon
therapist’s counts and commands.

 Once the patient has been moved part way onto the treatment table, the people on the side to
which the patient is being moved remove themselves and the assistant on the other side may
kneel on the cart to complete the transfer.

THREE PERSON CARRY

 A cart is positioned and secured at right angles to a treatment table, with the head of the cart at
the foot of the table or the foot of the cart at the head of the table.

 All the three personnel stand on the same side of the cart and are positioned in such a manner
that one can support the head and the upper trunk, one can support the midsection and the
third one can support the lower extremities

 The therapist at the head of the patient is responsible for instructing the patient, determining
everyone is ready and issuing counts and commands.

 Personnel stand in stride with their feet slightly apart and knees flexed.
  Personnel slide their arms under the patient such that their elbows are on the cart and the
patient is cradled from head to foot.

 The patient is moved to the edge of the cart upon command.

 By flexing elbows, the personnel log-roll the patient onto his side such that he is facing the
personnel.

 Upon command the personnel stand lifting the patient from the cart.

 The personnel walk backward to pivot 90 degrees upon command.

 Upon completion of the 90 degree pivot, personnel are aligned parallel to the treatment table.

 Personnel stand in stride at the edge of the treatment table. Upon command, personnel flex
their legs until elbows ret on the edge of the treatment table, lowering the patient to the
treatment table.

 The patient is uncradled onto the treatment table, moved to the center of the treatment table,
and positioned in proper alignment. Personnel then remove their arms carefully.

TWO PERSON LIFT

Wheelchair to floor

 Patients participate in this transfer by crossing their upper extremities in front of the trunk.

 Standing behind the patient, a therapist reaches under the patient's upper extremities and
grasps the opposite wrists of the patient (left on right and right on left).

 To prepare for a two-person lift transfer, a wheelchair is positioned close, and parallel, to the
surface to which a patient will be transferred.

 The therapist at the head of the patient places one foot on either side of the drive wheel and
leans around the push handle on the side to which the transfer will occur.

 A second therapist faces in the direction of the intended transfer, with feet in stride and hips
and knees flexed. This therapist places one arm under the thighs and the other arm under the
legs.

 On command from the therapist at the head of the patient, both personnel straighten, lifting
the patient to a height, ensuring clearance of all parts of the wheelchair,

 In unison, the therapists step to the side ( therapist at patient's head) or forward ( therapist
supporting lower extremities), moving away from the wheelchair

 Both therapists squat, using good body mechanics to lower the patient to the floor.

DEPENDENT STANDING PIVOT

  To perform a dependent standing pivot transfer, a wheelchair is placed parallel to a treatment
table or bed and wheel locks are engaged.

 The patient's feet are placed on the floor, footplates are raised, and footrests are removed from
the wheelchair when possible, or swung out of the way.

 To facilitate clearing the wheel, the patient is moved to the front edge of the wheelchair seat.

 To provide stability for the patient's lower extremities during the transfer, the therapist must
"block" the patient's lower extremities and hands are placed under the patient's buttocks.

 The therapist must create and maintain a static spinal posture throughout this transfer.

 The patient places the upper extremities around the therapist's upper back to provide control
for the patient's upper trunk, and not for the patient to "pull" on the therapist

 The therapist maintains static spinal posture throughout the transfer

 An alternative position, when a patient cannot place the upper extremities around the
therapist's upper back, is for a patient to rest the head on one of the physical therapist's
shoulders.

 It is best if the shoulder used is the shoulder on the side of the therapist opposite to the
direction in which the pivot will occur

 To synchronize the effort of the therapist and patient, the physical therapist provides counts and
commands ("One, two, three, up.").

 The physical therapist pivots toward the treatment table, rotating the patient to the proper
position for sitting on the table. The patient is lowered to a sitting position.

 Therapists must continue contact for support until patients are able to maintain a safe and com-
fortable position.

SLIDING BOARD

 The sliding board transfer is used, when patients have enough strength to lift most of the weight
off the buttocks

 When performing a one-person assisted transfer, therapists guard a patient by standing in front
of the patient and may block the knees to prevent perform sliding off the sliding board.

 When assistance in lifting is required, therapists do so by placing their .hands under a patient's
buttocks and lifting as the patient performs the push-up.

 When a patient heeds assistance for balance, therapists can place their hands on the patient's
shoulders. Assistance for lifting or balance is decreased as a patient improves.

 To perform a sliding board transfer, a wheelchair is positioned parallel, or at a slight angle to a

treatment table or bed and the wheel locks are engaged.
  The patient’s feet are placed on the floor, footplates are raised and footrests are removed from
the wheelchair when possible; or swung out of the way.

 The armrest on the side nearest the treatment table is removed.

 The patient leans, away from the treatment table and a sliding board are placed well under the
buttocks. Care must be taken not to pinch the patient between the sliding board and the
wheelchair seat.

 The patient returns to an upright sitting position, with the buttock nearest the treatment table
resting on the sliding board.

 The patient performs the transfer by doing a series of push-ups and slides sideways.

 Reducing body weight on the sliding board permits patients to slide toward the treatment table.

 A patient may place palms flat on the sliding board, or make a fist and place the outside of the
fists on the sliding board to achieve higher lift during push-ups.

 Wheelchair armrests can be used for the first few push-ups to achieve higher lift.

 Patients must not grasp the edge of the sliding board as fingers may be pinched as push-ups are
performed.

 Repositioning hands, this sequence is repeated until the patient is on the treatment table and
only one but- tock remains on the sliding board,

 The patient leans away from the wheelchair to remove the sliding board.

 Therapists must continue contact for support until patients are able to maintain a safe and
comfortable position

PUSH UP

 To perform a push-up transfer, a wheelchair is positioned parallel, or at a slight angle to a

treatment table or bed, and the wheel locks are engaged.

 The patient's feet are placed on the floor,

 The patient moves forward to the front of the wheelchair seat. The armrest on the side nearest
the treatment table is removed

 The patient performs the transfer by doing a series of push-ups and moves sideways.

 Extending the upper extremities, accompanied by shoulder depression, allows patients to lift
their body.

SQUAT PIVOT TRANSFER

 A wheelchair is placed parallel, or at a slight angle, to a treatment table or bed. A therapist sits
on a wheeled stool in front of the patient, blocking both of the patient’s knees with her knees.
  The therapist assists the patient to perform an anterior pelvic tilt and extension of the upper
back, while the patient shifts weight forward onto her feet

 The patient rises , pivots toward the wheelchair, and lowers to the treatment table

 The patient capabilities progress, a patient may be able to complete the transfer in one lift and
pivot movement.

 A therapist must continue contact for support until patients are able to maintain a safe and
comfortable position.

FLOOR TO WHEELCHAIR

 To prepare for a two-person lift transfer, a wheelchair is positioned close, and parallel, to the
surface from which a patient will be transferred.

 The armrest on the side of the wheelchair closest to the patient is removed.

 Patients participate in this transfer by crossing their upper extremities in front of the trunk.

 Standing behind the patient, a therapist reaches under the patient's upper extremities and
grasps the opposite wrists of the patient (left on right and right on left).

 A second therapist faces in the direction of the intended transfer, squatting with feet in stride.

 Although starting in a half-kneeling position may seem easier for the second therapist, this
necessitates movement into a squatting position, increasing the risk of injury to all participants.

 This therapist places one arm under the thighs and the other arm under the legs.

 On command from the physical therapist at the head of the patient, the patient is lifted to a
height that ensures clearance of all parts of the wheelchair

 In unison, the therapists step to the side (therapist at patient's head) or forward (therapist
supporting lower extremities) moving toward the wheelchair.

 The therapists move until the patient is centered over the seat of the wheelchair.

 The therapist supporting the patient’s lower extremities gently pulls the patient's lower
extremities away from the back of the wheelchair so the patient will clear the upright of the
back of the wheelchair.

 Once the wheelchair back upright has been cleared, the patient must be pushed toward the
back of the wheelchair for the assumption of proper sitting posture.

 Therapists continue contact for support until patients are able to maintain a safe and
comfortable position.

Sylvester Wakulwa

MPH/OT