Chapter 8 - Transfer Activities

Question 1

What does the word “bariatric” mean?

Answer 1

field of medicine that is concerned with weight loss or that deals with causes, prevention, and treatment of obesity

Question 2

What does “hemiplegia” mean?

Answer 2

paralysis of one side of the body

Question 3

What does “paralysis” mean?

Answer 3

loss of power or voluntary movement in a muscle through injury or disease of its nerve supply

Question 4

What does “paresis” mean?

Answer 4

partial or incomplete paralysis

Question 5

Different levels of assistance with transfers

Answer 5

min assist, mod assist, max assist, standby supervision (independent), dependent

Question 6

Contact guarding

Answer 6

Caregiver is positioned close to patient with hands on patient and gait belt to protect patient during activity

Question 7

Patient performance during min assist

Answer 7

pt performs 75% or more of activity, assistance required

Question 8

Patient performance during mod assist

Answer 8

pt performs 50-74% of activity, assistance required

Question 9

Patient performance during max assist

Answer 9

pt performs 25-49% of activity, assistance required

Question 10

Preparation for Patient Transfer

Answer 10

1. review medical record and interview pt/family for info to help plan activity: restrictions/precautions? Premorbid status? Cognitive status?
2. Set goals for treatment
3. Wash hands and wear gloves if appropriate
4. Make sure pt wears correct footwear and is properly dressed
5. Place gait belt on if transferring from one surface to another
6. Consider whether mechanical or human assistance is needed
7. explain transfer procedure and cue pt, make sure the pt understands and repeat steps if applicable
8. Transfer pt across shortest possible distance toward stronger side and assist with weaker side (exceptions e.g. THA)

Question 11

Performing the Transfer

Answer 11

• lock wheels on wheelchair, bed, gurney
• be aware of all objects (IV lines, leads, catheters) and make sure they are appropriate length for transfer
• apply safety belt
• remain close to patient and guard properly
• Use proper body mechanics
• Continually cue pt

Question 12

Total hip replacement precautions

Answer 12

surgically replaced hip should not be adducted or rotated, flexed more than 90 deg, or extended beyond neutral flex/ext
Do not cross ankles, pull on affected extremity, or allow pt to lie on affected extremity
Maintain affected extremity in abduction in motion, may use pillow

Question 13

Back surgery precautions

Answer 13

May wear brace, or have pt engage core muscles in movement
Avoid excessive rotation, flex/ext, side-bending
“logroll” technique

Question 14

Hemiplegia precautions

Answer 14

pay attention to weak side and make sure it is supported, do not pull on affected extremity
Check often for blood pressure changes
Sensation may be reduced

Question 15

Burns precautions

Answer 15

avoid shearing forces across surface of wound, graft, or area where graft was taken (sliding)
Have pt elevate body or extremities when moving area
Bandages, sensation, edema, pain, other restrictions

Question 16

Documentation for Transfer

Answer 16

• type of transfer
• type of assistance
• How much did I do? Did I need help? Were the instructions understood?
• “Intangibles” and “Tangibles”

Question 17

Intangibles of Transfer Documentation

Answer 17

amount of time (when abnormal)
level of safety
quality of movement
–make PT skilled, billable activity

Question 18

Tangibles of transfer documentation

Answer 18

precautions
level of consistency
equipment/devices used

Question 19

Requirements for all transfer movements

Answer 19

• proper body mechanics for pt and PT
• do not pull on extremities, head or neck
• cue and teach, have patient assist when possible
• get help if needed

Question 20

side-to-side movement in supine dependent

Answer 20

one forearm under pt shoulders, other under upper back, pull/slide toward self
forearms under distal trunk, pull toward self
forearms under thighs and legs, pull toward self
can also place hands on sides or shoulders and trunk
Lower, keep COG close to patient’s COG and move in transverse plane

Question 21

upward and downward movement in supine dependent

Answer 21

These movements use two people. The patient should lie on the back with arms crossed over chest. Each person should stand on either side of the patient and should grab a hold of the draw sheet under the patient by the pelvis and by the shoulder. Without lifting, the sheet is slid up or down 6-10 inches as needed.

Question 22

Supine to Side-lying

Answer 22

Initially place pt close to far edge of bed/mat with bedrail or wall on other side
Cross upper ankle over other ankle

Question 23

side-to-side movement supine independent

Answer 23

Bend your knees so your feet are flat on the bed
Place your hands by your sides with your palms facing down
Move one of your hands further away from your body – the one on the side you will move towards
Lift your hips up towards the ceiling, this is called a “bridge”
Move your hips over and put them down where you want to go
Prop yourself up and move your shoulders over
Walk your feet to the side one by one

Question 24

upward and downward movement in supine independent

Answer 24

Patient should lie with feet on table and arms reaching over head onto bedrails. The patient should pull with the arms and push with the legs if moving upward. The patient should push with the arms and pull with the legs if moving downward. The patient should only move 6-10 inches at a time.

Question 25

upward and downward movement in supine assisted

Answer 25

Upward: Patient should lie with feet on table, and arms crossed over chest. The PT should stand at the patient’s chest level with feet staggered. The PT’s hands should be placed underneath the pelvis and underneath the head for support. The PT should ask the patient to lift pelvis slightly off the table and push with the legs as the patient is moved 6-10 inches up the table. Downward: Patient should lie with feet on table and arms crossed over chest. The PT should place both hands on either side and underneath the patient’s pelvis. The PT should ask the patient to lift pelvis slightly off the table and pull with the legs as the patient is moved 6-10 inches down the table.

Question 26

supine to prone dependent

Answer 26

1. ) The therapist will move the patient to the edge of the bed. 2. ) The arm the patient is rolling over should be close to his or her side with the shoulder rolled out, elbow straight, palm up, hand placed under hip. 3. ) The patient will be rolled toward the therapist into a side-lying position. 4. ) The therapist will make sure there is enough room to continue the roll onto the stomach. 5. ) The therapist will then position his or her thigh against the edge of the bed to protect the patient from rolling off. 6. ) The therapist will gently ease the patient onto his or her stomach and adjust the body to a comfortable position.

Question 27

supine to prone independent

Answer 27

1. ) Move towards one side of the bed. 2. ) The arm that is being rolled over should be placed under the body or the shoulder can be placed up near the ear. 3. ) Cross the left leg over the right. 4. ) Roll into the side-lying position 5. ) Gently ease yourself over using your left hand for support. 6. ) Adjust as needed to find comfort

Question 28

prone to supine dependent

Answer 28

1. ) The therapist will move the patient to one side of the bed. 2. ) If rolling to the right, the patients left leg will be placed over the right. 3. ) The right arm should be close to the side with the elbow straight, palm up, hand tucked under the hip. 4. ) The therapist will stand on the far side of the table and roll the patient towards them into a side-lying position. 5. ) The therapist will place his or her leg against the table to protect the patient and gently ease the patient onto his or her stomach by resisting the hips and shoulder.

Question 29

Supine to side-lying dependent

Answer 29

1. Stand facing the patient so you can roll or turn them toward you to a side-lying position. 2. When rolling the patient towards the right, place their left leg over their right leg. Place their left arm on their chest and their right arm lying straight across the table. 3. Roll the patient towards you by pulling gently on their left upper back and their left hip in order to control the movement. 4. When the patient is in a side-lying position slightly bend their hips and knees. Then place a pillow under their head, between the knees and ankles, and along the front and back of the trunk for support.

Question 30

Supine to side-lying independent

Answer 30

1. Instruct the patient to move to the far side of the bed or mat. 2. To roll to the right tell the patient to simultaneously reach across their chest with their left arm and lift their left leg diagonally over their right leg. 3. Have the patient pull up their head and tighten their abdominal muscles to roll onto their side 4. The patient can also use their left hand to grasp the end of the mattress, sheet, or bed rail to pull to a side-lying position. 5. Alternatively a patient can push with their left arm and left leg before reaching across the body.

Question 31

Prone to supine independent

Answer 31

1. ) Move yourself towards one side of the bed. Make sure you have enough room to complete the roll! 2. ) The right arm should be placed under the body if attempting to roll toward the right. 3. ) The left hand should be flat on the table near the shoulder. 4. ) By pushing with the left hand move into the side-lying position. 5. ) Check your surroundings to make sure you have enough room to continue the roll. If you do not have enough room to continue the roll, scoot yourself forward. 6. ) Gently ease yourself onto your back and adjust as needed for comfort.

Question 32

2-person lift transfer: wheelchair to bed

Answer 32

1. Position wheelchair parallel and in the middle of the bed. 2. Lock wheels on bed and wheelchair. 3. Remove armrest and footrest on bedside WC. 4. Stronger person lift under armpits and give signal to begin. Second person should lift legs. 5. Have patient fold their arms across chest. 6. Have lead lifter go under armpits and above forearms while secondary lifts the legs. 7. Have lead lifter signal when to lift and transfer patient to bed. 8. Stay by patient while you make them comfortable.

Question 33

2-person lift transfer: bed to wheelchair

Answer 33

1. Position wheelchair parallel and in the middle of the bed. 2. Lock wheels on bed and wheelchair. 3. Remove armrest and footrest on bedside WC. 4. Have patient fold their arms across chest. 5. Have lead lifter go under armpits and above forearms while secondary lifts the legs. 6. Stronger person lift under armpits and give signal to begin. Second person should lift legs. 7. Have lead lifter signal when to begin and perform the transfer. 8. Replace the armrest and footrest.

Question 34

Supine to sitting dependent

Answer 34

1. Move patient to one side of the bed so that you can roll them onto their opposite side. 2. Cross the leg opposite of the direction that you are rolling over the other leg and cross the patients arms over their chest 3. With one hand under their hips and the other under their shoulders, slowly roll the patient onto their side in one smooth movement 4. Make sure they have a slight bend in their knees while in the side lying position 5. From there, place one hand under their knees and the other under the bottom of the shoulder 6. As you raise their upper body, rotate their legs over the side of the table 7. To prevent injury, make sure you gently lower their lower extremities to the floor 8. Never allow a patient to sit unattended or unsupported

Question 35

supine to sitting assisted

Answer 35

Follow same instructions as the dependent method, except for the following changes: o Once in side lying position, instruct the patient to push off with one or both arms as you assist in the rotation to the side of the table o When rotating, ask the patient to look into the direction of the movement Only use as much assistance as the patient requires; encourage them to help as much as possible

Question 36

supine to sitting independent

Answer 36

The patient should move themselves to one side of the bed, but making sure they are not too close to the edge The patient should roll to the side-lying position and make sure they have a slight bend in their knees and hips The patient should use both of their hands at the mid-chest level to push up and lift the upper body off the bed The lower body should turn simultaneously as the patient moves their upper body Once in the sitting position, the patient should keep each hand at their side on the bed to stabilize themselves

Question 37

sitting to supine

Answer 37

For each of the three methods, the patient can go from sitting to supine by following the instructions in the reverse order.

Question 38

general transfer principles

Answer 38

Predetermine the patient’s mental status and weight bearing capabilities Mentally prepare for the activity and transfer Assess the patient’s pain status prior to and at the completion of the transfer Instruct the patient slowly, clearly, and concisely, allow time for the patient to process and apply the information Secure any needed equipment for the transfer, apply a gait belt Be alert for any mishaps Do not guard the patient by using clothing or grasping the arm, USE THE GAIT BELT Position yourself to guard, direct and pro-tect and guide the patient Ask the patient to do as much as possible, assist as necessary At the conclusion, position the patient for comfort, stability, and safety

Question 39

Standing Dependent Pivot Transfer

Answer 39

With the patient elevated to a standing position, place your feet and knees on the outside of the patient’s feet and knees. Pivot the patient so that his/her back is toward the surface to which they will be moved. From this point, help the patient into a sitting or laying position and position them as needed to be comfortable and in a proper alignment.

Question 40

Proper body mechanics for transferring pt

Answer 40

``` Lift with legs Avoid bending and twisting Widen base of support Get close to the patient Use a staggered stance ```

Question 41

Preparations for Transfer

Answer 41

1. Prepare surroundings - No obstacles in path - Equipment is out and ready 2. Make sure patient is wearing safe clothing and footwear 3. Position wheelchair parallel to the table or at a slight angle 4. Lock wheelchair drive wheels 5. Swing away wheelchair front rigging 6. Apply the gait belt around the patient’s hips

Question 42

standing transfer - assisted pivot

Answer 42

1. STAND - Be in front of the patient, slightly to the side - Have patient initiate transfer (“nose over toes”) - Patient pushes down on wheelchair armrests - Patient stands with stronger leg behind weaker leg - Provide assistance with gait belt; stabilize weak leg by straddling weak leg 2. REST - Give the patient some time to establish balance - Check to see if dizzy 3. PIVOT - Patient takes small steps toward bed or table 4. SIT - Patient contacts bed or table with back of thighs and arms before sitting down

Question 43

Placing drawsheet under pt in bed

Answer 43

1. perform dependent side roll 2. gather sheet halfway, tuck under hips and shoulders 3. roll pt supine toward yourself 4. roll pt side-lying toward yourself (switch sides or toward siderail of bed) 5. unroll sheet and smooth out folds 6. roll pt supine

Question 44

contralateral vs. ipsilateral

Answer 44

contralateral: on the other-or opposite-side ipsilateral: homolateral; on the same side

Question 45

protective transfer to and from the floor for a person with low back dysfunction: movement from standing to the floor

Answer 45

1. pt places one hand on firm object and moves to a single knee (half-kneeling) position, keeping trunk erect 2. pt briefly kneels on both knees (high-kneeling), then moves to all fours 3. pt moves hands forward until he/she is prone or gently side sits, if not painful--lowers onto one elbow to side-lying 4. pt adjusts body as desired

Question 46

protective transfer to and from the floor for a person with low back dysfunction: movement from floor to standing

Answer 46

1. pt in prone and pushes to hands and knees or logrolls to side-lying position 2. if pt is on all fours, he/she moves to half-kneeling then to standing; firm object may be used for assistance 3. if pt side-lying: pt can push to side-sitting position, then performs previous movements

Question 47

Transfer with transfer board

Answer 47

* *try to work on two level surfaces--lower bed if applicable, etc. 1. position wheelchair at 45 deg angle to bed, lock chair and remove armrest and front rigging on side moving to 2. help pt lean away to place board under hip, with other side resting on chair or bed. PT position: slightly in front of and to the near side of the pt to guard and protect for transfer 3. help pt move across board, guard and protect trunk if LEs need to be lower from bed; help pt shift weight away from the board, and remove the board. keep hands and fingers on top of board so they don't get pinched. 4. position pt for safety and comfort

Question 48

guarding for patient with one non-weight-bearing LE in standing transfer

Answer 48

guard non-weight-bearing LE, possibly by placing own foot on outside of affected leg, with knee across to the inside of the affected leg