FUNCTIONAL TRAINING

Question 1

Transfer

Answer 1

safe movement of a person from one surface or location to another from one position to another

Question 2

Processes Involved in Transfer

Answer 2

pre transfer
transfer
post transfer

Question 3

Importance of Transfer

Answer 3

to function in various settings and make use of various equipment
to increase pt’s independence
to prevent complications of prolonged mobility

Question 4

Preparatory Activities Prior to Functional Training

Answer 4

1. muscle strengthening exercises
2. development of joint and muscle flexibility
3. endurance training
4. sitting and standing tolerance
   *check whether the strength of the pt is enough to carry their own body weight
   *check if the joint has an adequate amount of ROM
   *adequate tolerance in the upright position (sitting/ standing)

Question 5

General Parameters

Answer 5

PT evaluation
available written information
pt or caregiver information
goals of treatment

Question 6

Decision Regarding the Appropriate Transfer Depends On:

Answer 6

type of transfer and amount of assistance to be given
examination of pt prior to functional training
documentation of pt’s capability
treatment goal or max help from caregivers or relatives

Question 7

General Transfer Principles

Answer 7

evaluate the patient: mental and physical capabilities
select, position, and secure: apply safety or transfer belt
instruct pt how to perform tranfer: demonstrate
practice components of transfer as necessary before attempting: teach and practice
mentally preplan the activities and sequence associated with the transfer
position yourself to guard and protect the patient throughout the transfer
request the pt to initiate and perform the transfer: assist as necessary
at the conclusion of the transfer, position the pt for comfort, stability, and safety; document changes

Question 8

General Precautions During Transfers

Answer 8

pt’s clothing and footwear
be alert for unusual events that may occur
ensure that the attachments are secured
do not guard the pt by using his clothers/ grasping his arm

Question 9

Guidelines in Teaching Transfers

Answer 9

explain and demonstrate the procedure: simple, concise, understandable, brief
prepare all necessary equipment
immobilize and secure transfer surfaces
ask for assistance, when in doubt about the level of assistance required
use common commands and counts to synchronize actions of participants in the transfer
guard the pt against falls
direct contact wt the pt during transfers: best biochemical posture, proprioceptive input
allow pt to use all available and necessary function: attain highest level of function
transfer is complete when pt is moved safely in new position: appropriate positioning and draping

Question 10

Mobility Activities for a Bed and Mat

Answer 10

a. side to side movement, patient supine
b. upward movement , patient supine (assisted)
c. upward movement, patient supine (drawsheet)d. downward movement, patient supine
e. hooklying/ pelvic bridging

Question 11

Standing, Sitting, Lifting Transfers

Answer 11

a. assist to the front edge of the chair/ table
- side to side weight shifting
- pelvic slide
- sitting push up
b. standing transfer, dependent pivot
c. standing transfer, assisted pivot (stronger knee stabilized)
d. standing transfer, assisted pivot (weaker knee stabilized)
e. standing transfer, assisted pivot (with stool/ higher surface)
f. standing transfer, assisted pivot (hip replacement)
g. assisted/ independent sitting transfer
- lateral sliding
- anterior-posterior sliding
- push up transfer
h. sliding board transfer
i. one person dependent lift transfer
j. two person dependent lift transfer (chair <—> bed)
k. two person dependent lift transfer (chair <—> floor)
l: three person dependent lift transfer (bed <–> stretcher)

Question 12

Wheelchair Transfers

Answer 12

a. Floor <—> w/c
- anterior- posterior
-lateral
- push up

Question 13

Types of Transfers

Answer 13

Independent
a. independent standing transfers
b. independent sitting transfers
c. assist to front edge of chair (w/c <–> floor): side to side weight shifting, pelvic slide, sitting push up; anterior, posterior, and lateral
modified independence
Assisted
a. assisted standing pivot
b. two-person lift transfer
c. sliding board transfer
d. pushup transfer
Dependent Assistance
a. dependent
b. mechanical transfer
c. pull sheet transfer
d. three person lift transfer
e. dependent standing pivot
f. one-person lift transfer/ quad lift
Guarding
a. close guarding
b. contact guarding

Question 14

Independent Standing Transfer

Answer 14

no memory disorders
able to sequence a task
able to follow simple directions
can learn effectively by means of demonstration
ability to move freely in bed
good sitting balance and tolerance
ability to maintain hip and knee extension (voluntary muscle contraction, orthotic device spasticity)
good to normal UE strength in atleast 1 extremity

Question 15

Preparatory Activities for Independent Standing Transfers

Answer 15

bed activities or bed mobility exercises (pelvic bridging, rolling, supine on elbows)
sitting: balance and tolerance ex
standing: balance and tolerance ex

Question 16

Independent Sitting Transfers

Answer 16

adequate safety awareness
bed mobility skills
- rolling supine <–> prone
- supine <–> sidelying
POE
POH
hook lying
pelvic bridging
supine <–> sitting
adequate sitting balance and tolerance
good to normal UE/ trunk muscle strength
adequate hamstring range

Question 17

Assist to Front Edge of Chair (w/c<–> floor)

Answer 17

allows a pt to get to his COG over his BOS rapidly and easily as he stands
Techniques:
- side to side weight shifting
- pelvic slide
- sitting push up

Question 18

Conditions in Need of Assist to Front Edge of Chair (w/c <–> floor)

Answer 18

hemiplegic: pts with half body paralysis, d/t stroke
paraplegic: pts with paralysis of LE or lower trunk, d/t spinal cord injury (assist LE when transferring)

Question 19

Modified Independence

Answer 19

use of adaptive or assistive equipment to perform a task independently (boards, rails, overhead trapeze, grab bars, furniture)
pt has safety or timeliness issues

Question 20

Conditions in Need of Modified Independence

Answer 20

pts who use a cane and arm rest of sofa when transferring

Question 21

Assisted Transfers

Answer 21

assistance from another person to perform the activity safely in an acceptable time/ speed
oral/ tactile/ visual cures/ directions/ instructions may be used
standby assistance or supervision
minimal assistance
- pt performs 75% or more of the activity
- assistance is required to complete the activity
moderate assistance
-50%-75% of the activity
maximum assistance
-25%-50% of the activity

Question 22

Assisted Standing Pivot Transfer

Answer 22

pt can sit, stand, pivot, and bear some weight on the LE but with weakness or paralysis that necessitates assistance
can sit and stand independently
guarding the uninvolved LE
-when unfamiliar with pt’s capabilities
guarding the involved LE

Question 23

Two Person Lift Transfer

Answer 23

when a pt has some UE strength and good trunk control (to grab on the lifters)
often used in transfers of pt from w/c <–> floor or bed

Question 24

Sliding Board Transfer

Answer 24

when a pt has enough strength to lift his body and adequate sitting balance to move but still unable to perform a push-up transfer

Question 25

Conditions In Need of Sliding Board Transfer

Answer 25

pt w/ BKA

Question 26

Push Up Transfer

Answer 26

similar to sliding board transfer but without the use of a sliding board for support when the pt: -is able to perform the sliding board transfer independently - has developed enough strength to lift his buttocks clear of the supporting surface - has developed sufficient sitting balance and endurance

Question 27

Dependent Assistance

Answer 27

pt requires total physical assistance from one or more persons to accomplish the activity safely and in an acceptable time special equipment or devices may be used

Question 28

Conditions In Need of Dependent Assistance

Answer 28

pt in a decreased level of arousal or in a coma paralyzed on all fours and trunk or quadriplegic severely impaired cognitive functions (mental retardation)

Question 29

Dependent

Answer 29

pt requires total physical assistance from one or more persons to accomplish the activity safely in an acceptable time special equipment or devices may be used

Question 30

Mechanical Transfer

Answer 30

hydraulic lift: mechanical device that provides a method for one person to transfer a dependent pt for very large pts and for those who are extremely dependent

Question 31

Conditions In Need of Mechanical Transfer

Answer 31

pt w/t spastic quadriplegia obese

Question 32

Pull Sheet Transfer

Answer 32

sliding transfer from cart or stretcher to a treatment table cart is usually positioned parallel to the treatment table or bed draw sheet is placed under the pt

Question 33

Three Person Lift Transfer

Answer 33

when treatment table and cart cannot be positioned parallel to each other cart is positioned and secured at right angle to the treatment table

Question 34

Dependent Standing Pivot

Answer 34

for pt who are unable to stand independently but can bear some weight on their LE

Question 35

Conditions in Need of Dependent Standing Pivot

Answer 35

weakness, paresis, or paralysis on LE

Question 36

One Person Lift Transfer/ Quad Lift

Answer 36

dependent sitting transfer when pt falls out of, or tips over a w/c when pt is unable to stand or is unable to perform any type of sliding board transfer need a skilled and strong caregiver/ assistant to do this safely

Question 37

Guarding

Answer 37

pt requires guarding during the performance of the activity for safety cues or directions may be used

Question 38

Close Guarding

Answer 38

caregiver positioned close to but not touching the pt minimal likelihood of the pt requiring protection during the activity

Question 39

Contact Guarding

Answer 39

caregiver positioned close to the pt with the hands on the pt or safety belt high likelihood of pt requiring protection during the activity

Question 40

Documentation

Answer 40

Type of transfer performed Amount or type of assistance the patient requires to perform the transfer Equipment or devices used Quality of movement demonstrated Amount of time required to complete the transfer Level of safety demonstrated Level of consistency of the performance Precautions for transfer (e.g., spinal, total knee replacement, or total hip replacement)

Question 41

H.D. a 70 y/o female pt suffered a stroke 7 days ago. She cannot move the (R) side of her body and she cannot use her (L) side well due to old age weakness. She was referred for PT rx today and was prescribed to have transfer training. You want to teach the pt bed chair transfer. Upon assessment, pt has intact cognition, and a F balance in sitting if back is supported. What transfer technique will you use on this pt? Document your technique properly using the rx documentation format.

Answer 41

P> dependent standing pivot shift transfer x 3 reps to increase indep/to facilitate proper transfer technique

Question 42

G.A. a 20 y/o male pt who suffered an MVA 2 mos. ago and was diagnosed with complete quadriplegia. Pt cannot move his bilat UE/LE and trunk for mobility. He was referred for PT mobilization. Further exam showed, 0/5 strength of the UE/LE muscles, (-) trunk control and pelvic but can follow commands. What transfer technique will you use on this pt to transfer him from bed to plinth? Document your technique properly using the rx treatment format.

Answer 42

P> 3 person lift transfer x 3 reps to facilitate proper technique demonstration.

Question 43

B.G. is a 40 y/o female pt who just had an ACL reconstruction surgery on the ® knee 2 days ago because of a fall. What transfer technique will you suggest for this pt if she wants to move from the bed to the chair? Document your technique using the examination format.

Answer 43

P > Indep. standing pivot transfer c CGA X 3 rep to ^ indep.

Question 44

A 43 y.o. (B) BKA pt was referred to you today. You wanted to train her in the proper transfer from w/c ↔ high mat. What transfer technique will you teach this pt? Document your technique properly using the rx documentation format.

Answer 44

P → w/c high mat using sliding board transfer from chair to highmat (pwede c CGA or indep depending on applied method by PT) x 3 reps to ↑ independence

Question 45

A 38 y/o pt who had a L sided weakness due to stroke 2 weeks ago was referred for PT. The pt has N strength of the ® UE/LE, F trunk control and F balance in standing. The (L) LE is flaccid (no muscle tone and is limp). You wanted to train the pt how to transfer from chair to chair. What transfer technique will you use to train this pt? Document your technique properly using the rx documentation format.

Answer 45

P > w/c assisted standing pivot transfer from chair to chair x 3 reps to ↑ independence

Question 46

You have a stroke patient with ®-sided UE and LE weakness. The patient has difficulty standing from a sitting position since his ® knee buckles when standing. The average BP of the patient is 140/90 mmHg. This is his first PT session. Based on the patient's presentation, perform the appropriate transfer technique for the patient from wheelchair to bed.

Answer 46

dependent standing transfer

Question 47

You have a patient with traumatic brain injury due to a motor vehicular accident. The patient is in a coma right now. The patient needs to be transferred from the stretcher to his bed. The average BP of the patient is 110/70 mmHg. The beds cannot be positioned side-by-side from each other because of space limitations. Perform the most appropriate transfer technique for the patient.

Answer 47

three person lift transfer

Question 48

You have a patient with (B) LE paralysis due to spinal cord injury but has good UE strength. The patient is assisted by their caregiver when transferring from bed to wheelchair. They recently bought a sliding board so the patient can do the activity so the patient can do the activity even when the caregiver is not at home.

Answer 48

sliding board transfer

Question 49

You have a recently discharged patient with (B) LE paralysis due to spinal cord injury. He has excellent UE strength. The patient uses a wheelchair for mobility. At home, the patient sleeps on a mattress on the floor. Currently, his caregiver helps him move between the mattress and the wheelchair, but the patient wishes to be able to perform this task by himself. Teach the patient the most appropriate transfer technique.

Answer 49

posterior floor<--> w/c transfer