PCS 8 transfer activities

Question 1

Before the transfer

Answer 1

• Prepare the pt, the environment, and yourself
• Review pt’s medical record (PT eval) for pt’s status
• To make an appropriate decision how to transfer the pt depends
on:
• Evaluation
• Available written information
• Information from the pt/family member(s)
• The goals of tx
• Consider if you’ll need any extra assistance (e.g., extra person, any
equipment)

Question 2

During the transfer

Answer 2

• Explain the procedure to the pt
• Obtain pt’s consent
• Ask ptto repeat your instructions
• Your instructions should be brief, concise, and action oriented
• Encourage the ptto participate in the transfer to the fullest extend
possible and within the limits of safety
• Use proper body mechanics

Question 3

safety concerns

Answer 3

• Pt should wear proper shoes
• Apply safety belt
• Lock all the wheels on the w/c, bed, or gurney
• Any bandages/equipment attached to or used by the pt should be
protected (e.g., cast, drainage tubes, IV tubes…)
• When using a w/c, lock the drive wheels
• Determine the best position to use to protect the pt
• It is usually best to be in front of and slightly to one side of the pt when
he/she stands
• Do not leave the pt unattended unless adequate support,
stabilization, and protection is in place to prevent injury
• The environment should be free of unneeded equipment during the
transfer

Question 4

THR transfers

Answer 4

• Avoid adduction/rotation/flexion >90 degrees, or extension
beyond neutral flexion-extension
• Do not cross the ankle of the surgical LE over the opposite
LE, pull on the surgically affected LE, or allow the ptto lie on
the surgical LE
• Maintain the surgical LE in abduction; require the pt to sit in
a semi-reclining position; apply abduction pillow as ordered

Question 5

low back trauma discomfort transfers

Answer 5

• Avoid excessive lumbar rotation, trunk side bending, and
trunk flexion
• When turning the pt, use ‘logroll’ technique
• Ptsmay be also more comfortable with the hips/knees
partially flexed with a pillow under or between the knees
when they are in a supine/side-lying position

Question 6

SCI transfers

Answer 6

• Avoid distracting and rotational forces; log roll
• Ptsmay have OP if the injury has occurred years earlier; be
aware of potential risk for fx’s;
• Ptsmay be prone to syncope from supine to a sitting
position

Question 7

burn transfers

Answer 7

• Avoid creation a shear force across the surface of the burn
wound, graft site or area from which the graft was taken
• Sliding creates a shear force causing disruption of the
healing process
• The pt should be instructed to elevate the
body/extremities when moving an area with a burn to
avoid the effect of shear forces

Question 8

hemiplegia transfers

Answer 8

• Avoid pulling on the involved/weakened extremities
(especially the shoulder)
• Many pts experience pain/discomfort when they lie/roll
over the involved shoulder

Question 9

Standing, dependent pivot:

Answer 9

• At least one person is required to transfer the pt
• The ptis elevated to a standing position
• Ptis then pivoted so his/her back is toward the object to which the person
is lowered
• You may be required to lift eh ptto a standing position, stabilize the knees
and hips for the pivot, and help the ptto sit

Question 10

standing assisted pivot:

Answer 10

• The caregiver provides assistance for the ptto stand, pivot, and transfer to
another object (e.g., bed, w/c, toilet)
• The pt must be able to provide minimal (up to 25%) to maximal (75% or
more) physical effort during the transfer
• Standing, standby pivot:
• Requires the standby presence of a person
• Ptsmay be able to stand, pivot, and sit as they move from one object to
another
• The assistance required may vary from verbal cueing to close or casual
guarding
• Be alert to provide protection as needed

Question 11

standing independent pivot

Answer 11

• Standing, independent pivot:
• The ptis able to perform the entire transfer safely and consistently without
any physical/verbal assistance from another person
• Sitting or lateral assisted transfer:
• The ptis able to move from one surface to a second surface while in a
sitting position with the assistance of at least one person
• Ptmay require the use of a transfer board, an overhead bar or frame or
other equipment
• These items are used to bridge the space between the two objects or to permit
the ptto use the UEs for assistance
• The pt may be able to physically assist with the transfer but may require
physical assist and must be guarded

Question 12

sitting Independent transfer

Answer 12

• The ptis able to move safely and efficiently from one surface to a second
surface while in a sitting position without assistance from another person
• Ptmay still need to use a transfer board, an overhead bar/frame or other
equipment

Question 13

sitting Dependent lift

Answer 13

• One, two, or three persons may be required to lift and move the ptfrom
one surface to a second surface
• Mechanical lift may be used instead of multiple persons
• Used when th ptis totally unable to physically assist with the transfer

Question 14

Recumbent, dependent lift:

Answer 14

• Used with ptswho are physically unable to assist with the transfer and are
unable to be placed in a sitting position
• One, two, or three persons/special equipment are needed to lift and move
the pt
• Equipment that may be used: mechanical lift, mattress pad, draw sheet,
plastic transfer board,….

Question 15

Mobility activities

Answer 15

• Are used to adjust the recumbent pt’s body position
• Equipment used in these mobility activities are (for example):
• Bed rails
• Overhead bar/frame
• Loops attached to the bed, mat, or mattress
• Linen use (e.g., draw sheet)
• The pt should always participate to his/her fullest mentally and
physically
• There are 2 types of mobility activities:
1) Dependent or assisted mobility activities (several types)
2) Independent mobility activities (several types)

Question 16

Dependent/Assisted mobility activities

Answer 16

1. Side-to-side movement, ptin supine
2. Upward movement, ptin supine
3. Downward movement, ptin supine
4. Move to a side-lying position, ptin supine
5. Move to a prone position, ptin supine
6. Move to a supine position, ptin prone
7. Move to a sitting position, ptin supine
8. Move to supine position, pt sitting

Question 17

side to side movement pt in supine dependent

Answer 17

• Position one forearm under the pt’s upper back (you may also support pt’s
head) and one forearm under the middle of the back
• Gently slide the upper body and head toward you without lifting the upper
body
• Next, position your forearms under the pt’s lower trunk and just distal to
the pelvis; gently slide that body segment toward you
• Afterwards, position your forearms under the ghighs and legs and gently
slide them toward you (Fig. 8-1)
• When you slide rather than lift the pttoward you, the amount of energy
required and the stress to your UEs and back muscles is reduced
• If the pt needs to be moved sideward over a long distance, it is easier if
each body segment is moved several times

Question 18

• Upward movement, ptin supine:dependent

Answer 18

• Head of the bed and trunk should be flat, remove pillows from under the head
and shoulders
• Ask the ptto perform a bridging exercise by flexing the pt’ships/knees with
feet flat on the bed
• ffthe pt can’t assist this way, you may need to support pt’s thighs/LEs
• Face toward the pt’shead; support pt’shead and upper trunk with your arms,
and lift until the inferior angels of the scapulae clear the bed or mat
• You can ask for assistance from another person and use a ‘draw sheet’ to bring
the pt up the bed (mat) (Fig. 8-2)
• Slide the lower trunk and pelvis upward ~6-10inches
• Don’t attempt to move the pt over a long distance unless the ptis able to
provide assistance (in such case, reposition yourself and repeat the process)
• If an over-the-bed frame, trapeze, or bar is available, the pt can grasp it and
elevate his/her upper body

Question 19

Downward movement, ptin supine:dependent

Answer 19

• Flex partially pt’s hips and knees (if able) or support pt’s thighs/LEs
• Psotionyourself ~ opposite to the pt’swaist/hips or at the pt’s feet (Fig. 8-
3)
• Cradle and lift the pelvis slightly before you slide the pt’s upper body and
head downward
• Move the pt ~ 6-10 inches and then reposition yourself and the pt’s LEs if
more movement is required
• You can move a pt(upward, downward, sideward) with a small sheet or
linen pad (‘draw sheet’) and another person
• Both people, one on each side, grasp the sheet or pad and, on command by the
leader, they simultaneously move the pt by sliding (Fig. 8-4)
• The pt should be encouraged to assist
• Lower the upper portion of the bed when the ptis moved upward/sideward
• Raise the upper portion of the bed when the ptis moved downward

Question 20

Move to a Side-lying position, ptin supine:dependent

Answer 20

• Initially, position the pt close to the far edge of the bed/mat
• Because this position may be potentially dangerous (ptfalling out), you,
another person, side rail must protect the ptfrom rolling off the bed/mat
• Lock the bed wheels
• Stand facing the pt so you can roll (or turn) the pttoward you to a sidelying position
• When it si absolutely necessary to roll the pt away from you, be certain
he/she is protected from rolling off the bed
• If you plan to roll the pttoward the right, place the left LE over the right
LE, place the left UE on the chest, and place the right UE in straight
abduction Roll the pttoward you by pulling on the L posterior scapula (shoulder) and
the left posterior pelvis
• Do not pull on the UE or LE to initiate the roll
• When the ptis in a side-lying position, flex the hips and knees and place a
pillow under the head, between the knees and ankles, and along the front
and back of the trunk
• The lowermost upper and lower extremities should be positioned for
comfort
• Inform the ptwhen you move from one side of the bed to the other side
• It is recommended that you maintain manual contact with the pt as you move

Question 21

• Move to a prone position, pt in supine:dependent

Answer 21

• The bed wheels are locked
• Move the pt closer to one side of the bed/mat
• The arm over which the pt will roll should be positioned in one of 2 ways:
1. Close along the side with the shoulder externally rotated, the elbow straight,
the palm up, and the hand tucked under the pelvis
2. With the shoulder flexed so the arm rests next to the ear with the elbow
straight
• The other contralateralUE remains by the side (Fig. 8-5)
• Stand facing the pt and roll the pt to a side-lying position
Roll the pt toward you and protect the near edge of the bed/mat by placing
one of your thighs against it

Question 22

• Move to a supine position, patient prone: dependent

Answer 22

• Move the pt close to one edge of the bed/mat
• If the pt is going to roll toward the right side, cross the L leg over the R leg
• Position the RUE close to the side with the elbow straight, the palm up,
and the hand tucked under the pelvis; or the R shoulder can be flexed and
the arm can be positioned close to the pt’s ear, with the other UE placed
next to the pt’s side
• Stand on the far side of the table and roll the pt toward you to a side-lying
position
• Guide the pt from a side-lying position to a supine position by resisting
against the posterior L shoulder and pelvis to retard the movement to a
supine position
• Protect the near edge of the bed/mat by placing your thighs against it

Question 23

Move to a sitting position, patient supine dependent

Answer 23

• Move the pt close to one edge of the bed/mat
• Roll the pt to a side-lying position with the LEs partially flexed
• Elevate the trunk by lifting under the shoulders or by instructing the pt to
push up using either or both UEs
• Ask the pt to look in the direction of movement and to engage neck and
trunk muscles (Fig. 8-6)
• Pivot the LEs over the side of the bed/mat as the trunk is raised
• You may need to assist/guide the LEs to prevent pain/injury
• Do not allow the pt to sit unattended or unsupported
• This method is recommended for pts who have a lower back condition or
for pts who have functional use of only one UE and LE
• Alternative method: p. 179

Question 24

• Move to supine position, patient sitting: dependent

Answer 24

• Reverse the sequence of activities described in the preceding section to
move from a supine to a sitting position
• Reposition the pt in the center of the bed/mat when he/she is in supine

Question 25

Independent mobility activities

Answer 25

• Side-to-side movement, patient supine
• Upward movement, patient supine
• Downward movement, patient supine
• Move to a side-lying position, patient supine
• Move to a prone position, patient supine
• Move to a supine position, patient prone
• Move to a sitting position, patient supine

Question 26

• Side-to-side movement, patient supine: Independent

Answer 26

• Pt to flex the hips and knees and place the feet flat on the bed/mat
• Position one UE next to the trunk
• Abduct the other UE ~4 inches from the trunk
• Instruct the pt to push down with the LEs (perform a ‘bridging movement’)
to lift the pelvis and move it toward the abducted UE
• Pt then to elevate the upper trunk by pushing into the bed with the elbows
and the back of the head to move toward the abducted elbow
• The pt should then reposition the LEs and UEs to move again or form
comfort

Question 27

• Upward movement, patient supine: Indep.

Answer 27

• Instruct the pt to fully flex the hips and knees, position the feet flat on the
bed/mat with the heels close to the buttocks
• Position the UEs with the elbows flexed and next to the trunk with the
shoulders (scapulae) pulled up toward the ears (Fig. 8-8)
• The pt elevates the pelvis using the LEs and elevates the upper trunk by
simultaneously pushing into the bed/mat with the elbows and the back of
the head
• Then the pt moves upward by pushing with the LEs and depressing the
shoulders (scapulae)
• The pt then repositions the LEs/UEs for successive movements
• If the bed is adjustable, the upper portion should be flat/wheels locked

Question 28

• Downward movement, patient supine: indep.

Answer 28

• Instruct the pt to partially flex the hips/knees to position the feet flat on
the bed/mat
• The heels should be 8-12 inches distal to the buttocks
• The UEs should be positioned next to the trunk with the elbows flexed and
the shoulders (scapulae) depressed (Fig. 8-9)
• If the bed is adjustable, the upper portion should be slightly
elevated/wheels locked
• The pt elevates the pelvis using the LEs and elevates the upper trunk by
pushing into the bed/mat with the elbows and the back of the head, and
then moves downward by pulling with the LEs , simultaneously pushing up
with the shoulders (scapulae) and pulling downward with the
elbows/forearms

Question 29

• Move to a side-lying position, patient supine: Indep.

Answer 29

• Instruct the pt to move to the far side of the bed/mat
• To roll toward the R, the pt simultaneously reaches across the chest with
the LUE and lifts the LLE diagonally over the RLE
• Pt uses head flexion and the abdominal muscles to roll onto the side or
uses the L hand to grasp the edge of the mattress/bed rail to pull to a sidelying position
• Instruct the pt to maintain the side-lying position by using the L hand on
the bed/mat and by flexing the LEs
• A pillow will be needed for the head
• To roll to the L, the pt performs the same process with the opposite
extremities
• Alternative method: p. 181

Question 30

• Move to a prone position, patient supine:

Answer 30

Instruct the pt to move to one side of the bed/mat
• To roll to the R, the pt positions the RUE under the R side of the body or
flexes the shoulder so it is positioned next to the R ear and then moves to a
side-lying position
• As the pt rolls to the prone position, the LUE is used to protect and lower
the body

Question 31

• Move to a supine position, patient prone:

Answer 31

• Instruct the pt to move to one side of the bed/mat
• To roll to the R, the pt positions the RUE under the R side or flexes the R
shoulder so the upper arm is positioned next to the R ear
• The L hand is placed flat on the bed/mat near the anterior L shoulder; the L
hip and knee can be partially flexed or extended
• The pt pushes with the LUE, lifts the LLE over the RLE, and moves to a sidelying position

Question 32

Move to a sitting position, patient supine:

Answer 32

• Instruct the pt to move toward one edge of the bed/mat, but leave
sufficient space to roll to a side-lying position
• The pt rolls to a side-lying position and flexes the hips/knees , then
positions the hand of the uppermost UE on the bed/mat at the mid-chest
level (Fig. 8-10, A)
• The pt pushes with the UE to raise the trunk to a side-sitting position (Fig.
8-10, B)
• The LEs can be pivoted over the edge of the bed/mat simultaneously (Fig.
8-10, C)
• This technique is beneficial for the pt with low back dysfunction or pain
• The pt can return to a supine position by performing the movements in
reverse sequence
• Alternative method: p. 182

Question 33

Transfer activities: w/c and bed

•Independent standing transfer:

Answer 33

• The w/c should be positioned at ~45 degrees, and locked
• When there is a difference in the strength of the extremities, it usually will
be easier for the pt to transfer while leading with the stronger extremities
• These transfer should be done only by a pt who has the mental and
physical capabilities to accomplish it consistently ad safely
• The pt must be able to manipulate the w/c, rise form a supine to a sitting
position and return from a sitting to a supine position, move from sitting to
standing and from standing to sitting, and ambulate a short distance

Question 34

Transfer activities w/c and bed

• Standing, dependent pivot:

Answer 34

• This transfer should not be attempted with a dependent pt unless the pt is
small and the caregiver has sufficient strength for the maneuver
• Instead, a lateral or sitting transfer can be performed
• A safety belt is placed on the pt
• Position the w/c properly (at a 45-60-degree angle to the bed midway
between the head and foot of the bed; Fig. 8-15, A)
• Remove the w/c footrest and place pt’s feet flat on the floor; remove the
armrest nearest to the bed
• Move the pt forward in the chair: grasp the posterior area of the pelvis and
guide it so that the buttocks slide forward
• Some pts can be taught to move the hips forward by using the upper trunk to
push back against the upper portion of the seat back and sliding the pelvis
forward• The trunk needs to be repositioned over the pelvis before the transfer is
begun
• Partially stoop and position your knees and feet outside and touching the
pt’s knees and feet
• The pt should be discouraged from holding onto the caregiver during
transfers (Don’t allow the pt to hold you around the neck)
• Grasp the safety belt at the sides of the pt’s waist
• If necessary, you may rock the pt to develop momentum before standing
(Fig. 8-15, B)
• Instruct the pt to move his/her hips forward and shift his/her head forward
and shift his/her weight forward

Question 35

Transfer activities w/c and bed

• Standing, dependent pivot cont.:

Answer 35

• As you lift on the safety belt, straighten your LEs and stabilize the pt’s
knees by pushing in and forward with your knees
• Elevate the body high enough to clear the w/c wheel and stand the pt to
the height necessary to elevate the pelvis above the level of the surface of
the bed
• Pivot by sliding your feet and the pt toward the bed and lower the pt onto
the pelvis (buttocks) are turned and directed toward the bed
• Set the pt on the edge of the bed (Fig. 8-15, C to F; Procedure 8-3)
• Then help the pt perform sitting actvs or help the pt into a supine position• To return to the w/c is performed using the same procedure in reverse, but
the w/c may need to be reversed if the pt needs to lead with a stronger or
less involved side
• The pt should be transferred toward the L and R side for practice
• As the pt gains strength, the assisted standing transfer should be
attempted

Question 36

Transfer activities: w/c and bed

• Standing, assisted pivot:

Answer 36

• Decide in which direction the pt will transfer: initially, it will be easier and
safer for most pts to transfer by leading with the stronger extremities
• The pt should also learn to lead with the weaker extremity to improve pt’s
proprioceptionand kinesthesia
• Stabilize the weaker extremity
• If the pt goes to the stronger side (e.g., left side), grasp the safety belt and
stabilize the weaker (right) knee by placing your L foot next to the lateral
area of the R foot and by placing your left knee on the medial side of the R
knee (Fig. 8-16)
• Position the w/c parallel or at 45-60-degree angle to the bed, with the
stronger extremities nearest the bed
• The w/c should be at the mid-point between the head and foot of the
bed/mat (Fig. 8-16)• Lock the w/c, remove the foot rests, place pt’s feet on the floor
• The pt moves forward to the center or forward part of the seat by shifting
weight off one buttock, elevating the pelvis on that side, and moving it
forward to the desired position in the w/c or by leaning against the w/c
back and pushing the pelvis forward
• The pt positions the feet with the stronger foot posterior to the weaker or
most affected foot
• The pt places the hands forward on the armrests and pushes down with
the UEs and LEs while inclining the trunk forward slightly (‘nose over toes’)
to stand
• You may need to stabilize one or both of the knees
• Allow the pt to stand briefly to establish balance• The pt pivots by taking small steps with the Les toward the bed so the
back is nearest to the bed
• Pt then reaches with the nearest UE to the surface of the bed and lowers
to sitting on the bed
• The pt places the LEs onto the bed and then lies down
• You may need to assist to lift the LEs onto the bed and help the pt recline

Question 37

Transfer activities: w/c and bed

• Sitting, assisted (using transfer board): (w/cbed)

Answer 37

• Instruct the pt to position the w/c properly; lock the w/c, remove the
footrests; pt’s feet on the floor; apply the safety belt
• Instruct the pt to move forward in the w/c and to remove the armrest
nearest to the bed/mat
• The transfer board is positioned under the pt’s thigh, in front of the drive
wheel, so it extends from the w/c seat to the bed (Fig. 8-19)
• Do not place the transfer board just under the buttocks, which can result in the pt
sliding forward off the board; the board needs to be under the thighs!!)
• If the pt is moving to the L side, the left hand is placed on the board ~4-6
inches from the L thigh and the R hand is placed next to the R thigh
• The pt performs a ‘push up’ with the UEs to elevate the body and begins
to move toward the bed• You should guard the pt’s knees and use the safety belt
• You can protect the pt’s loss of balance by placing your hand on the upper
trunk
• The pt will need to shift weight off of one hip so the transfer board can be
removed when he/she is seated on the bed
• The caregiver may need to assist with the removal of the board, but the pt
will need to learn how to remove the board in order to be independent
• The return to the w/c is performed using the same technique• This transfer is most commonly used for pts:
• Who are unable to stand but have functional UEs
• With weakness in one UE and LE and normal strength in the other extremities but
who is unable to stand safely
• Some pts will require the use of a transfer board at all times
• Some pts will develop the balance, strength, and skill to permit them to
perform the transfer without the board (Procedure 8-4)

Question 38

Transfer activities: w/c and bed

• Sitting, independent: (w/cbed)

Answer 38

• Instruct the pt to position the w/c properly, lock the w/c, remove the
footrest, and place the feet on the floor
• Pt to move forward in the w/c; remove the armrest nearest to the bed
• The pt then moves the buttocks to partially pivot the body so the back is
toward the bed
• If pt is moving to the R side, the R hand is placed on the edge of the bed
and the L hand is placed on the armrest on the seat of the chair or on the
back of the chair
• The pt pushes with the UEs to elevate the body and swings the buttocks
onto the edge of the bed
• The pt stabilizes the body on the edge of the bed, places the LEs onto the
bed, and lies on the bed
• It may be necessary to help some pts place their LEs onto the bed and lie
down (Fig. 8-20)
• The return to the w/c is performed by using the same techniques in reverse
order

Question 39

Transfer activities: w/c and bed

• Sitting, dependent (one-person dependent):

Answer 39

• Also known as ‘quad pivot’
• Can be used for pts who:
• Are unable to stand
• Are unable to perform any type of assisted transfer and when the assistant
insufficiently strong and skilled to perform the lift (Fig. 8-21)
• Position the w/c properly + touching the other surface
• Use a commercial transfer sling/large towel under the pt’s buttocks to
perform the transfer
• Elevate the footrests, place pt’s feet on the floor, remove the armrest
nearest to the bed/mat
• Move the pt toward the front of the chair
• Stand in front of the pt, flex your hips and knees, and position your knees
and feet on the outside, but next to, the pt’s knees and feet
• Lift the pt’s thighs and hold them between your knees or the lower area of
your thighs so the pt’s feet are off the floor
• Flex the pt’s trunk with his/her head positioned on the side of your body
that faces away from the direction of the transfer (Fig. 8-21, A)
• The pt’s arms should be folded in the lap or across the chest
• Grasp the transfer sling/towel on each side of the pt and lift from the chair
(Fig. 8-21, B)
• Pivot your body by moving your feet and turn the pt’s buttocks toward the
transfer object and lower the pt onto the transfer object (Fig. 8-21, C)
The return to the w/c is performed by using the same techniques in reverse
order

Question 40

Transfer activities: w/c and bed

• Sitting, dependent (two-person dependent) (w/cbed):

Answer 40

• This transfer can be used when:
• The pt is unable to stand
• The transfer is performed from 2 surfaces of unequal height
• The pt is unable to assist with the transfer
• Use proper body mechanics; review mentally the transfer; one person must
assume the role of the leader
• Explain the procedure to the pt
• See the Procedure 8-5 and Fig. 8-22 (A two-person lift transfer from a w/c
to a bed)
• Position the w/c properly: parallel to the side and midway between the
head and foot of the bed; lock the w/c and the bed
• The taller/stronger person stands behind the w/c
• The pt crosses his/her arms over the abdomen
• The person behind the w/c reaches through the axillae and grasps either
the pt’s forearms near the wrists or a safety belt
• A second person stoops or squats at the side of the pt’s LEs, facing the
bed, and positions one forearm under the thighs and one forearm under
the lower legs to cradle the LEs (one forearm is under pt’s thighs)
• The person standing behind the pt instructs the pt to push down and hold
the position with the shoulder muscles9/11/2013
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• On command from the person standing behind the pt, the two persons
simultaneously lift and place the pt on the near side of the bed/mattress
(pt’s knees should be straight during the lift)
• The pt is maintained in an upright position (long-sitting position) by the
person at the pt’s back while the other person moves the w/c
• The two persons partially lift and move the pt to a safe position on the bed

Question 41

Transfer activities: bed and w/c

• Two-person dependent: bedw/c

Answer 41

• The pt is moved toward the near edge of the bed/mat
• w/c is positioned and locked (Procedure 8-5)
• This transfer is the reverse of the two-person chairbed dependent lift
• Alternative method: p. 196/Fig. 8-23

Question 42

Transfer activities: bed and w/c

• Bariatric patient:

Answer 42

• A technique that requires 2 persons and a sheet can be used
• The sheet is applied to cradle, control, and move the pt from one surface to
another (fig. 8-24, A)
• With the pt supine, roll the pt to a side-lying position and place a folded
sheet next tot eh body from mid-chest to mid-thighs (Fig. 8-24, B)
• Roll the pt to the opposite side, extending the sheet under the body (Fig. 8-
24, C)
• help the pt to a sitting position by moving the legs over the edge of the
mat and using the sheet to get the pt to an upright position (Fig. 8-24, D
and E)
• Both caregivers brace the pt’s knees with their knees and use the sheet in a
cradle-like fashion to help the pt stand (Fig. 8-24, F)
• The caregivers then pivot the pt and help him/her to sit, using the sheet to
lower the pt into the chair (Fig. 8-24, G)
• Position the feet on the foot-rests
• Transfer from a w/cbed/mat is accomplished by reversal of the sequence

Question 43

Transfer activities: bed and w/c

• Two-person dependent: chair to floor

Answer 43

• Place the w/c parallel to the area on the floor to which the pt is to be
transferred
• Once person stands behind the pt, and another person stands at the side
of the Les
• The pt is lifted from the chair (as described before) and the lifters move
sideward away from the chair
• On command, both lifters stoop to lower the pt to the floor (Fig. 8-25)
• The pt is assisted to a lying position

Question 44

Transfer activities: bed and w/c

• Three-person dependent (bed to stretcher): (Fig. 8-26; Procedure 8-6)

Answer 44

• This type of the transfer can be used to transfer a pt from one flat surface to
another with the pt in supine
• It is used when:
• No other type of transfer can be used
• In an emergency
• When mechanical equipment is not available
• When the pt cannot sit or stand
• It is important to properly position the stretcher in relation to the bed
• The 2 stronger and taller of the 3 persons should be positioned at the pt’s
head, shoulders, and pelvis
• The third person is positioned to control the LEs
• One person is the leader
• To transfer the pt from the stretcher to the bed, the process described
previously is performed inn reverse sequence

Question 45

Transfers: w/c and floor

Answer 45

• These transfers should be practiced in an area free of hazards, and
mats may be placed on the floor to protect the pt
• Some pts may benefit from the use of incremental steps/platforms
when they initially practice
• Eventually the pt should be taught how to move down to the floor
and return to the chair without any additional equipment to
maximize independence
• Not all pts will be able to accomplish this transfer9/11/2013
30
• Strong R extremities and weak L extremities (Hemiplegia):
• w/c to floor
• Floor to w/c
• Strong UEs and weak/paralyzed LEs (Paraplegia):
• w/c to floor forward or sideward
• Floor to w/c forward push-up
• w/c to floor in a backward position
• Standing dependent pivot from a lift chair to a w/c

Question 46

Transfers: w/c and floor-Hemiplegia

• w/c to floor transfer:

Answer 46

• Turn the caster wheels forward, lock the w/c, remove the foot rests
• The pt moves forward in the w/c with body pivoted/turned slightly so the R
extremities are forward-most (Fig. 8-28, A)
• The pt shifts the weight onto the RLE and reaches toward the floor with
the RUE (Fig. 8-28, B)
• When the R hand is on the floor, the pt uses the RUE and RLE to lower the
body to the floor and sit on the R buttock or both buttocks (Fig. 8-28, C)

Question 47

Transfer w/c and floor-Hemiplegia

• Floor to w/c transfer:

Answer 47

• pt sits on the R hip facing the locked w/c with its caster wheels positioned
forward
• The LEs should be flexed at the hips and knees (Fig. 8-29, A)
• The pt reaches to the back of the seat or the armrest and pulls up to a
kneeling position with the R foot forward and flat on the floor, and he/she
kneels on the left knee (Fig. 8-29, B and C)
• The pt places the RUE on the near armrest or on the seat of the w/c and
uses the R extremities to push to a partial or full standing position (Fig. 8-
29, D)
• The pt reaches for the far armrest with the RUE and pivots on the RLE so
the back is toward the chair, then lowers into the chair using the right
extremities

Question 48

Transfer w/c and floor-Paraplegia

• w/c to floor forward or sideward:

Answer 48

• Position the w/c properly
• The pt moves to the front of the w/c and positions the Les to one side with
the knees extended or under the chair with the knees flexed
• The pt maintains one hand on the armrest or chair seat rail and reaches
toward the floor with the other upper extremity while flexing the head and
trunk (Fig. 8-30, A)
• After the hand has contacted the floor, the pt releases the grasp on the
w/c and lowers onto the floor (Fig. 8-30, B)
• The pt repositions the body as desired
• During practice, it may be helpful to place pillows on the floor to reduce
the trauma to the knees
• Alternative method: p. 201

Question 49

Transfer w/c and floor-Paraplegia

• Floor to w/c forward push-up:

Answer 49

• The pt sits on one hip close to and facing the w/c with the hips and knees
flexed (Fig. 8-32, A)
• The chair must be locked/caster wheels positioned forward or turned to
one side
• Some pts may prefer to initiate this transfer from an all-fours position (on
hands and knees)
• The pt moves to the front of the chair and places one hand on the armrest
or on the seat (Fig. 8-32, B)
• The pt grasps the armrest/seat of the chair and pushes down on the chair
to a high kneeling position and maintains balance (Fig. 8-32, C)
• The pt grasps both armrests or places one hand on the seat of the chair
and one hand on the armrest and then performs a push-up to elevate the
hips (Fig. 8-32, D)
• At the peak of the lift, the pt pivots so one hip is over the seat and moves
the hand to allow one hip onto the chair (Fig. 8-32, E)
• The pt repositions the hands on the armrests (Fig. 8-32, F) and performs a
push-up position the body in the chair

Question 50

Transfer w/c and floor-Paraplegia

• w/c to floor in a backward position:

Answer 50

• The pt positions and prepares the w/c properly
• The pt moves to the front of the w/c, pivots onto the R or L side of the hip,
and grasps the armrests
• If the pt is sitting on the R side of the hip, the R hand grasps the L armrest
and the L hand grasps the R armrest to rotate the upper body so the pt
now partially faces the back of the chair
• The pt performs a partial push-up to clear the pelvis form the seat and then
uses the UEs to lower onto the knees to a high kneeling position facing the
front of the chair
• The pt then lowers to a side-sitting position or onto all fours and then onto
one hip
• This method is the reverse of moving form the floor to a chiarin the
forward position

Question 51

Transfer w/c and floor-Paraplegia

• Standing dependent pivot from a Lift chair to a w/c:

Answer 51

• A Lift chair is commercially manufactured electric chair with a switch to
raise and lower it
• Use a gait belt on the pt
• An assistant raises the lift chair and then stabilizes the w/c during the
transfer
• The caregiver stands in front of the pt, grasps the gait belt, and raises the
pt the rest of the way to standing (Fig. 8-33, A)
• Then the pt is pivoted toward the w/c and lowered onto the w/c (Fig. 8-33,
B)

Question 52

Mechanical equipment
•Is used when a heavy/dependent pt needs to be lifted or
transported
• There are 2 types of devices:

Answer 52

1. Manual (hydraulic)

2. Electrical (battery powered)

Question 53

Mechanical equipment: Manually operated lift

Answer 53

• This lift uses a hydraulic fluid system to raise and lower the pt
• There is a valve on the cylinder that contains the fluid and controls
the containment or release of pressure developed on the cylinder
• When the valve is opened, pressure is released
• When the valve is closed, the pressure can be increased
• A manually operated lever is used to control the fluid in the cylinder
• When the valve is ‘closed’ you can raise the pt up
• The valve must remain closed while the pt is elevated
• When the valve is ‘opened’ pressure in the cylinder is released and
the arm and spreader bar are lowered
• The pt’s weight and the amount the valve is opened determine the
rate of descent of the pt
• See the Procedure 8-7/p. 206

Question 54

Mechanical equipment: w/cbed transfer

Answer 54

Transfer from a w/c to a bed/mat is accomplished by reversal of the
sequence described fro transferring the pt from a bed to a w/c
• After the pt has returned to the bed, the slings are removed by
rolling the pt to one side, rolling the sling into a tube that is placed
as close to the pt’s body as possible, and then rolling the pt to the
opposite side and removing the sling
• The sling should be laundered periodically or when it becomes
soiled
• Pts are often apprehensive when they use the mechanical lift for
the first time—explain the procedure/let the pt observe the unit

Question 55

Mechanical equipment: Electrical lift

Answer 55

•It uses power from rechargeable batterirs that ae connected to a
control unit that accompanies the lift
• The pt can be raised/lowered by pressing a button
• The remainder of the features of the lift are similar to those of the
manual lift
• See the Procedure 8-8/Fig. 8-35

Question 56

Totally dependent patient: stretcherbed or

bedstretcher

Answer 56

• When the 2 surfaces are at the same height, position the stretcher
(gurney) parallel to and touching one edge of the bed
• Be certain the stretcher and the bed wheels are locked
•If the stretcher has a loose pad, slide it and the pt onto the bed and
then remove the pad
• You can also use a draw sheet to slide the pt from the stretcher onto the
bed
• Slide the pt by segments from the stretcher to the bed as you kneel
on the bed
• Be cautious: the stretcher and bed could separate and the pt can
fall
• This technique is used only in an emergency when no other option
is possible or when the situation requires a rapid transfer

Question 57

Pt with a THR: Assisted standing transfer

Answer 57

• Pts with THR must follow special precautions: each MD (surgeon)
will have specific instructions for the amount of weight allowed, the
movement/activities to be permitted, and the alignment of the
trunk in relation to the surgically replaced hip
• The pt and the health care provider must be aware and follow these
precautions (MD orders)

Question 58

Pt with a THR: Movement from the bedwalker

Answer 58

• Most pts use a walker initially for stability/support
• Before using the walker measure it properly for pt’s height (Ch 9),
apply safety belt, shoes, lock the bed, adjust the height of the bed
•Instruct the pt to move to the edge of the bed using the UEs and
the strong LE to elevate the body
• The pt should move toward the strong (normal) LE to maintain the
surgically replaced hip in abduction
• The trunk should be maintained so the surgical hip is in no more
than 60 degrees of flexion by semi-reclining on the arms positioned
behind the body
• The therapist can control the surgical hip (LE) in slight abduction as
the pt pivots and puts LEs to the floor
Pt with a THR: Movement from the bedwalker
• The pt maintains the trunk in a semi-reclining position by resting on
the extended UEs
• The pt pushes up from the bed, stands, and grasps the hand grips
on the walker while you maintain control of the safety belt
• The pt maintains balance and takes time to accommodate to
standing before ambulating
•Instruct the pt to turn by pivoting on the strong LE and stepping
around the strong LE with the surgically affected LE (e.g., a pt with
R hip replacement will be taught to turn toward the L side)

Question 59

Pt with a THR: Return to bed

Answer 59

• The pt backs toward the bed until the posterior area of the thigh of
the strong LE touches the edge of the mattress
• The surgical LE should remain slightly forward of the opposite LE
• The pt reaches back to the mattress and shifts the body weight
onto the strong LE while allowing the surgical LE to slide forward
• The pt sits on the edge of the bed in a semi0reclining position
• The pt then pivots toward the center of the bed, leading with the
strong LE and keeping the surgical hip (LE) abducted
• The therapist should assist in controlling the surgical hip to
maintain abduction and to limit flexion of the hip
• The pt uses the strong LE and the UEs to shift the body toward the
center of the bed while you guide the surgical LE
• A pillow/hip abd pillow should be placed between LEs

Question 60

Precautions for pts with a THR (Box 8-2)

Answer 60

• When the pt is supine, maintain the surgical hip abducted from the
midline of the body and in neutral rotation
• The hip should not be adducted beyond the midline of the body
when the pt lies, sits, or stands
• Maintain the surgical hip in neutral extension
• Maintain hip abduction and neutral rotation while ht pt is in a sidelying position on the unaffected hip by supporting the surgical LE
with pillows or a bolster; the surgical extremity must be in the
uppermost position
• Avoid ER of the hip with an anterior or antero-lateral surgical
approach was used
Precautions for pts with a THR (Box 8-2)
• Avoid IR of the hip when a posterior or postero-lateral surgical
approach was used
• Avoid rotating/twisting the upper body with the LE fixed or
immobile–such activity indirectly causes hip rotation
• Avid hip flexion beyond a range of 60 degrees—pt should not sit
erect in a w/c or in bed, because bringing the trunk closer to the
thigh produces hip flexion
• Avoid excessive trunk flexion while the pt is sitting; use an elevated
toilet seat and an elevated chair when available

Question 61

Pt with one NWB LE, Standing transfer

(Procedure 8-9)• Bedw/c transfer (do w/cbedtransfer in reverse):

Answer 61

• Position the w/c at an angle on the side next to the hip of the FWB LE,
facing the foot of the bed; lock the w/c
• Help the pt move to the edge of the bed; apply a safety belt
• Position yourself in front of the pt to guard and protect hi/her; assist in
moving the NWB LE to the edge of the bed
• Help the pt stand on the FWB LE; assist in controlling the NWB LE
• Instruct the pt to reach for and grasp the far armrest of the w/c and pivot
on the FWB foot to position the hips in preparation to sit
• Instruct the pt to use the UEs and FWB LE to slowly lower the body into the
w/c; maintain control of the NWB LE
• Position the NWB LE on an elevated leg rest as necessary
• Position the pt for safety and comfort and remove the safety belt