Transfers and Gait Training

Question 1

Full Weight Bearing

Answer 1

No restrictions on WB; 100% of body weight can be borne on the lower extremity

Question 2

Non Weight Bearing

Answer 2

No weight is borne on the involved limb; foot/toes make no contact with floor/ground surface.

Question 3

Partial weight-bearing (PWB)

Answer 3

Only a portion of weight can be borne on the extremity; sometimes expressed as a percentage of body weight (e.g., 25% or 50%)

Question 4

Toe-touch weight-bearing (TTWB) or touch-down weight-bearing(TDWB)

Answer 4

• Only the toes of the affected extremity contact the floor to improve balance (not to support body weight)
• NOTE: some variability may exist; check with surgeon to clarify

Question 5

Weight-bearing as tolerated (WBAT)

Answer 5

WB is limited by patient tolerance of weight borne on extremity, usually between 50% to 100% of weight is tolerated

Question 6

Principles of Safe Transfers and Gait Training

Answer 6

STABILITY precedes MOBILITY
MAINTAINING precedes ATTAINING
LARGE base of support (BoS) precedes SMALL BoS
LOW center of gravity (CoG) precedes HIGH CoG

Question 7

• First assess whether you can safely handle the patient or is additional assistance needed
  
  • Factors to consider:

Answer 7

• Person’s weight
• Mental status (ability to understand and follow directions)
• Physical status (strength, ROM, weight-bearing limitations)
• Assess environment (space, floor, hazards)
• Footwear of you and the person to be moved must be secure and non-slip

Question 8

Principles of Proper Body Mechanics During Transfers and Gait Training

Answer 8

• Lower your center of gravity by bending your knees
  
  • Broaden your base of support
  • Use your arm and leg muscles, limit strain on back and neck
  • Keep as close as possible to the patient
  • Plan ahead: what to do if patient loses balance, slips, falls, panics, etc.

Question 9

when should a gait belt be applied?

Answer 9

Whenever a person is outside their normal ability to move.

Question 10

Gait belts
Apply around the person’s waist over clothes, not against

Answer 10

bare skin

Question 11

Maximum Assist Transfers

Answer 11

• Usually requires at least 2 people to perform transfer safely
• Maintain proper body mechanics to avoid injury
• Use mechanical lifts such as Hoyer Lift

Question 12

Transfers: lateral and vertical

Answer 12

• Person’s abilities and limitations
• Tasks
  
  • Purpose (learning mobility skills as opposed to being moved to a different surface)
  • Progression from wide base of support (BOS) and low center of gravity (COG) to small BOS and higher COG
  • Stability-mobility trade-off
• Environment: variety of surfaces

Question 13

Lateral Transfers: General Procedures

Answer 13

• Plan ahead (equipment, assistance, draping, patient footwear, etc.)
• Explain procedure
• Secure surfaces
• Transfer is complete only when patient is comfortable and secure.

Question 14

Independent Sliding Board Transfer to the LeftBed-to-Wheelchair

Answer 14

• Angle right side of wheelchair close to bed. Secure surfaces.
• Lean trunk to right. Place one end of board under left hip and other end over wheelchair seat.
• Place left hand out on board and press down with both hands.
• Lift, shift, and lower hips. Repeat as needed.
• Remove board.

Question 15

Clinician Assistance in Sliding Board Transfer

Answer 15

• Typically guard from front.
• Assist with hip movement (control centrally, direct distally [CCDD]) as needed.
• May need to make several small moves to complete transfer.

Question 16

Independent Lateral Seated Transfer to LeftWheelchair-to-Mat Without Board

Answer 16

• Some patients will progress to independent lateral transfers without the use of a sliding board.
• Similar to a squat-pivot transfer.