Horizontal Transfers

• General Procedures


   Gather and organize equipment; prepare surfaces, remove obstacles.

   Position and lock transfer surfaces.

   Communicate with patient.

   Coordinate with assisting personnel, as needed.

   Move patient using good body mechanics.

   Use weight shift, not arm lift

   Situate patient safely with important items within reach.
• Body Mechanics

  • Position yourself close to the load; hold objects close

  •Maintain normal spinal curvature (neutral spine)

  •Get help if needed
• Levels of Assistance


  • Independent- no assist
  • Modified Independent - no assist, but equipment
  • Stand-by assistance (SBA)- need someone close
  • Contact guard assistance (CGA)- touching, but no assist
  • Minimal Assistance- needs 25% assist
  • Moderate Assistance- assist of 25-50%
  • Maximal Assistance- assist of 50-75%
  • Dependent- assist for greater than 75%
• Independent


  No assistance needed
• Modified Independent


  No assistance, but equipment required
• Stand-by assistance (SBA)


  Need someone close
• Contact guard assistance (CGA)


  You are touching the patient, but not giving physical assist (doesn't exist in balance)
• Minimal Assistance


  Needing assistance up to 25% of task (patient performing at least 75% of activity)
• Moderate Assistance


  Assist of 25-50% (pt providing 50-75% of effort)
• Maximal Assistance


  Assist of 50-75% (patient performing 25-50%)
• Dependent


  Assist for greater than 75% of task (pt doing <25%)
• Supervision (S)


  Therapist can be 15 feet away, but supervision needed
• Head-Hips/Butt-Head Principle


  • Whichever way your head goes, your hips go theopposite– Frontal Plane (ex: hips to the right, head to the left)– Horizontal Plane– Sagittal Plane
• Horizontal Seated Transfers


   Can be done when NWB on BLEs or when LE muscles cannot fire

   Pivoting around shoulders and primarily Weight-bearing through UEs

   Sliding/Transfer board lateral transfers (Head-hips principle, a.k.a. Butt-head principle)
• Independent Seated Transfers

  1.Remove wheelchair’s armrest and leg rest

  2. Angle wheelchair tightly next to mat (< 90 degrees)

  3. Make tripod between buttocks and 2 hands (feet just part of 2nd tripod, maybe)
• Clinician Assistance


   Typically guard from front if patient is unable to reliablymaintain balance Place board (as independently as possible) Knees ready to block any forward transfer/slide Assist with hip movement, gripping lateral aspects of trousers, gait belt, sides of draw sheet, or under ischial tuberosities
• Sit to Stand/Pivot Transfer

  Pivot transfer, variation of sit to stand

  • Goal: shift COM from over buttocks to over feet,

  – Scoot forward (1 bottom)

  – Feet back (2 feet)

  – Lean forward (3rd eye)
• Pivot Transfer


   Pivot around the feet. Requires Weight bearing on at least one LE
• Squat Pivot vs Stand Pivot

  • Squat is more common, is less work
  • They differ in amount of uprightness the patient achieves.
• Pivot Transfer Preperation


   Setting up the environment

   Choose your direction/chair placement, move to STRONG side

   Remove obstacles, including leg rest and possibly armrest

   Shorten the distance between surfaces as much as possible

   Attempt to equalize surface heights

   Secure/lock both surfaces

   Ensure patient has appropriate footwear

   Use a gait belt for transfers that require ANY assist

  –Get as close as possible to ending position BEFORE

  leaving the start surface

  –Communicate desired hand placement**
• Prepare for LE Weight bearing

  ** Gait Belt

  1. Hips forward (CoM shift)– Up and forward lift*– Alternate weight shifts– Forward slide
  2. 2. Feet back, flat on floor– Point feet direction want them to end
  3. 3. Flexed trunk (“nose over toes”)
  4. 4. Hands on armrests
• Knee Blocking


  • Used to prevent knees from buckling (weak or flaccid quads)

  – Contact is NOT on patellae

  – Use anterior proximal tibia/distal thigh to proximal tibia or sides of knee

  – Maintain contact/control through entire movement

  • Don't block limited weight bearing, or fresh incision
• Unilateral Limited Weightbearing

  • Slide the affected LE forward prior to rising to limit ability to WB.

  • Pivot on uninvolved LE TOWARD STRONG LEG.
• Hemiplegia (stroke)

   Easier to transfer to the stronger side

   Want them to use their affected leg as much as possible, but will need to block that knee (so don’t slide it out)

   The involved UE should be supported.
• THA Posterior Approach

   Requires STAND-pivot transfer

   When arising/sitting: Think about flexion precaution

  • PIVOT TO AFFECTED SIDE
  • Pillow in chair to help with the transfer OUT, use armrests if there
• Spinal Cord Injury (SCI)

   SCI at level C6-7 and lower have potential to performtransfers independently transfer)

   Typically use a lateral seated transfer (depression scoot transfer)

  • It is generally preferred to have the stronger or less painful UE be the trailing/push arm