Transfers

Definition of Transfer

• The activity of moving a person of limited function from one location to another.

• Transfers may be done by the patient alone, with the assistance of another person or by another person.

Patient’s ability to transfer and the amount of assist needed will depend on cardiopulmonary status, joint flexibility, muscle tone and strength, neuromuscular control, balance and coordination, endurance, weight bearing status and cognition.

Considering the patient’s physical mobility, condition, comprehension and motivation the primary goal of transfer training is to assist the patient into becoming as safe and independent as possible.

• Patient and therapist safety is of most importance during transfers. Whenever in doubt about the level of assistance needed to transfer a patient safely, ask for additional assistance!

Precautions with Transfers

• Some conditions will require special precautions with transfer such as a THR or a patient with a wound.

• Treatment precautions will be discussed in more detail in later intervention courses.

Levels of Transfers in Physical Therapy Activities (page 164)

Independent Transfers

• No assistance of any type needed for any aspect of the transfer.

• Patient can perform set up and transfer safely without any assistance.

Assisted Transfer

• Patient actively participates in transfer but requires assistance.

• Types of assisted transfers– Two-person lift– Sliding board transfer (SBT)– Squat pivot transfer– Standing pivot transfer

Dependent Transfer

• Patient does not or cannot actively participate in transfer. May be able to assist minimally.

• Types of dependent transfers:– Sliding transfer from cart to table (team transfer)– Three person carry– Dependent stand pivot transfer– Hydraulic lift transfer

Levels of Assistance for Transfers (page 164)

Minimal Assistance (Min A)

1. PTA provides assist for about 25% of total patient’s work. Requires assist for balance, to move an extremity or assistive device.

Moderate Assistance (Mod A)

1. PTA provides assist for about 50% of total patient’s work

Maximum Assistance (Max A)

1. PTA provides assist for about 75% of total patient’s work

Contact Guard (CGA)

1. PTA supervises patient’s work by CONTINUOSLY guiding or guarding with touch/contact for support/balance

Close Guarding Assist

1. PTA supervises patient’s work by INTERMITTENTLY guiding or guarding with touch/contact

Stand – By Assist

• Patient can perform activities without assist but do not do it consistently.

• Examples of stand – by assist (SBA) = verbal cues (VC)

Independent (I) Transfer

• PTA supervises the pt. without any assist

Amount of Assistance

• When more than one person is required to transfer a patient safely the number of people required to complete the transfer is documented.

• Example – 2 people required to use moderate assistance

–Mod A x 2

Types of Assistance

• Assistance can be more than just physical assisting or supporting.

• Others types of Assistance:• Verbal cuing• Balance control

• Any type of assistance should be documented

General Rules of Transferring

Body Mechanics• Proper attention to body

mechanics and the relationship of center of mass and base of support allow the therapist to maintain the safest position while working with a patient.

* Position the patient close to your BOS to decrease stress on your back and arms.

PTA Preparation

• read patient chart (diagnosis, medical hx, meds, PT eval, patient current level of function, POC)

• plan treatment (type of transfer, how much assist, where will you treat, secure area, any equip needed)

USE A GAIT OR TRANSFER BELT

• Gait or transfer belts are used around the patients waist to provide a secure point of contact and control for the therapist.

Instructions and Verbal Cues• A patient should always be informed the transfer

to be performed and what they are expected to do. Instructions should be in a manner that can be understood by the patient.

• Instructions should be short and clear.

• If more than one person is transferring a patient, communication is essential.

Completing The Transfer

• The transfer is NOT complete until the patient is safely and securely in the new position.

Types of Transfers

• Bed Mobility Transfers

• Sitting Transfers

• Standing Transfers

Bed Mobility Transfers

• Bed mobility transfers can be done independently or with assist to move in bed.

• Patients may need assist with bed mobility due to weakness, obesity, para or quadriplegia, amputation or cognition problems.

• Bed mobility can help to prevent pressure ulcers and decrease joint contractures.

Bed mobility independent transfers

• supine sidelying sitting

• (page 225 & 226)

• Can also be taught to avoid excessive strain on LB.

Bed Mobility with Assist

– assist from PTA

– assist from assistive devices i.e. bed rails and trapeze (should only be used if necessary.

– REMEMBER your goal is to get pt. independent if possible

If a patient is have difficulty with bed mobility what types of activities might you do to increase independence?

Sliding Transfer (p 169)

• Used to move patient to/from cart and treatment table.

• 3 or more clinicians perform the transfer using a draw sheet.

Two Person Lift (p 181)

• The 2 person lift is an assisted transfer with max assist of 2 people.

• This type of transfer is often used to move a pt. from WC to/from floor or lower surface.

Sitting assisted transfers - sliding board transfers (page 191)

• Can be done with assist of PTA or (I)

• A sliding board is used when a patient does not have enough strength to lift most of the weight of the buttocks, sufficient sitting balance to move in a sitting position safely but can not perform push up transfers.

push up transfer (p 194)• A push up transfer is

used when pts. Have enough strength to lift themselves from the supporting surface and sufficient sitting balance to move safely.

Standing pivot transfer • used with patients when a pt, can

site, stand, pivot, and bear some weight on the LE, but have some weakness, paresis, paralysis, or loss of balance or sensation, which necessitates assistance to transfer safely.

• Amount of assist will vary usually moderate to minimal assist is needed.

• Better to transfer leading with stronger LE in MOST cases.

• A stand pivot transfer can be dependent (page 188) or assisted (p 202).

“Zero” Lifting Using Transfer Equip

Hydraulic Lift (p. 175)

• A hydraulic lift is a mechanical device that allows one person to transfer a dependent patient.

• The hydraulic lift is a mechanical device that utilizes hydraulics to lift the patient (similar to a hydraulic floor jack).

• A sling (similar to a hammock) is placed under the patient and is secured to the Hoyer lift via chains or bars to raise and lower the patient.

Sling needs to be placed under patient

• Generally roll patient from side to side to place sling under patient

Time to Transfer• introduce self to patient• explain what will happen during Rx• explain what is expected of patient• is patient ready? Does he need shoes or other

clothing?• assess area for safety• use gait belt• use proper body mechanics• make sure surfaces are as level as possible• give clear, concise commands• BE READY FOR ANYTHING

Safety Awareness with Transfers

• Use gait belt

• Lock Wheelchair & Bed

• Be sure sliding board is secure

• Use proper body mechanics

• Be sure WC is close enough to mat/bed

• Block feet or knees so LE do not slip

Documenting Transfers

• Type of transfer• Transfer to/from• Amount of assist required• If verbal cues required

Example

Stand Pivot Transfer WC →Bed, Min (A) x 1 with moderate vc’s.