Transfering Technique


TRANSFER


Moving From Bed to Chair or Chair to Toilet

Safely helping a survivor to move depends on the abilities of both the health care provider and the survivor. No single technique works in all situations. Consider the following factors when planning a transfer:
• The survivor’s level of control and movement: Poor control of the affected side may cause
  overuse of the unaffected side during transfers.
• Size and weight of the survivor compared with the health care provider.
• Time of day and how tired the survivor is (a fatigued survivor needs more help). Is the survivor
  better able to perform in the morning but fatigued at night?.
• Your level of comfort in safely moving the survivor. If you are not sure you can do this safely,
  ask for help.


Rules For Safe Transfers

Follow these steps when helping a stroke survivor to move:
1. Make sure the survivor is wearing safe shoes.
2. Apply wheelchair brakes.
3. Move any arm rests and swing foot rests out of the way. Support the affected arm with a sling
    if needed.
4. Help the survivor get into the right starting position. The persons unaffected side should be closest to the chair. Shift the person’s buttocks closer to the edge of the wheelchair, one side at a time.
5. Position yourself as close to the survivor as possible. Do not block the direction of movement or the survivor’s view of the path of movement.
6. Guide and support the survivor’s upper body. Place your hands around the upper back and
    shoulder blades.
7. Bend your knees and keep your back straight. Note: Do not lift the survivor by placing your hands under the arms or armpits. This can cause pain. Do not pull the affected arm.
8. Shift your weight from the front to the back foot. Doing this makes the transfer easier.



One-Person Pivot (Stepping) Transfer

        A one-person pivot (stepping) transfer is often used for assisting a survivor to stand. It is also used for
toilet, car, and bed-to-wheelchair transfers.

Follow these steps:
1. Stand in front of the survivor, supporting the shoulder blades.
2. Tell the survivor which way they are being moved.
3. Rock the survivor gently forward and guide the person to a standing position.
4. Position your feet on either side of the affected foot to support the leg and prevent it
from collapsing.
5. Assist survivor to step and transfer weight to the leg closest to the destination.
6. Pivot.
7. Help the survivor bend forward and place the buttocks down and back on the new surface.




Two-Person Pivot (Stepping) Transfer

       The two-person pivot (stepping) transfer is used on the survivor who can bear weight on the legs but is heavy, likely to make sudden movements, or unable to follow direction. You need 2 health care providers for this transfer. The taller care provider stands behind the survivor. The care provider at the front leads the transfer. The rear care provider guides the hips.

Step 1: Getting ready for the transfer

A. Both caregivers:
•  Lower the bed so the survivor’s feet rest on the floor.
•  Lock the bed brakes, if the bed has casters.
•  Adjust or remove the wheelchair foot rests and the arm rest on the side closest to the bed.
•  Place the wheelchair beside the bed at a slight angle.
•  Lock the wheelchair brakes to allow the rear care provider to be closer to the survivor.

B. If you are standing in front:
•  Assist the survivor to sit on the edge of the bed with feet flat on the floor.
•  Have the survivor place the unaffected arm around your waist.
•  Place your hands on the survivor’s upper back.
• Position your feet on either side of the affected foot to support the leg and prevent it from collapsing.

C. If you are standing behind:
• Stand behind the survivor with one knee on the bed.

Step 2: The transfer

A. If you are standing in front:
•  Use a no-verbal signal (like a head nod to the second caregiver) to start the transfer if the survivor overuse their unaffected side.
•  Assist the survivor to transfer weight to the leg closest to the destination.
•  Turn, and place the buttocks down and back on the new surface. Note: A transfer belt placed low on the survivor’s pelvis can simplify this step. It can also make it more comfortable for the survivor, and allow the care provider at the back to help more.

B. If you are standing behind:
•  S upport the survivor at hip level and guide (do not lift) the hips.



C. Both caregivers:
•  Do not lift using the survivor’s clothing
•  Replace the wheelchair foot rests and arm rest
•  Position the survivor comfortably

A low-pivot transfer may be more effective if the stroke survivor can help by coming into a half-standing
position, but not a full standing position. Follow the steps above.



Wheelchair Use

       Even after treatment, most survivors have some problems moving. These problems range from someone who is easily fatigued to being unable to move. A survivor may require a wheelchair for part or all of the day. The physiotherapist or occupational therapist can decide what wheelchair is needed. They will know whether or not the survivor will also need a pressure-relieving cushion and back support. Many survivors learn to move their wheelchair during rehabilitation. You may need to remind them how best to use their wheelchair.

Survivors may slide forward in a wheelchair so that their feet can reach the floor. Sliding forward in a wheelchair can:
• Affect postural tone and control
• Cause problems with transfers and control
• Increase high tone (spasticity), pain, and the risk of skin breakdown

The physiotherapist or occupational therapist may prescribe a hemi-height wheelchair. This chair has a lower seat than a standard chair. It allows the survivor to reach the floor with their feet without sliding forward.





What You Can Do to Help?

Watch the survivor moving the wheelchair so you can spot any problems. Ask yourself these questions:
• Does the movement look normal? If not, why not?
• What can I do to change it?
• Do I need to have a member of the team assess the survivor?

Watch for increasing muscle tone (stiffness). This tells you that the survivor is using too much effort. Check with the healthcare team if you are concerned. Excessive effort reinforces abnormal movements. Make sure the survivor is not doing too much too soon.


The Too Much, Too Soon Rule!!

Doing too much, too soon has a long-term, negative effect on the survivor’s ability. Overuse can cause wear and tear on the unaffected side and increase the need for help. Always balance the benefits of faster independence with the risk of overuse and deterioration.

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