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Objectives

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1.Describe supine to sit transfers 2.Describe ?zero-lift? policy and its purpose. 3.Describe transfers and their indications including: •Dependent transfers: Two-person lift •Dependent transfers: Hydraulic lift •Dependent transfers: Dependent standing pivot •Assisted transfers: Sliding board •Assisted transfers: Assisted standing pivot •Assisted transfers: Squat pivot transfer 4. Describe types and levels of assistance used when transferring a patient.

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Planning for transfers

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•Assess the cognitive and physical capabilities of the patient -To what extent can the patient cooperate? -To what extent might the patient interfere? •Choose a technique •Set up the environment -Organize needed equipment -Remove unnecessary objects and obstacles •Prepare the patient -Inform, instruct -Clothe appropriately including footwear •Apply safety belt •Prepare any helpers

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Independent

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Patient is able to consistently perform skill safely with no one present

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Distant Supervision

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Patient requires someone w/in arm's reach as a precaution; low probability of patient requiring assistance

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Close Supervision

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Therapist assisting is positioned as if to (A); Hands raised, but not touching patient; Full attention on patient; fair probability of patient requiring assistance.

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Contact Guard

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Therapist is positioned as with close supervision, with hands on patient, but not giving any assistance. High probability of patient requiring assistance

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Minimal Assistance

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Patient is able to complete majority of the activity w/o (A). Pt provides 75% or more of effort, therapist provides ~25% of effort.

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Moderate Assistance

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Patient is able to complete part of the activity w/o (A). Pt provides ~50% of effort, therapist provides ~50% of effort.

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Maximum Assistance

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Patient is unable to complete the activity w/o (A). Pt provides less than 25% or more of effort, therapist provides more than 75% of effort.

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Dependent Assistance

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Patient requires total physical assist from 1 or more persons to accomplish activity safely and in acceptable amount of time Special equipment or devices may be used

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Cueing

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All levels of assistance may require cues (except Independent) -Verbal -Visual -Tactile Progress may be shown through changes in frequency of cueing

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Contraindications for Use of Gait Belt

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1. Recent colostomy/ileostomysurgery 2. Severe respiratory problems 3. Recent abdominal, chest, or back surgery 4. Abdominal aneurysm 5. Phobia regarding belts

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Gait Belts,

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•Provide a firm grasping surface •Protects the patient from accidental trauma to the skin •Enables therapist to gradually lower a patient to the floor (if necessary) without injuring self orpatien

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Transfers

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safe movement of a person from one surface or location to another or from one position to another

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Types of tranfers

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•Supine to Sit •Dependent transfers: Hydraulic lift •Three person carry •Two person carry •Dependent transfers: Dependent standing pivot •Dependent transfers: Dependent sitting pivot •Assisted transfers: Sliding board •Assisted transfers: Assisted standing pivot •Assisted transfers: Squat pivot transfer •Sit to Stand.

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Supine to Short-sitting

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•Typical movement pattern is simultaneous upper-and lower-body movement, powered primarily by core musculature. •When mobility is impaired, the movement is usually done segmentally through side-lying.

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Supine to Sitting on the Right Side of the Bed

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•Roll from supine to right side-lying. •Lift or slide both lower extremities (LEs) off the edge of the bed. •Push left hand down into the bed, extending the elbow. •Abduct right arm, using it to push upright.

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Supine to Sitting

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•Direct distally if patient requires only cueing. •To provide physical assistance, apply force through the humeral head to control the movement more centrally.

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Short-sitting to Supine

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•Lower upper body to the bed, controlling with UEs. •Lift both LEs onto the bed. •Roll to supine. •(Having the patient sit about one-third of the way down the bed results in a better supine position.)

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in sitting Scooting Sideways

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•Used for repositioning prior to lying down •A component of lateral seated transfers

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in sitting Scooting Forward and Back

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•Used for repositioning in chair •A component of sit-to-stand and pivot transfers

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in sitting scooting sideways to right

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•Abduct the right arm, and place hand on bed. •Push down with both hands, lifting hips up and to the right. •Repeat as needed.

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Special Circumstances: THA (Posterior Approach)

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•Restrict movement of postoperative hip: 60-90 flexion, 0 adduction, 0 IR •Supine sitting without side-lying •May initially require assistance of more than one person •Less risk of adduction when getting out of bed on the nonoperative side, but getting back in bed may be patient specific

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THA: Supine to Sitting(Posterior Approach)

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•Remove abduction wedge (maintain slight abduction). •Prop up on elbows. •Pivot on bed, alternately moving UEs and LEs. •Sit on edge of bed (EOB) with the trunk leaned back.

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Manual Dependent Lifts

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•U.S. Department of Labor: health-care workers lifting and moving patients have increased musculoskeletal disorders. •Manual lifting and patient repositioning—increased risk of injury to lower back and shoulders •Chair-toilet transfers most stressful

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Zero Lift Policy

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•Mechanically assisted lifting when objective is to move a patient •Occupational Safety and Health Administration (OSHA): manual lifting of residents should be minimized in all cases and eliminated when feasible. •Legal requirement in many states

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Dependency Levels and Recommended Lift Assists Level 4

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Total dependence: no manual lifting -Mechanical lift with full sling

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Dependency Levels and Recommended Lift Assists Level 3

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Extensive assistance: no manual lifting -Mechanical lift with full sling -Stand-assist lift if deemed appropriate

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Dependency Levels and Recommended Lift Assists Level 2 or 1.

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Limited assistance or supervision -Variable, possibly some manual lifting; technique depends on physical, mental, and emotional capability of patient -May include mechanical lift, walker, transfer board, gait belt

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Dependency Levels and Recommended Lift Assists Level 0

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Independent: no mechanical assist typically needed

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Total Body Lift

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•Position sling under patient with the bottom edge of the sling near the sacrum. •Smooth wrinkles from the sling. •Position leg straps.

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Sit-to-Stand Lift

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•Moving from one seated position to another through standing •Coming to stand for therapeutic purposes •Especially useful for toileting and perineal hygiene

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Sit-to-Stand Lift—IndicationsLevel 3 or 2 Assistance

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•Patient is able to bear some weight on the LEs. •Patient can flex hips, knees, and ankles. •Patient can maintain sitting balance without extensive support. •Patient can participate in transfer process. •Lift does not exacerbate any back problems.

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Dependent Transfers

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•Manual lifting places the clinician at increased risk of injury. •Perform manual lifts only when the patient is participating as a learner or in an emergency. •Use lifts or lateral transfer devices for improved safety of the patient and the clinician. •Follow all equipment safety guidelines.

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Manual Dependent Lifts:General Guidelines

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•Risk of injury is much higher than with mechanical lifts. •Clinician must be able to manage the load created by the patient, as well as any lines, leads, or tubes. •Get assistance if needed.

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Manual Dependent Lifts:General Procedure

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•Gather and organize equipment; prepare surfaces. •Position and secure transfer surfaces. •Inform and engage patient. •Coordinate with assisting personnel. •Grasp patient securely. •Move patient using good body mechanics. •Situate patient safely with important items within reach.

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Manual Vertical Lifts

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•Require two or more people •Are used for dependent patient transfers in which patients are lifted up before being moved laterally •Include: Bedchair, bedfloor, chairfloor, chairchair •Have the taller or stronger clinician managing patient's upper body.

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Two personWheelchair-to-Bed Lift

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•Position chair. •Position one clinician behind the patient. •Position another clinician in front of the patient. •Hold patient securely. •Lift, shift, and lower. •Adjust as needed.

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Floor to Chair Lift

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•The clinician behind the patient uses lower extremities (LEs) rather than upper extremities (UEs) to lift. •The clinician in front of the patient faces the direction of the lateral move. •The clinician behind the patient must clear the drive wheels and hand grips.

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Manual Pivot Transfers

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•Used for dependent transfers when patient has some use of LEs •Typically require one to two people

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Bed to Chair Pivot Transfers

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•Prepare patient. •Move chair close. •Lower bed as needed. •Bring patient to sitting on the EOB. •Move chair into position; engage locks. •Lift, pivot, and lower. •Reposition as necessary. •Supply means to call for assistance.

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Chair to Bed Pivot Transfers

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•This is the reverse of bed-to-chair. •Watch for tight grip on wheelchair armrests. •Guard carefully to prevent the patient from sliding off the edge of the bed.

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Independent Sliding Board Transfer to the LeftBed-to-Wheelchair

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•Angle left 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 hips up and over. Repeat as needed. •Remove board.

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Hand caution

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•Take care to not allow the patient's fingers to be pinched by the board. -The patient should not reach through the open handle during the transfer. -The patient should not grasp the end of the transfer board during the transfer process.

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

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•Remove wheelchair's armrest and legrest. •Position left side of chair close to the mat and slightly angled. •Lean left, and place left hand on mat with room for sitting. •Place right hand on armrest. •Push down with both hands, lifting hips up and over onto mat in one motion. •Adjust position as needed.

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Sliding Board Transfer

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•Typically guard from front if patient is unable to reliably maintain balance. •Assist with hip movement by gripping lateral aspects of gait belt or trousers, sides of draw sheet, or under ischial tuberosities. •Several small moves may be needed to complete transfer.

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Pivot Transfer: Rise, Pivot, Sit

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•Primary action occurs at the feet. •Requires WB on at least one LE: -Squat-pivot transfers -Standing-pivot transfers

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Pivot Transfer

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•Setting up the environment -Remove obstacles, including legrest and possibly armrest. -Attempt to equalize surface heights. -Secure both surfaces. -Ensure patient has appropriate footwear. -Use a gait belt for dependent transfers.

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Pivot Transfer 2

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•Patient position -Hips forward •Up and forward lift •Alternate weight shifts •Forward slide -Feet back, flat on floor, with inner foot slightly forward -Flexed trunk (?nose over toes?) -Hands on armrests

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Pivot Transfer 3

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•Clinician position -In front of patient -Hips and knees flexed, wide BoS -Staggered stance with inner foot slightly posterior -Holding gait belt in underhand grip on either side of patient's lumbar spine

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Pivot Transfer 4

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•Blocking the knee(s): creating an extension moment to counteract the flexion moment at the patient's hips and knees •Contact at the patient's proximal tibia •1:1, 2:1, or 2:2

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Pivot Transfer 5

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•Rise -Count of three -Rocking for momentum -Clinician leans posteriorly to help patient rise •Pivot when patient's hips clear the seat (squat pivot) or when patient is erect and stable (stand pivot). •Before sitting: -Patient reaches hands to armrests. -Patient flexes trunk. •Control descent

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Squat-pivot vs. Standing-pivot Transfer

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•They differ in amount of uprightness the patient achieves. •They can differ in hand placements. •Patient may pause when upright in stand-pivot transfer.

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Seated Repositioning

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•Ensure the patient's hips are fully back in the seat: -Patient uses UEs and LEs to lift hips up and back (requires forward trunk lean). -Clinician assists through knee blocking from in front, hip lift from behind, or underarm lift from behind.

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Special Patient Considerations

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•Unilateral limited WB •Hemiplegia •THA (posterior approach) •SCI (spinal cord injury)

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Unilateral Limited WB

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•Slide the affected LE forward prior to rising. •Hold NWB limb slightly off the ground during pivot. •Pivot on uninvolved LE through a series of small hops. •Extend knee of involved LE prior to sitting.

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Hemiplegia

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•It is generally easier to transfer to the stronger side. •The patient may need to rely on the stronger side for a unilateral pivot •The involved UE may need to be supported. •Do not pull on patient's involved arm.

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THA Posterior Approach

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•Scoot forward in chair without trunk flexion beyond 60to 90. •Extend knee of involved LE prior to standing. •Avoid forward trunk flexion beyond 60to 90before rising. •Pushing to standing without trunk flexion is very difficult. •Avoid internal rotation of involved hip during pivot. •Avoid forward trunk flexion beyond 60to 90during sitting.

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THA

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•CAUTION: If the feet are planted on the floor, be sure that the hip on the operated side does not internally rotate whether the patient is turning the upper body toward the involved or uninvolvedside. With the feet planted, turning the upper body toward the uninvolvedside while shifting the pelvis toward the involved side may result in internal rotation of the involved hip.

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SCI

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•SCI at level C7 and lower typically have potential to perform transfers independently. •Typically use a sitting-pivot transfer: feet contact the floor for stability, but the force to power the transfer comes from UEs. •It is generally preferred to have the stronger or less painful UE be the trailing arm. •Guard for trunk stability, and watch for possible tissue damage.

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Momentum Transfer strategy

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REQUIRES: •Adequate strength and coordination •Eccentric contraction of trunk and hip ms •Concentric contraction of hip and knee ms to lift body

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Zero Momentum strategy

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•Flexing the trunk sufficiently to bring COM within BOS before lift-off •Requires larger LE forces •No Momentum

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Sit to Stand armrests

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Assist in stability and force generation

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Summary

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•Vertical lifts include the additional challenge of gravity and require good upper extremity strength. •As patients'skill levels increase, their transfers may be able to be accomplished in one smooth movement rather than broken down into components. •There are multiple vertical transfer methods, and patients sometimes develop their own to accommodate their own particular needs.

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Videos

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Assisting transfers:http://media.pearsoncmg.com/ph/chet/chet_minor_patient_care_skills_6/5_transfers/Ch8aAssistToFrontBack.movStand Pivot transfers:http://media.pearsoncmg.com/ph/chet/chet_minor_patient_care_skills_6/5_transfers/Ch8bDepStandingPivot.movTwo Person Lift:http://media.pearsoncmg.com/ph/chet/chet_minor_patient_care_skills_6/5_transfers/Ch8cTwoManLift.movSliding Board Transfer:http://media.pearsoncmg.com/ph/chet/chet_minor_patient_care_skills_6/5_transfers/Ch8dSlidingBoardTransfer.movAssisted Stand Pivot Transfer:http://media.pearsoncmg.com/ph/chet/chet_minor_patient_care_skills_6/5_transfers/Ch8eAssistedStandingPivot.movGuarding Sit to Stand Transfer with Assistive Device:http://media.pearsoncmg.com/ph/chet/chet_minor_patient_care_skills_6/6_guarding/Ch9A1StandingSitting.mov

Foundation of Physical therapy Quiz 2 Concepts and Techniques of Assisted Transfers – Flashcards

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