Ready. Set. Stand!
The term transfers gets tossed around a lot in healthcare. When professionals are trying to determine how well someone gets around, this term refers to someone standing up, sitting down with control, pivoting to the wheelchair, bed or toilet and getting in or out of the car.
If you are having difficulty with getting out of a couch or off the toilet, many folks we come in contact with have already started to modify this by raising the toilet height or sitting in a lift chair recliner rather than that old, soft sofa. These modifications can be critical in maintaining independence and we have listed some nice options to help assist in standing up on our products page.
What if this isn’t enough? Well, that’s when caregivers come into the equation to solve this problematic issue. As a therapist, the goal is always to consider strengthening as a top priority in getting someone back to independence. The next option is critiquing the technique of the individual attempting to transfer. There are key setup items to keep in mind.
Scooting out to the end of the surface (chair, bed, couch).
Placing both hands on the arm rests(if available) to allow arms to assist.
Bring both feet back and place knees in a flexed (90-degree angle) in which your feet are under you. This is often overlooked but weight needs to be over your base of support.
Lean your body forward into a flexed trunk position so that your nose is about over your toes.
Setting up in this position allows for success in independently getting up. However, it’s not always a one-size-fits-all-all.
Each person is different in their limitations which could be a knee that doesn’t bend well or hurts, a torn rotator cuff that doesn’t allow the arm to assist at the arm rest position, or a back injury that doesn’t allow bending forward. Quite frankly, these make it hard to successfully get up.
This is where the caregiver role requires assistance. The most important thing is that the person attempting the transfer sets up the best they can in the way described above. As the assisting individual, you may pick a side of the person trying to stand and assist by using a gait belt or pulling at the waistband. Grabbing under the arms of the individual standing is not recommended due to the potential for injury to the shoulder. If someone repetitively needs assistance, this incorrect technique may lead to great problems through injury and further immobility.
While someone may have trouble getting into a standing position, that doesn’t mean they shouldn’t try as well. We recommend a communicating phrase such as, “Let’s stand on the count of 3.” This allows for everyone’s effort to be synchronized.
If they use a walker or cane, it should be in place before standing to assist once in the standing position. Ideally, the brakes are in the on position for a rollator as well. Some people insist on having one hand on the device as they attempt to stand which may be the only way in certain cases but can be dangerous as the walker may move forward or tip over.
A pivot transfer is slightly different in that you setup in front of the person who needs help. When you are assisting, there should be no hands or arms wrapped around your neck to use you as a source of pulling. Bending at the knees, back straight and using the entire body to lift are recommended to protect the back. Try using these steps:
Angle wheelchair or chair close to the destination surface such as the bed. It can also be set up parallel. You may want to remove the armrest if possible to reduce lifting over it.
Place a gait belt around the waist of the person you are assisting or plan to place hands under buttocks to “scoop” the person.
Position the person as described earlier by having them at the edge of the chair etc.
If going to the right for example, then your right foot should be pointing in that direction and your left leg should be between theirs.
Plan a communicative phrase
Back should be straight, lean their body forward and remember to lift with your legs, not your arms to protect yourself from injury. No twisting motion should occur at the spine and legs should transition the person by pivoting!
There are lots of great devices on the market to help with transfers. Some of the old standards such as a sliding board or a Hoyer lift may be more familiar to you. Some machines use a battery and plug-in while some items such as the Spryte require no battery. If considering any of these products, it is highly recommended to seek professional advice for most appropriate equipment from a therapist.
What about those car transfers that are a common limitation for going to appointments and events? Hiring a transport service for wheelchairs can be difficult and costly. There is a seriously cost-effective device on the market linked in our products page that makes this process a whole lot easier. When it comes to getting in and out of the various types of vehicles out there, it is hard to precisely describe a “how to” here.
Sitting sideways on the passenger side and utilizing the car's features of roof grab handles or boosting ourselves with running boards on a lifted vehicle are all ways to help us maneuver. It is highly recommended to start with the car door handle tool that can easily be found in local stores and on Amazon due to its level of popularity. This can allow for proper boosting and positioning. I’d highly consider using the tool and sitting all the way back before attempting to swing legs into the car.
No matter where you’re going, how many people there are or what equipment you choose, safety is a top priority. Slow, controlled movements with proper setup and back protection are vital to safely get where you’re going.
Slow and steady wins the race in this case! Don’t forget, you can visit our products page to find the items featured in this article.
Written by Kayla Fluder, DPT
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