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TRANSFERS IN QUADRIPLEGIC.pptx

  1. DEFINITION OF TRANSFER  The activity of moving a person of limited function from one location to another.  Transfers may be done by the I. patient alone, II. with the assistance of another person III. or by another person.
  2.  Patient’s ability to transfer and the amount of assist needed will depend on I. Cardiopulmonary status II. Joint flexibility III. Muscle tone and strength IV. Neuromuscular control V. Balance and coordination VI. Endurance VII.Weight bearing status VIII.and Cognition.
  3. INDEPENDENT TRANSFER  No assistance of any type needed for any aspect of the transfer.  Patient can perform set up and transfer safely without any assistance.
  4. ASSISTED TRANSFER  Patient actively participates in transfer but requires assistance.
  5. DEPENDENT TRANSFER  Patient does not or cannot actively participate in transfer. May be able to assist minimally.
  6. MINIMAL ASSISTANCE  Therapist provides assist for about 25% of total patient’s work.
  7. MODERATE ASSISTANCE  Therapist provides assist for about 50% of total patient’s work.
  8. MAXIMUM ASSISTANCE  Therapist provides assist for about 75% of total patient’s work.
  9. 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 base of support to decrease stress on your back and arms.
  10. THERAPIST PREPRATION  Read patient chart (diagnosis, medical treatment, PT eval, patient current level of function).  Plan treatment (type of transfer, how much assist, where will you treat, secure area, any equip needed).
  11. USE A TRANSFER BELT  Transfer belts are used around the patients waist to provide a secure point of contact and control for the therapist.
  12. 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.
  13. TECHNIQUE  The patient is always to lift, not drag, his body to avoid knocking of his limbs on furniture or his buttocks on the wheel.  While transferring the buttocks, the head, shoulders and trunk must be flexed and with the head well forward over the knees.  THE PLINTH SHOULD BE OF SAME HEIGHT AS THE WHEELCHAIR for transfer training and ideally all surfaces should be at correct height.  The chair must be in position of maximum stability.
  14. COMPLETING THE TRANSFER  The transfer is NOT complete until the patient is safely and securely in the new position.
  15. WHEELCHAIRS  It is not just a ‘chair with wheels’. It is a second home for disabled, since he spends so much time in it.
  16. WHEELCHAIR MODIFICATIONS  One Arm Drive Wheelchair (Hemiplegic Wheelchair)  Growing Wheelchair  Powered Wheelchair.
  17. HEMIPLEGIC WHEELCHAIR
  18. LIGHTWEIGHT MANUAL WHEELCHAIR
  19. BATTERY POWERED WHEELCHAIR
  20. WOODEN WHEELCHAIR (early part of 20th century)
  21. WHEELCHAIR FITTED WITH MECANUM WHEELS
  22. ANTIQUE WHEELCHAIR
  23. OTHER TYPES
  24. SEAT WIDTH  OBJECTIVES: I. Distributing the patient’s weight over the widest possible surface. II. Keeping the overall width of chair as narrow as possible.  MEASURMENT:  Measure the individual across the widest part of either the thighs or hips while the client is sitting in a chair comparable to the anticipated wheelchair.
  25. SEAT DEPTH  OBJECTIVES: I. Distribute the body weight along the sitting surface by bearing weight along the entire length of thigh to just behind the knees. II. This approach is necessary to prevent pressure sores on the buttocks and lower back.  MEASURMENT:  Measure from the base of back to inside of the bent knee.
  26. SEAT HEIGHT FROM FLOOR AND FOOT ADJUSTMENT  OBJECTIVES: I. Supporting the patient’s body while maintaining the thighs parallel to the floor. II. Elevating the foot plates to provide ground clearance over varied surfaces.  MEASURMENT:  Seat height is determined by measuring from the top of the wheel chair frame supporting the seat to the floor and the patient’s popliteal fossa to the bottom of heel.
  27. BACK HEIGHT  OBJECTIVE: I. Back support consistent with physical and functional need must be provided. II. The chair back should be low enough for maximal function and high enough for maximal support.  MEASURMENT:  For full trunk support: Measuring from the top of seat frame on the wheel chair to the top of user’s shoulders.  For minimum trunk support: measuring upto below the inferior angle of scapula.
  28. ARMREST HEIGHT  OBJECTIVE: I. Maintaining the posture and balance. II. Providing support and alignment for upper extremities. III. Allowing change in position by pushing down on armrests.  MEASURMENT:  Measure from the seat frame to the bottom of the user’s bent elbow.
  29. TRANSFER BY ONE THERAPIST  When one therapist transfer a patient who can give little or no assistance, the therapist must take great care to position himself and patient correctly in order to avoid undue strain.  To Transfer From Chair To Plinth:  Position of the chair: chair is angled at approx 30 degree to the side of the bed.
  30. CRITERIA  Patient should be able to FLEX his trunk.  Patient’s all the upper limb and lower limb joint should move through at least half the ROM to complete transfer in case of one therapist transfer.  Lower limb MMT grade: should be 3 so that he can come out of chair in case of independent and assisted transfer.  Upper limb MMT grade: should be 3 and should be strong enough to perform the transfer.
  31.  Position of the patient:
  32.  Action of therapist:
  33.  Transfer belt can be used.  Sliding board can also be  used.
  34. THE “CERVICAL LIFT” USING TWO THERAPISTS  Safest method for both patient and therapist.  This lift can be used: 1) To transfer a patient to and from the bed. 2) A second chair. 3) From the floor in an emergency.
  35.  Transfer from bed to chair:  Chair is angled at approx 30 degree to the side of the bed.  Position of the patient:  Patient is in long sitting with head and trunk and arms folded across lower ribs.
  36.  Position of the therapist:  Therapist one:
  37.  Therapist two:
  38.  Patient must be lifted enough to avoid knocking of the buttocks against the rear wheel or spine against the chair handle or backrest support.
  39. INDEPENDENT TRANSFER (lesion below C6)  To transfer to the plinth:  Consist of three manoeuvres: 1) To bring the buttocks forward in the chair. 2) To lift the legs onto the plinth. 3) To transfer trunk onto the plinth.  Position of the chair:  Chair is angled at 20 degree to the plinth. A pillow is placed over the rear wheel to prevent injury.  Position of the therapist:  Therapist stands in front of the patient, ready to encourage flexion of the head and trunk and to assist and resist movements as necessary.
  40.  Action of the patient: 1) To bring buttocks forward in the chair:
  41. 2) To lift leg onto the plinth:
  42. 3) To transfer the trunk onto the plinth:
  43. REMOVAL OF FOOTPLATES  To remove right footplate: Transfer the right foot to the left footplate or to the floor. Maintain balance with left hand on armrest if patient has a lesion at c7, or with left elbow or wwrist hooked around the left chair handle if tricep is paralysed With right wrist extended under lower leg, flex the elbow and lift the foot over to the left footplate Remove the footplate With wrist extended, release the lever by pushing it forward with dorsum of hand. Swing back the footplate using extension of the wrist. Lift the footplate off the bracket using the dorsum of hand and wrist extension
  44. TO TRANSFER TO FLOOR (lesion below T11)  Position of the therapist:  Therapist stands in front of the patient, correcting his position and assisting him to maintain balance as necessary.
  45.  Action of the patient:
  46. TRANSFER FROM FLOOR TO CHAIR (LESION BELOW T12)
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