Definition of Disability
Refers to impairment or loss of motor/sensory function in thoracic, lumbar or
sacral segments of the spinal cord
Arm function spared
Possible impairment of function in trunk, legs and pelvic organs
Improved balance control
May have limited walking with bracing
Driving with hand controls
Added motor function in hips and knees
L2 Hip- minimal control
L3 hip-partial Knee – minimal
L4 hip, knee, ankle-partial,foot-minimal
L 5 hip and knee-completecontrol, ankle and foot
Ankle and foot-complete control
various degrees of bowel, bladder and sexual function
Lower level equals greater function
Increased ability to walk with less adaptive/supportive
Manual w/c for distance
1)anterior posterior transfer:
bed to w/c
Physical requirements: loose hamstrings, strong elbow
extensors, good balance of trunk, strong wrist
Layout: w/c –braked, 180˚ to bed, footrest –swung
Technique: coming to a sitting position : head raise,
palms down ,elbow-flexed, walking forearms
backwards ,wt. shift to rt., straighten left elbow, wt. to
left, straighten rt. Elbow, bring trunk forward by
walking hands forward one at a time.
Legs are moved by hands one at a time to bed end
opposite to w/c.
Push sideways and backwards with fist, moving each
hip and leg alternatively to bring hips close to w/c
Place hands on arm rests lift yourself back in w/c.
Move chair back until only heel remains on bed, lock
brakes, lean each side swing footrests, carefully place
feet on footrests.
To get back into bed reverse this procedure
W/C TO BED:
Place leg one by one on bed by lifting them with
Push on seat and move buttocks forward alternatively
Then lift yourself out of chair into bed by pushing
Move legs by lifting them one by one at side
Shift wt. on rt. Side and flex elbow
Shift wt. on left side lean and flex elbow
Slowly extend back come in supine lying.
While coming in sitting put your hand at pt. back
going to other scapula assist in motion
While sitting support pt. at scapulae
While coming out and going to bed during lift pt. can
be lifted up with a waist belt or supporting under
2) lateral sitting transfer
Bed to w/c:
Physical requirements: strong shoulder depressors and
abductors, good balance of trunk, ability to lift
buttocks off the bed and move from bed to w/c in 1
Layout: w/c-45˚ to bed , footrests swung out.
Come in sitting position on side of bed
Turn so that knees are away but hips direct towards
w/c. bring feet directly under body
Hand at the farther armrest
Push down with hands and swing off in 1 motion into
Turn trunk while lowering into w/c.
Wheel chair to bed
Lay out: Position of the chair: Line the chair up
with the plinth at an approximately angle of
45 degree. Arm rest is removed on bed end.
The therapist stands in front of the patient
ready to encourage flexion of head and trunk
and to assist or resist the individual
movement as necessary.
Technique: Bring forward buttocks one by
put rt. Hand under rt. Knee lift leg and
puts it on bed
Put rt. Hand under lt. knee lift it and put it
on bed.( can use both hands as well)
Lean forward ,push down with hands on
seat to get on bed.
Adjust legs with hands and come in supine.
3) Transfer using a slide
Bed to wheel chair:
Physical requirement: good sitting balance, strong
shoulder depressors, adductors, elbow and wrist
extensors (to lift hips)
Layout: w/c at head or foot end of bed at round
30˚armrest is removed from the side next to bed end ,
brakes locked .
Technique: come in sitting ,
moves towards edge of bed,
turning so that knees are away
and hips are towards w/c. bring
feet directly under the body.
Lean over rt. Forearm ,raise lt.
buttock off bed to place sliding
board under it between bed and
Using upper extremity ,move laterally across board
Lean over lt. forearm, raise buttock and remove sliding
Replace armrest, swing lt. footrest put foot on it,
unlock break, move away from bed, swing rt. Footrest
and place your foot on it.
Assistance: therapist can assist by placing her hand on
patient’s waist or scapulae and helping patient shift
weight forward or slide across board as needed.
To move from w/c to bed
with sliding board
Lay out: keep the w/c near head end of bed , brakes
are locked. w/c at 45˚ to bed
Raise your rt. Leg and put it on bed with hands
Lift let. Leg and put it on bed crossing over another leg
Put slide board under rt. Hip by tilting lt. side
Push downwards with hands and slide yourself
Adjust your leg in by hands
Slide board w/c to bed
While putting slide board
under pelvis lift pt. to left
side with help of waist belt.
Give assistance in sliding
pelvis along the board by
stabilizing trunk over