TRANSFERS IN QUADRIPLEGIC

2. 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.

3.  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.

5. 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.

6. ASSISTED TRANSFER
 Patient actively participates in transfer but requires
assistance.

7. DEPENDENT TRANSFER
 Patient does not or cannot actively participate in
transfer. May be able to assist minimally.

9. MINIMAL ASSISTANCE
 Therapist provides
assist for about 25% of
total patient’s work.

10. MODERATE ASSISTANCE
 Therapist provides assist for about 50% of total
patient’s work.

11. MAXIMUM ASSISTANCE
 Therapist provides assist for
about 75% of total patient’s
work.

13. 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.

14. 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).

15. USE A TRANSFER BELT
 Transfer belts are used around the patients waist to
provide a secure point of contact and control for the
therapist.

16. 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.

17. 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.

18. COMPLETING THE TRANSFER
 The transfer is NOT complete until the patient is safely
and securely in the new position.

20. WHEELCHAIRS
 It is not just a ‘chair with wheels’. It is a second home
for disabled, since he spends so much time in it.

22. WHEELCHAIR MODIFICATIONS
 One Arm Drive Wheelchair (Hemiplegic Wheelchair)
 Growing Wheelchair
 Powered Wheelchair.

23. HEMIPLEGIC WHEELCHAIR

24. LIGHTWEIGHT MANUAL WHEELCHAIR

25. BATTERY POWERED WHEELCHAIR

26. WOODEN WHEELCHAIR
(early part of 20th century)

27. WHEELCHAIR FITTED WITH MECANUM WHEELS

28. ANTIQUE WHEELCHAIR

29. OTHER TYPES

31. 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.

32. 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.

33. 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.

34. 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.

35. 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.

37. 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.

38. 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.

39.  Position of the patient:

40.  Action of therapist:

41.  Transfer belt can be used.
 Sliding board can also be
 used.

42. 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.

43.  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.

44.  Position of the therapist:
 Therapist one:

45.  Therapist two:

46.  Patient must be lifted enough to avoid knocking of the
buttocks against the rear wheel or spine against the
chair handle or backrest support.

47. 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.

48.  Action of the patient:
1) To bring buttocks forward in the chair:

49. 2) To lift leg onto the plinth:

52. 3) To transfer the trunk onto the plinth:

53. 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

54. 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.

55.  Action of the patient:

57. TRANSFER FROM FLOOR TO CHAIR
(LESION BELOW T12)