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chapter part one

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Seated Transfers

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Fran

Sixty-year-old Fran was admitted to the hospital through the emergency department for local, severe low-back pain and decreased mobility that had begun 3 weeks ago. Fran immediately underwent surgery to remove a mass pressing on her spinal cord. Although the severe pain is gone and her arm and trunk control are good, she still has bilateral lower-extremity (LE) weakness. Until a more definitive prognosis can be made regarding the full return of strength in her LEs, Fran is proceeding with rehabilitation. How do you expect transfers to fit into Fran's plan of care? What factors must be considered? What additional information will help determine the best plan of care?

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Introduction

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Transferring between two surfaces of similar height can be done while in a seated position (Part 1) or by pivoting on the lower extremities (Part 2). The seated transfer can be performed in the anteroposterior direction or in the lateral direction. The transfer can take place without weight-bearing (WB) on either LE and allows the patient to maintain a lower center of mass (CoM) and broader base of support (BoS) than a standing pivot transfer.

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Lateral Transfers

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Lateral, or side-to-side, transfers allow patients to transfer between a variety of seating surfaces—beds, chairs, car seats, toilets, tub benches, etc.—without having to bear weight through the LEs. Therefore, patients whose LEs cannot safely support the patient's body weight, whether for musculoskeletal, neurological, or integumentary reasons, often use the lateral seated transfer technique. Lateral transfers may be performed with or without the aid of a transfer board. Performing an independent side-to-side transfer without a transfer board requires high levels of trunk and upper-body strength and motor control. The patient must be able to lift the body up high enough to clear all obstacles and to shift across a gap and safely onto another seating surface. Use of a transfer board allows the patient to perform the lateral transfer in a series of small shifts, with a smooth, even surface facilitating the move (see Box 11-1). The easiest lateral transfers are performed between surfaces at the same height or from a slightly higher surface to a slightly lower one. Lateral transfers to and from a wheelchair require that the chair have removable armrests.

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Box 11-1 Clinical Debate: Is It a “Sliding” Board or a “Transfer” Board?

The assistive device commonly used in lateral transfers has traditionally been called a “sliding” board. In recent years, however, many clinicians have come to refer to it as a “transfer” board.

As the patient moves laterally across the board during a transfer, some sliding may occur. Because of the risk of skin breakdown caused by sliding, however, many health-care professionals prefer to avoid the term “sliding” and encourage the more generic image of a “transfer.”

In either case, the boards ...

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