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Case

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Kommer

Kommer, 45 years old, was hit by a car while riding his bicycle, resulting in an injury at the T5 spinal cord level. His condition is medically and physically stable, but the extent of the damage to the spinal cord is still being determined. In his rehabilitation, he has just started learning to transfer to and from surfaces of different heights.

What factors will help you determine which transfer technique may be best for Kommer to use when moving between the chair and the floor?

What other up-and-down transfers might he have to perform?

What guarding techniques will be needed for safety while he is learning?

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Introduction

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Sometimes transfers involve not just horizontal, or lateral, but vertical changes in position, such as moving between the chair and the floor and between the chair and a treatment plinth. Performing vertical transfers allows patients to be functionally mobile in a variety of settings and provides them with the means to get up off the floor after a fall (AMAP/ANAP). These transfers can be more challenging, however, because of the added factor of moving against gravity.

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Chair ↔ Plinth Transfers

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The chair ↔ plinth transfer is a variation of the standing-pivot transfer and therefore is easier when the patient turns toward the stronger side (see Chapter 11). If the table surface is higher than the top of the patient’s legs in standing (i.e., higher than the patient’s gluteal fold), a step stool will probably be needed for safe completion of the transfer. To maintain the patient’s safety while practicing this high center-of-mass (CoM) activity, remember to control centrally (CCDD); the patient should be guarded at the control points of the shoulder and pelvic girdles.

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Preparing the Environment

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As with any patient interaction, awareness and preparation of the environment are essential. For a safe transfer to occur, there needs to be enough room for the table and wheelchair and for the healthcare professional to be able to guard and assist the patient during the transfer as needed.

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The stool should be positioned nearby before the transfer is initiated. Adjustable height tables should be lowered to facilitate vertical transfers. Both transfer surfaces should be securely locked, and the patient should don nonslip footwear.

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Preparing the Patient

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Explain the procedure to the patient and address any concerns the patient might have. Drape the patient appropriately, and place a gait belt on the patient if the patient requires physical assistance or close guarding to perform the transfer.

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In this example, the patient has weakness in the left lower extremity (LE) and is turning toward the right, the patient’s stronger side (see Fig. 12-1).

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