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INTRODUCTION

Chapter Outline

Introduction

Sit to/from Stand Transfers

  • Biomechanics: Sit to/from Stand Transfers

  • Task Analysis: Sit to/from Stand Transfer

  • Intervention Strategies: Sit to/from Stand Transfer

  • Stand-to-Sit Transfers

  • Transfers to/from a Wheelchair

Stand to/from Floor Transfers

  • Biomechanics and Task Analysis: Stand to/from Floor Transfers

  • Intervention Strategies: Stand to/from Floor Transfers

Sit Pivot Transfers

  • Biomechanics: Sit Pivot Transfer

  • Intervention Strategies: Sit Pivot Transfer

Floor-to-Wheelchair Transfers

  • Forward Approach

  • Sideward Approach

Outcome Measures to Assess Transfer Ability

Clinical Reasoning Summary

Summary

Student Practice Activities

INTRODUCTION

The ability to transfer between body positions and surfaces is an essential skill that many people who receive rehabilitation services need to reacquire after an injury or illness. Being able to transition from bed to wheelchair and sit to stand places the individual in a position to begin locomotion and improves interaction with the environment. Although there are various types of transfers, the ability to transfer from a seated surface to standing (and back again) (Fig. 8.1) is the most basic and provides the foundation for other types of transfers. An individual who cannot bear weight through his or her lower extremities (LEs) and stand (e.g., a person with a complete spinal cord injury [SCI]) may transfer from one surface to another (e.g., wheelchair) using a sit pivot technique (Fig. 8.2). The ability to transfer from standing to the floor and back to standing (stand to/from floor) is also an important skill that enhances functional independence. This chapter examines various training strategies that can be used to enhance an individual’s ability to perform these vital transfer skills.

FIGURE 8.1

A patient with a stroke (left hemiparesis) transfers from sitting to standing.

FIGURE 8.2

A patient with T12 incomplete spinal cord injury (SCI) transfers from a wheelchair to a mat.

SIT TO/FROM STAND TRANSFERS

Biomechanics: Sit to/from Stand Transfers

It is important to have a good understanding of the normal biomechanics required to complete a successful transfer in and out of the sitting position. The therapist uses this information as part of the task analysis to compare how the patient is performing the task and to identify possible impairments that may be causing any functional limitations observed. Sit-to-stand is commonly broken down into two phases: preextension and extension;1 although, some authors have broken it down even further into three or four phases.2–5 The preextension phase involves a forward or horizontal translation of body mass as the trunk flexes and the center of gravity shifts over the feet. The extension phase involves a vertical translation of body mass as the knee, hip, and trunk extend into an upright standing position. The point in time when the thighs ...

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