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Chapter 10: Transfer Skills

Martha F. Somers; Laura A. Rice

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Chapter 10 presents transfer skills and therapeutic strategies for increasing independence in transfers.

INTRODUCTION

Transfers are crucial for independent mobility. A person who can transfer independently can get out of bed in the morning without waiting for assistance and can leave the wheelchair to sit on a couch, get into a car, or get onto the ground. Independent transfer skills also make it possible to get back into a wheelchair after a fall.

This chapter presents a variety of transfer techniquesa as well as suggestions on how to teach them. The descriptions of techniques and training should be used as a guide, not as a set of hard and fast rules. The exact motions used to perform any activity vary among people because of differences in body build, skill level, range of motion, muscle tone, patterns of strength and weakness, and presence or absence of additional impairments.1 During transfer training, the therapist and patient should work together to find the exact techniques that best suit that particular individual.

aThis chapter does not attempt to present all possible transfer techniques. An individual who is unable to master a transfer described in this chapter may fare better with a variation of that transfer or with an altogether different method.

PRECAUTIONS

Following spinal cord injuries, the activities involved in transfer training can cause problems if appropriate precautions are not taken. Transfer activities can result in excessive motion in unstable segments of the spine, skin damage, overstretching of the low back and long finger flexors, and injuries from falls. Over time, transfers may also cause overuse injuries in the upper extremities. Table 10-1 presents a summary of precautions for transfers and transfer training.

TABLE 10-1Precautions During Transfers and Transfer Training
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TABLE 10-1 Precautions During Transfers and Transfer Training
Potential Problems Transfer Activities That Place Patients at Risk Precautions
Excessive motion at site of vertebral instability, potentially causing additional neurological and orthopedic damage Any activity involving excessive motion or muscular action at or near site of unstable spine; example: upright activities while the spine remains unstable

  • Strictly adhere to orthopedic precautions.

  • Check fit of vertebral orthosis with patient in the different postures involved in transfer training.

  • When the spine is unstable, avoid activities that may cause motion or strong muscular contraction at site of instability.
Skin abrasions and pressure injuries Any activities creating shearing forces on the skin; example: sliding buttocks on transfer board or mat

  • When possible, instruct patient to lift buttocks instead of sliding.

  • Vary activities to avoid prolonged periods during which shearing forces are placed on skin.

  • Choose proper clothing for transfer training (pants rather than hospital gowns).
Any activities in which the patient's buttocks may forcefully contact the wheelchair; example: transfers between wheelchair and mat ...

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