1. WHEELCHAIR
AND
WHEELCHAIR TRANSFERRING
Acknowledge to
D. Michael McKeough, PT, EdD, Associate Professor, Division of Physical Therapy
Catherin A Trombly
elearnSCI
Shamima Akter
B. Sc (Honors) in Occupational Therapy
& M. Sc in Rehabilitation Science
Assistant Professor,
Department of Occupational Therapy
Bangladesh Health Professions Institute (BHPI)
Centre for the Rehabilitation of the Paralysed (CRP)
Chapain, Savar
2. WHEELCHAIR
A wheelchair is a device used for mobility by people
for whom walking is different or impossible due to
illness or disability.
It can be the primary means of mobility for someone
with a permanent or progressive disability such as
cerebral palsy, brain injury, spinal cord injury,
multiple sclerosis, or muscular dystrophy.
Someone with a short-term illness or orthopedic
problem may need it as a temporary means of
mobility.
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3. AN APPROPRIATE W/C FACILITATES
• easy transfers;
• greater mobility (propelling) with less energy;
• folding and handling the wheelchair;
• carrying out activities;
• moving around in the user's environment;
• proper fit and support;
• safety and better quality of life.
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4. BENEFIT
Mobility: Wheelchairs help people to get around with the
greatest possible
independence and do the things they want to do.
Health: A wheelchair can improve the user’s health in many
ways. A well fitting wheelchair with a cushion can reduce
common problems, such as pressure sores or poor posture. A
wheelchair that works well, fits well and can be propelled
easily can increase the physical activity of the user, thus
improving health.
Independence: Wheelchair users can be more independent and
more in control of their own life.
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5. Continue…
Self-esteem and confidence: Wheelchair users may
become more confident and have more self-
esteem when they have a wheelchair which fits
them and which they can use well.
Access to community life: With a wheelchair,
wheelchair users can be more involved in
community life. For example, it enables the user
to go to work or school; visit friends; attend
places of worship or other community activities.
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6. Frames
Wheels
Backrests
Armrest
Push ring
Push handle
Brakes
Anti-tip bar
Castor
Cushions
Seat
Calf strap
Foot plate
Hand grip
Rear wheel
Caster front
Caster fork
Back upholstery
Side pawl
Armrest Pad
Seat upholstery
Rigging
Leg-rest
Parts of wheelchair
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38. Transferring
• A transfer is the means by which a person
moves one’s body from one surface to an
adjacent surface.
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39. PRELIMINARY CONCEPT
• The therapist must be aware of the following
concepts when selecting and carrying out transfer
techniques to ensure safety for the client and self:
• The client’s status, especially his or her physical,
cognitive, perceptual, and behavioral abilities and
limitations
• His or her own physical abilities and limitations and
whether he or she can communicate clear, sequential
instructions to the client and caregiver
• The use of correct moving and lifting techniques.
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40. POINTS SHOULD BE CONSIDERED DURING
SAFW TRANSFER
• The method can be simple or complex depending
upon the performance skill level, upper and lower
extremity strength, physical endurance, trunk
balance, body type, orthotic devices, and/or
wheelchair style of the person performing the
transfers.
• This process includes the sequence of events that
must occur both before and after the move, such as
the pre-transfer sequence of bed mobility and the
post-transfer phase of wheelchair positioning.
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41. Continue…
• Occupational therapist must supervise a transfer
especially if the client has some physical and
cognitive limitation.
• Each transfer must be adapted for the particular
client and his or her needs.
• A graded training program for transfers is necessary
as patient progresses through the rehabilitation
process.
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42. Continue…
• The occupational therapy intervention should
include family training so that the family member
learns each step of transfer.
• Proper body mechanics should be taught and
practiced throughout any transfer to protect the
helper as well as the person being transferred.
• To prevent back injury, the helper should keep the
back and spine straight.
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43. GUIDELINES FOR USING PROPER MECHANICS DURING
TRANSFERRING
• The therapist should be aware of the following
principles of basic body mechanics:
• Get close to the client or move the client close to you
• Position your body to face the client
• Bend the knees; use your legs, not your back
• Keep a neutral spine (not a bent or arched back)
• Keep a wide base of support
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44. Continue…
• Don’t tackle more than you can handle; ask
for help
• Don’t combine movements. Avoid rotating at
the same time as bending forward or
backward
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45. VARIOUS LEVELS OF TRANSFERS
DEPENDENT TRANSFER
Person requires maximum assistance of one or more person
using a special technique or device to assist in moving from
one surface to another.
SLIDING BOARD TRANSFER
Person cannot bridge the gap between two surfaces with the
use of a sliding board.
STANDING PIVOT TRANSFER
Person can stand up, then pivot the feet and turn the trunk,
and then sit down on the transferring surface.
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47. PREPARING EQUIPMENT AND CLIENT FOR TRANSFER
• The transfer process includes setting up the
environment, positioning the wheelchair, and
helping the client into a pre-transfer position.
• The following is a general overview of these
steps:
– Place the wheelchair at approximately a 0- to 30-
degree angle to the surface to which the client is
transferring. The angle depends on the type of
transfer and the client’s level of assist.
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48. POSITIONING THE WHEELCHAIR
– Lock the brakes on the wheelchair and the bed
– Place both of the client’s feet firmly on the floor,
hip width apart, with knees over the feet
– Remove the wheelchair armrest closer to the bed
– Remove the wheelchair pelvic seat belt
– Remove the wheelchair chest belt and trunk or
lateral supports if present
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49. BED MOBILITY IN PREPARATION FOR TRANSFER
A. Rolling the client who has hemiplegia
– Before rolling the client, you may need to put your hand
under the client’s scapula on the weaker side and gently
mobilize it forward (into protraction) to prevent the client
from rolling onto the shoulder, potentially causing pain and
injury.
– Assist the client in clasping the strong hand around the
wrist of the weak arm, and lift the upper extremities
upward toward the ceiling
– Assist the client in flexing his or her knees
– You may assist the client to roll onto his or her side by
moving first arms toward the side, then the legs, and
finally by placing one of the therapist’s hands at the
scapular area and the other therapist’s hand at hip, guiding
the roll
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50. Continue…
B. Side-lying to sit up at the edge of the bed
– Bring the client’s feet off the edge of the bed
– Stabilize the client’s lower extremities with your
knees
– Shift the client’s body to an upright sitting position
– Place the client’s hands on the bed at the sides of
his or her body to help maintain balance
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51. Continue…
C. Scooting
• It is an important skill for moving to the edge of a
bed or seat and can be a useful movement pattern in
activity of daily living tasks such as donning pants in
a seated position.
• The patient should begin in symmetrical sitting
• The therapist can encourage scooting by first cueing
a lateral weight shift and
• Then advancing the non-weight-bearing buttock to
move anteriorly.
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53. Stand pivot transfer
• The standing pivot transfer requires the client to
be able to come to a standing position and pivot
on both feet.
• It is most commonly used with clients who have
hemiplegia, hemiparesis, or general loss of
strength or balance.
** Pivot- Stepping with one foot while keeping the other foot at its
point of contact with the floor.
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54. Method
• Facilitate the client’s scoot to the edge of the surface,
and put his or her flat on the floor.
The client’s heels should be pointed toward the
surface to which the client in transferring.
The feet should not be perpendicular to the transfer
surface, but the heel should be angled toward the
surface.
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55. Continue…
• Stand on the client’s affected side with your hands
on the client’s scapulae or around the client’s trunk,
waist, or hips.
Stabilize the client’s involved foot and knee with your
own foot and knee. Provide assistance by guiding the
client forward as the buttocks are lifted up from the
present surface and toward the transfer surface.
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56. Continue…
• The client may reach toward the surface to
which he or she is transferring or may push off
the surface from which he or she is
transferring.
• Guide the client toward the transfer surface,
and gently help him or her down to a sitting
position.
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57. Bent pivot transfer
• The bent pivot transfer is used when the client
cannot initiate or maintain a standing
position. The therapist often prefers to keep a
client in the bent knee position to maintain
equal weight bearing, provide optimal trunk
and lower extremity support, and perform a
safer and easier therapist-assisted transfer.
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58. Method
• Assist the client to scoot to the edge of the
bed until both of the client’s feet are flat on
the floor.
• Facilitate the client’s trunk into a midline
position
• Shift the weight forward from the buttocks
toward and over the client’s feet.
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59. Continue…
• Grasp the client around the waist, trunk, or
hips, or even under the buttocks, if a
moderate or maximal amount of assistance is
required.
• Have the client reach toward the surface he or
she is transferring to or push from the surface
he or she is transferring from
• Then lift the patient and Provide assistance by
guiding and pivoting the client around toward
the transfer surface
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60. – Pivot with the client and move him or her onto
the sliding board. Reposition yourself and the
client’s feet and repeat the pivot until the client is
firmly seated on the bed surface, perpendicular to
edge of the mattress and as far back as possible.
This step usually can be achieved in two or three
stages
– You can secure the client onto the bed by easing
him or her against the back of an elevated bed or
onto the mattress in a side-lying position, then by
lifting the legs onto the bed.
Continue…
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61. Two-person dependent transferring
• This dependent transfer is also designed for use with
the client who has minimal to no functional ability. If
this transfer is performed incorrectly, it is potentially
hazardous for therapist and client. A bent pivot
transfer is used to allow increased therapist
interaction and support. It provides the therapist
with greater control of the client’s trunk and
buttocks during the transfer.
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62. Method
• Set up the wheelchair and bed as described
previously
• One therapist assumes a position in front of the
client and other in back
• The therapist in front assists in walking the
client’s hip forward until the feet are flat on the
floor
• The same therapist stabilizes the client’s knees,
and feet by placing his or her knees and feet
lateral to each of the client’s knee
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63. Continue…
• The therapist in back positions himself or herself
squarely behind the client’s buttocks, grasping the
client’s waistband, grasping the sides of the client’s
pants, or placing his or her hands under the buttocks.
Maintain proper body mechanics.
• The therapist in front moves the client’s trunk into a
midline position, grasps the client around the back of the
shoulders, waist, or hips, and guides the client to lean
forward and shift his or her weight forward, over the feet
and off the buttocks. The client’s head and trunk should
lean in the direction opposite the transfer. The client’s
hands can rest on the lap.
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64. • As the therapist in front shifts the client’s weight
forward, the therapist in back shifts the client’s buttocks
in the direction of the transfer.
• This can be done in two or three steps, making sure the
client’s buttocks land on a safe, solid surface.
• The therapists reposition themselves and the client to
maintain safe and proper body mechanics.
• The therapists should be sure they coordinate the time of
the transfer with the client and one another by counting
to three aloud and instructing the team to initiate the
transfer on three
Continue…
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65. Sliding board transfers
• Sliding board transfers are best used with
those who cannot bear weight on the lower
extremities and who have paralysis, weakness,
or poor endurance in their upper extremities.
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66. Method
• Position and set up the wheelchair as previously
outlined
• Lift the leg closer to the transfer surface and the
place the board under this leg, at midthigh between
the buttocks the knee, angled toward the opposite
hip. The board must be firmly under the thigh and
firmly on the surface to which the client is
transferring.
• Block the client’s knees with your own knees.
• Instruct the client to place one hand toward the edge
of the board and other hand on the wheelchair seat.
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67. Continue…
• Instruct the client to lean forward and slightly
away from the transferring surface.
• The client should transfer his or her upper body
weight in the direction opposite to which he or
she is going. The client should use both arms to
lift or side the buttocks along the board.
• Assist the client where needed to shift weight
and support the trunk while moving to the
intended surface
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68. One person dependent sliding transferring
• The dependent transfer is designed for use
with the client who has minimal to no
functional ability. If this transfer is performed
incorrectly, it is potentially hazardous for
therapist and client.
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69. Method
The procedure for transferring the client from
wheelchair to bed is as follows:
– Set up the wheelchair and bed as described previously
– Position the client’s feet together on the floor, directly
under the knees, and swing the outside footrest away.
Grasp the client’s legs from behind the knees, and pull
the client slightly forward in the wheelchair, so the
buttocks will clear the large wheel when the transfer
is made.
– Place a sliding board under the client’s inside thigh,
midway between the buttocks and the knee, to form a
bridge from the bed to the wheelchair. The sliding
board is angled toward the client’s opposite hip
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70. Continue…
– Stabilize the client’s feet by placing your feet
laterally around the client’s feet
– Stabilize the client’s knees by placing your own
knees firmly against the anterolateral aspect of
the client’s knees
– Facilitate the client’s lean over the knees by
guiding him or her forward from the shoulders.
The client’s head and trunk should lean opposite
the direction of the transfer. The client’s hands
can rest on lap.
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71. – Reach under the client’s lean over the knees by guiding
him or her forward from the shoulders. The client’s head
and trunk should lean opposite the direction of transfer.
The client’s hands can rest on the lap.
– After your arms are positioned correctly, lock them to
stabilize the client’s trunk. Keep your knees slightly bent
and brace them firmly against the client’s knees.
– Gently rock with the client to gain some momentum, and
prepare to move after the count of three. Count to three
aloud with the client. On three, holding your knees,
transfer the client’s weight over his or her feet. You must
keep your back straight and your knees bent to maintain
good body mechanics.
Continue…
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73. Transferring is an important skill for people
with SCI and many different strategies are
used.
• A horizontal transfer from the wheelchair to
bed for people with paraplegia and C6
tetraplegia commonly involves important key
sub-tasks:
– Positioning the wheelchair and moving to the front edge.
– Positioning the feet.
– Positioning the hands.
– Lifting and shifting across the bed.
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74. • (i) Moving to the front edge of the wheelchair
is important to avoid skin damage caused by
friction between the buttocks and the wheel.
People with paraplegia and C6 tetraplegia use
different strategies to move forward.
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75. • (ii) Positioning the feet ‘legs down’ or ‘legs up’
is important in preparation to transfer. People
with paraplegia typically transfer with the
‘legs down’. People with tetraplegia can
transfer with ‘legs up’ or ‘legs down’.
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76. • (iii) Positioning the hands on the bed and
wheelchair is also important in preparation to
transfer. Off setting the hands when
transferring can add to stability.
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77. • (iv) Lifting and shifting the body across to the
bed. This can be done in long sitting or short
sitting.
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78. Independent transferring for tetraplegic patient
• Step 1
Moving to the front edge of the wheelchair.
• Step 2
Lifting the first leg onto the bed.
• Step 3
Lifting the second leg onto the bed.
• Step 4
Positioning the hands.
• Step 5
Lifting and shifting the body onto the bed.
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80. Independent transferring for paraplegic patient
• Step 1
Moving to the front edge of the wheelchair
• Step 2
Positioning the feet on the floor.
• Step 3
Positioning the hands
• Step 4
Lifting and shifting the body onto the bed
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82. • Position the legs.
• Position the hands with the lead hand forward
and away from trunk and the trail hand close
to the hip.
• Lift and rotate the body.
• Position the buttocks on the wheelchair.
• Move into an upright position.
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83. Referenes
• elearnSCI
• Radomski, M. V., & Latham, C. A. T. (Eds.).
(2008). Occupational therapy for physical
dysfunction. Lippincott Williams & Wilkins.
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