There are many types of transfer a clinician can guide a patient to perform. As physical therapists, we come across different kind of people with different limitation and abilities. While providing a PT treatment or assessing the patient, our goal (along with patients and families) is to make our patients independent in the majority of functional tasks. Being independent makes patients stronger, gives them chance to work on their own, and reduces stress on caregivers or family members. Being able to go from one place to other independently is a major achievement! Before moving from place to place, a person needs to go from surface to surface. Moving from one to other surface is called transfer. It takes a fine clinical judgment of a therapist to determine what type of transfer a patient will be able to perform. So let’s talk about few different types of transfer that we teach our patients.
Slide Board transfer :
This is my personal favorite. It is very common when a person has weight bearing restrictions or unable to stand up. Or if you are working with the neurological population like I do. You can teach this transfer to your hemiplegic patients or paraplegic patients. As this transfers put shearing force on buttock/hip area while sliding, skin checks of that area are recommended frequently.
Non-weight bearing state, paraplegia, stroke, other medical conditions with weakness in BLE but stronger BUE (at least 4/ 5 in manual muscle testing). Able to follow simple commands and has good carry over. A person needs to be able to sit unsupported and should have a good dynamic sitting balance to be able to perform this transfer safely.
Skin checks daily are recommended. If a person has a history of malnourishment less than ideal body weight, history of wound or skin breakdown, or presence of a wound (mainly in buttock areas), I will not recommend this kind of transfer.
Scoot types of transfer:
This is when a person has good upper body strength, but unable to stand up (due to physical inability or medical condition). A person scoots, in other words, lifts his hips off of the bed/chair several times in order to get to another surface. A person may have the ability to move the legs throughout the transfer or a caregiver needs to help move the legs during this transfer. I have also given a leg lifter to my patients to help move the legs during the transfer.
Clinically, the only difference of this type of transfer than slide board is a person is actually able to lift his/her hips off of the surface. So stronger BUE and good sitting balance is a must. A person needs to have good cognition, ability to follow the verbal and visual cues, and able to reproduce the same movement (needs to have good a carry over).
Good dynamic sitting balance is a key for this transfer. When a person is unable to stand or weight bear through the feet but has strong BUE, than I will practice this kind of transfer with him/her.
Pivot types of transfer: can sit and pivot or stand and pivot transfer
This is when a person is able to sit or stand, shifts pelvis area (pivots from pelvis area) and sits again on the different surface. This kind of transfers are good with a person who is not ready to weight shifts, has poor balance, unable to walk or take steps etc. Sometimes, a PT will use this type as an initiation of a functional task. This is a safer option for regular transfer as a patient is not actually taking any steps.
A person with the ability to turn or weight shifts safely can perform this kind. A person needs to have a good vision, good cognition, ability to perform complex tasks, good strength on BUE and BLE and good sitting or standing balance.
Impulsivity or anxiety can cause falls with this one.
Stand, turn and transfer
This is a regular type, can be with or without an assistive device. This depends on patient’s needs and functional abilities.
A patient with impulsivity or anxiety may need supervision while performing this kind of transfer.
Few other types of transfers are Hoyer transfer, sit-to-stand lift, standing frame etc. Hoyer transfer is when a person is moved from one surface to another surface via a mechanical lift. A person does not perform any work during this transfer. It is completely dependent transfer. Use a sit-to-stand lift when a person has an ability to weight bear, but unable to move BUE and or BLE safely.
Muscle work for transfers differs depending on surfaces involved. Some surfaces are higher compared to others, some surfaces are adjustable. This makes a huge impact on patient’s ability as the amount of muscle work, type of muscle contractions, and muscle groups are different with the different surface.
For example, to perform a functional transfer from a low surface, the patient needs to have strong hip extensors, abductors, knee flexors, ankle plantar flexors, back extensors, trunk flexors and trunk rotators. A PT can prescribe some exercises that concentrate on these muscles. Examples of these exercises include squats, sit to stand, wall slides etc.
I did not talk about how to actually perform the transfers, as It is difficult to explain the hand and foot position with words. As always, feel free to comment below.
Bye bye till next time.