- 1 - Mrs. Jones: (Tucks chin in on chest.) Like this? Does that help?

Transcription

1 - 1 - Transfer and Lift Scenarios The following sections provide specific examples of various transfer and lift methods. These examples are intended to be a reference only. Remember that each client s needs must be assessed individually, taking into consideration the diagnosis and degree of impairment. Use the transfer examples as a guide for your thought process rather than as a recipe to be followed. Transfer Generalized Weakness Bed Mobility Lift to the side of the bed Scene: Acute-care hospital room. Buzzer is ringing in the background. Curtain is drawn between the two hospital beds. Client lies with right side of body closest to the curtain and on the far right side of bed (almost touching the bed rail that is up). Therapist enters the room and shuts off the bell. Yes, Mrs. Jones. What can I do for you? Mrs. Jones: I feel like I am getting squished up against this bar here (points to the railing). I need some help to move over. Could you help me? Okay, but I need you to do a little work here. Can you cross your arms over your stomach? (Mrs. Jones crosses arms over her abdomen.) Good. Now can you tuck your chin into your chest so that I can get my arm under your shoulders? Mrs. Jones: (Tucks chin in on chest.) Like this? Does that help? Very much so. Let me put one knee up on the bed because you have got yourself far over on the side of the bed. Now I am putting my arm under your shoulders and under your waist so that I can pull your upper body over to the left side of the bed. On the count of three, we are going to move towards me move. (OT shifts weight from front knee to back leg on the ground and moves Mrs. Jones s trunk to the left side of the bed.) Remember to maintain proper body mechanics. Keep knees bent and back straight. Mrs. Jones: Can you move my legs also? I was just going over to help move them. They are not so far over on the bed, so this time I will keep both of my legs on the floor (wide stance with one leg farther back.). This time I will put my arms under your hips and under your legs. Again we will move on three

2 - 2 - move. (Therapist shifts weight from forward leg onto back leg, moving Mrs. Jones s lower body closer to the therapist s body.) Mrs. Jones: That is much better. Thank you very much. Not a problem, Mrs. Jones. Lift up the bed from a supine position Scene: A small-framed client appears to have slid down towards the foot of the hospital bed. Therapist enters the room to assist the client to the head of the bed. Ms. Smith: Hello, Ms. Smith, I am Stacy, your occupational therapist. It appears that you have slid down the bed a little. Would you like me to help you get more comfortable? That would be wonderful. I am going to put this pillow at the head of your bed. What I need you to do, Ms. Smith, is fold your arms over your stomach and tuck your chin towards your chest. Also, could you please bend your knees so that you can help push with your feet when I say move? To protect the client s head, use a pillow. Ms. Smith: Ms. Smith: How is this? And you want me to push on move? That is great. Let me just get in a good position here. (Therapist faces the direction in which the client is to be moved, one knee on the bed or in a wide stance.) I am going to place my hand under your shoulder and just under your thigh here. We will do this on the count of move. We will do this in little movements so you don t hit your head and to protect my back. Are you ready, Ms. Smith? Yes, I am ready. (Therapist places weight on back leg, closest to the thigh.) Okay, move. (Therapist transfers weight from back leg to front leg as client pushes with feet.) Ms. Smith, we are going to do this again move. (Therapist transfers weight while client moves and continues these steps until client looks comfortable.) Remember to maintain proper body mechanics. Keep knees bent and back straight. Face the direction in which you want the client to move, and shift your weight in that direction.

3 - 3 - Ms. Smith: That feels a lot better. Could you please adjust my pillow for me? (Therapist adjusts pillow.) Now I am comfortable. Thank you very much, Stacy. Lift up the bed from a sitting position Scene: Client is sitting up in a hospital bed, ringing the bell. The head of the bed is rolled up. Therapist enters room and shuts off the bell. Good afternoon, Mrs. Pyper. My name is Leanne, and I am your occupational therapist. Is there something I can help you with? Mrs. Pyper: I would like to lie down for a rest until supper. Do you think that you can roll down the head of the bed so that I can have a sleep? I can do that, but I also think that I will have to help you up towards the head of the bed once I lower the head of the bed. I d like you to stay in a sitting position until we can move you up the bed a bit. Does that sound okay? Mrs. Pyper: That would be fine, Leanne. Anything to get me lying down. (Therapist goes to the foot of the bed, cranks down the head of the bed, and proceeds to stand beside client.) Mrs. Pyper, I will need a little bit of assistance from you for this. I would like you to cross your arms over your abdomen, tuck your chin in towards your chest, and also bend your knees. I am going to come around behind you so that I can get into a good position to help move you. (Therapist places one knee on the bed behind the client s back and approximately a foot away from client s body. Her other leg remains on the ground, close to the bed.) Now Mrs. Pyper, I am going to reach from behind you, under your armpits, and grab onto your arms. (Therapist grabs opposite bare forearm.) We are going to rock back and forth. I will count move. On 3, I would like you to rock forward. On move, I would like you to push back with your legs. Do you understand, Mrs. Pyper? When assisting a client from behind, slide your arm under his or her armpits. If a transfer belt is used, wrap your arms across the client s chest and securely grip the transfer belt. Otherwise, cross your arms across the client s chest and grasp the opposite bare forearm. Mrs. Pyper: Yes, I understand. (Therapist places her body weight on her leg on the ground.) Okay, Mrs. Pyper, let s lean forward and move. (Therapist leans forward and then backwards and upwards while shifting her body weight to the knee on the bed. Repeats if necessary.) There you go, Mrs. Pyper. We have got you moved up to the head of the bed. Are you able to lie down on your own?

4 - 4 - While helping the client move back, pull the client in as if you are giving her or him a hug. Mrs. Pyper: Yes, I am able to do that. Thank you very much, Leanne. Have a good rest, Mrs. Pyper. Supine lying to sitting on edge of bed Scene: Client is lying on a bed in a supine position. Therapist enters the room. Mr. Dunn: Mr. Dunn: Mr. Dunn: Mr. Dunn: Good morning, Mr. Dunn. My name is Susan, and I am here to help you out of bed this morning. How are you feeling today? I am feeling a little tired today, I don t think that I am able to get out of bed today. What if I help you from lying to sitting, and then we can see how you feel? I guess I could try, but you will need to help me. I assist you, but you need to help me a little bit also. First, could you fold your arms over your abdomen and then tuck your chin in? What I am going to do is get close to the bed and put my one knee (therapist s left knee) on the bed. I will just place my one hand under your shoulder (at the scapula) and my other hand under your leg (around knee or thigh area). Mr. Dunn, I am going to count move, and then I am going to get you sitting up in one movement. Are you ready, Mr. Dunn? I am ready. (Therapist has weight on left knee.) Here we go move. (Therapist transfers weight to right leg on the ground while pulling client s upper body to sitting, and pulls client s legs off the bed.) There we go, Mr. Dunn. You are now sitting up. How do you feel now that you are sitting up? I am feeling better. Thanks for asking and for the help. You re welcome. One-Person Standing Transfer Client Can Bear Weight Bed to wheelchair Scene: Continued from supine lying to sitting on edge of bed. Therapist is already at client s bedside with client sitting. Mr. Dunn, how about we get you into your wheelchair now so you don t have to just sit on the edge of the bed?

5 - 5 - Mr. Dunn: Mr. Dunn: That would probably be better, considering I am still feeling a bit weak. First of all, we should put this transfer belt around your waist so I have something to hold on to while you move to the wheelchair. Are you comfortable sitting here for a moment while I get your wheelchair ready? I should be okay for a few minutes. (Therapist positions wheelchair, removes footrests, and places them out of the way. Then she places the wheelchair on a angle to the bed, castors forward, and applies brakes.) Okay, Mr. Dunn, I have your wheelchair all ready. Now I need you to shuffle forward so that your feet are flat on the floor. (Client scoots bum forward.) Good. Now I would like you to lean forward so that your nose is over your toes. I am just going to put my feet on either side of your feet. I will also bend my knees a little so that I can brace your knees. I am going to grab on to the transfer belt, and I would like you to push up with your arms or put them around my shoulders. I will be counting stand, and then you will stand up. I will then say turn, and we will turn towards the wheelchair. Please tell me when you feel the back of your knees touching the wheelchair, and then I will say sit, and then you will sit down. Do you think that you can do all of that, Mr. Dunn? When client is transferring from the bed to the wheelchair, the wheelchair should be on the client s non-affected side. Ensure wheelchair is at a angle, castors forward, brakes on, and footrest closest to the bed out of the way. Asking the client to lean forward will make it easier to stand. Remember: Nose over toes. Mr. Dunn: So it is stand, turn, and then sit when I feel my knees touching the wheelchair? Yes, that is correct. Are you ready? (Client nods his head.) Okay, stand. (Therapist lifts on belt and straightens knees while client stands.) turn. (Therapist braces knees while client pivots towards wheelchair until client s back is towards wheelchair with knees touching.) Can you feel the wheelchair, Mr. Dunn? To help prevent the client from falling, support the client s weak leg with your leg. Place your foot on the outside and your knee inside the client s leg. Remember to maintain proper body mechanics. Keep your knees bent and back straight.

6 - 6 - Mr. Dunn: Mr. Dunn: Yes I do, Susan. Can I sit down now? First reach back for the armrests. Now we will sit down sit. (Therapist bends knees while client sits down slowly into wheelchair. She takes off the brakes and replaces the footrests.) Here, I will take the transfer belt off also. There you go, Mr. Dunn. Thank you, Susan. Wheelchair to bed Scene: Mr. Dunn has returned from therapy and would like to return to bed. Susan, the OT, is there to help Mr. Dunn transfer from his wheelchair to the bed. Mr. Dunn: Hi, Mr. Dunn. How was physiotherapy? It was good, Susan, but I am feeling really tired. Could you help me back to bed? I think I could do that. First of all, let s get the transfer belt on and then we will get the wheelchair in a good position by your bed. (Therapist puts belt on Mr. Dunn, removes footrests from wheelchair, positions wheelchair at angle to bed, places castors forward, and applies brakes.) Now, Mr. Dunn, we are going to do this like we did to get you into your wheelchair from your bed. I need you to shuffle your bottom forward so that your nose is over your toes. When a client is transferring from the wheelchair to the bed, the bed should be on the client s non-affected side. Ensure the wheelchair is at 20 30, castors forward, brakes on, and footrest closest to the bed out of the way. Asking the client to lean forward will make it easier for her or him to stand. Remember: Nose over toes. Mr. Dunn: I am feeling a little exhausted. Can you help me move forward, Susan? Of course I can, Mr. Dunn. (Therapist helps client move bum forward by reaching behind his back around the hip/thigh area. She brings one side forward at a time until client s feet are on the floor.) There you go, now your feet are on the floor. I will get into position with my feet on each side of your feet. (Therapist braces client s knees with her knees while also bending her knees for proper body mechanics.) I am going to go under your arms and reach for the transfer belt, Mr. Dunn. Do you remember how we did this transfer this morning? To help prevent the client from falling, support his or her weak leg with your leg. Place your foot on the outside and your knee inside the client s

7 - 7 - leg. Remember to maintain proper body mechanics. Keep knees bent and back straight. Mr. Dunn: Mr. Dunn: Mr. Dunn: Mr. Dunn: Yes, you said stand, then turn, and then sit when I felt the bed behind my knees. You remembered it perfectly, Mr. Dunn. You can either push up with your arms or put them around my shoulders. (Mr. Dunn grabs around therapist s neck.) Actually, Mr. Dunn, can you please put your arms around my shoulders and not my neck? (Mr. Dunn moves his arms.) Thank you. Ready? Yes, I am ready stand. (Therapist lifts with belt and bent knees.) turn. (Therapist and client turn towards bed by pivoting until client s back is towards bed.) I can feel the bed with my knees. Thanks, Mr. Dunn. You can reach back for the bed. Now sit. (Therapist bends knees and slowly lowers client.) Do you need help to get your legs up on the bed? (Client nods yes.) I will just put my knee up on your bed and reach under your shoulder and under your thighs here. I am going to do this in one movement. (Therapist grasps with one arm under the client s shoulder and with the other arm under his thigh. In one motion she swings the client s legs around and up onto the bed while lowering the client s shoulders.) Thanks, Susan. I will just remove the transfer belt and pull up the blanket. Have a good rest.

8 - 8 - Transfer One-Sided Involvement Bed Mobility Rolling from supine to side, lying towards non-affected side Scene: A client with right-side hemiplegia is lying in a hospital bed. Therapist enters the client s room to teach the client how to transfer. Kyla: Kyla: Kyla: Kyla: Kyla: Hello, Kyla, I am Joan, the occupational therapist here on the unit. How are you today? I am fine. How about you? I am good also, thanks for asking. Kyla, I would like to spend some time with you working on your bed mobility. I would like to teach you how to roll over from your back to your non-affected side. Once you can roll in bed, you ll be able to move around and reposition yourself. Do you think we can work on that? That sounds okay. I am going to need to know how to do that at some point if I want to be independent. That is the right attitude. I will be here to help support you, but I will be getting you to do all the work. First of all, I would like you to place your affected arm across your chest so it will come with you when you roll over. (Kyla moves her arm across her chest.) Now I want you to bend your non-affected knee and hip. With that foot, I would like you to hook your other leg so you can bring it with you. (Kyla does what the therapist asks her to do.) Like this? That is perfect. At this point you are almost ready to roll over. What you do next is grasp the mattress with your non-affected hand so you can pull yourself over with that side. At the same time you are going to push with your non-affected foot and pull with your arm until you roll over to your non-affected side. Do you think you could try that? I will try, but are you going to be close by just in case? I will stay nice and close to your bed and support you when necessary. Ready? Give it a try. (Kyla pulls with her hand and pushes with her foot on the mattress with her non-affected side. She successfully rolls over.) I did it! Great job! Now we will work on rolling onto the other side. Rolling from supine to side, lying towards affected side Scene: Same as rolling to non-affected side. Joan, the OT, is teaching Kyla, the rehabilitation client. Kyla is lying supine on a hospital bed.

9 - 9 - Kyla: Kyla: Kyla: Kyla: Kyla: Kyla: Kyla: Okay Kyla, now you are going to learn how to roll over to your affected side. It is a little bit different, but I am sure that you will do fine. Once again, I will be here, but you are going to do the work. Are you ready to learn this one? I sure am. Hopefully, it will be the same as the other side. Actually, Kyla, it will be a little different because you don t have much sensation on that affected side. It may be a little bit scarier because you may not be aware of the position of your body. I will stay close by to make sure you are safe. Okay. For this transfer, you are going to bend your non-affected hip and knee to use it as momentum to roll over. You can place your affected arm at the side of your body, and you will be rolling on it. (Kyla bends her hip and knee and places her affected arm at her side.) Did I do this right? That looks good. Okay, now you are going to cross your body with your non-affected arm and grab the mattress. Use your non-affected leg by pushing against the mattress and pull yourself over with your arm until you are lying on your side. So I pull with my hand and push with my foot. Here I go. (Kyla does what was instructed of her and rolls over successfully.) This does feel weird, but I got over. Can I roll over onto my back now? Yes you can. How do you feel? A little tired, but okay. Do you feel like trying one more thing today? One more thing? What is that? How about rolling over and sitting up on your own? Sitting up? Okay, I ll give it a try. Coming to a sitting position Scene: Kyla, the client, is learning how to roll over and sit up from her hospital bed. Joan, the OT, is at the bedside. Kyla: Kyla, remember how I taught you to roll over to your non-affected side? Yes I do. (Kyla does the actions while saying them.) First I bring my affected arm over, bend my hip and knee, and hook my affected leg. I grab the mattress with my non-affected arm and pull while I push with my leg. Then I roll over, like this!

10 Kyla: Kyla: Good job! Now I am going to teach you how to sit up. Bring your nonaffected arm close to your trunk and push up with your elbow. (Kyla follows the instructions.) Your foot is already hooked, so now flex your hip and bring your legs towards the edge of the bed. To the edge of the bed? Yes, the weight of your legs is going to help you to sit up. Start crawling with your non-affected arm until all the weight is on your hand. Keep on walking with your hand until you are sitting. (Kyla moves her non-affected arm and both legs at the same time until she is sitting upright.) I am sitting up! Look at me; I am sitting up on my own! Yes you are! Way to go! That is probably enough for today, but we can practise it more tomorrow. Good job today! Wheelchair to Bed / Chair / Toilet Transfers Independent transfer (wheelchair from bed and back) Scene: Client is sitting on the edge of the bed. Hello, Mrs. Watts. How are you today? (Therapist moves wheelchair to client s non-affected side, positions wheelchair at angle to the bed, swings footrest closest to the bed out of the way, places castors forward, and applies brakes.) When the client is transferring from the bed to the wheelchair, the wheelchair should be on the client s non-affected side. Ensure the wheelchair is at 20 30, castors forward, brakes on, and footrest closest to the bed out of the way. Mrs. Watts: I am okay. Are you the occupational therapist who is going to teach me how to get into my wheelchair? Yes. My name is Jack, and I am going to teach you how to get in and out of your wheelchair independently. The most important thing with this transfer is to move towards your non-affected side. Let s put a transfer belt on for safety, and I can show you how to do this. Mrs. Watts: Okay. I need you to put both of your feet on the floor, with your non-affected foot slightly back. (Client does as instructed.) Now lean forward with your nose over your toes and push up with your hand until standing. (Client continues to do as instructed. Therapist has hand on transfer belt only for supervision, standing on affected side.)

11 Asking the client to lean forward will make it easier for her or him to stand. Remember: Nose over toes. Mrs. Watts: What do I do now that I am standing? Do you have good balance? Mrs. Watts: Yes. Can I move into the wheelchair now? Just about. I would like you reach over for the armrest farthest away from your body. (Client reaches for armrest.) Now you can pivot on your non-affected leg and turn. Mrs. Watts: (Client pivots until the backs of her knees touch the wheelchair.) Like this? I can feel the wheelchair touching the back of my knees. That is perfect. Now you can slowly lower yourself into the wheelchair. (Client lowers into her wheelchair, takes the brakes off, swings the footrest in place, and places her leg on the footplate.) Mrs. Watts, do you think we could try that one more time, but this time you will go from the wheelchair to your bed? Mrs. Watts: I guess we could try that. Do we do it from here? Actually, Mrs. Watts, we have to turn your wheelchair to the other side of your bed. Do you remember me saying that you need to have your stronger side closest to the direction you want to move? When a client is transferring from the wheelchair to the bed, the bed should be on the client s non-affected side. Mrs. Watts: Oh yes, I remember now. (Client positions her wheelchair on the other side of the bed, moves the footrest closest to the bed out of the way, makes sure that the castors are forward, and applies the brakes.) Ensure the wheelchair is at 20 30, castors forward, brakes on, and footrest closest to the bed out of the way. Good. We already have the transfer belt on, so I will just stand on your affected side just in case. This transfer is the same as the last one. First you will get both feet on the floor with your stronger foot slightly back. Then you will lean forward and push up with your hand on the armrest. Once you are standing, make sure you have your balance. Then you can turn towards your bed and let me know when you feel the bed behind your knees. Mrs. Watts: (Client does as instructed.) I can feel the bed. Now I reach down and sit?

12 That is correct. (Client reaches for bed and sits down slowly.) Good job. Now you know how to transfer independently. Let me take that transfer belt off you. Assisted transfer Scene: Therapist and client (in a wheelchair) enter the room. Therapist wheels client to the bed (non-affected side closest to the bed). Jack: Jack, I am going to help you get back into bed now. Does that sound okay? That would be nice. Let me just put this belt around you, and then we will get the wheelchair into the proper position. (Both footrests are out of the way, wheelchair is at a angle, castors forward, and brakes on.) Jack, do you think that you can shuffle forward a little bit so that both of your feet are on the floor? When a client is transferring from the bed to the wheelchair, the wheelchair should be on the client s non-affected side. Ensure the wheelchair is at 20 30, castors forward, brakes on, and both footrests out of the way. Jack: (Client brings bum forward and has both feet on the ground.) Is this better? Much better. Now, I am going to cradle your one arm while I hold on to the transfer belt. I am also going to brace your weaker leg with my leg by putting my foot on the outside and my knee on the inside of your leg. How does that feel? Cradle the affected arm. To help prevent the client from falling, support the weak leg with your leg. Place your foot on the outside and your knee inside the client s leg. Jack: I don t think my leg is going anywhere. What do you want me to do with my other hand? You can either push up from your armrest or place it on my shoulder. (Client places hand on shoulder.) I would like you to lean forward, and I will count stand. You will then stand, turn towards the bed, and sit down once you feel the bed behind your knees. Do you understand, Jack?

13 Securely grip the back of the transfer belt with both hands. Asking the client to lean forward will make it easier for him or her to stand. Remember: Nose over toes. Jack: Yes. Okay, stand. (Therapist has knees bent, lifts upwards on transfer belt, and client stands.) Let s turn. (Therapist brings affected leg while turning.) Can you feel the bed with the back of your leg? While counting, rock the client back and forth to help build momentum. Ensure proper posturing when lifting or seating the client. Keep back straight and knees bent. Jack: Jack: (Nods.) I can feel the bed. Now you can reach back for the bed with your unaffected hand, and then I will lower you slowly until you are sitting on the bed. (Therapist does as stated while continuing to support arm and leg. She also continues to bend knees while lowering.) There we are, Jack. Thank you. You re welcome. Wheelchair to Tub to Wheelchair Assisted transfer Scene: Client is sitting in a wheelchair waiting in the bathroom. Therapist and caregiver enter the room to assist client. Good morning, Mrs. Kendrick. My name is Cheryl, and I am an occupational therapist. I m here to help teach your caregiver how to help you in and out of the tub safely on your bath days. First thing I would like to do is put this transfer belt on you while I teach her this. Mrs. Kendrick: Okay. (Talking to the caregiver) It is important not to have any water in the tub until she is sitting on the bath seat and to have the wheelchair positioned with her stronger side closest to the tub. I am just going to move you, Mrs. Kendrick, so that we can practise this. (Therapist positions wheelchair close to the tub, castors forward, footrests off, brakes on, and armrest closest to the tub off.) Of course, you will

14 have less clothing on for your bath, but we will practise with you dressed today. Position the wheelchair close to the tub. Ensure the castors are forward, footrest off, brakes on, and armrest closest to the tub off. Mrs. Kendrick: That will be okay. (Talking to the caregiver) Now that she is in the right position, I will put both of her feet in the tub. (Therapist moves client s feet and then goes behind client.) The best place to stand is behind her with one foot in the bathtub and one out. Get nice and close to her back and hold on to the transfer belt. Mrs. Kendrick, I am going to count move, and then you will move towards the edge of your wheelchair and then grab on to the wall bar. Once there, I will count move, and I would like you to put some weight on your nonaffected leg and hold on to the wall bar. I am going to help you transfer over and onto the bath seat. Let s give it a try move. (Client moves to edge of wheelchair and repositions her body.) move. (Client transfers over to the bath seat.) When assisting a client from behind, ensure the transfer belt is securely gripped with both hands by sliding your hands under the client s armpit and wrapping your arms across the client s chest. Ensure proper posturing when lifting or seating client. Keep back straight and knees bent. Mrs. Kendrick: That was not so bad. I think we could do that on my bath day. That is good to hear. Now we will get you out of the tub. Once again, we will get your legs out first and then transfer back onto your wheelchair. (Therapist moves client s legs out.) Mrs. Kendrick, I want you to put weight on your non-affected leg again when I say move. (Therapist positions herself behind client with one leg still in the tub and holds on to the transfer belt.) move. (Therapist and client move to edge of bath seat and then back into wheelchair. Reposition if necessary.) Do either of you have any questions? Mrs. Kendrick: (Looks at caregiver; caregiver signals no questions.) I don t think so, Cheryl. Okay, now let s try it again, but the two of you will do the transfer together and I ll just watch to make sure it goes smoothly. (end of sequence)

15 Independent transfer Scene: In a bathroom with grab bars on the wall and a bath seat in the tub, a male client in shorts will be independently transferring under the supervision of an occupational therapist. The client, in a wheelchair, and the therapist enter the room together. Mark: Okay Mark, today I am going to teach you how to independently get in and out of the bathtub. We have set up the bathroom to look like the one you have at home. I ve set up some safety equipment that I think will make it easier and safer for you. Let s try it out, and then we can decide what equipment we should order for you for when you go home. Should we have water in the bathtub already? It is best not to have water running until after you have transferred onto the seat, and you should drain the water before you transfer out. I am going to put this transfer belt on you while we practise this transfer, but I think you will be able to do this independently. The easiest way to do this is if you position your wheelchair with your unaffected side closest to the tub. Do not run bath water until client is in the tub. Mark: (Client positions his wheelchair on a angle, castors forward, footrest closest to tub swung out of the way, brakes on.) Now what? Ensure the wheelchair is 20 30, castors forward, footrest closest to the tub out of the way, and brakes on. Mark: Mark: What you are going to do is stand up, turn until you feel the bath seat behind your knees, reach back for the seat, and sit down. Once you are sitting, you can slide your bottom back on the seat as far as you can, so you can bring your legs into the bathtub. Bring your unaffected leg in first and then your other leg. You might have to use your hand to assist that leg over the side of the tub. I will stand close by to assist you if necessary. Okay. (Client does as instructed.) When would I have undressed? That is a good question. Try to get undressed while sitting in your wheelchair as much as possible, before you transfer into the tub. To transfer out of the tub, you will be leading with your affected side first. Turn, feel the wheelchair behind your knees, and then sit down. Let s see you try that. (Client does as instructed.) Here I am back in my wheelchair. Thanks for showing me that. I think I would need a bath seat like that and a wall bar on the back wall.

16 Yes, I think that worked well for you. Wheelchair to Car Scene: Outside. A client in a wheelchair and a therapist are waiting by a car. Now that the car is here, let s help you get into it and out of the cold. What you are going to do is position the wheelchair with your unaffected side as close to the car as possible. (Client positions wheelchair and puts brakes on.) Next, you are going to stand up, pivot so your back is towards the car seat, hold on to a non-moveable part with your strong hand, and then you can sit down. Ensure the brakes are on. The client should position the wheelchair so her or his unaffected side is closest to the car. Client: Okay. (Client stands, pivots, reaches for a car part, and sits down slowly.) Good job. All you have to do now is bring your legs in, and then you are on your way. (Client moves legs, and therapist closes the door.)

17 Transfer Bilateral Lower Limb Involvement Bed Mobility: Lying to Sitting Position (with abdominal muscles) Scene: Client is lying supine on gym mat in rehab unit. Therapist is sitting on the mat. June: June: June: June: June: Good morning, June. I am Sarah, your occupational therapist. Today we re going to practise going from lying to a sitting position. Your arms are quite strong, so we are going to take advantage of this. Do you have any questions? Am I going to have to flip over on my stomach and all that stuff like some of the other clients? Because you have use of your arms and not your abdominal muscles, you will not have to do all of that. How about we get started and I can show you how to do it? Okay. I would like you to place both arms on one side of your body. Let s go to your left side so we can get onto your right arm first. (Client does as instructed. Therapist moves to client s head to assist with head/shoulder movements.) Now I would like you to flex your head and shoulders from the right side towards your left side. This will allow us some momentum to get you up on your right elbow. Give it a try. (Client flexes head and shoulder while therapist directs the movements.) Like that? Perfect, June. Now when you go up this time, bring your right arm down and land on your elbow. Let s go on move. Ready? (Client nods.) move. (Client flexes body and positions her right arm.) Now get onto your left elbow. (Client balances on both elbows.) What do I do now? Balance on your left elbow and extend your right arm until you are on your hand. Then do this on the other side. (Client does as instructed.) Should I move my hands towards my body? Exactly. Crawl both hands up until you come to a sitting position. (Client moves to sitting.) Good job! Transfer to/from Wheelchair Transfer to bed (side method) both directions Scene: Client is waiting by the bed. Occupational therapist enters the room.

18 Good afternoon, Marcy, I am Anne, your occupational therapist. I have come here today to teach you how to transfer from your wheelchair to your bed and back using a side method. Are you ready to try this today? I am ready to learn anything to make me more independent. That is a great attitude. Let s get started by getting your wheelchair in a good position beside the bed. The wheelchair should be parallel or adjacent to the bed. (Marcy wheels her chair to the bed.) Okay, now make sure your castors are forward. You can do this by wheeling forward a little and then back. (Marcy does this.) Put both brakes on and remove the armrest closest to the bed. (Marcy follows the instructions.) Ensure the wheelchair is parallel and adjacent to the bed, castors forward, armrest closest to the bed off, and brakes on. What about my footrests? Should I move them? Actually, Marcy, we will keep them the way they are because they will not be in your way. But I am going to put this transfer belt around your waist just in case you need a little bit of help the first few tries. I need you to remove your shoes. I also need you to move your body forward to make this easier. (Client shuffles forward.) We will try first of all with your legs up on the bed. (Client lifts legs onto the bed.) Good job. We are going to do this in a few steps move, and then you move to the wheel. Then move when you will rise your buttocks and put all the weight on your hands while you go over onto the bed. Ensure clients put their legs on the bed before they begin transferring the rest of their body onto the bed. Where are you going to stand? I will be here in front holding on to the transfer belt. Are you ready? (Client nods her head.) move. (Client moves towards wheel while therapist supports client by grasping transfer belt with knees bent and proper body mechanics.) move. (Client lifts up her buttocks and transfers weight onto arms. Therapist still supports client. Client transfers onto the bed.) You made it, Marcy. Now we will practise moving back to the wheelchair. Is this the same as I just did? Pretty much, but this time we will keep your legs on the bed while you move your body into your wheelchair. I will stand right here again holding the belt. You can do this in small movements: over to the edge of the bed, and then into the wheelchair. Do you have any questions? Is it move and then move again?

19 That is it. Ready? (Client nods her head.) move. (Client moves to the edge of the bed as therapist holds on to the belt with proper body mechanics.) move. (Client places one hand on wheelchair, lifts body up with arms, and transfers over to the wheelchair.) Now you can use your arms to bring your legs over to your footrests. (Client does as instructed.) And that is how you transfer to and from your bed from the side. For fear of tipping the wheelchair, the client should not reach for the far armrest until part of his or her body is on the wheelchair. Transfer to bed (side method) with transfer board Scene: Client is waiting by bed. Occupational therapist enters the room. Good afternoon, Marcy. I am Anne, your occupational therapist. I have come here today to teach you how to transfer from your wheelchair to your bed and back using a side method and a transfer board. Are you ready to try this today? I am ready to learn anything to make me more independent. That is a great attitude. Let s get started by getting your wheelchair in a good position beside the bed. The wheelchair should be parallel or adjacent to the bed. (Marcy wheels her chair to the bed.) Okay, now make sure your castors are forward. You can do this by wheeling forward a little and then back. (Marcy does this.) Put both brakes on and remove the armrest closest to the bed. (Marcy follows the instructions.) Ensure the wheelchair is parallel and adjacent to the bed, castors forward, armrest closest to the bed off, and brakes on. What about my footrests? Should I move them? Actually Marcy, we will keep them the way they are because they will not be in your way. But I am going to put this transfer belt around your waist just in case you need a little bit of help the first few tries. I also need you to move your body forward to make this easier. (Client shuffles forward.) What is that thing there? (Pointing to the transfer board) This is a transfer board, and we are going to use it for you to slide over to the bed from your wheelchair. I need you to remove your shoes. I also need you to lean over on your armrest and place this board under your bottom. (Client does as instructed.) Now I would like you to get your legs up on the bed, (Client lifts legs up onto the bed.) Be very careful that you don t get your hand pinched between the transfer board and the bed. Good job. We are going to do this in a few steps.

20 move, and then you move over on the board while pushing on your armrest. Then move, and you will slide over the board and onto the bed. A transfer board is used to help the client shift her or his body onto the bed. Ensure the client puts his or her legs on the bed before beginning to transfer the rest of the body. When using a transfer board, ensure the client s fingers are not wrapped around the edge of the board. Otherwise, the fingers can get pinched between the transfer board and bed. Where are you going to stand? I will be here in front holding on to the transfer belt. Are you ready? (Client nods her head.) move. (Client moves onto the board while the therapist supports the client by grasping the transfer belt with her knees bent and proper body mechanics.) move. (Client adjusts her hand and slides her buttocks across the board and onto the bed. Therapist still supports client.) You made it, Marcy. Now we will practise going back to the wheelchair. Is this the same as I just did? Pretty much, but this time we will keep your legs on the bed while you move your body into your wheelchair. I will stand right here again holding the belt. You can do this in small movements: onto the transfer board, and then into the wheelchair. Do you have any questions? Is it move and then move again? That is it. Ready? (Client nods her head.) move. (Client moves to the edge of the bed and onto the board as therapist holds on to the belt with proper body mechanics.) move. (Client places one hand on wheelchair, slides body over the board, and transfers over to the wheelchair.) Now you can use your arms to bring your legs over to your footrests. (Client does as instructed.) And that is how you transfer to and from your bed from the side using a board. For fear of tipping the wheelchair, the client should not reach for the far armrest until part of his or her body is on the wheelchair. Transfer to bed (forward, backward method) Scene: Client is waiting by the bed in a wheelchair. Occupational therapist enters room. Hi, Marcy, do you remember me? I am Anne, your occupational therapist.

21 I remember you. You taught me how to move in and out of my chair yesterday. That is right. Today, I would like to teach you how to transfer to and from your wheelchair to the bed, but using a forward and backward method. That sounds different, but I could give it a try. Great! First of all, let s get you into the proper position with your wheelchair. Wheel yourself perpendicular to the bed and swing your footrests out of the way. (Client does as instructed.) Ensure the brakes are on when swinging the footrest out of the way. Now, wheel your chair closer and bring your legs up onto the bed. (Client follows the instructions.) Good job. Bring the wheelchair closer to the bed and apply your brakes. Let s put this belt on you for me to hold while I stand to the side of your wheelchair. Now you will push with your arms on the armrests while you move your body onto the bed. We will do it on move. It is very important that the brakes are on when transferring to the bed. The client should lean forward and extend the arms to help push. I am ready move. (Client pushes on her arms, lifts up her buttocks, and moves towards the bed. Therapist supports her by holding on to the belt and moving with the client.) Good job! How about getting back into the chair? It is pretty much the same thing in reverse. Have the wheelchair close by the bed with your footrests out of the way and your brakes locked. Shuffle your bottom towards the edge of the bed with your back facing the wheelchair. You can place your hands on the armrests and slide back into the chair. Do you want to give it a try? Yes. On move, right? That is right. We have everything already set up, so now I would like you to move towards the edge of the bed. (Client moves.) Okay, grab onto the armrest and move. (Client transfers into the wheelchair as therapist holds on to transfer belt to support client.) Now do I take my brakes off and lock my footrests back in place?

22 You have got it. (Client moves her chair and replaces footrests.) All you have to do now is bring your legs off the bed and onto your footrests. (Client moves legs and therapist takes off the transfer belt.) Thanks, Anne. Transfer to toilet (facing toilet) both directions Scene: Client is waiting by bathroom door for occupational therapist. Therapist arrives to teach the client how to transfer on and off the toilet. Good morning, Ms. Matthews. How are you today? Ms. Matthews: I am doing okay. Just waiting for you to arrive to show me how to transfer on and off the toilet. I am glad to hear that you remembered our appointment. You are correct, I will be teaching you a couple of different ways to transfer on and off the toilet. The first transfer starts with you facing the toilet, so let s get you turned in that direction and have your castors forward. (Client wheels herself so she is facing the toilet.) I need you to swing away your footrests and then move closer to the toilet. Ms. Matthews: (Client removes footrests and moves closer to the toilet.) Do you want me to lock my brakes? Ensure the brakes are on. That would be great. Can you also position your feet on each side of the toilet on the floor, close to the toilet bowl? (Client applies brakes and positions feet.) At this point, you would lower your clothing, but because we are just practising, I will not ask you to do that this time. The next step is that you are going to hold on to the armrests with both hands, push your body up, and move forward, straddling the toilet. I can put a transfer belt on you if you like while you try this. Ms. Matthews: That would make me feel better. So I push up and straddle the toilet, facing the toilet? (Therapist places transfer belt on.) That s right! Let s give a try on move. Ready? Ms. Matthews: Yes. (Therapist supports client by holding on to belt while standing at client s side. Client pushes up on armrests and moves her body forward onto the toilet.) Good job, Ms. Matthews. Do you want to get off of there now? Ms. Matthews: Yes I would. This feels awkward.

23 It may just take a little getting used to. I will teach you another transfer, but right now we need to get you back in your wheelchair. Just do the reverse process: reach for the armrests, push up, and move your body back into the wheelchair. Ms. Matthews: I can do that! (Client reaches for armrests, pushes up, and transfers while therapist holds on to the belt and moves with the client.) That was great. Are you ready to learn a different transfer? Ms. Matthews: Yes. Transfer to Toilet (side transfer) Scene: Ms. Matthews and occupational therapist are in a bathroom with a grab bar on the wall. They ve just finished a facing toilet transfer, but the client wants to learn a different transfer. Let me teach you a different transfer that we call the side transfer. For this one, I need you to position your wheelchair at a angle to the toilet. I can help you estimate this angle. We also need to have your castors forward for safety. (Therapist positions the wheelchair.) What I need you to do is move your legs off the footrests, place them flat on the floor, and swing the footrests out of the way. Also, can you remove the armrest closest to the toilet and apply your brakes? Ms. Matthews: I could do that! (Client moves legs and footrests, removes armrests, and applies brakes.) Position the wheelchair at a angle. Ensure the castors are forward, footrests out of the way, brakes on, and armrest closest to the toilet off. We already have your transfer belt on, so the next thing that I need you to do is lean forward. (Client leans forward over her knees.) I would like you to hold on to the armrest here. (Therapist points to armrest remaining on the chair.) Now grab on to the railing over here. (Therapist points to grab railing on the wall.) What you are going to do next is push down on the armrest and pull up with the wall bar. I will stand in front of you bracing your knees and holding on to the belt while you move your body over to the toilet. Ms. Matthews: I have got it. How about I will count this time? Okay. Let me know when you are ready. Ms. Matthews: move. (Client pushes and pulls with upper extremity and transfers over to the toilet. Therapist stands in front of client, braces legs, and holds on to belt by the client s back while she transfers.) I made it!

24 Yes, you did. While doing this, we would have lowered your clothes before you transferred onto the toilet. We can practise that later, but now you can transfer back into the wheelchair. Ms. Matthews: I will hold on to the bar and the armrest, push and pull, and then move back into the chair? That s it. Ready? (Client nods.) move. (Client pushes on bar, pulls on armrest, and transfers back into wheelchair. Therapist braces legs and holds on to transfer belt.) You have got it. Transfer to bathtub (side transfer) Scene: Client is waiting by the bathtub for the occupational therapist. Therapist enters the bathroom. Tom: Tom: Hello, Tom, I am Tammy. I am the occupational therapist who is going to show you how to get into the bathtub. We are going to practise this with your clothes on, but you would usually disrobe while you are still sitting in your wheelchair. Do you have any questions before we start? What is this chair doing in the bathtub? That is called a bath seat, and I am going to show you how to transfer from your wheelchair and onto this seat. This way you can sit on the chair safely while you use the showerhead or run a bath. We can look at different options later if you don t feel comfortable using the bath seat. Does that sound okay? I guess so. Where would you like me to park my wheelchair? Let s get you to put you chair on a 30-degree angle to the tub, but if we need to we can put it facing perpendicular. I would like to try the 30- degree angle first, but before you put on your brakes, can you swing your footrests out of the way? (Client positions wheelchair and swings footrests out of the way. He then moves as close to tub as possible and locks the brakes.) Now I would like you to remove the armrest closest to the bathtub, and I will put this transfer belt on you to help you move on this first-time transfer. (Client removes armrest, and therapist places transfer belt around client s waist.) Position the wheelchair at a angle. Ensure the footrests are out of the way, brakes on, and armrest closest to the bathtub off. Tom: What would you like me to do next? I will get you to place both of your legs in the bathtub, and then you can unlock your brakes and move your wheelchair as close to the tub as possible. (Client places legs in tub, unlocks brakes, moves wheelchair, and locks brakes again.) Now you can grab the tub with one arm and the armrest with your other arm. Push down with your

25 arms so you can move your body to the bathtub edge. We can do this in little movements. After the client has moved closer to the bathtub, ensure brakes are put on again. Tom: One arm here on the tub and the other here on the armrest. Okay, I am going to move now. Is it okay if I do the counting? (Therapist nods.) move. (Client pushes down on arms, and his body goes up and over. Therapist supports client by standing behind him, holding on to the transfer belt with one foot in the bathtub and good body mechanics.) Remember to maintain proper body mechanics. Keep knees bent and back straight. Transfer to floor both directions Scene: The client, in a wheelchair, and therapist are in the rehab gym. Note: wheelchair cushion should be bendable, probably 2 3 inch thick foam. Tom: Okay, Tom. Today I want to teach you how to get from your wheelchair to the floor and back into your chair. Can I ask you a question, Tammy? Why would I want to know how to get on the floor? That is a good question. There may come a time when, for whatever reason, you find yourself on the ground. We want you to know how to safely go from the ground to the wheelchair and vice versa. (Client nods to show he understands this answer.) Let s get this belt on you before we start anything else. Okay. We can do this from where we are already, but it is important that your castors are forward. I would like you to lock your brakes and remove one armrest. Ensure brakes are on and castors are forward. Tom: Tom: (Client does as instructed.) Why am I only getting rid of one armrest? I will get you to remove the other one after you lean over that armrest and remove your cushion. After, I would like you to swing your footrests out of the way and place the cushion on the floor between your castors. Now you can get rid of the other armrest. (Client does as instructed. Therapist hooks armrests on wheelchair cane.) Now what? Now you can place your feet over the cushion and slide your body forward. (Client follows instructions.) Next, you can position your hands