AIM:
To train moving to the front of the chair (wheelchair to bed legs down transfer, complete T4 tetraplegia)
Rationale:
An important component of transferring is moving to the front edge of the wheelchair. Training is set so the patient can practise something similar but simpler. Two strategies are illustrated:
1. Moving forward in long sitting on a bed
2. Moving forward in the wheelchair
Equipment:
- Wheelchair
- Wide bed
- Slip sheet
- Wheelie stool
Key Points:
1. Moving forwards in long sitting on a bed
- Position slip sheet under legs to minimize friction
- Therapist is positioned on the bed behind the patient to prevent a backward fall
- Ensure patient positions hands close to hips
- Encourage patient to lift bottom and move heels forward towards the end of the bed and back again
2. Moving forwards in the wheelchair
- Therapist is positioned on a wheelie stool in front of the patient
- Ensure the front wheels of the wheelchair are facing forwards
- Ensure patient positions hands on top of the wheel
- Therapist provides manual guidance behind knees to shift weight forwards
Common Errors:
- Patient does not lift high enough to clear the buttocks when moving forward
- Patient does not move buttocks far enough forward
- Therapist is too close (interfering with forward movement in the wheelchair) or too far away (compromising safety)
Progression and Variety:
- Modify position of the hands to change arm length:body ratio (eg. lift from small blocks when on the bed)
- Modify position of buttock to change arm length:body ratio (eg. sit patient on a cushion when on the bed)
- Decrease/remove manual guidance