AIM:
To train lifting the legs onto the bed (wheelchair to beg legs up transfer, complete C6 tetraplegia)
Rationale:
An important component of transferring from the wheelchair to bed is lifting the legs onto the bed. Training is set up so the patient can practise something similar but simpler. Two strategies are illustrated:
1. Moving legs across the bed
2. Moving legs up and onto bed
Equipment:
- Wheelchair
- Height-adjustable wide bed
- Stools
- Wheelie stool
- Slip sheet
Key Points:
1. Moving legs across the bed
- Patient is positioned in long sitting on the bed with slip sheet under legs
- Therapist is positioned behind patient on bed and provides manual guidance if necessary
- Ensure patient uses one hand to hook with extended wrist under one knee, while leaning forward to balance the trunk on the opposite flexed elbow
- Ensure patient reaches down as close as possible to the ankle to push the leg using the back of the hand to move the leg sideways
2. Moving legs up and onto bed
- Patient is positioned in the wheelchair in long sitting with one leg on the bed and the other leg flexed and supported on a stool
- Ensure patient hooks arm nearest to bed behind the handle bar of the wheelchair to stabilise the trunk
- Ensure patient flexes hip of leg on the stool to clear foot and lift flexed leg onto bed
- Ensure patient lifts and flicks leg onto bed into an extended position
Common Errors:
- Therapist is too far away from patient to ensure safety
- Patient leans too far back and falls backwards on the bed
- Patient fails to use balancing arm and falls forwards on bed
- Patient fails to stabilise trunk in wheelchair and falls forwards
Progression and Variety:
- Remove slip sheet
- Decrease height of stool/ remove stool