AIM:
To train lifting and shifting the body onto the bed (wheelchair to bed legs down transfer, complete T4 paraplegia)
Rationale:
An important component of transferring from the wheelchair to bed is lifting and shifting the body. Training is set up so the patient can practise something similar but simpler. Two strategies are illustrated:
1. Lifting and moving sideways in short-sitting on a bed
2. Lifting and moving from wheelchair to bed using a transfer (slide) board
Equipment:
- Wheelchair
- Slide board
- Height-adjustable wide bed
- Wheelie stool
Key Points:
1. Lifting and moving sideways in short-sitting on a bed
- Therapist is positioned in front of patient on a wheelie stool
- Ensure patient’s feet are on the floor to passively bear some weight
- Ensure patient’s hands are in front of hips
- Ensure patient rotates about the shoulders (ie. head down and buttocks up) while pushing through the hands
- Therapist provides manual guidance under thighs to assist with lifting/moving
2. Lifting and moving from wheelchair to bed using a transfer (slide) board
- Therapist is positioned in front of patient on a wheelie stool
- Ensure patient’s feet are on the floor to passively bear some weight
- Therapist positions slide board as the patient lifts and moves forward in the chair
- Ensure patient moves far enough forward so the buttocks clear the wheel of the wheelchair
- Therapist provides manual guidance by directing the knees and preventing the patient from slipping off front edge of wheelchair
Common Errors:
- Bed positioned too high so feet are not on the floor and/or lift is uphill
- Therapist positions slide board perpendicular to the bed rather than angled forwards
- Patient slides (when slide board is not being used) rather than lifting predisposing to the development of pressure areas
- Patient does not lean far enough forward for fear of falling
Progression and Variety:
- Increase height of bed to increase height of required lift
- Increase movement amplitude, aiming to complete transfer in one motion.