AIM:
To train lifting and shifting the body onto the bed (wheelchair to bed legs up transfer, complete C6 tetraplegia)
Rationale:
An important component of transferring is lifting and shifting the body from the wheelchair onto the bed. Training is set so the patient can practise something similar but simpler. Two strategies are illustrated:
1. Lifting and moving sideways in long sitting on a bed
2. Lifting and moving from wheelchair to bed using a transfer (slide) board
Equipment:
- Wheelchair
- Height-adjustable wide bed
- 2 x Bathroom scales
- Slip sheet
- 2 x High blocks
- Slide board
Key Points:
1. Lifting in long sitting on a bed
- Therapist is positioned behind patient for safety
- Ensure patient is leaning far enough forwards
- Ensure patient rotates about the shoulders when lifting (ie. head down and buttocks up)
- When lifting with straight elbows, ensure patient’s shoulders are externally rotated and hands are just anterior to hips with IP joints flexed
2. Lifting and moving from wheelchair to bed using a transfer (slide) board
- Therapist is positioned in front of patient on a wheelie stool
- Patient is positioned in long sitting in wheelchair with feet on the bed
- Therapist lifts patient’s leg to position slide board
- Therapist provides manual guidance as the patient lifts and slides bottom
Common Errors:
- Bed positioned too high
- Therapist positions slide board perpendicular to the bed rather than angled forwards
- Patient does not maintain external rotation of shoulders resulting in collapse at the elbow
- Patient moves sideways instead of across and forwards predisposing to development of pressure areas
- Therapist does not provide sufficient manual guidance to ensure safety
Progression and Variety:
- Remove slide board