TRANSFERS
In order to perform ADLs, individuals must be able to transfer themselves
onto different surfaces. A transfer is the transitional movement a
person makes to position him- or herself onto a surface, for example,
into or out of a car, tub, or bed. Because a disabled adult’s mobility
may be significantly impaired, his or her ability to transfer is also limited.
The therapist trains adults to use the safest, most effective way to
transfer. This may include using a wheelchair or ambulation devices,
as well as other adaptive equipment such as shower benches and
transfer boards. As an O.T. aide, you’ll be specially trained by the OT
practitioner to assist with or supervise patients while transferring in
specific settings.
When the nature of a patient’s disorder is such that he or she now
requires assistance to do everyday things that were done independently
before, it’s not surprising to find that the patient is having some
difficulty accepting this change. In some cases, a person can remain
independent, but in order to do so, he or she must learn new ways of
getting from a standing to a sitting position and vice versa. He or she
must also learn new ways of getting into and out of a tub or shower,
bed, and motor vehicle.
For other persons, these and other such changes will require assistance
from others. Initially, the OT worker may provide the necessary assistance,
demonstrating how the transfer is to be done. Eventually,
others—family, friends, or other caregivers—may assume these
responsibilities when necessary.
Other factors that will influence transfer training and choice include
_ Patient’s physical characteristics—such as gender, age, weight,
and height
_ Patient’s disorder
_ Type of transfer to be made
_ Availability of adaptive equipment and assistive devices, like
bath rails, gait belts, pivot poles, and slide boards
Of course, a person assisting in patient transfers should be physically
able to manage the transfers and should be knowledgeable of proper
transfer techniques. As a general rule, it’s unwise to seek to assist a
patient in a transfer if these two conditions aren’t met. It’s preferable
for a person to witness effective transfers and then practice them to
learn the proper body mechanics, before attempting to help transfer a
patient.
The information that follows is specific to wheelchair patients and may
need to be modified for patients whose circumstances are different.
The following are some general guidelines for patient transfers:
_ Encourage the patient to assist in the transfer, as much as is
reasonable, but discourage the patient from putting her or his
arms around the assistor’s shoulders, because this increases the
risk of injuring the assistor’s back.
_ The person assisting should be knowledgeable of, and use,
proper body mechanics—for example, the assistor should have
the lower back slightly arched, with knees bent. This helps to ensure
that the lifting is accomplished using the legs, not the arms
or the back, and enhances the assistor’s control of the patient’s
movement.
_ Be clear about how the move is to be accomplished and when it
will begin.
_ Before beginning a transfer, be sure there are no obstacles in the
transfer path to complicate or prevent the transfer.
_ The assistor should communicate with the patient before the
transfer, so both patient and assistor are clear about what they’ll
be doing, and when they’ll be doing it, during the transfer.
Numerous techniques for helping a sitting patient rise to a standing
position have been used. The stand-pivot transfer is one common
method for accomplishing this. It’s described in the next section.

Stand-Pivot Transfers
A technique known as the stand-pivot transfer can be useful in each of
the following transfer situations. It can be used to transfer or move a
patient from one sitting surface to another—such as from a seated
position to a bed, a chair, a commode, a tub seat, or a vehicle seat.
To begin a transfer, the assistor faces the patient to be transferred,
almost “toe to toe.” The assistor stoops so that the knees are bent and
the assistor is leaning forward slightly, toward the patient, with the
assistor’s lower back slightly arched. In this position, the assistor’s
knees will almost be touching the patient’s knees.
It’s helpful if the patient is wearing a gait belt, which is a canvas belt
worn about the patient’s waist, to be used to provide for firm handholds
when transferring the patient. If the patient isn’t wearing a gait
belt, the assistor may
_ Grip the patient’s belt, if it’s sturdy enough
_ Grip the waistband of the patient’s clothing, if sturdy enough
_ Place her or his hands on each side of the patient’s waist
From this position, the assistor helps the patient to rise and stand. In
this position, the assistor’s knees will block the patient’s knees,
preventing the patient’s feet and legs from slipping forward and
preventing the patient from falling forward while rising.
When the patient is standing, the assistor steadies her or him and
assists her or him in pivoting or turning to face the appropriate direction.
For example, if the patient is to be helped from a wheelchair to a
bed, once the patient is standing, the assistor will help the patient to
pivot so the backs of the patient’s legs are touching or almost touching
the side of the bed. The assistor now instructs the patient to reach
back carefully, to grasp an appropriate surface—such as the back of a
chair or seat—to help steady him- or herself as the assistor helps to
lower the patient slowly onto the target surface.
Transfers should be practiced both from and to the right and left
sides, by both assistors and patients because one can’t always be
assured that facilities, like commodes in public places, will be accessible
from a particular side or angle.

Bed Transfers
To transfer a patient from a wheelchair to a bed, the wheelchair
should be brought to a position beside the bed, one side of the wheelchair
touching the side of the bed with the wheels locked. The assistor
should face the patient in the usual position for a stand-pivot transfer.
The assistor then helps the person to stand, making sure his or her
knees block the patient’s knees. The assistor then helps the patient to
turn so that her or his back is toward the bed and the backs of her or
his legs are touching the side of the bed.
For a patient capable of doing so, the assistor instructs the patient to
reach back to the mattress surface of the bed with her or his hands.
The patient is slowly lowered to a sitting position upon the mattress
surface of the bed.

Chair Transfers
For a patient with use of the upper extremities to move from a sitting
to a standing position, the patient moves (“scoots”) toward the forward
edge of the chair and, with her or his feet about shoulder-width
apart on the floor, uses the upper extremities to push to a standing
position.
To move from a standing to a sitting position, the patient should
stand so that the backs of the legs are touching the forward edge of
the chair seat, then reach down with the hands to the arms of the chair
for support, before lowering onto the chair. The target chair should
have arms and be steady and fixed in place as firmly as possible to
avoid movement and accidents.

Commode Transfers
For a wheelchair patient, the assistor would begin by helping to get
the wheelchair into a position at a 90-degree angle to the toilet—or as
close as possible to this position. Before making any attempt to lift
the patient, make sure the wheelchair brakes are locked, to prevent
unwanted movement of the chair.
Face the patient in the standard position and help him or her to rise to
a standing position. Then help him or her to pivot so his or her back is
toward the toilet. Encourage the patient to reach back with his or her
hands, for the toilet, or for the chair if an “over-the-toilet” commode
chair is used, to stabilize him- or herself when lowering onto the seat.

Tub Transfers
There should be a nonslip surface of some sort in the tub, and a
tubseat, if necessary. The wheelchair should be positioned alongside
the tub, one side of the chair against the tub so that, when the patient
stands, he or she will almost be able to touch the side of the tub with
his or her legs. If the patient isn’t already in a standing position, he or she
should be helped to a standing position. Once in a standing position, the
patient should be pivoted so his or her back is toward the tub. Then
the patient may reach back for the tub seat and use it to steady himor
herself when lowering onto it. The assistor should then help the
patient to get his or her legs into the tub.

Vehicle Transfers
For transfers into a car or other vehicle where there’s no height
disparity between the seated patient and the seat level of the vehicle,
first make sure the vehicle door is open so the patient can approach
the seat. Then move the wheelchair into a position at about a 45-
degree angle to the seat of the car. Once again, make sure
the brakes on the wheelchair are locked before beginning the transfer.
Assist the patient to a standing position. Next, assist the person in
pivoting so that her or his back is toward the vehicle and the seat.
(The vehicle door shouldn’t be used for stabilization because it may
move and crush an extremity or cause a fall.) Instruct the person to
reach back to the upper portion of the seat for stabilization. Help the
person to lower herself or himself onto the car seat. Then assist the
person in swinging her or his legs into the car.
All the transfers described here are assisted techniques. There are
also prescribed techniques for independent transfers, in which a
person learns to transfers herself or himself without assistance from
others. And, in those cases in which neither independent nor assisted
transfers are usable, there are prescribed lifting techniques in which
assistors do all the necessary transfer work.