Transfers
By
Dr. H.EL Sharkawy
Objectives
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List type of transfers .
Explain type and level of assistant .
Explain the purpose of Transfer .
Precautions with Transfers.
List the Types of Assistance.
Equipment related to transfer .
Definition of Transfer
• The activity of moving a person of limited
function from one location to another.
• Transfers may be done by the patient
alone, with the assistance of another
person or by another person.
Patient’s ability to transfer and the amount
of assist needed will depend on
cardiopulmonary status, joint flexibility,
muscle tone and strength, neuromuscular
control, balance and coordination,
endurance, weight bearing status and
cognition.
Considering the patient’s physical mobility,
condition, comprehension and motivation
the primary goal of transfer training is to
assist the patient into becoming as safe and
independent as possible.
• Patient and therapist safety is of most
importance during transfers. Whenever
in doubt about the level of assistance
needed to transfer a patient safely, ask for
additional assistance!
Precautions with Transfers
• Some conditions will require special
precautions with transfer such as a THR or a
patient with a wound.
• Treatment precautions will be discussed in
more detail in later intervention courses.
Levels of Transfers in Physical
Therapy Activities
Independent Transfers
• No assistance of any type needed for any
aspect of the transfer.
• Patient can perform set up and transfer safely
without any assistance.
Assisted Transfer
• Patient actively participates in transfer but
requires assistance.
• Types of assisted transfers
– Two-person lift
– Sliding board transfer (SBT)
– Squat pivot transfer
– Standing pivot transfer
Standing pivot transfer
Dependent Transfer
• Patient does not or cannot actively participate
in transfer. May be able to assist minimally.
• Types of dependent transfers:
– Sliding transfer from cart to table (team transfer)
– Three person carry
– Dependent stand pivot transfer
– Hydraulic lift transfer
Levels of Assistance for Transfers
Minimal Assistance (Min A)
1. PTA provides assist
for about 25% of
total patient’s
work. Requires
assist for balance,
to move an
extremity or
assistive device.
Moderate Assistance (Mod A)
1. PTA provides assist
for about 50% of
total patient’s work
Maximum Assistance (Max A)
1. PTA provides assist
for about 75% of
total patient’s work
Contact Guard (CGA)
1. PTA supervises
patient’s work by
CONTINUOSLY
guiding or guarding
with touch/contact
for
support/balance
Close Guarding Assist
1. PTA supervises
patient’s work by
INTERMITTENTLY
guiding or guarding
with touch/contact
Stand – By Assist
• Patient can perform
activities without
assist but do not do
it consistently.
Independent (I) Transfer
• PTA supervises the
pt. without any
assist
Amount of Assistance
• When more than one person is required to
transfer a patient safely the number of people
required to complete the transfer is
documented.
• Example – 2 people required to use moderate
assistance
General Rules of Transferring
Body Mechanics
• Proper attention to body
mechanics and the
relationship of center of mass
and base of support allow the
therapist to maintain the
safest position while working
with a patient.
* Position the patient close to
your BOS to decrease stress
on your back and arms.
PTA Preparation
• read patient chart
(diagnosis, medical hx,
meds, PT eval, patient
current level of
function, POC)
• plan treatment (type of
transfer, how much
assist, where will you
treat, secure area, any
equip needed)
USE A GAIT OR TRANSFER BELT
• Gait or transfer belts
are used around the
patients waist to
provide a secure
point of contact and
control for the
therapist.
Instructions and Verbal Cues
• A patient should always be informed the transfer
to be performed and what they are expected to
do. Instructions should be in a manner that can
be understood by the patient.
• Instructions should be short and clear.
• If more than one person is transferring a patient,
communication is essential.
Completing The Transfer
• The transfer is NOT complete until the patient
is safely and securely in the new position.
Types of Transfers
• Bed Mobility Transfers
• Sitting Transfers
• Standing Transfers
Bed Mobility Transfers
• Bed mobility transfers can be done independently or
with assist to move in bed.
• Patients may need assist with bed mobility due to
weakness, obesity, para or quadriplegia, amputation
or cognition problems.
• Bed mobility can help to prevent pressure ulcers and
decrease joint contractures.
Bed mobility independent transfers
• supine  sidelying
sitting
• Can also be taught to
avoid excessive
strain on LB.
Bed Mobility with Assist
– assist from PTA
– assist from assistive devices
i.e. bed rails and trapeze
(should only be used if
necessary.
– REMEMBER your goal is to
get pt. independent if
possible
If a patient is have difficulty with
bed mobility what types of
activities might you do to increase
independence?
Sliding Transfer
• Used to move
patient to/from
cart and treatment
table.
• 3 or more
clinicians perform
the transfer using
a draw sheet.
Two Person Lift
• The 2 person lift is
an assisted transfer
with max assist of 2
people.
• This type of transfer
is often used to
move a pt. from WC
to/from floor or
lower surface.
Sitting assisted transfers - sliding
board transfers
• Can be done with assist of
PTA or (I)
• A sliding board is used
when a patient does not
have enough strength to
lift most of the weight of
the buttocks, sufficient
sitting balance to move in
a sitting position safely
but can not perform push
up transfers.
push up transfer
• A push up transfer is
used when pts. Have
enough strength to
lift themselves from
the supporting
surface and
sufficient sitting
balance to move
safely.
Standing pivot transfer
• used with patients when a pt, can
site, stand, pivot, and bear some
weight on the LE, but have some
weakness, paresis, paralysis, or
loss of balance or sensation, which
necessitates assistance to transfer
safely.
• Amount of assist will vary usually
moderate to minimal assist is
needed.
• Better to transfer leading with
stronger LE in MOST cases.
Hydraulic Lift
• A hydraulic lift is a
mechanical device that
allows one person to
transfer a dependent
patient.
• The hydraulic lift is a
mechanical device that
utilizes hydraulics to lift
the patient (similar to a
hydraulic floor jack).
• A sling (similar to a
hammock) is placed
under the patient and is
secured to the Hoyer lift
via chains or bars to raise
and lower the patient.
Sling needs to be placed under
patient
• Generally roll patient
from side to side to
place sling under
patient
Time to Transfer
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introduce self to patient
explain what will happen during Rx
explain what is expected of patient
is patient ready? Does he need shoes or other
clothing?
assess area for safety
use gait belt
use proper body mechanics
make sure surfaces are as level as possible
give clear, concise commands
BE READY FOR ANYTHING
Safety Awareness with Transfers
• Use gait belt
• Lock Wheelchair & Bed
• Be sure sliding board is secure
• Use proper body mechanics
• Be sure WC is close enough to mat/bed
• Block feet or knees so LE do not slip
Transferring activities of the handicapped
1-Entry Doors:
Accessible route on either side of the door. In
addition, the door hardware must not require tight
twisting, pinching, or grasping in order to use it.
- Keep in mind that the hallway outside of the door
and the space inside the door should be kept free of
boxes, chairs, or equipment, so that they do not
interfere with the accessible route.
Plan view showing clear floor space
on both sides of entry door to permit
entry and exit
2- At Clear floor and turning Space inside
examination Rooms:
-Because some individuals can only transfer from the right or
left side, providing clear floor space on both sides of the table
allows one accessible table to serve both right and left side
transfers.
- Another way to allow transfers to either side of exam tables,
particularly when more than one accessible examination room
is available, is to provide a reverse furniture layout in another
accessible examination room.
-the room should also have enough turning space for an
individual using a wheelchair to make a 180-degree turn
Plan view of part of an examination
room showing clear floor space for
turning a wheelchair. This space can
also make it possible for use of a
portable patient lift.
Patient sitting on adjustable height
exam table
positioned with clear floor space on
both sides
Features of an Accessible Examination Room
1-A clear floor space, 30” X 48” minimum, adjacent to the exam table and
adjoining accessible route make it possible to do a side transfer.
2-Adjustable height accessible exam table lowers for transfers.
3-Providing space between table and wall allows staff to assist with patient
transfers and positioning. When additional space is provided, transfers may
be made from both sides.
4-Amount of floor space needed beside and at end of exam table will vary
depending on method of patient transfer and lift equipment size.
5-Accessible route connects to other accessible public and common use
spaces.
6-Accessible entry door has 32” minimum clear opening width with
door open 90 degrees.
7-Maneuvering clearances are needed at the door to the room.
Note: Additional clear floor space can be provided by moving or
relocating chairs, trash cans, carts, and other items.
3- ACCESSIBLE MEDICAL EQUIPMENT:
this section provides examples of accessible medical equipment
and how it is used by people with mobility disabilities.
Such equipment includes adjustable-height exam tables and
chairs, wheelchair-accessible scales, adjustable-height radiologic
equipment, portable floor and overhead track lifts, and gurneys
and stretchers.
A patient with a mobility disability is
examined
while lying down on an adjustable
height exam table.
An adjustable height exam table equipped
with adjustable, padded leg supports.
4- Exam Tables and Chairs :
Individuals with mobility disabilities often need to use an
adjustable-height table which, when positioned at a low height,
allows them to transfer from a wheelchair
. A handle or support rail is often needed along one side of the
table for stability during a transfer and during the examination
An adjustable height exam table
shown in lowered and raised
positions
An adjustable height exam table
shown in lowered and raised
positions
Features of Accessible Exam Tables
1- Removable/adjustable support rails with continuous gripping
surfaces
2-30” X 48” minimum clear floor space adjacent to exam table
and adjoining accessible route
3-Exam surface lowers to 17” to 19” above the floor
4-36” wide minimum accessible route
5.Exam surface may articulate to provide support during
patient transfers and positioning
6.Rails/armrests can be moved for transfers
7.Rails can be added beside the table surface to assist
transfers, provide support, or prevent falls
8.Space to position a wheelchair alongside table is critical for
transfer
9.Positioning and support aids, such as wedges and rolled up
blankets, should be available
10.Exam surface extensions, such as head and foot rests, provide
additional support and positioning options
Typical Transfer Techniques
1-Using Patient Lifts
1-Gait belt with handles assists with guiding along transfer
board
2-Transfer or sliding board acts as a bridge between
wheelchair seat and table surface
2-Portable Floor Lifts
A low height, adjustable width base permits the lift to be
positioned at the end of the examination table
Movable exam tables allow additional flexibility to position
table and lift for optimal patient transfer
Clearance beneath the exam table and an angled approach
of the lift allows the patient to be positioned directly over
the exam table for a safe transfer
3-Ceiling Mounted Lifts
Ceiling structure must support weight of lift and person
Overhead track lifts can be used in rooms with limited
floor space or where an exam table cannot accommodate a
portable floor lift
4-Free Standing Overhead Lifts
1-Free-standing overhead track lift systems function like ceilingmounted lifts and do not require modifications to existing
construction.
2-While not as portable as floor lifts with wheels, these lifts are
movable and can be relocated as needs or services change.
3-An overhead lift does not require the additional maneuvering
space needed by a portable floor lift.
5-Use of Stretchers and Gurneys
1- Adjustable height stretchers facilitate transfer onto radiologic
equipment with a table surface. Assisted transfers from a
wheelchair may require use of a lift.
2-Open space under stretcher allows close positioning of lift for
transfer.
6- Radiologic Equipment&Mammography
Equipment
1-Set stretcher height to be level with table surface for lateral
transfer.
2-Adequate floor space to maneuver and position stretcher.
Stretcher locked in place to prevent movement during lateral
transfer.
3-Slip/slide sheets, boards, or other aids assist with lateral
transfers.
7-at the scales
1.Sloped surface provides access to scale platform -- no abrupt
level changes at floor or platform.
2.Edge protection at drop off.
3.Large platform to accommodates various wheelchair sizes.
4.Provide maneuvering space to pull onto and off scale.
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