Welcome to Central Induction

							Transfers and Therapeutic Handling

       Judith Croxon-Stroud
 Clinical specialist physiotherapist
             May 2011
Objectives
   To understand the different transfers used in
    stroke rehabilitation
   To understand the factors which influence the
    choice of transfers
   To increase awareness on how to facilitate
    transfers
   To begin to understand the concept of
    therapeutic handling
Types of Transfers
 Hoist
 ARJO steady
 Sliding Board
 Low Lateral Transfer
 Step round Transfer with or without a
  walking aid
Purpose of Transfers
   To help get the patient out of bed, for the
    purpose of sitting out
   To help the patient become more independent
   To aide recovery
   To increase function
Assessment of transfers
   Physical status
   Sensation
   Cognition
   Language
Physical Ability- Sitting

    Can they sit independently?


    Can they lean forward in sitting?

    Can place feet on the floor?

    Can they move out of their Base of Support?

    Can the patient follow movement?
Physical- standing
  Can the patient weight bare through both legs?


   Can the patient maintain control of their trunk
    in sit to stand?

   Is the patient able to follow movement?

   Can the patient step both legs independently?
Other factors

   Sensation/ proprioception :- Can the patient
    feel and/or know where they are in space?

   Cognition:- Is there safety concerns ?
                Are they impulsive?

   Understanding:- Can the patient understand
    what you are asking them to do ?
    What is the best way to communicate with
    them?
Hoisting
   Used for low level patients who have poor or
    no sitting balance or patients who have sitting
    balance, but either are impulsive or cannot
    follow instructions and therefore other transfers
    are a risk to themselves and/ or carers
Advantages / Disadvantages
   Advantages :- A way of getting very dependent
    people out of bed and sitting in an appropriate
    chair
   Disadvantages :- Patient is not required to be
    active.
    It is not a normal way of getting out of bed
    Space is needed
ARJO Steady
   Able to sit with minimal assistance of one
   Able to place both feet on the floor
   Able to weight bare through both legs
   Able to flex forward at trunk
   Able to pull up into standing using at least one
    arm
Advantages
   Requires the patient to be active

   Patient is getting the experience of standing

   Patient is weight baring
Disadvantages
   Patient is being asked to sit to stand in a way
    that encourages a poor pattern of movement

   Patient is not standing in a good alignment

   Equipment is large and space is required
Sliding boards
   Able to sit with supervision
   Able to flex forward in the trunk
   Feet can be placed on the floor
   One arm can be placed in the direction of
    movement
   Able to co-operate with the transfer
Advantages
   Requires patient to be active and working
    against gravity
   Requires patient to move in and out of base of
    support
   Patient can work towards independence
   Equipment is small and easily transported
Disadvantages
   Not a normal way of moving

   Encourages the patient to become one sided

   Often carers will not carry transfer out unless
    patient is more or less independent

   Need chairs where the arms are removable or
    drop down
   May be unidirectional
Low lateral transfer

    Able to sit independently and move out of base
     of support in sitting
    Able to help with moving forward to edge of
     chair
    Can maintain placed feet on the floor
    Able to initiate sit to stand with minimal
     assistance
    Able to assist with weight transfer in crouch
     standing
    Able to place arm in direction of movement
Advantages
   Patient is required to be active

   It is a weight baring transfer

   Practice of initiating of sit to stand

   No equipment is needed
Disadvantages
   Can encourage overuse of one side
   If only has use of one hand, is unidirectional
Step round Transfer
   Able to maintain sitting with supervision
   Able to flex forward at trunk
   Able to maintain feet on floor
   Able to initiate sit to stand with minimal
    assistance
   Able to stand with minimal assistance of 2
   Able to weight bare through one lower limb
    and second lower limb with minimal assistance
   Able to actively step both legs – may need
    prompting to place/ move one leg
Advantages
   Encourages normal movement
   Requires weight baring through both lower
    limbs
   Practice of sit to stand
   Practice of standing balance
   Functional – can be carried out in most places
   Is multidirectional
Disadvantages
   None
   Cautions- check no swivelling on unaffected
               leg
               Support of Hemi arm
Therapeutic Handling
   It is the concept of handling the patient in a
    way which allows the patient to recruit their
    own activity to make moving easier
   Therapists hands work to increase sensory
    input and create correct alignment to increase
    muscle activity
Where to handle from?
   Facilitate at an area of reduced activity

   At a place where the best response is got

   Give the feeling / experience of normal
    movement

   Where the therapist is able to explore the
    response to displacement
Practical
 To explore ways of facilitating sliding board or
  lateral reach transfers
 Considerations
o What is the persons movement like in sitting?
o Where are you putting your hands?
o Who is doing the work?
References
   EDWARDS S (2002) Neurological Physiotherapy 2nd Edn. Churchill and Livingstone

   BASSOE GJELSVIK B.E (2008) The Bobath Concept in Adult Neurology. Thieme

   Stokes, M. (1998) Physical Management in Neurological Rehabilitation. London: Elsevier Ltd