Transfers: Considerations for You and Your Clients

     Transfers take place when someone moves from one surface to another. This can take place between beds, chairs, assistive devices, vehicles and more. A transfer is considered safe when both the therapist and client are free of harm. 

    In order to ensure a safe transfer, there are many factors to take into consideration. First and foremost, it is important to make sure the environment is clear and free of obstacles. If transferring to or from a wheelchair, make sure the brakes are locked and the castor wheels are out of the way. Footrests and armrests may also need to be removed. Additionally, if the client has any IVs, catheters, etc., make sure they are out of the client's path. 

    When determining the type of transfer to use, there are many aspects to consider. The client's balance, strength, cognition, endurance, and ROM are all determinants for the best type of transfer. For example, if a patient lacks strength, they may benefit from using a sliding board. Instead of lifting their entire body weight, they can use the board to scoot/slide from one surface to another. When using a sliding board, hand placement is crucial. You should always instruct your client to place their fingers flat onto the board instead of grasping the edge with their fingers underneath. Placing your fingers under the board during a transfer increases the risk of injury. Just as a sliding board may be used for someone with low strength, a gait belt may be used for someone with low balance. Gait belts are an excellent tool for increasing safety measures and may be used regardless of the patient's balance. The belt should be worn around the thinnest section of the body above the waist. It should be tight yet comfortable to the client. 

    At the beginning of a transfer, it is important to make sure the client is positioned toward the edge of the surface. Scooting to the edge of the surface decreases their base of support, and puts the client into a prime position for moving. Less stability leads to greater mobility. Another crucial note regarding positioning is proper contact points. Therapists should support the client at their proximal joints (shoulders & hips) rather than distal joints (elbows, knees, etc). It is also important to keep in mind the client's affected areas and weakened sides. 

    When conducting a transfer, promoting therapist safety is just as important as client safety. Proper body mechanics should always be considered. The therapist should stay as close to the client as comfortably possible, and they should always remain at the client's front or side. To protect the therapists back, it is important to bend more at the knees than at the hips and avoid trunk rotation. Lastly, it is extremely important that the client never wrap their arms around the therapist's body or neck. This puts both the therapist and client at risk for injury. 

    Ultimately, it is important to note that communication is key. The therapist should always use clear and effective instructions. It is crucial to understand the client's abilities and encourage their participation during a transfer. It may also be beneficial to demonstrate the transfer for the client prior to their participation.  In conclusion, there are many factors to consider when completing a transfer. Transfers are frequently performed during therapy sessions and should be conducted properly. 

Weisser- Pike, O, (2023). Lecture 10: Bed Mobility and Transfers [PowerPoint Slides]