Starting out as an new occupational therapist presents many huge challenges. From learning the ins and outs of treatments to documenting, and time management…it can feel like there’s no end to all the new things you need to know.
One of the most difficult skills to master as a new occupational therapist is transfer training during ADLs.
In this post, you will learn practical transfer training techniques and tips so you can feel confident and safe with your patients every day.
Why Does Transfer Training Matter?
Whether you work in inpatient rehab, acute care, or sub-acute rehab, transfer training is one of the most physically demanding aspects of occupational therapy.
It is also one of the most important.
Many of your patients will be dealing with severe illness or injuries, like an amputation, a head injury, a stroke or a spinal cord injury.
For these patients, the treatment focus will be on mobilization so the patient can return home. This is where your transfer training expertise will come into play.
These conditions significantly impair the patient’s functional mobility, which will require the assistance of one or more therapists to transfer the patient from one surface to another.
During patient transfers, there are two critical goals:
- Maximize safety for the patient.
- Minimize physical stress on on the therapists performing the transfer.
1. Maximize Safety: Setting Up the Transfer for Success
Generally, it is easier to position a patient so that they will transfer to their stronger side. The locked wheelchair should be placed close to the surface you are transferring to and at a slight angle so if the patient does lose their balance, they won’t fall.
In most cases, it is also better to remove the wheelchair arm closest to the surface you are transferring to.
If you are transferring a patient to an adjustable surface, like a bed or a mat, adjust the height of the surface to be at the same level of the wheelchair.
Once a patient has mastered an easier transfer as described above, then the patient can progress to transferring to the weaker side, and to/from different heights.
Image Source: KarmanHealthCare.com
2. Minimize Physical Stress: Using Proper Body Mechanics During Transfers
Before going into the nitty gritty of the transfers, you want to always make sure you are using proper body mechanics to prevent injury.
Keep these points in mind:
- LEGS – Lift with your legs and NOT your back.
- CENTER OF GRAVITY – Keep the center of gravity (the patient) close to you.
- USE YOUR CORE – To protect your back, engage your core abdominal muscles before lifting.
- DON’T TWIST – Avoid any twisting in your trunk. Instead, pivot on your feet so that your whole body rotates, not just your back.
- COMMUNICATE – Before completing a transfer, tell the patient what you need them to do. Don’t assume they know how to best help you.
- DON’T HOLD THE THERAPIST – Do not allow the patient to hold onto to you during the transfer. This can lead to major injury to you and the patient.
Transfer Training Techniques for Different Patient Populations
REMEMBER: It is important to remember that while it is a part of an occupational therapist’s job to teach a patient how to transfer, the safety of both the patient and the therapist is of utmost importance.
Patients with a Spinal Cord Injury
A patient that has had a spinal cord injury will have special considerations. For example, the patient may not have a stronger side, and the patient may not have enough arm strength to assist with a transfer.
In most cases, transfers will initially need to be completed with a sliding board and with the assistance of other staff. It is also helpful to use your own knees and feet to block the patient’s knees and feet from sliding forward during the transfer.
The patient may be on some sort of air mattress while in the hospital to prevent pressure ulcers. These are often higher than a regular bed, and slippery. It is often best to turn the mattress off prior to attempting a transfer to reduce the height and decrease the chance that the patient will slide out of the bed.
Patients with a Stroke
For many patients that have had a stroke, the general recommendations for transfers will apply.
However, some patients will present with pusher syndrome. These patients will lean to their weaker side, causing loss of balance and may actively resist any tactile assistance from the therapist to correct their posture.
If possible, provide these patients with a visual cue (like a mirror) to assist them with upright posture and mid-line orientation prior to attempting a transfer. It may also be helpful to instruct the patient to lean to their stronger side.
Placing your hand on the patient’s shoulder (on the stronger side) and instructing them to push into it may also improve mid-line orientation to allow a safe transfer.
These patients will often find it easier to transfer to their weaker side as they are pushing that way anyway.
Patients that have a BMI of 35 or greater present a unique challenge to the rehab staff.
In some cases, the bariatric patient will be able to transfer with minimal assistance, though they may have low endurance. In these cases, it is best to structure the rehab day with scheduled rest breaks so that the patient will have adequate energy to complete the transfers on their own.
Bariatric patients that need additional assistance may need to have gait belts attached together to be able reach all the way around them. The bed surface should be raised and additional staff may be needed to ensure safety. If additional staff is not available, a mechanical lift should be used as needed.
Education with the patient about proper positioning during a transfer will greatly diminish the amount of help required from additional staff. A good reminder for the patient is “nose over toes” (to keep their nose above their toes to help with their balance). It’s also helpful if they push up with their hands from the surface after the surface is raised up.
Check out this great video summarizing these transfer techniques:
Transfer Training in the Shower
Transferring in the shower presents multiple challenges for a therapist.
The patient is not wearing clothing, so gait belts may not stay on as well. The patient is wet, and the shower chair is wet, causing the patient to be slippery and increasing the risk of falls. The patient won’t be wearing shoes, so while the bathroom floor should provide a nonslip surface, it will still be more challenging than transferring a patient with shoes on.
It is generally best to transfer the patient to the shower chair with their shoes and some clothing (possibly a shirt) still on. Once this initial transfer has been completed, then clothing and the gait belt can be removed.
Then when the shower has been completed, make sure both the patient and the floor are completely dry prior to attempting a transfer back to the wheelchair.
If the patient’s feet continue to slide, nonslip socks or shoes can be donned before the transfer is attempted. The gait belt may need to be tightened more than usual to prevent slippage on skin, or a gown can be put on prior to the transfer.
While there are many special considerations during transfer training with patients, the priority is to keep both the patient and the therapist safe and free from injury.
This is best done by assessing the environment first:
Make sure the floor is dry, the bed is lowered, and the wheelchair is appropriately placed and locked to minimize falls.
If there is any possibility that the patient may require the assistance of more than one staff member, additional help should be obtained prior to attempting to transfer.
It is also best to make transfers as easy as possible – to/from same height surfaces and using the patient’s stronger side. Try this before attempting a harder transfer to/from surfaces of different heights and using the weaker side.
I hope this post gave you a good starting point on safe transfer training during your beginning years as a new occupational therapist or COTA. I’ve also provided some additional transfer training and body mechanics resources below.