15 replies to this topic

[kirk]

Hello,
I am a physical therapist working with a T3-T6 paraplegic. I was wondering if anyone could give me any insight into how long it took you, or those in your care to learn to completely independently transfer from wheelchair to bed, etc.

Thanks,
Colleen

[Ches]

Took me like 8 or 9 months to fully wing myself from the board. Chair to bed was one of the first I learned without the board. The last was low surfaces, like couches.. Getting up can be difficult at first, takes time and strength.

[nomis]

This is my area of expertise. No, not expert, just strongly opinionated.

Firstly, I'm opposed to set time targets - while it pleases insurance companies and other measures by money, it also puts unsafe pressures and expectations on clients and therapists.

It varies greatly depending on a person's physical shape (age, weight, fitness...) and confidence.

I used to work as a therapist in a spinal unit and it annoyed me to see clients being rushed to perform transfers before they had the necessary strength/balance to feel confident. And, of course, the constant failure further undermined their confidence and made them unecessarily miserable.

My technique was to work people hard in strength building and balance skills and delay the higher risk-taking transfers till they had all the ability and confidence to succeed. A faster process in the long run with a happier client.

There. I've had my say.

So, how long does it take? Depends on how long it takes to rebuild their strength, balance and confidence. With transverse myelitis, maybe a few days, with trauma T3 complete anything around 4 to 6 months for a basic trnsfr generally could be expected.

Edited by nomis, 17 November 2008 - 12:30 AM.

[kirk]

First off...thanks for your reply. I would appreciate any and all information that you could provide to me. I am working with a 43 yr. old male that fell off of a roof and sustaiined a complete T3-T6 injury. We have been working on upper body strength and balance for about 4 months now. He just received his ultra-light wheelchair last week. Problems that we have: 1. wheelchiar wants to move in his attempts to transfers into/and out of it. 2. Should he put his feet on the foot plate prior to transferring into the wheelchair?

Thanks

Edited by kirk, 17 November 2008 - 01:24 AM.

[Yong]

One of the things I hated hearing from AB therapists were things like..."you should be able to do this at your injury level...or you should have already mastered this technique"

Everyone's injury is a bit different. As for me, I was an extremely athletic 21 yr old male at time of injury. But with a shattered thumb and injured deltoid with little innervation, I had my share of initial hurdles.

But to answer your question, as soon as my shoulder and thumb healed, it only took me about a month of practice to totally master bed to chair or chair to bed....this including transferring bare skinned and also early in the morning when i am usually stiff... and about two to three months to do low transfers from sofa to chair.

I am still working on floor transfers..but I have gained some weight since my injury so I think this will not be overcome until i lose some more poundage.

Best of luck to you.

[Kev-O]

Im a T-5 an they way i learned was by getting rid of the sliding board as soon as i can. It took me awhile to get it down with no problems. It also helps to transfer to a bed at the same level as your chair or even maybe a little higher. I find it essayer to get from my chair to my bed then from my bed to the chair.

[russ1]

kirk, on Nov 17 2008, 01:21 AM, said:

First off...thanks for your reply. I would appreciate any and all information that you could provide to me. I am working with a 43 yr. old male that fell off of a roof and sustaiined a complete T3-T6 injury. We have been working on upper body strength and balance for about 4 months now. He just received his ultra-light wheelchair last week. Problems that we have: 1. wheelchiar wants to move in his attempts to transfers into/and out of it. 2. Should he put his feet on the foot plate prior to transferring into the wheelchair?

Thanks

Well I was a 38yr old with a T2 injury when first injured so not dissimilar, Took me between 2 and 3 months to do bed to chair and chair to bed unassisted and with no sliding board, about 4 to 5 months to learn to do different level transfers (say 8 to 10" difference). I was very fit with really good balance pre injury so had a bit of a head start though.

If the chair is moving it needs it's brakes sorting out but this can be got over by pulling it towards you as you lift but it's more of an advanced technique that eventually allows brakeless transfers. Personally I always transfer with at least one (but usually both) feet on the floor (the exception being a wheelchair to wheelchair transfer). Putting his feet on the footplate prior to transferring will exacerbate the problem with the chair moving away. Shifting forward in the chair to allow the feet onto the floor makes transferring easier too. Means you can go round the wheel rather than over it.

Edited by russ1, 17 November 2008 - 12:20 PM.

[DaveP]

kirk, on Nov 17 2008, 01:21 AM, said:

First off...thanks for your reply. I would appreciate any and all information that you could provide to me. I am working with a 43 yr. old male that fell off of a roof and sustaiined a complete T3-T6 injury. We have been working on upper body strength and balance for about 4 months now. He just received his ultra-light wheelchair last week. Problems that we have: 1. wheelchiar wants to move in his attempts to transfers into/and out of it. 2. Should he put his feet on the foot plate prior to transferring into the wheelchair?

Thanks

It's not the chair that's supposed to move - it's him! I have a manual wheelchair with no brakes and have no problems transferring.

Feet should be off the foot plate, other wise chair will move.

It's not really about strength - it's more about technique... practice makes perfect! Like a pendulum. the lower the head goes, the higher the arse goes, and this weight shifting makes its easy to throw the arse where it's supposed to go.

[Ches]

I beg to differ with the transfer issues. Putting both my feet on the floor never helps the chair stay in place. In fact, if I get caught between the chair and whatever other surface and my one of my legs isnt propped on the leg plate I cant get that clearing I need below my knees to get up there. One leg on the plate, with my knee already sitting slightly over the edge of the cushion helps me. I have tile floors and my brakes arent the best, so my chair does often slip. Theres not much that can be once youre in the middle of a transfer except GO. I wouldnt worry to much about that, he will eventually learn what he can and cant do, how much sliding away is too much, and how much he can get away with without having to start the transfer all over there.

Theres plenty of methods, but its too individual to set a guideline. Just keep helping him while HE figures it out.

Edited by Ches, 17 November 2008 - 08:57 PM.

[nomis]

kirk, on Nov 17 2008, 02:21 PM, said:

Problems that we have: 1. wheelchiar wants to move in his attempts to transfers into/and out of it. 2. Should he put his feet on the foot plate prior to transferring into the wheelchair?

As you can see, different styles for different people.

I'd suggest you get your 43-yr-old man in position ready to transfer then get him to decide where best to put his feet and how to place the chair. Get him thinking. Get him to visualise the transfer in his mind, how and where does his butt land. What's happened to his legs and feet. If his legs or feet cross or tangle he's going to be in big trouble. Personally, I like feet squarely on the ground but that's not for everyone.

It's not a muscle event, it's ballet. It's largely about balance and should be smooth.

To stop the chair moving, he needs to get some height so that he comes down on the seat and not push into it. You could suggest he transfer not into the seat but to a holding position just above the seat - then drop. He likely won't yet have control to hover above but the intention should be enough.

The hand on the chair should be in a position so that the weight transfers to it when it is perpendicular - initially it is non-weightbearing, maybe angled, but on push-off by the other hand, the chair hand should be straight up-and-down when the weight force arrives. This is getting too complex and detailed and I'm going to confuse you if you're still reading.

He won't do it right until he decides he's going to do it and that's confidence. So, if during a session he is taking his time to sort it out, just relax and let him come to the moment that he's ready. Damn, it's easy telling other people how to do it. I wish it always worked that easily for me.

[E-DOG]

The key to a graceful transfer is proper preperation.
Feet flat on the ground and directly under the knees for support.
The patient looking (facing) the direction in which he wants to go.
Lift up till elboe is fully extended so as not to slide but to "hop"

If he falls and is too heavy to put back in the chair, call the fire dept. not an ambulance (too costly)

E

[qbounce]

After being used to a behemith of a monster wheelchair, like the ones found to wheel the average Joe around in a Hospital, it's normal to have to reevaluate how it works on a light weight chair. Good luck

[Texaswheelz]

I'm with the ones that say feet on ground, but that is what works for some, as you read though it doesn't work for everyone. I find that putting my feet on the footplate tends to push the chair. Also a lot will depend on spasms and whether he has them or not. There are times when I have a big spasms and my legs push me to the back of the chair and almost over backwards. It's all about practice practice practice. Don't try to teach him a certain way, but tell him lets work on a way that works best for you and your most comfortable and confident with. Try no feet on the foot plate, 1 foot, 2 feet.... The time to experiment is now, when he has some one there to help, which might make him feel a little more safe.

I don't remember how they taught me in rehab, but I know I soon started doing it my own way when I got out. I wasn't able to transfer without the board until i didn't have to wear the body brace that I was stuck in for 5 or 6 months. Having that off changed how I did everything they taught me in rehab.

[carole338]

Feet firmly on the ground and a transfer board. My arms are too short for a complete lift of my butt.

[longhaul]

Before attempting the transfer go through the motions in your head what you are going to attempt so the brain has some idea of what it's going to try to do. The brain is being taught to do something it has never been ask to do and it has to lean to do it so be patient. After you get used to doing them it is pretty much second nature.

[Ches]

Same here Carole, about the arms. I cant get the lift I need unless I cheat, I guess thats why I start with one leg on the plate. It also seems to help guide my legs instead of flopping around.

Kirk keep us updated on his progress!