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Review Mondays Lecture Why learn body mechanics?

Principles of body mechanics

How to prepare

Traditional Lift Model Golfers Lift


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The goal of transfer training is

Some skills learned for one transfer can beused for other transfers

For example, W/C to bed transfer is similar toW/C to couch transfer


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Based on the results of the initial eval (MMT,ROM, pain, cognition, quality of movement,etc) the PT or PTA selects an appropriatetransfer method that can be performed in a

method that is

Consistent

Safe

Efficient


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Clinician and patient safety must never be

compromised. Whenever in doubt about thelevel of assistance required to transfer apatient safely, obtain additional assistance.

Always stabilize W/C, carts, beds by securingwheel locks or bracing them against a wall

Use proper body mechanics to reduce thepossibility of injury


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The patient consistently performsall aspects of the transfer,including setup, in a safe mannerand without assistance

The patient actively participates,but also requires assistance by aclinician(s)

The patient does not participateactively, or only very minimallyand the clinician(s) perform all

aspects of the transfer


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Stand-by assist(aka supervision)

Close guarding Contact guarding

Minimal assist

Moderate assist

Maximal assist


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Indicated for patients whocan usually perform theactivity without assist, butnot consistently

Verbal cues, assistance inproblem solving during atransfer, assistance if anemergency arises

Clinician not necessarily inclose proximity to the patient


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Indicated for patient who can usually performthe activity without assist but have a greaterlikelihood for needing physical assistance

Clinician is in close proximity to the patient,immediately ready to assist


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Indicated for patients who can usuallyperform the activity but have a significantlikelihood of requiring physical assistance

Clinician maintains contact with the patient tobe able to provide assistance immediately


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Min Assist Patient performs at least 75% of the activity

Mod Assist Patient performs at least 50% of the activity

Max Assist Patient performs less than 25% of the activity


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When more than one person is required forsafe transfers, the number is indicated afterdocumenting the level of assist.

Example: If a patient required moderateassistance from 2 people mod A X2


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Belts secured around a patients waist

Providing a secure point of contact

An alternative method to control patientmotion during transfers

Patients should be kept close to the PTAand not at arms length

The gait belt must not become a handle

In some facilities, gait belts are requiredequipment

Should not be too tight or too loose

Loose ends need to be tucked, so thereis no tripping over them


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Typically,

is easier andshould be done first to

bolster patientconfidence

However, eventuallytransferring to bothsides is necessary


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Patients need to be informed aboutthe transfer and what they are expected to do

The PTA at the head of the patient is incharge of providing VCs to other assistants 1. I will count to three and then give the command

to lift

2. When I say lift, we will lift

3. Visually and verbally ensure that all assistants &

the pt are ready before initiating transfer 4. The PTA says, One, two, three, lift


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A transfer is not complete until the patient issafely & securely in the new position

Appropriate positioning & draping must becompleted

Necessary equipment needs to be placed withinthe patients reach


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THUMB WAR with your desk partner


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Bed Mobility: Transfers used to adjust thepatients body position while he/she isrecumbent Supine side to side

Supine upward Supine downward

Supine to sidelying

Supine to prone

Prone to supine Supine to sit


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Position one forearm underpatients neck/upper back & otherforearm under middle of back &gently slide upper body & headtoward you. Then positionforearms under patients lowertrunk distal to pelvis & slide thatsegment toward you. Finally,position forearms under thighs &legs & gently slide toward you.

Instruct patient to flex hips/knees& place feet flat on bed. One UEadd, one abd. Push feet into bedto move pelvis toward abd UE,then push elbows & back of headinto bed to move upper trunktoward abd UE. Then, repositionLE & UE to move again, or forcomfort.


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Flex patients hips/knees & placefeet flat on bed. Stand at head ofbed and grasp bedsheet or chuckclose to the patient and pullpatient up toward HOB. With twopeople, one on either side, graspbed sheet very close to patient(supination), one verbally leadsand move patient simultaneouslyup towards the HOB.

Patient fully flexes hips/knees withfeet flat on bed, heels close tobuttocks. Elbows flexed, close tothe trunk with shoulder elevation.Pt elevates pelvis using LEs &elevates upper trunk by pushinginto bed with elbows & back ofhead. Then to move upward, thepatient pushes on the LE anddepresses the shoulders

simultaneously.


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Most easily accomplished withsmall sheet (a draw) placed underpatient from upper back tobuttocks or mid thighs. PatientsLE flexed with feet on bed. Byyourself, grasp draw near buttocksand slide, or with two people, oneon either side, grasp sheet andsimultaneously slide patientdownward.

Patient partially flexes hips/kneeswith feet flat on bed. UE next totrunk with elbows flexed &shoulders depressed. Pelvis iselevated using LE & elevates uppertrunk by pushing into bed withelbows & back of head. Then toslide down, the patient pulls withthe LEs while pushing up with theshoulders.


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May need to position pt close tothe far edge of the mat (with aperson, bedrail or wall protectingthe pt). Stand facing the pt, placethe uppermost LE over thelowermost LE; place the uppermostUE on the chest & the lowermostUE in abd. Roll the pt toward youby pulling gently on the posteriorscapula and posterior pelvis.

Instruct the patient to move to thefar side of the bed. The patientneeds to reach across the chestwith the uppermost extremitywhile lifting the uppermost LEdiagonally over the lowermostextremity. The patient uses headflexion & abdominal muscles toroll onto her side.


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Move the pt closer to one side of the bed,prepare to roll him to the S/L position.However, the lowermost UE should bepositioned either close along the side of thebody (shldr ER, elbow ext, palm up, handtucked under pelvis) or with shldr flexed witharm close to ear. Stand facing the pt, roll himto a S/L position, determine if there is enoughroom to complete the roll. If not, move thepatient backward while S/L, then complete the

roll.

Instruct the patient asper dependent


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Move the pt close to one edge of the mat.Cross the uppermost leg over the lowermost legand tuck the lowermost UE under the patient.Stand on the far side of the bed, roll the patient

toward you to a S/L position. Determine ifthere is enough space to continue. Guide thepatient from S/L to supine by resisting at theposterior shoulder and pelvis.

Instruct the patient asper dependent


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Move the patient close to one edge of the bed.Roll the patient into the S/L position facing theedge of the bed(EOB). Lower the feet and lowerextremities off of the EOB. Elevate the trunk bylifting under the shoulders (can instruct patient topush with both UE to help you). At the same time,applying downward pressure on the opposite hip.

Instruct the patientas per dependent


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Used in PT, but less often Sliding Transfer

2 person lift

Frequently Used in PT Transfer Board Transfer

Stand Pivot

Squat Pivot


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Minor, pg 169


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Minor, page 181 W/C to floor and back

Patient must have some UE strength & trunkcontrol

w/c should be close to desired transfersurface, wheel locks engaged, removefootrests & armrest on side transfer will occur

Patient crosses arms in front & the lead PTAstands behind the patient, reaching undertheir UE & grasping the opposite wrists of thepatient


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Other PTA places 1 arm under thighs and 1arm under calves

This PTA at the legs should be facing the newtransfer surface

On command, the 2 PTAs lift the patient, steptoward the new surface and squat to lowerthe patient down using proper bodymechanics


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Used when patient has enough strength to liftmost of the weight off the buttocks & enoughsitting balance to move in a seated position

Patients who are unable to perform squat

pivot transfers


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Minor, pg 190 Use gravity to assist you

Chair parallel to table

Guard by standing in front of patient May block pts knees with yours so pt doesnt

slide off the board

May assist with balance by placing hands on

shoulders May assist by placing hands under buttocks


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w/c parallel to bed Engage wheel locks

Remove foot plates & place patients feet onfloor

Remove the armrest on the side they aremoving to

Patient weight shifts to place transfer board

under buttock Patient performs transfer by doing a series of

pushups & slides sideways


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Patient may place hands flat on the board orfisted on the board, but MAY NOT grasp theedge of the board (which may cause fingersto get pinched!)

Repeat sequence until patient is on thedesired surface

The patient weight shifts away from thetransfer board to remove it


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Performed by one clinician Used with patients who are

unable to standindependently, but can

bear some weight on theirLE

Minor, page 185


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A variation of the Stand Pivot Transfer Used with patients who are unable to stand

independently, but can bear some weight ontheir LE

Lower level patients than those who usestand pivot transfers

Minor page 188,194 & 211


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Side to side weight shifting Minor, page 197

Pelvic slide Minor, page 199

Sitting push up Minor, page 200


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Minor, page 201


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(including removing footrests,applying wheel locks, removing armrests,sliding forward in the chair, propelling

themselves, transfers, etc) Position the W/C as close to the bed as

possible

W/C generally faces the foot of the bed

Where along the bed should it be placed?


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Use proper body mechanics Wheel locks should be engaged whenever a

patient moves into or out of the W/C

Use gait belts appropriately & safely

Prepare the environment Which direction is the patient moving?

Remove jewelry on hands/wrists before slidinghands under a patient

Remove armrests and footrests


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ALWAYS inform your patient about thetransfer to be performed and what yourexpectations of them are

The transfer is considered complete when the

patient is safely positioned and draped, withall necessary equipment within reach


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Transfer safety Levels of transfers

Levels of assist

Proper use of gait belts


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Minor, M.A., Minor, S., (2006), Patient CareSkills, 6th ed. Pearson Prentice Hall: UpperSaddle River, NJ.

Pierson, F.M., (1999), Principles andTechniques of Patient Care, 2nd ed. W.B.Saunders Company: Philadelphia.

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