Practical 3

Question 1

What bed mobility is used when knees are bent? Client is in supine position.

Answer 1

Hook lying

Question 2

What bed mobility is used when client is in supine? Bends knees and lifts buttocks, using arms to push down. This skill transfers to scooting up in bed and assisting with bed toileting and hygiene.

Answer 2

Bridging

Question 3

What bed mobility is used when client bends knees, pushes with arms, lifts buttocks?

Answer 3

Scooting

Question 4

This technique should be utilized to encourage independence in rolling to the side, transferring to the edge of the bed (EOB), scooting up in bed, and assisting a caregiver to place a draw sheet underneath.

1. From supine, instruct the client to bend their knees one at a time into the hook-lying position.
2. If available, instruct them to reach across their body to grasp the bed rail.
3. Simultaneously, allow the knees to fall to the side while pulling the upper body to the same side. (it is called log rolling due to the objective of the upper body and lower body rolling together and therefore preventing trunk rotation).

Returning to supine is the same steps in opposite order.

Answer 4

Log rolling

Question 5

1. While in side-lying, explain to the client all that will occur and describe what their role is.
   i.e. “I will help you bring your feet off the bed, when they fall towards the floor, I will help you sit up. You need to push with this hand and dig this elbow into the bed to help get up. Try to lean towards me and do not lean backward. I will not let you fall.”
2. Place your hand under the client’s head and around to their upper back, their lower neck should be resting on your forearm (your hand will be in a place where you can help them lean forward towards you).
   Do NOT pull on their head or put strain on their neck.
3. After warning the client, pull their feet forward off the bed at the same time as lifting them to sit.
   i.e. “On the count of three, we are going to go. Ready? One, two, three…”
4. After coming to sit, assess the client’s status. Look into their eyes for signs of confusion or dizziness and assess how much support you are giving them.
   i.e. “How are you feeling? Any dizziness?

Answer 5

Side-Lying to Sit at the Edge of the Bed

Question 6

This is the ideal method for a client who requires little assistance since it is closest to an independent technique?
1. In sitting and if clinically appropriate, don a transfer belt.

2. While sitting, explain to the client all that will occur and describe what their role is.
   i.e. “I will help you scoot forward to the edge of the bed. Put your hands at the edge and lean forward. I will help you lean forward and lift your bottom off the bed. Once your bottom is nearly off, scoot forward and try to get your feet on the floor. You can immediately sit back down once you have scooted a bit. We will do this a few times until you are right at the edge with your feet firmly on the ground”.
3. Direct the client to put their hand at the edge of the bed and to lean forward.
4. At the same time the client attempts to scoot forward, assist them by pulling forward on both sides of the transfer belt (do not pull up on the belt). Alternatively without a belt, help them lean forward and scoot by reaching over their shoulders.
   i.e. “Ready? On the count of three. One, two, three…
5. Repeat until they are close to the edge and able to get their “nose over toes”.

Answer 6

Near-Stand Method

Question 7

This is the ideal method for a client who requires moderate to maximal assistance since it does not require getting all their weight off their bottom. Teaching this technique also transfers to teaching weight shift to prevent pressure ulcers for someone who may spend a great deal of time in a wheelchair (i.e. spinal cord injury)
1. In sitting and if clinically appropriate, don a transfer belt.

2. While sitting, explain to the client all that will occur and describe what their role is.
   i.e. “I will help you scoot forward to the edge of the bed. Put your hands at the edge and lean forward and to the right. When you lean to the right, your weight will shift off the left hip so I can help you slide it forward. Then we will switch and do the same thing on the right side. We will switch sides, back and forth until you are at the edge of the bed.”
3. Direct the client to put their hand at the edge of the bed and to lean forward and to the right.
4. At the same time, the client leans to the right, assist them by pulling their left leg forward pulling behind the knee and behind the pelvis.
   i.e. “Ready? On the count of three. One, two, three…
5. Repeat on the other side and alternate until they are close to the edge and able to get their “nose over toes”.

Answer 7

“Walk Your Hips” Method

Question 8

• Getting close to the client and move the client close to you.
• Position your body so that you face the client
• Bend your knees not your back
• Keep a neutral spine
• Keep a wide base of support
• Keep your heels down
• Don’t twist or combine movements.

Answer 8

Proper Body Mechanics for completing a Transfer

Question 9

1. Prepare the environment, where is the client gong to?
2. Ensure that the client has appropriate footwear on.
3. Ensure each surface is stable (bed wheel locked, wheelchair wheel locked, bed-side commode level).
4. Ensure the client is in a neutral or slight anterior pelvic tilt position.
5. Ensure trunk alignment
6. Shift the client’s weight forward
7. Position lower extremities on the floor with knees aligned at 90 degrees of flexion over the feet.
8. Ensure UEs are in a safe position and/or are in a position to assist
9. Apply gait belt

Answer 9

General Process for Transfers

Question 10

1. Prepare the surface to transfer to
2. Be sure that the client has NON-SKID footwear on!
3. Apply gait belt
4. Place the wheelchair at a 20-30-degree angle
5. Lock the brakes
6. Remove the armrest on the side you plan to transfer to
7. Remove the leg rest
8. Remove the W/C seat belt (if applicable)
9. Cue the client to scoot (may do side to side to scoot or may lean back on chair and push hips forward. If needed the clinician may assist the client by reaching back and bringing the hips forward one hip at a time)

Answer 10

Process Specific to Wheelchair Transfers

Question 11

This transfer is typically used when the client is unable to step/walk, and they are able to bear at least partial weight on their lower extremities.

Answer 11

Squat-Pivot Transfers

Question 12

This transfer is typically used when the client is able to take a few small steps (1-2) to the surface they are transferring to and/or they are able to bear at least partial weight on their lower extremities.

Answer 12

Stand-Pivot (Stand-Turn) Transfers

Question 13

This transfer allows the client to pivot on their lower extremities.

Answer 13

Squat-Pivot Transfers

Question 14

This transfer allows the client to take 1-2 steps.

Answer 14

Stand-Pivot (Stand-Turn) Transfers

Question 15

1. The clinician should prepare the environment and prepare the client.
2. Be sure that the client has NON-SKID footwear on!
3. Apply the gait belt
4. Place the wheelchair at a 20-30-degree angle
5. Lock w/c breaks
6. Remove the w/c arm rest (if applicable)
7. Remove the w/c seat belt (if applicable)
8. The clinician should cue the client to scoot with feet placed on the floor. Assist the client with scooting as indicated.
9. Indicate where the client is to transfer to, using cues as indicated
10. Transfer the client to the non-affected side (if there is an affected side) when you initially begin transfer training
11. Guide the client to lean forward
12. Have the client point their heels in the direction in which they are transferring
13. Clinician should stabilize the client’s foot/knee as they come into standing, if indicated
14. Have the client push up from the surface they are sitting on (unless contraindicated)
15. Count to 3 and rock the client forward as needed in preparation for standing, “nose over toes”. (in some instances, rocking and leaning forward is contraindicated)
16. Once in standing allow the client to acclimate to standing and to get their balance
17. Direct the client to reach with one hand for the armrest before sitting.
18. Assist the client in lowering slowly into the wheelchair by maintaining support on the transfer belt.

Answer 15

Stand-Pivot (Stand-Turn) Transfers

Question 16

What transfer is typically used when a client is not able to initiate or maintain a standing position?
1. The clinician should prepare the client and the environment.
2. Be sure that the client has NON-SKID footwear on!
3. Apply gait belt
4. Place the wheelchair at a 20-30-degree angle
5. Lock w/c breaks
6. Remove arm and leg rest on the side you plan to transfer to
7. Remove the w/c seat belt (if applicable)
8. Cue the client to scoot (may do side to side to scoot or may lean back on chair and push hips forward. If needed the clinician may assist the client by reaching back and bringing the hips forward one hip at a time).
9. Place feet on the floor.
10. Have the client point their heels in the direction in which they are transferring.
11. Indicate where the client is to transfer to, using cues.
12. Clinician should stabilize the client’s feet/knees
13. Guide the client forward, shifting their weight over their feet
14. Have client reach for transfer surface and turn their head away from the direction of the transfer
15. Have the client push with UEs from where they are sitting (unless it is contraindicated)
16. Count to 3 and rock forward (unless it is contraindicated)
17. Use good body mechanics
18. Guide client toward transfer surface (may need to transfer in 2-3 sequenced steps)

Answer 16

Squat-Pivot Transfer (Bent-Pivot)

Question 17

What transfers are used with those who can not bear weight on the LE’s, are paralyzed, have LE amputations, or are unable to use UE’s?
1. The clinician should prepare the client and the environment.
2. Apply gait belt
3. Apply footwear (assists with stability)
4. Place the chair at a 20 to 30-degree angle.
5. Lock the brakes, remove arm and leg rest
6. Cue the client to scoot (may do side to side to scoot or may lean back on chair and push hips forward. If needed the clinician may assist the client by reaching back and bringing the hips forward one hip at a time)
7. Place feet on the floor
8. Place the board under the leg toward the direction of the transfer.
9. Place the board between mid-thigh and buttocks, angled toward the opposite hip and the transfer surface.
10. Block the client’s knees with your knees (if indicated)
11. Instruct the client to place one hand on the board and one hand on the surface they are sitting on.
12. MAKE SURE THE CLIENT DOES NOT CURL THEIR FINGERS UNDER THE BOARD!!
13. Instruct the client to slightly lean in the direction of the surface they are transferring to. DO NOT ROCK!! The transfer board will shift if this is done.
14. The client should attempt to slightly lift their buttocks as they move along the board, completing a lift/place series until they are on the surface they are transferring to. Count to three and begin the lift/place movement.
15. Ideally, the client should lift and place their buttocks as they move along the board and should not slide along the board.
16. Assist the client as necessary
17. Remove the board by having the client lean to one side. Provide trunk support if indicated.

Answer 17

Transfer Boards (AKA Sliding Boards)