Bed Mobility & Transfers: Principles
To which side should you be transferring the patient to? (and where should you be positioned to assist?)
Transfer to patient's stronger side, assist at patient's weaker side
What conditions would you instruct your patient to log roll in bed?
How do you lift an object using good body mechanics?
When turning, rotate whole body by taking small steps. If object is too heavy, ask for help.
What is ADA recommended minimum for door openings? BONUS: what is the minimum clear passage width to accommodate a single wheelchair?
32''
BONUS: 36''
What are some examples of accommodations when traveling by airplane?
How should the wheelchair be set up prior to transferring a patient?
Positioned at patient's stronger side with brakes locked, footrests swung away, and armrest closest to bed removed
What conditions would you do a sliding board transfer with a patient?
Paraplegia, LE amputation
How to practice good body mechanics to position a person on their back with the bed flat?
Put a pillow under the person's head, a rolled towel may be used to support the lower back, and a small pillow can be put under the calves and ankles to raise the heels off the bed
What is the ADA-recommended sink and toilet seat height maximums?
34'' and 17''
Who is at risk for diminished community mobility?
Individuals with mental illness or physical disabilities (i.e., hearing impaired, visually impaired, mobility impaired)
What are two items that the patient should wear for safety during transfers?
Transfer/gait belt and shoes/non-slip slippers
What precautions/condition would you use a stand pivot transfer with a FWW?
NWB of the LE
(if PWB, can use stand pivot without FWW)
How to practice good body mechanics when positioning a person on their back with the head of the bed raised?
Put one (or more) pillows behind the head and shoulders and under the knees to bend them a little; a footboard may be used to keep the feet in place
What is the ADA minimum requirement wheelchair turn radius?
60'' diameter
What are OT interventions related to taxi and ride-sharing services?
- Increasing efficiency in skills such as using a phone, computer, and smartphone apps to arrange for rides
- If client uses a w/c, they should be trained in securing it in a vehicle and instruct steps to other person
- Providing education on resources for information about legal requirements if denied service/treated unfairly
How do you transfer a patient to and from the toilet and wheelchair?
1.Position wheelchair facing toilet and place gait belt around patient.
2. Have patient unfasten pants prior to standing, and assist patient to stand by having them push up on armrests.
3. Have patient use wall bar to assist with stand pivot transfer and slowly sit down.
4. To transfer back, use wall bar to stand and pull up clothing.
5. Place patient's strong arm on armrest.
6. Turn strong foot and pivot, slowly sitting down in wheelchair
What precautions/patient conditions would you use a squat pivot transfer?
What transfer technique/aid should be used to transfer a patient from bed to chair if the patient is PWB and is not cooperative?
Full body sling lift and 2 caregivers
What is the forward reach range?
15'' - 48''
What are some examples of OT interventions and services related to community mobility, and what is the goal of these interventions?
Assist in training/resource usage:
1) travel training
2) recommendation and training in adaptive equipment use
3) route planning
4) advocacy
5) address safety concerns when riding as a passenger, walking, biking, use of mass transit
6) evaluation of drivers with age-related changes
7) exploration of alternative transportation options
Goal is to increase independence and support participation in the community and reduce crashes, injuries, and fatalities
What are the steps to lift a patient upright in a wheelchair to reposition them?
1. Stand behind the patient, leaning body forward with a leg against the back of the WC
2. Shift weight from front to back leg while maintaining backward pelvic tilt
3. Bend hips/knees and lean forward to reach under patient's arms
4. Interlace arms under patient's arms to hold onto patient's crossed forearms
5. Set and support spine by pulling in with stomach before lifting patient up and back into the wheelchair (may take more than 1 move to correctly reposition)
How would you instruct a patient with hemiplegia to supine to sit EOB?
Bend knee, grab affected arm with strong arm, use foot and momentum from arms to roll onto side, use strong leg to push both legs off EOB, push against bed with strong hand to bring body up to sitting position
What transfer technique/aid should be used to transfer a patient from bed to chair if the patient is NWB but has UE strength?
Seated transfer aid; gait/transfer belt may be used until the patient is proficient in completing transfer independently
If a ramp is to be built to replace 5 steps that have a height of 5 inches each step, what is the length of the ramp?
25 feet long
What are the benefits of public transportation (fixed route and paratransit)? What are some intervention implications for both fixed-route transit and paratransit?
1) affordable
2) increase independence
3) integrate into community
4) access to places of public accommodation
5) generally safe
Fixed route interventions: evaluation of skills such as boarding/exiting vehicle, managing money, reading schedule, planning trips, etc. Ensuring meets special needs of client.
Paratransit interventions: understand passenger assistance level, assisting client during interview process through education, orientation to local system, training in making reservation, education related to service limitations