FUNCTIONAL REHABILITATION: TRANSFERS: ACCESSORY SKILLS

     To perform any transfer, the patient must first be able to sit or learn to tolerate a Sitting position. The patient must also be able to perform numerous accessory skills to transfer from a wheelchair. To perform the necessary accessory skills requires strength in the deltoids, biceps, brachialis, and/or brachioradialis; range of motion in shoulder extension, abduction, and flexion, and elbow extension and flexion; and the following skills. Techniques to acquire the following skills appear in the Training Strategies section.

  1. Stabilize the Truck in a Wheelchair - The patient with nonfunctional trunk musculature stabilizes the trunk by:
    • Hooking one arm behind a push handle of the wheelchair
    • Pushing on the thigh or an armrest
    • Holding the far armrest of the wheelchair with the hand, wrist or forearm
    • Achieving unsupported sitting balance.

  2. Move the Trunk in a Wheelchair - The patient with nonfunctional trunk musculature leans the trunk forward, to the side, and returns to upright by:
    • Pulling on the front (or the sides) of the armrest or seat to lean
    • Throwing the head and arms forward (or to the side) with enough force to move the body forward (or to the side)
    • Pushing on the tires of the wheelchair behind the seat to lean
    • Pushing on the thighs, the front of the chair, or the armrests to return to upright.

  3. Move the Buttocks in a Wheelchair - The patient:
    • Moves the buttocks in one direction by pushing on the armrests or seat of the wheelchair and throwing the head in the opposite direction. The patient with nonfunctional triceps moves the buttocks forward on the wheelchair seat by:
      • Throwing the head back repeatedly and forcefully
      • Leaning the head and torso back and twisting the trunk to the right and left by throwing the head and arms to the right and left repeatedly
    • Moves the buttocks forward and to the left by:
      • Hooking the right shoulder behind the wheelchair's push handle on the right side and hooking the left hand on the right armrest
      • Pulling with the arms and twisting the head and upper truck in large twisting motions to the right
    • Move the buttocks back and to one side by:
      • Leaning forward and twisting first to one side and then to the other
      • Leaning forward, pushing the hands against the front of the armrests, and shimmying the head and shoulders to each side.

  4. Position the Wheelchair, Lock the Brakes, and Position the Armrests
    • The wheel and caster should be as close as possible and the chair should be parked at about a 30-degree angle to the bed or other surface
      • If positioning is difficult, the chair can be placed parallel to and with the wheel touching the transfer surface. The brake closest to the surface should then be locked, and the other wheel pushed to place the chair at the proper angle.
      • If the patient falls and needs to return the chair to an upright position, the brakes should be locked and the front of the chair pulled down
    • The brake lever must be pushed or pulled to lock the chair.
    • The armrests should be either rotated out of the way, or, removed and stored on one of the wheelchair's push handles.

  5. Manage the Legs and Position the Footrests
    • The patient with functional hands grasps the leg and lifts it with one hand, while the other hand stabilizes the trunk.
    • The patient with nonfunctional hands:
      • Leans forward and stabilizes the trunk with one arm
      • Places the arm, opposite the leg being lifted, between the legs and uses the forearm to lift the leg, stabilizing the forearm on the other leg for more power
      • By pushing or pulling, the patient positions the feet flat on the floor with the legs perpendicular to the floor
    • The patient folds the footrests or positions the footrests and other front rigging out of the way, by either grasping the footrest or placing the hand or forearm under the footrest and pulling up and against it.

The PoinTIS SCI Physical Therapy site of the SCI Manual for Providers is based on information in Spinal Cord Injury: Functional Rehabilitation, by M.F. Somers, Norwalk, CT, Appleton & Lange, 1992, and information in "Respiratory Rehabilitation of the Patient with a Spinal Cord Injury", by J.L. Wetzel, B.R. Lunsford, M.J. Peterson, and S.E. Alvarez, Chapter 28 in Cardiopulmonary Physical Therapy, S. Irwin and J.S. Tecklin, eds., St. Louis, Mosby, 1995, unless otherwise indicated.