Lab Guide 13

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Questions and Answers

How is a pivot transfer named?

By the patient's weight

By the type of mobility aid used

By the direction of the pivot (correct)

By the therapist's preference

What is the recommended foot placement for a patient during a stand pivot transfer?

Feet together and toes pointed forward

Stronger foot slightly forward with both feet firmly on ground (correct)

Feet positioned on the transfer board

Weaker foot forward for stability

When should a gait belt be used during patient transfers?

Only for patients with severe injuries

Exclusively during manual lifting

When the therapist feels confident

Whenever assisting in transfers or mobility tasks (correct)

Which leg should be blocked if both legs are partially reliable and one is stronger?

The weaker leg Signup and view all the answers

What is a proper modification during a stand-pivot transfer for a patient who is non-weight bearing (NWB)?

Modify to a squat pivot transfer Signup and view all the answers

What should you caution a patient about when using a transfer board regarding hand placement?

Hands should be positioned to prevent slipping off the board Signup and view all the answers

If transferring a patient with a CVA using a squat pivot transfer, which direction is optimal?

To the side opposite of affected limbs Signup and view all the answers

When using a transfer board, how should you position the chair relative to the transfer board?

Very close to prevent gaps Signup and view all the answers

What action should be taken to assist a patient who needs to move forward in a chair?

Use weight shifting or have the patient rock side to side. Signup and view all the answers

When is it necessary to block both knees during a stand pivot transfer?

When both legs are weak or unreliable. Signup and view all the answers

Which leg should be blocked when a patient has one leg that is stronger than the other?

The weak leg. Signup and view all the answers

What is a key consideration when performing a pivot transfer for a patient with Total Hip Arthroplasty (THA)?

Block the non-operative leg to avoid violating precautions. Signup and view all the answers

Under what circumstance would a squat pivot be preferred over a stand pivot transfer?

The patient cannot stand fully but can bear partial weight. Signup and view all the answers

What is the optimal direction for a squat pivot transfer with a patient who has had a cerebrovascular accident (CVA)?

Toward the stronger, unaffected side. Signup and view all the answers

When should a gait belt be utilized during patient transfers?

In any standing, pivoting, or ambulatory transfer activity. Signup and view all the answers

What should you do if a patient is non-weight bearing (NWB) during a stand-pivot transfer?

Keep the NWB leg elevated and pivot on the stronger leg. Signup and view all the answers

What precaution is important to take when a patient uses a transfer board?

Advise the patient to keep hands away from the edges of the board. Signup and view all the answers

What method should be used to assist a patient with shoulder pain during a transfer?

Transfer toward the left side to reduce the load on the right shoulder. Signup and view all the answers

What is the primary action a patient should take to safely transition from sitting to standing during a transfer?

Push down through the armrests Signup and view all the answers

Which of the following is a key consideration when preparing the environment for transferring a patient with Total Hip Arthroplasty (THA)?

Ensure the transfer surface is at a proper height Signup and view all the answers

In the context of blocking limbs during a transfer, what is the protocol if a patient has one reliable leg and one unreliable leg?

Block the unreliable leg 1:1 or 2:1 Signup and view all the answers

When executing a squat pivot transfer, which indication suggests that this method is preferable over a stand pivot transfer?

The patient has limited trunk control Signup and view all the answers

What is the recommended approach when transferring a patient with a cerebrovascular accident (CVA)?

Transfer toward the stronger side as much as possible Signup and view all the answers

In what situation should a physical therapist block both legs during a transfer?

When both legs are weak or unreliable Signup and view all the answers

What is the recommended method of guarding a patient who is about to be transferred to ensure their safety?

Use a gait belt and maintain a stance on the patient's stronger side Signup and view all the answers

Which of the following actions is crucial when completing the transfer process for a patient?

Instruct the patient to reach back with both hands to lower themselves Signup and view all the answers

What is the primary goal of using a gait belt during patient transfers?

To provide a secure hold for transferring and prevent falls Signup and view all the answers

During a transfer for a patient who is classified as partially reliable on both legs, what is the appropriate blocking strategy?

Block the stronger leg 1:1 or 2:1 Signup and view all the answers

When preparing the environment for a stand-pivot transfer, which of the following should be prioritized?

Removing any obstacles between the patient and the new surface Signup and view all the answers

Which technique is advised when performing a squat pivot transfer?

Facilitate a slow, rocking motion for better momentum Signup and view all the answers

What should be taken into account when choosing footwear for a patient during transfers?

Ensure shoes fit properly to provide adequate support Signup and view all the answers

What should be avoided when performing a transfer for a patient with a Total Hip Arthroplasty (THA)?

Transferring on the operated leg side Signup and view all the answers

In a scenario where a patient is non-weight bearing (NWB), which protocol should be followed?

Completely avoid any movement of the NWB leg during transfers Signup and view all the answers

Which of the following is a key safety consideration during patient transfers?

Secure brakes on the wheelchair and transfer surfaces Signup and view all the answers

What is a primary consideration for a patient recovering from a cerebrovascular accident (CVA) when performing transfers?

Positioning the patient with their stronger side facing the direction of movement Signup and view all the answers

Which aspect is NOT essential when preparing the environment for patient transfers?

Keeping the wheelchair in a moving state Signup and view all the answers

What is the recommended strategy for minimal weight-bearing (NWB) patients during transfers?

Utilizing supportive devices and ensuring assistance is provided Signup and view all the answers

In a squat pivot transfer, what must the patient be able to demonstrate?

Some level of leg strength and ability to follow simple directions Signup and view all the answers

What crucial aspect should be monitored during guarding and safety considerations?

Observe both verbal and non-verbal responses throughout the transfer Signup and view all the answers

Why is the use of gait belts emphasized during transfers?

Gait belts provide a means to ensure proper weight distribution Signup and view all the answers

What precaution should be taken when a patient uses socks or shoes during a transfer?

Ensuring shoes or grippy socks are worn to prevent slipping Signup and view all the answers

Which is NOT an indication for utilizing a stand pivot transfer?

Patient's lack of leg strength Signup and view all the answers

What is an important verbal cue to provide during a pivot transfer?

Use short and crisp commands to direct movements Signup and view all the answers

When should the plan for a transfer be described to a patient?

Before initiating any movement when the patient is safe Signup and view all the answers

Study Notes

Naming Pivot Transfers

Pivot transfers are named by their direction of movement, for example left pivot transfer.

Foot and Hand Placement in a Stand Pivot Transfer

The patient's feet should be on the ground with the stronger foot slightly forward.
The patient places one hand on the chair's armrest while the therapist assists with a gait belt.

Using a Gait Belt

Use during transfers, mobility tasks, and when the patient has poor balance or strength.

Helping a Patient Move Forward in a Chair

Use weight shifting or side-to-side rocking.
The therapist can gently assist by lifting from behind.

Blocking Both Knees in a Stand Pivot Transfer

Block both knees if both legs are weak or unreliable to prevent buckling.

Blocking One Leg in a Stand Pivot Transfer

Block the weaker leg to prevent buckling.

Pivot Transfer with a Total Hip Arthroplasty (THA)

Block the non-operative leg to avoid hip flexion beyond 90 degrees.
Avoid twisting and keep minimal flexion at the hip.

Squat Pivot Transfer

Use when the patient cannot fully stand but can partially bear weight.
Different from a stand pivot, the patient remains partially seated.

Squat Pivot Transfer with Cerebrovascular Accident (CVA)

Transfer toward the stronger, unaffected side to reduce strain and improve stability.

Stand Pivot Transfer with Non-Weight-Bearing (NWB) Patient

Keep the NWB leg elevated, and ensure it doesn't bear weight.
Pivot on only the strong leg and the therapist may need to give more assistance.

Using a Transfer Board

Advise the patient to keep their hands away from the board edges to avoid pinching or injury.

Transfer Board Use with Right Shoulder Pain or Weakness

Transfer towards the left side to reduce stress on the problematic shoulder.

Transfer Board Use from Wheelchair (WC) to Bed

Position the WC angled toward the bed with minimal gap for stability and easier access.

Transfer Board Use with Spinal Cord Injury (SCI) to Prevent Slipping Forward

Use a gait belt or towel roll under the thighs to prevent forward sliding.

Anterior-Posterior (A-P) Transfer from WC to Bed

Maintaining balance and alignment while moving backward is challenging.
It is especially difficult if the patient lacks core stability or arm strength.

Options for Teaching WC to Floor Transfers for SCI Patients

Sideways transfer
Forward transfer
Backward transfer
Using a transfer board

Best WC to Floor Transfer Option for Limited Range of Motion (ROM) or Shoulder Pain

Sideways transfer because it minimizes shoulder stress and is adaptable.

Modifications for a Backward Lift from Floor to Chair with Weak Patients

Utilize incremental height surfaces to step up.
Use a sliding method to reduce the lift demand.

Transfer Strategies

Levels of assistance:
- Independent: Patient performs the task safely, timely, and consistently; modifications may be required (time or device)
- Supervision: Patient performs 100% of the task but needs oversight
- Minimal Assistance: Patient performs more than 75% of the task (or less than 50%, 25%); Number of assistants required must be specified (e.g., maximum assist x2)
- Total Assistance: Patient performs less than 25% of the task; or task is not testable.

Pivot Transfers

Types: Stand pivot, Squat pivot, Step pivot.
Named based on: Direction of the patient's hip movement
Stand Pivot Transfer:
- Indications: Patient must have leg strength and balance to stand fully, follow directions, and weight-bear on at least one lower extremity.
- Preparation:
  - Ensure equal surface heights (or adjust for THA).
  - Remove footrests, leave both armrests.
  - Lock wheelchair.
  - Explain the transfer and demonstrate in a safe position.
  - Gait belt and shoes are essential.
- Procedure:
  - Patient scoots forward: using up and forward motions, with weight shifts, or sliding (last resort). Never hold the patient's neck to scoot.
  - Feet should be underneath the patient, with the inside foot forward for a wide base of support.
  - Patient pushes down on the armrests to stand.
  - Blocking:
    - Both legs strong: No blocking
    - Both legs strong, first time transfer: Block 1:1 or 2:1
    - Both legs weak: Block both legs 2:2
    - One leg strong: Block the weaker leg 1:1 or 2:1 (unless THA, never block the operated leg).
    - Both legs partially reliable: Block the stronger leg 1:1 or 2:1.
  - Patient stands fully, pauses, turns, and lowers themselves down on the new surface.
- Cues: "Scoot, stand, turn, sit."
- Guard: Wheelchair brakes, gait belt, guarding, and shoes!

Special Case Considerations

THA:
- Modified stand pivot: Use STEP PIVOT to avoid hip rotation beyond 90 degrees.
- Prepare: Ensure surface height is high enough to maintain 90 degrees, externally rotate the operated leg.
- Procedure: Patient scoots to the edge of the bed with a backward lean, stands with leg in external rotation, steps instead of pivoting.
CVA:
- Transfer toward the stronger side whenever possible.
- Support but DO NOT PULL on the involved upper extremity.

Key Considerations for Transfer Decision Making

Direction to pivot: Assess which direction is safer and more efficient given the patient's condition and environment.
Blocking stance: Consider the patient's leg strength and balance to decide on blocking one or both legs.

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Description

This quiz covers the techniques and considerations for performing stand pivot transfers with patients, including the use of gait belts and strategies for blocking legs. It's essential for caregivers to understand these techniques to ensure patient safety during transfers, especially for those with limited mobility. Test your knowledge on the various methods and their applications in therapy settings.