Session 12 Lab Guide (Student) PDF

Session 12 Lab Guide ==================== ### Learning Goal: Safely and effectively utilize foundational intervention strategies when working with non-complex patients ### Course Goal 8: Transfer patients effectively Levels of Assistance -------------------- - **Independent** (Safely, Timely,...

Session 12 Lab Guide ==================== ### Learning Goal: Safely and effectively utilize foundational intervention strategies when working with non-complex patients ### Course Goal 8: Transfer patients effectively Levels of Assistance -------------------- - **Independent** (Safely, Timely, Consistently) - **Supervision** (pt. performs 100%) - **Minimal Assistance** (pt. performs [\>]75% \]50%\]25%\ - Added - Assessed - Cued (verbal, manual, proprioceptive) - Demonstrated - Educated - Modified - Monitored - Progressed - Provided - Reviewed - Trained - Instructed Dependent Transfers ------------------- - Skills: ------- - Zero / Hoyer Lift - Dependent Lateral Transfer (plinth to plinth) with Draw Sheet - Dependent Lateral Bed Chair - Dependent Vertical Transfer Floor Bed - Dependent Pivot Transfer Key Considerations for Dependent Transfers: --------------------------------------------------------------------------------------- - Gather supplies - Prepare area - Position and secure surfaces - Communicate and coordinate - Secure grasp - Good body mechanics - Get assistance if needed - Complete the transfer - TOTAL BODY LIFT/ ZERO LIFT/HOYER LIFT DEPENDENT TRANSFERS ========================================================= - Indications for Total Body Lift - Point-to-Point Transfers (seated or supine) for extensive assistance or total dependence when no direct therapeutic intervention is desired in the transfer process - B LE non-weight bearing (NWB): when a patient cannot perform a seated lateral transfer without breaking precautions - All dependent transfers Old Key with solid fillKEY POINTS for Zero Lift Transfers --------------------------------------------------------- - **Plan Ahead!** Plan for the placement of equipment and the amount of excursion the lift will need to move through **Floor lift:** base positioned perpendicular to the bed and under the bed if possible - adjust as needed based on circumstances (may not always fit in the environment ie. Bathroom) - watch the cross-bar above pt's head - watch for wrinkles in the sling - Always Complete the Transfer! - 2+ PERSON DEPENDENT TRANSFERS ============================= - Plinth to Plinth ---------------- - Potential Clinical Uses: - **Repositioning**: When a pt is poorly positioned and requires dependent reapportioning you may use an assistive transfer device like a trapeze, slippery sheet, or a draw sheet - **Plinth to Plinth:** used when a dependent pt needs to be moved from one surface to another horizontal surface. Goal is to **reduce friction** between the pt and the transfer surface, reduce sheering and optimize pt and PT safety - Make sure you look at the distance covered, width of surfaces and height of the adjacent surfaces, need for head control, external devices/lines/tubes, musculoskeletal complications, weight, pt's psychological condition - Pt weight: - If pt weighs 100-200lbs need 2 people with device (slippery sheet, air assisted, transfer board) - \200 lb minimum of 3 people plus device - If pt is fearful: - Use small incremental steps to allow your pt to adjust - Move slowly and with control - If pt lacks head control or has an external device: - Small, slow movements - Use transfer device with sufficient support - Get help! An addition person to support for safety - Requires 2+ people: - 2 people (head and foot) - 3 people (sides) - Potential Equipment Used: - Draw Sheet - Typically requires 3 people: - Two clinicians on the side the patient is moving toward - One clinician on the opposite side - Roll patient to each side to place sheet underneath patient - Hold sheet with **supinated grip** - **Clinicians may need to place one knee on the bed or climb up on the bed or plinth during the transfer to maintain good body mechanics**. - Slippery Sheet - Transfer Board - Roller Board -  Safety Considerations- - Leave patient safely positioned. - Stabilize both surfaces. - **Body mechanics:** - If you must move a distance laterally: - Do not use forward trunk lean - Consider small incremental steps to allow clinicians to reposition themselves - Minimize lumbar flexion by lifting 1 leg - If you must transfer across wide surface: - Do not use forward trunk leaning - Kneel on the bed using pelvis and LEs to stabilize the trunk - Use a series of small steps - Megaphone with solid fillSteps for **Lateral Transfers:** 1. Let pt know what to expect and check the equipment 2. Place device under pt, roll pt to the slide and slide under or if a sheet fold half the sheet accordion or fan-style and then turn the pt to the other side and smooth it out under the pt 3. Bring the 2 surfaces close together and minimize the height difference, stabilize both surfaces 4. If 1 person is performing the transfer be near the pelvis CCDD, if other people put the tallest position toward the pt's head and the shorter at the feet a. Can also position on either side of the pt 5. Grip with a supinated power-grasp 6. Coordinate the transfer, person near head is in charge and will occur in 1 movement or small movements 7. Move on the count of 3 - Bed to Chair and Chair to Bed Dependent Lift Transfer (Lateral 2 Person Lift) ============================================================================= - Patient Considerations: - Pt must be able to wt bear through BLEs and have some voluntary muscle tone of one or both legs - Therapist Considerations: - Position one clinician behind the patient **preferably the taller and stronger clinician** - Position another clinician in front of the patient at the feet - When returning to the bed: - To minimize the need for repositioning be sure to **situate the patient's hips 1/3 down from the head of the bed** - When returning to the chair: - To minimize the need for repositioning be sure to **situate the patient's hip as far back in the chair as possible** - Prior to the Transfer: - Prepare patient - Communicate! - Shoes or non-skid slippers - Prepare the environment - Lower bed as needed - In line with the chair height - Position chair - Move chair close - Remove arm and leg rests - PTs Plan and Prepare - Make sure stable BOS- - PT behind: may have 1 foot on floor behind the drive wheel and 1 knee on bed - PT in front: squats or half knees perpendicular to the pt's legs facing the bed - During the Transfer: - Hold pt securely - PT Behind: Fold arms across chest and then PT reaches under the pt's upper arms and with a pronated grip grasps the forarms to "lock" the UEs and maximize control - PT in front: legs on forearms with legs close to the body - Cue pt - Lift, shift, lower - Person in front cues with count of 3 because they can see the pt's face and readiness - PT in front creates the lateral movement by stepping forward - Both PTs bend knees to lower---WATCH BODY MECHANICS - Perform in a single movement - After the Transfer: Complete the Transfer -  Safety Considerations: - Gait belts are used at all times in this class. Guarding is needed at all times when the pt is seated on the EOB and the PT is placing the gait belt or bringing the wheelchair closer - Body Mechanics: Use your core and legs - Hold the patient securely - Megaphone with solid fillSteps for Lateral Transfers: - On the count of 1-2-3 - **Lift, shift, and lower** 1. - Floor to Chair and Chair to Floor (Vertical Dependent Lift) =========================================================== - Key Decisions for therapist placement: - When 2 people are lifting, the stronger and or taller person should be behind the patient to lift the upper body - The person in front should be as **close to the patient's CoM** to support the lift as much as possible, lifting the lower trunk, pelvis, and BLEs - The clinician behind the patient uses lower extremities (LEs) rather than upper extremities (UEs) to lift - The clinician in front must squat to the level of the patients LEs - The clinician in front of the patient faces the direction of the lateral move. - The clinician behind the patient must clear the drive wheels and hand grips. ### KEY POINTS for Floor to Chair and Chair to Floor Transfers - Good body mechanics are key: clinicians must bend at the knee - Avoid twisting- work on lateral weight shifting - Ensure flat footed with wide base of support with knees bent not crouching - Ensure the PT at the legs is moving forward and not backward - Prepare the environment - Casters forward (increases the BOS), locks on, remove leg rests and arm rests if needed - Prepare the pt: explain and engage - Prepare the clinician - Coordinate movement in advance - Similar to the bed-\ w/c but with a deeper squat - PT at feet calls the transfer because they have better view of pt's face [ ] - DEPENDENT PIVOT TRANSFERS (bed to wheelchair) ============================================= - **Indications for Dependent Pivot Transfers:** Are used for dependent transfers when patient can bear weight BLEs and has some voluntary muscle tone of one or both legs - Can be used for a patient with impaired strength or cognitive deficits - - - - - Prepare patient - - - - - - - - During the Transfer - Blocking at the knees provides counterforce to prevent the tibias from going forward due to the hip/knee/ankle flexion movement - If pt needs maximal assistance may need 2:2 - Position pt's feet together and slightly staggered - PT places medial aspect of both knees against antero-lateral aspect of pt's knees as close to midline - After the Transfer: Complete the Transfer - Construction worker female with solid fill Safety Considerations- - **Be sure you are always in contact with the patient** - Use the gait belt - Guard carefully to prevent the patient from sliding off the edge of the bed. - Shoes!!! - Cues for **Lateral Transfers:** - Lift, pivot, and lower - **Supply means to call for assistance** Signature outlineDocumentation Tips: ==================================== - Describe the TYPE of transfer performed or taught to the patient or caregivers - Describe the AMOUNT of assistance, be sure to be specific and note what the assistance is for - Indicate the NUMBER of persons involved in the transfer (ex. X3 means with 3 people) - Indicate the LEVEL of safety - Note the level of CONSISTENCY of performance - EQUIPMENT or devices used Summary ------- - Risk of injury is much higher with dependent manual lifts than with mechanical lifts. Be sure to focus on **Core stability, Good posture, Body mechanics** - **Plan Ahead:** clinicians must be able to manage the load created by the patient, as well as any lines, leads, or tubes. - **Get assistance if needed** it is always better to be safe than sorry!! - Know your contraindications - Move patient using **good body mechanics**. - **Always provide a means to call for assistance** Summary Questions Dependent Transfers Lab ----------------------------------------- 1. What are some indications for use of a Hoyer lift? 2. What special considerations would you have in using a Hoyer lift for a patient with THA? 3. Would you use a Hoyer lift for a patient immediately s/p PSF? If not, why not and what is your alternative? 4. What do we mean when we say "Complete the Transfer"? 5. What is the purpose of using a slippery sheet? What other devices might you use for this purpose? 6. When would you opt for a transfer board over a slippery sheet in doing a lateral transfer? 7. When doing a lateral transfer, what position should your hands be in? why? 8. What might be some reasons you would need 3 people for a lateral transfer? 9. You are doing a 2-person vertical lift from wheelchair to bed. Describe the position of the two people lifting and the position of the patient 10. What cues would you use to communicate in transferring from chair to bed? 11. What are the most common errors clinicians make in doing floor to chair transfers? End activity SOAP note **S: reported bright lights hurting eyes, Light sensitivity** **Obj: squat pivot, emphasized AMAP/ANAP lateral scoot, lift and shift, Min A needed for lateral transfer, less cues needed, placed in long term supine** Here are answers for transferring techniques, especially with the Hoyer lift and other support equipment: 1\. \*\*Indications for Using a Hoyer Lift\*\*: \- Patients who are \*\*non-weight bearing\*\*, \*\*completely dependent\*\*, or unable to assist in transfers due to \*\*severe weakness, decreased mobility, paralysis, or unsteady balance\*\*. It's also helpful for those with high fall risks or requiring \*\*frequent transfers\*\*. 2\. \*\*Special Considerations for a Patient with THA (Total Hip Arthroplasty)\*\*: \- Ensure the \*\*affected leg remains in neutral\*\* or slightly abducted and avoid \*\*hip flexion beyond 90 degrees\*\*. Place the patient's hips and knees in proper alignment, avoiding adduction or internal rotation. Make sure the sling and leg straps are positioned to \*\*prevent rotation\*\*. 3\. \*\*Use of a Hoyer Lift for a Patient Immediately s/p PSF (Posterior Spinal Fusion)\*\*: \- Generally, a Hoyer lift isn't recommended right after PSF due to \*\*risk of spinal movement\*\*. Instead, use a \*\*log roll technique\*\* or \*\*slippery sheet with assistance\*\* to maintain spinal alignment and reduce strain on the spine. 4\. \*\*What Does \"Complete the Transfer\" Mean?\*\* \- "Complete the transfer" refers to ensuring the patient is \*\*securely positioned and comfortable\*\* at the end of the transfer, removing equipment, adjusting positioning for support, and making sure they have \*\*access to necessities\*\* like call buttons or blankets. 5\. \*\*Purpose of a Slippery Sheet\*\*: \- A slippery sheet reduces friction, making \*\*lateral transfers easier\*\* and less strenuous for both the patient and caregiver. Other devices, like \*\*transfer boards, air-assisted transfer devices, and roller boards\*\*, can also serve this purpose. 6\. \*\*Opting for a Transfer Board over a Slippery Sheet\*\*: \- Use a transfer board if a patient has \*\*some upper body strength and control\*\*, allowing them to assist with the transfer, or when \*\*bridging a larger gap\*\* between surfaces, as transfer boards provide a solid base for the move. 7\. \*\*Hand Position for Lateral Transfer\*\*: \- Hands should be placed \*\*open and flat\*\* on the patient's back or support surfaces to \*\*distribute pressure evenly\*\* and maintain control. Avoid grabbing to minimize pressure points. 8\. \*\*Reasons for Needing Three People for a Lateral Transfer\*\*: \- Three people are needed if the patient is \*\*heavier, has limited control, or requires strict spinal precautions\*\* to maintain alignment. This setup ensures the patient can be moved smoothly and with minimal strain on caregivers. 9\. \*\*2-Person Vertical Lift from Wheelchair to Bed\*\*: \- One person is positioned behind the patient, supporting their \*\*torso and shoulders\*\*, while the other stands in front, supporting the \*\*legs or under the knees\*\*. The patient should be in a \*\*semi-seated position\*\* to avoid strain on the back. 10\. \*\*Cues for Chair-to-Bed Transfer\*\*: \- Use clear, sequential cues, like "On the count of three, we're going to stand," or "Lean forward," and "Reach toward the bed." Emphasize commands like "lift," "pivot," and "sit" to synchronize movement. 11\. \*\*Common Errors in Floor-to-Chair Transfers\*\*: \- Some common errors include \*\*improper body mechanics\*\* (leading to strain or injury), \*\*not using enough assistance or equipment\*\* when needed, lack of clear communication, and \*\*failure to properly support\*\* the patient's weaker side, causing instability.