Considerations For Performing Transfers

    Transfers are performed to help facilitate a client's movement from one surface to another. Transfers are essential for helping clients participate in their activities of daily living (ADL'S). Some clients are completely dependent on transfers and rely on either their therapist or caregiver to safely move them throughout the day. Some common transfers involve moving a client from their bed to a wheelchair, helping them out of their wheelchair for toileting, or helping them get into the shower. While transfers are essential to help the client participate in their daily occupations; if they are performed wrong, the therapist could severely injure themselves or the client.    

    There are many aspects to consider when it comes to performing safe transfers! The first one coming to my mind was the use of proper body mechanics. When performing a transfer, the therapist must utilize their muscle strength and joint forces to achieve optimal power when ambulating clients. The therapist must follow this series of steps to ensure their and the client's safety: first, they will position themselves to where they are standing either in front of or to the side of the client and get as close as possible, next the therapist will need to attain a wide base of support and ensure that they keep their trunk and spine vertically aligned, and finally when lifting the client they must slightly bend their knees and rely on leg muscles such as the glutes, hamstrings, and quadriceps. 

    Coinciding with therapist positioning, client positioning is just as vital when it comes to performing safe transfers. When beginning to position the client, the therapist must first analyze the client's physical abilities, size, and mental cognition. The client will need to move to the edge of the surface they are on and place their feet firmly on the ground with their heels pointed in the direction they are intending to move. With the use of the gait belt, the therapist will then stand them up and facilitate the transfer. 

    Another important topic to consider when performing transfers is making sure all adaptive equipment (such as wheelchairs and walkers) is positioned properly to avoid stumbling or tripping over them. When working with wheelchairs; first, the therapist needs to position the wheelchair perpendicular to the bed, couch, toilet, etc. that the client is moving to, then the therapist must make sure the brakes are engaged,  the caster wheels are turned backward, and the footrests have been moved out of the way or taken off the chair, if possible. 

    An additional aspect to take into account when performing transfers is to check your surroundings. When moving clients, one must clear the area and remove items such as clothes, footwear, footrests, railings, or medical necessities such as catheter tubing (Weisser-Pike, 2023). If the therapist fails to remove these hazards then they are creating a risk of them tripping and likely injuring themselves and their client.

    My final point to consider for performing safe transfers is the use of vocal encouragement and positive body language. In my own experiences with transfers, the difference between caregivers who demand the client to move versus caregivers who speak in a calm and collected manner and encourage the client to shift positions is like night and day. As future occupational therapists, we will be focusing on not only accommodating a client's physical needs but also their mental needs. It is of utmost importance that take into consideration the client's feelings and speak to them in a gentle and cheerful manner that eases the stress that can come with transferring. 

     When writing this blog, I thought it would be a fun idea to ask a transfer expert what the most important part of the process is to her. Tempie, my grandmother's caregiver, has a 40-year-old daughter with Cerebral Palsy so, needless to say, performing transfers have long been a part of her daily routine! Her response to my question was that she believes knowing how to properly "pivot" and use your body weight is essential in making sure transfers go smoothly. From watching her, I have seen firsthand the importance of speaking to your client with kindness and doing whatever it takes to get them to help you out; rather that be dancing, singing, or talking in silly voices. 

Tempie and her daughter, Katrina. 

Weisser-Pike, O. (2023, May). Lecture 10: Bed Mobility and Transfers. OT 430 Biomechanics, University of Tennessee Health Science Center.