Page 23 - Mobility Management, August/September 2020

their primary mobility device. Thus, this includes many people: Users status post cerebrovascular accident, amputation, traumatic brain injury, spinal cord injury, multiple sclerosis, etc. For each person, we base the transfer technique on what skills exist and when deficits need to be compensated for.
“For example, a client with poor balance would be instructed on a transfer during which they are always in contact with stable surfaces and never are letting go fully (i.e., hand on bed, and other hand remains on
the wheelchair armrest, low pivot). The technique for a client with spinal cord injury would change depending on the level of injury: Clients with lower injuries are usually successful with depression-style ‘push-up’ transfer techniques, while clients with higher injuries may start off with a sliding board and progress to a depression-style transfer. In general, the key elements remain: wheelchair position and parts prep; hand and foot/feet
placement; and head/hips relationship to maximize weight shift.”
Techniques & Tune-Ups
Another potential transfer complication is that equipment and techniques that work well earlier in a wheelchair user’s life can lose their efficiency as clients age and their bodies change. For example, after years of self propelling and transferring, ultralightweight users could experience shoulder wear.
“Because of that population being so vulnerable, that shoulder being so vulner- able, I always start by watching the person transfer,” Sweeney said. “That’s when I decide, ‘This person needs a tuneup.’ Or this person can transfer successfully: They’re not shearing, but they’re putting themselves in a very vulnerable position for injury. They’ve been doing it a long time, and they’ve been getting away with it.”
Sweeney said she asks about daily routines: “I try to ask each person what
they do, other than transfers, in their daily life for their body and for strengthening. Folks are overworking the anterior muscles of their shoulders and chest, and their posterior muscles become overstretched. If you’re not working on them, that scapular position ends up protracted and forward and dumping their shoulder joints. So I try to do education about posterior struc-
ture strengthening: stretching the front, strengthening the back, and why. And basically saying yes, you’re successful now, but you have decades more. We need to make sure your shoulders are there for you throughout everything.”
Peterson emphasized that transfer routines need to be re-evaluated regularly to determine if adjustments are needed. “We tend to look at certain diagnoses,
like spinal cord injuries, and think their capabilities are either going to get better or they’re going to get worse. A lot of folks are in a steady state and have been transferring
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