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CHAPTER OBJECTIVES

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At the completion of this chapter, the reader will be able to:

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  1. Understand the importance of choosing the most efficient and safest method of transfer and mobility task

  2. Determine the best transfer or mobility procedure based on the level of patient dependence or independence

  3. Discuss the importance of patient safety during transfers and mobility tasks

  4. Discuss the importance of clinician safety during transfers and mobility tasks

  5. Transfer a patient to and from a number of different types of surfaces

  6. Perform a variety of mobility tasks

  7. Describe the various wheelchair components and their functions

  8. Measure a patient for a wheelchair

  9. Train a patient in how to use a wheelchair

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OVERVIEW

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A transfer can be viewed as the safe movement of a person from one place or surface to another, and as an opportunity to train an individual to enhance independent function. In both cases the clinician must choose the most efficient and safest method.

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Controlling a patient's movement, while moving the patient from one position, or surface, to another, or preventing a patient falling requires that the clinician be close to the center of motion (COM) of the patient, which is typically located between the shoulders and the pelvis. When these points of control are used, patient transfers are more efficient and patient safety is enhanced. The most efficient way to enhance the movement of the patient (unless he or she is totally dependent) is to encourage movement of the distal component of the body—the part of the body that is farthest from the trunk. For example, when assisting a patient to stand from a seated position, a common verbal cue is to ask the patient to lean his or her trunk forward. In addition, it is also important to have the patient look in the direction of the transfer's destination to encourage correct head turning.

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PATIENT TRANSFERS

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One of the purposes of transfers is to permit a patient to function in different environments and to increase the level of independence of the patient. Because of advancements in recent years, a number of moving and lifting devices (total body lifts and sit-to-stand lifts) have been designed and incorporated into the healthcare system. However, because of the expense and sometimes the inconvenience of these devices, manual transfers continue to be commonly used. In these cases, the best body mechanics possible should be used to maximize the ability to encompass a task with minimal effort and maximum safety (see Chapter 10). It is important to note that certain transfers increase the risk for injury (Table 13-1), necessitating additional care and attention. Depending on the functional ability of the patient, a transfer may be performed independently by the patient, with assistance from the clinician (minimal, moderate, maximal, or standby supervision), or dependently (Table 13-2).

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