Transfers

A transfer is used by occupational therapists and other health care professionals to assist a client in moving from one place to another. Transfers are commonly used in positioning a client on/off a bed, chair, wheelchair, toilet, or even in/out of a bathtub. When performing a transfer with a client, it is important to consider the client's muscle tone, range of motion, balance, ability to hear prompts, ability to feel and respond to physical guidance from the practitioner, and cognitively apply the practitioner’s verbal direction to the task of transferring. The client's ability to perform a transfer with assistance may determine the type of transfer performed and the amount of assistance needed by wither the practitioner or more advanced transferring equipment. In order for the practitioner to ensure safety for both themselves and the client, it is important to take into account any medical precautions that client is under, properly prepare the environment for a transfer, fit the client into a gait belt, give clear verbal direction to the client throughout the transfer (demonstrate if needed), and directly assist the client in performing motions by using physical prompts. 

By doing a thorough chart review to gain information about your client’s needs and precautions, the practitioner will know prior to transfer what limitations the client might have as well as precaution that the overseeing physician may have placed on the client due to a medical condition. Doing this will prepare the practitioner to adjust the transfer in any way needed, such as allowing for more time to adjust when the client moves from lying down to seated position and seated to standing position. Additionally, this will contribute to the practitioner’s to assessment of the client’s ability to perform certain transfers and if additional people or equipment may be needed in assisting with transfer. 

The practitioner should also take time to diligently prepare the environment and equipment being used for transfer. It is important that if the client is transferring from a wheel chair that the practitioner remove the leg rests are removed from the wheel chair and moved away from the area that the transfer is taking place, wheelchair breaks are locked, and the caster wheels are facing inward. And for any type of transfer, it is vital that all obstacles are removed from the area the transfer is being performed and that the practitioner aligns the surfaces in a way that allows for the client to move the minimal distance from one surface to another.

One of the most important part of guiding a client through a transfer is outfitting them with a gait belt. This is a belt that is adjusted to fit the client’s form and works as a point of contact between the client and the practitioner. The gait belt is one of the major safety measures used during a transfer because it gives the practitioner a firm and stable grasp on the client without the potential for injury that could occur if the client was being held directly. 

Another important part of a transfer is the practitioner’s ability to concisely direct the client to a successful transfer. The practitioner must use clear language and keep in mind the client’s cognitive and hearing status. If the client does not understand the process and their involvement needed in a transfer, the safety of the transfer will decrease because the client will become dependent on the practitioner, often leading to injury of both parties. 

The practitioner will provide physical prompts to promote movement of the client’s body. By putting pressure on certain areas of the client’s body, the therapist is able to guide them through movements in a way that decreases likelihood of skin tears, falling, and injury. An example of this during a transfer is when the practitioner applies pressure to the Tibia to prompt the client to stand up from a seated position. 

The ability to perform a transfer is important knowledge to have as an occupational therapist because clients in almost every setting may need assistance in moving from one place to another in order to perform the therapist’s interventions in addition to ADLs such as toileting, bathing, and sleeping. By applying our knowledge of the safety measures involved in performing a transfer, we are able to move our clients toward performing necessary occupations.