The Home Physical Therapist

Caregiver Resources From A Home Mobility Expert

Category: Transfers (page 1 of 2)

4 Tips To Help Get Someone Out Of A Chair

laborer photo

“If you’re sweating you’re working too hard.”

This is what I tell a lot of caregivers I do training with. A lot of caregivers report that they struggle when they’re trying to get their loved one or the patient out of a wheelchair or off the commode we’re out of any seated position. There are basically four reasons that why this may be happening.  And if you keep these things in mind it will make the job of caregiving a lot easier.

1. Not working as a team.

It goes without saying that when two people are trying to accomplish something they get a lot farther when they work together. This is just as important in the job of caregiving. Both people need to be on the same page when they’re trying to do something.

Are you telling your loved one or your patient what you need them to do when you are trying to transfer them?  Are you working together?  Or are you going in opposite directions?  Make sure that you’re trying to work together when you’re trying to perform a transfer or get someone out of a seated position. It will make doing so a lot easier.

If you’re not working together you’re working too hard.

2. Incorrect positioning.

Simply from a mechanical standpoint we as humans need to be in a specific position in order to stand up from a sitting position. Did you know that it was impossible to stand up unless you’re shoulders are over your knees and your feet positioned slightly behind your knees? Well maybe not impossible but a whole lot easier if you were in this position.

A young strapping gymnast has to be in this position in order to stand up easily and efficiently without much effort.  If this is required for a young strapping gymnast how much more important is it for a elderly patient who may have physical limitations?

If your patient isn’t in the right position you will be working too hard.

3.The caregiver needs to be going in the right direction.

A common practice for caregivers is to grab a loved one or a patient under their shoulder through their armpit and attempt to lift them straight out of the chair. This can cause any number of injuries and is pretty uncomfortable for the patient. Especially if they’re frail or have chronic pain.

Remember we are humans and not rocket ships.  When we are standing up we do not go straight up.  Our direction is forward and up.  When a human being stands up from a chair they do not go straight up into the air.  They make an arcing motion forward and upward.

We want to continue with the idea that the patient has to be in the right position with the shoulders above the knees. From here the caregiver want to help the patient move further forward and then upward. This type of motion is totally different from what is commonly done. But it brings the body over the seat which are the base of support and lets the patient balance on their feet before trying to come to an upright position.

If you’re not helping your patient or loved one move in the right direction you’re working too hard.

4.The patient needs to push in the right direction.

While this is the last point it’s certainly not the least point. That’s because many caregivers get the wrong idea that their loved one or patient is actually resisting them when they’re trying to stand them up. They’re not resisting you they just happened to be pushing or moving in the wrong direction against you.

There are a couple of things that are going on with the patient or loved one when they’re trying to stand up. For one thing they are actually afraid of falling forward on to their face and so unconsciously they push backwards were they lean backwards. This makes it more difficult to stand them up when we’re trying to get their shoulders over there nice they are pushing backwards.

Now, at the same time they’re pushing back they’re actually trying to stand up.  However they don’t realize that when they’re pushing with their legs there pushing to the rear and not forward.

The combination of these two errors on the part of the patient makes it very difficult for a caregiver to help stand a person up from a chair or off of the bed, or, off  the toilet. Because when the caregiver is trying to bring them up and forward the patient is trying to push back and upward.

If your loved one or patient is pushing backwards while trying to stand, you’re working too hard.

So what’s the solution?

It goes back to the first point that I made. You have to tell your loved one or the patient exactly what you want them to do so that you’re working as a team. If you need them to bend forward ask them to bend forward or put their shoulders over there knees.

If you need them to push forward versus pushing backwards then ask him to push forward in order to bring the shoulders further over their knees. That way you both will be on the same page and it will not be such a struggle trying to get a person to stand up from a chair or from a sitting position.

Having patience on both parts is extremely important when both of you are trying to learn how to work together to perform a specific task like this. It should be practiced several times a day. Not just in times of necessity like when you’re going to the toilet or need to get up for an emergency. Take some time and practice together when you both can look at the technique and the specifics of it objectively.

Please let me know what you think by leaving a comment.

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This Makes Getting Into and Out Of The Car A Lot Easier

Handy Bar

Have You Ever Seen The Handy Bar?

 

Ever had a hard time with getting your caree into or out of a car before? Whether the client is too short or the car too high…, whether the client is too weak or there’s just not that much room to maneuver, a lot of people fret about the task of having to get into or out of the car safely.

Most of the time the main problem is simply having a good place to hold onto to get some leverage.

With most cars all of the firm and stable things seem to be just out of reach to make your client feel secure enough to patiently and safely get in or out of the car. There’s always the fear of falling in the back of their minds. And, to be honest, it’s there with most care givers too.

So, what do you do?

I stumbled across a cool little tool that I had seen before but had put it in the back of my mind. It’s called the Handy Bar. It’s a pretty simple set up and it gives your caree a solid surface to lean on when doing a car transfer.

The thing that i like about this tool is that it fits in the door frame basically at the exact height (about hip height or a little lower) that most people would need to have a little more support.

It takes no tools or advanced degrees to set up or take down. You simply slip it into the the fixture that keeps the door shut and the design and pressure you place on it keeps the whole thing in place. When you’re down with it, just tilt and lift and it’s out. Pretty simple.

If you’ve ever (or still do) struggle with doing a car transfer with your caree, it might be a good idea to look into something like this to see if it will make your job any easier.

Sure, there are some principles and techniques that you may need to learn. But, it also goes a long way to make sure that your caree has the subconscious security that they need in order to listen to you and help you help them get into or out of the car.

You can get more info on the Handy Bar here.

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The Real Reason It’s Hard To Get Them To Stand Up

“I really can’t get him up by myself. And, even when my son helps, it’s still a struggle. We just don’t know what to do”.

This (or something similar) is a frequent comment that a lot of caregivers make when they share aspects of the job that are more physically challenging than others.

Some family caregivers think that their caree is “too heavy” or that they themselves are “too weak”. Then again, some professional caregivers tend to think that their caree is “fighting” against them and is un-cooperative.

While there may be some truth to any of these assumptions, before jumping to conclusions let’s consider something else.

There are a couple of different things that happen to people who are not as physically active as they had been in previous years. From a mental standpoint, it seems that people actually forget how to move well and become fearful of making a mistake that may lead to falling. Let’s face it. No one wants to fall.

(I also have a gut suspicion that the lack of activity somehow affects how they perceive their balance. But, I haven’t seen any research on it.

I have heard from many a person that I have worked with “I’m going to fall on my face!” when they are nowhere near falling forward. So, that’s why I think that their sense of balance is somehow out of whack.)

Another thing that happens is that people start to use poor techniques and strategies when trying to get up from sitting.

One of the simplest things you can help correct when standing up is to get your caree “off their heels”.

The problem of getting someone up from a chair or from sitting isn’t that “they’re too heavy” or that “they’re fighting” you.

The problem is that, more times than not, they are trying to stand up on their heels. This actually forces them backwards. That’s the primary reason they feel heavy or seem to be resisting your efforts. They’re basically falling backwards with all their weight and taking you with them.

When trying to get someone out of a sitting position, make sure they aren’t doing this:

leaning-into-couch

See the calves pressed into the seat cushion? This tells you that your caree is actually leaning backwards. And, it’s physically impossible to stand up one your two feet while at the same time leaning backwards!

When they are standing on their heels, this is what happens:

Falling Backwards

Falling Backwards

 

What you want to get them to do is move away from the chair, not up from the chair. The body needs to shift forward from the chair. The calves should not be in contact with the chair, bed, commode, etc.

If your caree has dementia or has trouble understanding, it may take awhile to figure out the right commands or suggestions to give so that they get it right.

But, when it’s done the right way, their calves should move away from the chair which allows them to rock forward onto their toes rather than their heels.

rock onto toes

 

And, once a person has rocked forward onto their toes, it’s fairly simple to get to standing from that position.

Give it a try. Test it out on yourself and see if it doesn’t make sense and make standing a little easier.

Once you figure out what’s going on with your caree in the physical struggles, it makes caregiving a lot easier.

 

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The Scoot Pivot Transfer

Doing the scoot pivot transfer is sort of like doing a slide board transfer without the slide board. It’s done by scooting sideways in stages, while at the same time pivoting and repositioning the feet. This movement is done over and over until the patient has transferred from one surface to another.

There are at least a few reasons why someone would choose, or, have to use the scoot technique rather than any of the other types of transfers listed. The following is a short list of those reasons.

The patient is too large to attempt standing. Many times is a patient is overweight or just too large for their caregiver to safely help them get from one seat surface to another. Scooting is a safe way for them to do it while at the same time virtually eliminating the risk of falling.

The patient is extremely fearful. The fear of falling is so great in some people that trying to stand actually becomes too dangerous to attempt. When this happens, using a scoot pivot transfer, while it may take longer, will give your loved one or patient more security when moving.

Most of the time the fear comes from a feeling that they are not in control. By sitting and scooting the patient has secure hold of their seat or bed at all times. If they get overly anxious, they can stop and gather themselves before proceeding.

The patient is a bilateral amputee. An amputee is a person that has had one leg removed. A bilateral amputee is a person who has had some of both legs removed and is unable to bear weight in order to transfer any other way.

Now, this may seem obvious to some. But, the scoot pivot transfer may be a viable option for the bilateral amputee if they don’t have a slide board or aren’t using this technique.

You may not believe it, but, there are those caregivers who are used to picking up their client from sitting on one surface and placing them to sit on another. There may be valid reasons for this but doing it over a period of time can take a toll on a caregiver.

That’s why the scoot pivot is a good option if a slide board isn’t available.

I am sure that there are other situations, scenarios, and diagnoses that will make the scoot pivot a good option. These have just been some of the more common ones.

If you’re going to use this option, there are a couple of things to keep in mind.

In general, you can only use a chair that has removable armrests or no armrests at all for obvious reasons. Most regular wheelchairs fit this description. However, if you’re using a light weight “transport wheelchair” this would not be an option. Most transport chairs do not have removable arm rests.

The patient has to have good balance and endurance. This technique takes a lot of energy to do on the part of the patient.

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The Stand Pivot Transfer

The Stand Pivot Transfer Is Very Common

The stand pivot transfer is probably one of the most utilized transfer techniques. If a loved one or friend has been in the hospital or nursing home, you are probably familiar with it.

People use the stand pivot transfer in medical facilities for most anytime someone needs to get from their bed to a wheelchair or from their wheelchair to a toilet or most any other time.

Generally nursing staff or patients will have their wheelchair next to the bed and a walker in front of them. Using the walker, they stand up and pivot, turning their back to the wheelchair before they sit down.

Most people like doing the stand pivot transfer because it looks like the best way to get from sitting on one object to sitting on another. And it has been used for a long time.

The stand pivot transfer is basically the same as the sit to stand transfer except with a twist. The sit to stand is used to get someone up to walk. On the other hand, the stand pivot transfer is used to get someone up from one seat to another seat surface.

However, it can be challenging if you’re dealing with any of the following challenges:

  • Space is tight and there isn’t much room to move or use a walker
  • The patient has trouble standing up for any reason such as pain or weakness
  • The patient has trouble following directions
  • The patient has trouble moving their feet for any reason after standing up.
  • The patient has trouble managing the walker.

All of the above reasons can make doing a stand pivot transfer more dangerous than some of the other transfer types.

If your loved one or patient has trouble in any of the above situations, you may want to try a modified pivot or scoot pivot transfer.



 

See This Page for Caregiver Training Videos

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The Modified Stand Pivot Transfer

The Modified Stand Pivot Is “Quick and Dirty”

Sometimes patients need a little more assistance, or, they have difficulty using a walker or standing. Or, sometimes you may be in a rush to get somewhere. Using a modified pivot transfer will help in each of these cases.

The modified pivot transfer is a little easier to do and a little more efficient than the traditional stand pivot transfer. But, it may require a little more effort on your part rather than the patients part.

The reason for this is that when modifying the pivot transfer, the patient doesn’t actually have to stand up all the way. They just raise their hips high enough to clear any hurdles as they swing over to the other chair.

Make Sure They’re In The Right Position First

While this technique doesn’t call for the use of a walker, it does work a lot better if the patient is “pre-positioned” prior to attempting to transfer.

To pre-position a patient, the patient needs to turn their back toward the direction that they’re moving in. And, also point their toes away from the seat that they are moving toward.

When a person is positioned correctly, there is no need to take any steps. The only movement in the feet is a twisting, or pivoting, as they swing their rear-end over to the new seat surface.

Remember Not To “Lift” The Patient

One thing that caregivers need to keep in mind with this and all transfers is not to “lift” or “pick up” the patient. This is where many caregivers go wrong.

The modified pivot transfer relies on the caregiver “rocking” the patient forward shoulders over knees and once the hips are airborne, they are swung “into place”.

When done correctly this technique makes transferring a patient out of bed or out of a wheelchair as simple as can be. Its typically a lot faster and the patients tend to prefer this because there is actually less opportunity to fall.

Most patients who need help with transfers generally have a fear of falling either when they are standing or when they have to take any steps. The modified pivot eliminates both of these factors.

But, in case your loved one or patient has difficulty doing the modified pivot, they may be able to do the scoot pivot transfer.

 



See This Page For Caregiver Training Videos

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