Functional Training 11/2/2016

DEFINITION OF TERMS

FUNCTIONAL TRAINING • Transfer

 Safe movement of a person from one surface
or location to another or from one position to
another
 Act of moving or pattern of movements by

Physical Therapy 1 Lecture

which the patient moves from one position in
College of Rehabilitation Sciences
space a short distance to another position
 Includes bed mobility skills

TERMINOLOGY FOR TRANSFER OR

PURPOSE
AMBULATION ASSISTANCE

• To permit patients to function in various • Independent

settings and make use of various • Assisted
 Standby assistance or supervision
equipments
 Minimal assistance
• To increase patient’s level of independence  Moderate assistance

• To prevent complications of prolonged  Maximal assistance

immobility • Dependent assistance

• Guarding
 Close guarding
 Contact guarding

TERMINOLOGY FOR TRANSFER OR TERMINOLOGY FOR TRANSFER OR

AMBULATION ASSISTANCE AMBULATION ASSISTANCE

• Independent
 Patient does not require any physical
supervision or assistance from another person
to consistently perform the activity safely and in
an acceptable time
 May sometimes use specific equipment or
devices
• Assisted
 Patient requires assistance from another
person to perform the activity safely in an
acceptable time
 Oral or tactile cues, directions, or instructions
may be used

Anne Marie Co-Aseron, MSPT 1

Functional Training 11/2/2016

TERMINOLOGY FOR TRANSFER OR TERMINOLOGY FOR TRANSFER OR

AMBULATION ASSISTANCE AMBULATION ASSISTANCE

• Standby assistance or Supervision • Minimal assistance

 Patient requires verbal or tactile cues,  Patient performs 75% or more of the activity
directions or instruction from another person  Assistance is required to complete the activity
positioned close to, but not touching, the
patient to perform the activity safely and in an
• Moderate assistance
acceptable time  50% - 75% of the activity
 Assistance may provide protection should the • Maximum assistance
patient’s safety be threatened  25% - 50% of the activity

TERMINOLOGY FOR TRANSFER OR TERMINOLOGY FOR TRANSFER OR

AMBULATION ASSISTANCE AMBULATION ASSISTANCE

• Dependent assistance • Guarding

 Patient requires total physical assistance from  Patient requires guarding during the
one or more persons to accomplish the activity performance of the activity for safety
safely and in an acceptable time  Cues or directions may be used
 Special equipment or devices may be used

TERMINOLOGY FOR TRANSFER OR TERMINOLOGY FOR TRANSFER OR

AMBULATION ASSISTANCE AMBULATION ASSISTANCE

• Guarding • Guarding
 Close  Contact
 Caregiver positioned close to, but not touching, the  Caregiver positioned close to the patient with the
patient hands on the patient or safety belt
 Minimal likelihood of the patient requiring  High likelihood of the patient requiring protection
protection during the activity during the activity

Anne Marie Co-Aseron, MSPT 2

Functional Training
PREPARATORY ACTIVITIES PRIOR
TO FUNCTIONAL TRAINING
• Muscle strengthening exercises
• Development of joint and muscle flexibility
• Endurance training
• *Sitting and standing tolerance
GENERAL TRANSFER PRINCIPLES
• Practice components of the transfer as
necessary before attempting the entire
transfer
• Position yourself to guard and protect the
patient throughout the transfer (primary responsibility)
• Request the patient to initiate and perform
the transfer; assist as necessary
GENERAL PRECAUTIONS DURING
TRANSFERS
• Patient’s clothing and footwear should be
suitable for the transfer
• Mentally preplan the activities and
sequence associated with the transfer
• Be alert for unusual events that may occur
• Do not guard the patient by using his
clothing or grasping his arm
Anne Marie Co-Aseron, MSPT
11/2/2016
GENERAL TRANSFER PRINCIPLES
• Evaluate the patient to determine his mental
and physical capacities to perform the
transfer
• Select, position and secure needed
equipment; apply safety belt on the patient
• Instruct the patient how to perform the
transfer, demonstrate as necessary
GENERAL TRANSFER PRINCIPLES
• Guide and direct the patient throughout the
transfer and closely guard him
• At the conclusion of the transfer, position
the patient for comfort, stability and safety;
document changes
GUIDELINES IN TEACHING
TRANSFERS
• Explain and demonstrate the procedure to
the patient
 Brief, concise and action oriented
• Prepare all necessary equipments
• Immobilize and secure transfer surfaces
e.g. brakes
• When in doubt about the level of assistance
required by the patient, ask for assistance
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Functional Training 11/2/2016

GUIDELINES IN TEACHING GUIDELINES IN TEACHING

TRANSFERS TRANSFERS

• Use commands and counts to synchronize
actions of participants in the transfer
• Guard the patient against falls
• Direct contact with the patient during
transfers is very important
 Permits best biomechanical posture
 Provides proprioceptive input or feedback to
patient regarding the direction of movement
• Allow the patient to use all available and
necessary function
 GOAL:TO ATTAIN HIGHEST LEVEL OF
FUNCTION
• A transfer is only complete when the patient
is moved safely in the new position
 Consider appropriate positioning and draping

DEPENDENT TRANSFERS MECHANICAL TRANSFER

• Mechanical transfer • Hydraulic lift

• Pull sheet transfer  Mechanical device that provides a method for
• Three-person lift transfer one person to transfer a dependent patient
 For very large patients and for those who are
• Dependent standing pivot extremely dependent
• One-person lift transfer

PULL SHEET OR SLIDING TRANSFER THREE-PERSON LIFT/CARRY

• Sliding transfer from cart or stretcher to a
treatment table
• Cart is usually positioned parallel to the
treatment table or bed
• Draw sheet is placed under the px
• When treatment table and cart cannot be
positioned parallel to each other
• Cart is positioned and secured at right
angle to the treatment table

Anne Marie Co-Aseron, MSPT 4

Functional Training
DEPENDENT STANDING PIVOT
• For patients who are unable to stand
independently but can bear some weight on
their LE’s (weakness, paresis, or paralysis)
ASSISTED TRANSFERS
• Two-person lift transfer
• Sliding board transfer
• Push-up transfer
• Assisted standing pivot transfer
• *Standby standing pivot transfer
SLIDING BOARD TRANSFER
• When a patient has enough strength to lift
his body and adequate sitting balance to
move but still unable to perform a push-up
transfer
Anne Marie Co-Aseron, MSPT
11/2/2016
ONE-PERSON LIFT TRANSFER
• Dependent sitting transfer when patient falls
out of, or tips over a wheelchair OR
• When patient is unable to stand or is unable
to perform any type of sliding board transfer
• Need a skilled and strong
caregiver/assistant to do this safely
TWO-PERSON LIFT TRANSFER
• When a patient has some UE strength and
trunk control
• Often used in transfers of patient from w/c
<-> floor or bed
PUSH-UP TRANSFER
• Similar to sliding board transfer but without
the use of a sliding board for support
• When the patient:
 Isable to perform the sliding board transfer
independently
 Has developed enough strength to lift his
buttocks clear of the supporting surface
 Has developed sufficient sitting balance and
endurance
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Functional Training 11/2/2016

ASSISTED STANDING PIVOT

INDEPENDENT TRANSFERS
TRANSFER

• When a patient can sit, stand, pivot and • Standing transfers

bear some weight on the LE but with • Sitting transfers
weakness or paralysis that necessitates
assistance • W/c <-> floor
• Also used to teach patient to transfer
independently
• Guarding the uninvolved LE
 when unfamiliar with patient’s capability
• Guarding the involved LE

STANDING TRANSFERS STANDING TRANSFERS

• Requirements • Requirements:
 Adequate safety awareness  Ability to maintain hip and knee extension
 No memory disorders  Voluntary muscle contraction
 Able to sequence a task  Orthotic device
 Able to follow directions  Spasticity
 Can learn effectively by means of demonstrations  Good to Normal UE strength in at least 1
 Ability
to move in bed extremity
 Good sitting balance and tolerance

STANDING TRANSFERS SITTING TRANSFERS

• Preparatory activities: • Long sitting

 Bed activities or bed mobility exercises • Short sitting
 Sitting
• Sitting near edge of the bed
 Standing
• Types / approaches:
 Lateral sliding transfer
 Anterior-posterior sliding transfer
 Push-up transfer

Anne Marie Co-Aseron, MSPT 6

Functional Training 11/2/2016

SITTING TRANSFERS BED MOBILITY SKILLS

• Requirements: • Rolling supine <-> prone

 Adequate safety awareness • Supine <-> sidelying
 Bed mobility skills
• POE
 Adequate sitting balance and tolerance
• POH
 Good to Normal UE/trunk muscle strength
 Adequate hamstring range
• Hooklying
• Pelvic bridging
• Supine <-> sitting

ASSIST TO FRONT EDGE OF CHAIR

• Allows a patient to get to his COG over his

BOS rapidly and easily as he stands GOOD DAY!
• Side-to-side weight shifting
• Pelvic slide
• Sitting push-up

Anne Marie Co-Aseron, MSPT 7