Assistive Devices and Wheelchair Transfers

Assistive Devices for Walking

Walkers

Clients who can bear weight on their legs but are unsteady and/or need help with balance use walkers. It is important to ensure that the walker’s height is adjusted for the client. Encourage clients who use walkers to:

use the walker properly – some have wheels to slide, and others should be picked up and placed forward;
avoid leaning into the walker;
place their weight on the stronger leg and hands;
avoid pulling on the walker when standing up; and
follow the manufacturer’s guidelines for front-wheeled walkers.

Canes

Straight canes are for balance and are not designed to bear weight. The client must be able to bear weight on both legs and hold the cane. For clients who use a cane, follow these guidelines:

The client should use the cane on their stronger side.
The cane goes forward first, followed by the weaker leg and then the stronger leg.
If the client needs assistance walking, you should stand on a client’s weaker side (if they have one).

Crutches

Crutches provide support and stability when a client can only bear weight on one foot. Crutches that are in poor condition or that are not adjusted correctly can lead to injury. Crutches must be correctly adjusted to the client’s height. They should have heavy, rubber suction tips to prevent slips and falls.

Braces

Braces provide specific support for weakened muscles or joints or immobilize an injured area. The brace should be custom-made for the individual. The client may need protective padding, and there may be a prescribed schedule for use and rest. It is important to watch for skin breakdown or sores and report those to your supervisor and the prescriber.

Skill: Transfer a Client from Bed to Chair or Wheelchair

Transfers are changing a client’s position and/or moving them from one surface to another. Transfers are very personal. A client knows what works and doesn’t for them and will have a definite opinion about how they wish to transfer. In order to prevent injury to the client as well as to yourself, it is important to follow best practices with every transfer. If a client asks you to transfer them in a way that is unsafe, do not complete the transfer and report this to your supervisor. As with any personal care task, talk with the client about their preferences before beginning any transfer.

Assisting a Client to Sit on the Side of a Bed

A person lying in bed will need to sit up and put their feet on the floor before they can stand or transfer to a wheelchair or other type of chair. To assist a client to sit up on the side of a bed:

make sure the client is not too close to the edge of the bed;
have the client bend their knees with their feet flat on the bed and to roll onto their side towards you;
watch closely and provide assistance if needed;
have the client bring their legs off the bed and push up with their arms to a sitting position;
encourage the client to use hip walking if able (scooting forward one hip at a time) when scooting toward the edge of a bed;
if the client cannot move from a lying to a sitting position without hands-on assistance, assist the client by placing one arm under their shoulder and your other arm over their thighs; and
finally, swing the client’s legs off the edge of the bed and plant their feet on the floor.

After following these steps, the client will be in a position to stand or transfer to a wheelchair or other chair.

See Transfer a Client from Bed to Chair or Wheelchair in the Skills Checklists on page 421 for the specific transfer procedures.

Assistive Devices for Transfers

Transfer Boards

A transfer board is a strong flat board that helps a person slide from one surface to another. Transfer boards can help a client to transfer with less assistance. Transfer boards work well for clients who can use their arms to scoot from one side to the other.

Transfer Belt/Gait Belt

A transfer belt, also called a gait belt, is made of sturdy webbing or twill with a buckle or clasp on it. The transfer belt is placed around a client’s waist and gives the caregiver a sturdy hold. The use of a transfer belt is recommended for clients who need help transferring or walk. Talk with your supervisor about getting a transfer belt if you need one.

The following are tips to use a transfer belt safely.

Fasten the belt around the client’s waist.
Place the belt around the client’s clothing, not their bare skin.
The belt should be snug but not too tight. You should be able to put the flat of your hand
under the belt.
Make sure a client’s breasts are not caught under the belt.
Grasp the belt firmly when assisting with transfers or walking.

Draw Sheets

A draw sheet is a small bed sheet (or a regular sheet folded in half) that caregivers can use to help move clients in bed. Draw sheets are used to roll a client onto their sides or lift them higher in the bed. The draw sheet is placed lengthwise under the client, between their knees and shoulders.

Using a draw sheet to lift a client requires two people. Roll up each side of the draw sheet to the client lying in bed, and then lift the client up in bed. Be careful not to drag the client’s heels. If the client is able, they can also assist by bending their knees and pushing up while the caregivers use the draw sheet. To reduce the risk of injuries, use a mechanical lift when possible.

Mechanical Lifts

Some clients cannot bear their own full weight or need complete assistance to transfer. You will need special training and a mechanical lift (such as a patient lift, sling lift, sit-to-stand, or Hoyer Lift) to assist them with transfers. Your employer will provide training for any mechanical lifts you will use in your work.

Other Enablers

Devices such as bed/side rails, bed canes, and transfer poles can help a client self-positon and self-transfer. These devices are unsafe if they are damaged or not used correctly. Loose or unsecured devices can cause serious injury.

Make sure the client uses these enablers safely and correctly. Report any unsafe use or damaged enabler to your supervisor immediately. Enablers can become restraints if they prevent clients from moving how they want to. If you notice that an assistive device is preventing a client from moving how they want to, what should you do?

Transferring a Client from a Wheelchair into a Car

One common transfer is from a wheelchair to a car. There are several steps you can follow to perform this transfer safely.

Position the Car

Avoid parking the car on an incline.
Position the car away from the curb so the client stands on level pavement, or have the car close to the curb so the client will not have to step down onto the pavement from the curb.
Have the car door open.
Position the car seat as far back as possible. The front passenger seat is preferred.
Non-friction upholstery such as vinyl or leather helps the client to slide easily. A large, plastic garbage can liner may also be used to make it easier for the person to slide.
Have the car engine off—put the car in park with brakes set.

Help the Client Transfer

Make sure the wheelchair is in the locked position. Remove the footrests.
Have the client put their right hand on the car door.
Have the client use their left hand to push off the wheelchair to a standing position.
Have the client turn, face the door, place their left hand on the seat back or door frame, and sit down sideways on the seat.
Have the client turn in the seat and assist them, if needed, in placing one, then the other foot, in the car.
Reverse this process if transferring the client out of the car.

See the Wheelchair Safety Tips in the Resource Directory on page 335 for more information on wheelchair safety.

Safety with Transfers

Performing transfers incorrectly can cause injury to both the client and the caregiver. If you or the client are struggling with the transfer, stop and reassess the situation. If you feel a strain in your lower back, this is a warning that you may be injuring yourself. Stop the transfer and get help.
The client should never put their arms around your neck during a transfer. It can pull you forward, make you lose your balance, and/or hurt your back. If the client uses a wheelchair, always ensure the wheels are locked before every transfer. Remove the footrests so that they do not cause a trip hazard during the transfer.