Last week we discussed accessing the school environment. This week is all about transfers!
What is a transfer? In the realm of physical therapy, a transfer is the movement of an individual from one place or surface to another. For instance, think of when you stand up from a chair. In this example, you are moving from a seated position from the seat of the chair to a standing position with feet planted firmly on the ground. This particular example is known as a sit to stand transfer. While this may seem like such a simple task, for individuals with physical disabilities performing transfers can be very challenging.
Generally, the overall goal with transfers is to improve an individual’s overall function and increase their independence with the skill. We must also consider safety and what level of assistance the individual needs in order to perform the skill. Some individuals require the total assistance of another person to transfer from one surface to another or one area/place to another; this means that 100% of the effort to perform this is being done by the person assisting. Other individuals may require less assistance such as maximal assistance, moderate assistance, minimal assistance, contact guard assistance, or stand by assistance.
So what do these levels of assistance even mean? (Also side note these levels of assistance can be used to grade more than just transfers; they can be used to grade the level of assistance an individual needs for any gross motor skill (i.e. walking, climbing, balancing on one leg, crawling, etc.).
- Maximal assistance means that the individual requires assistance with 75% of the gross motor skill and is able to perform 25% of the task on their own.
- Moderate assistance means that the individual requires assistance with 50% of the gross motor skill and is able to perform 50% of the task on their own.
- Minimal assistance means that the individual requires assistance with 25% of the gross motor skill and is able to perform 75% of the task on their own.
- Contact guard assistance means that the individual is able to perform 100% of the gross motor skill on their own but requires 1-2 hands lightly placed on them for safety as they may struggle with balance or be a fall risk.
- Stand by assistance means that the individual requires no physical assistance to perform the gross motor skill but may require verbal cueing, coaxing, or set-up to complete the gross motor skill. With stand by assistance the person assisting also is within close proximity to the individual performing the skill.
There are also pieces of equipment which can be utilized to assist an individual with their transfers known as a sliding board/transfer board, a ceiling lift, and a Hoyer lift. Sliding boards or transfer boards are typically utilized for individuals with good upper body strength & sitting balance who need to transfer between two surfaces adjacent to each other. A ceiling lift or a Hoyer lift are typically utilized for individuals who need more physical assistance or transferring them manually (by another human being) is unsafe for them or the person assisting. Ceiling lifts or Hoyer lifts are operated by the person who is assisting in the transfer.
What do transfers look like in the school system? Again, the overall goal of physical therapy in the school system is to increase students’ access to their educational environment and to improve their ability to participate with a greater level of independence in their school environment. Thus, depending on the physical impairments of the student transfers could look very different. For instance, a child in a wheelchair who is continent (has the awareness of their bowel & bladder functions and has the ability to control these functions) will need to transfer to & from the toilet. A child who is in a wheelchair but is incontinent (does not have the awareness of their bowel & bladder functions nor has the capability to control these functions) will need to transfer to/from a changing table. For instance, a younger child who participates in circle time or a child who falls a lot will need to be able to stand up from the floor; a skill known as a floor to stand transfer. A child who utilizes a wheelchair for mobility may also have the capability to sit in a regular desk chair and needs to be able to transfer back & forth from their desk chair to/from their wheelchair. The list for transfers goes on & on!
Who can assist a child with their transfers in the school environment? A physical therapist, an occupational therapist, a speech therapist, a teacher, a teacher’s assistance, a school nurse, a one on one aid, etc. However, it is the responsibility of the physical therapist that these other disciplines and staff members are given formal training in how to do so safely & effectively whether performing a manual transfer or utilizing the transfer equipment.
Ultimately, transfers enable us to change position, change surfaces/areas, and access & explore our environment. They are an extremely important component of our gross motor repertoire and should be considered when addressing the needs of children, especially those with physical & mental disabilities, in the school environment.
Catherine C. Skelton, PT, DPT
Pediatric Physical Therapist