11.7 Patient Transfers, Assisted Dressing & Mobility Aids
Key Takeaways
Before any transfer, the therapist checks weight-bearing status, strength, cognition, blood pressure risk, and equipment, and does not attempt a lift beyond their safe capacity.
For a wheelchair-to-table transfer, the chair is placed at about 30° to 45° to a lowered table, brakes are locked, footrests are moved, and the client usually leads with their stronger side.
A client with hemiplegia is never lifted or pulled by the affected arm, which is supported to protect against shoulder subluxation and pain.
A cane is held in the hand opposite the affected leg, with the top at about wrist-crease height so the elbow is slightly flexed.
When assisting with clothing, dress the weaker or affected limb first and undress it last, with the client's consent and privacy preserved.
Patient Transfers, Assisted Dressing & Mobility Aids
1. Why Transfers and Dressing Assistance Are Tested
Two CKT-testable treatment principles are utilize patient/client transfer techniques (3.1.e) and assist patient/client with dressing and undressing (3.1.f), alongside draping (3.1.g) and positioning. Clients with stroke, spinal cord injury, Parkinson's disease, recent surgery, frailty, or acute pain may need help getting onto and off the table or managing clothing. Falls in the clinic injure clients and therapists, and help with undressing raises consent and boundary issues (11.2).
2. Pre-Transfer Screening and Planning
- Ask and observe: How does the client usually transfer? What help do they use at home? Are there weight-bearing or movement precautions (for example, hip precautions after arthroplasty)?
- Assess ability: Strength (especially of the legs), balance, pain, sensation, cognition, and the ability to follow instructions.
- Cardiovascular risk: Clients prone to orthostatic hypotension (medications, Parkinson's disease, spinal cord injury, prolonged lying) need staged changes of position and a pause sitting on the table edge.
- Prepare the environment: A height-adjustable table lowered to wheelchair-seat height, locked wheels and brakes, a clear path, a stable step if needed, and non-slip footwear.
- Know your limit: RMTs assist; they do not perform dependent lifts. If a client cannot bear weight or help, treat them seated in their wheelchair or arrange for trained help and equipment.
- Communicate: Explain the plan, agree on a count ("on three, lean forward and stand"), and let the client do as much as safely possible.
Therapist Body Mechanics
Use a wide base of support, keep the client close, bend at the hips and knees rather than the back, pivot with the feet instead of twisting, and use a gait belt where the clinic provides one (never lift by the client's arms or clothing).
3. Common Transfer Techniques
| Technique | When used | Key steps |
|---|---|---|
| Stand-pivot transfer | Client can bear weight on at least one leg | Wheelchair at about 30°–45° to the lowered table; brakes on; footrests swung away; client scoots forward; feet under knees; "nose over toes" to stand; pivot on the stronger leg toward the table; sit, then swing the legs up |
| Sliding-board transfer | Client cannot stand but has good sitting balance (e.g., paraplegia) | Surfaces level; armrest removed; board under the thigh; client slides in small movements toward the table |
| Assisted sit-to-stand | General weakness, post-operative clients | Scoot forward, feet back, lean forward, push from the chair arms; therapist guards at the hips |
| Log roll (supine to side-lying to sitting) | Acute low back pain, recent spinal surgery, abdominal surgery | Knees bent, roll the body as one unit to side-lying, lower the legs off the table while pushing up with the arms |
| Turning prone to supine on the table | All clients | Hold the drape up as a visual barrier, ask the client to roll toward you or away as appropriate, and keep the drape in contact throughout (11.2) |
Special Situations
- Hemiplegia after stroke: Position the wheelchair so the client transfers toward the stronger side. Support the affected arm; never pull or lift by it, because the flaccid or weak shoulder is prone to inferior subluxation and pain.
- Hip arthroplasty precautions: Avoid deep hip flexion when sitting down or swinging the legs onto the table; a higher table and a pillow between the knees help.
- Spinal cord injury: Check skin after transfers, because pressure and friction injuries may not be felt.
4. Mobility Aids
- Cane: Held in the hand opposite the affected leg so it moves together with that leg. With the client standing, the top of the cane reaches about the wrist crease or greater trochanter, giving roughly 15°–30° of elbow flexion.
- Walker: Same height guideline; the client steps into the walker frame rather than pushing it far ahead.
- Stairs with a cane: "Up with the good, down with the bad"—the stronger leg leads going up, and the cane and affected leg lead going down.
- Wheelchairs: Lock both brakes before any transfer and check that footrests will not catch the client's legs.
5. Assisting With Dressing and Undressing
Most clients undress in private (11.2). Assistance is offered only when needed and wanted:
- Consent and choice: Ask whether the client wants help and which items they want to remove; clients may keep clothing on. Help is limited to what the treatment needs.
- Privacy and dignity: Keep the client covered with a drape or towel, turn away where possible, and never rush.
- Sequence: Dress the affected or weaker limb first and undress it last (for example, put the sleeve on the hemiplegic arm first, and take it off the strong arm first). This reduces the range of motion the affected joint must reach.
- Safety: The client sits on a stable surface with feet supported; never leave a confused or unsteady client alone on the table.
- Adaptive aids: Sock aids, long-handled shoe horns, and reachers help clients who must avoid deep hip flexion after hip replacement.
- Documentation: Note the assistance given and the client's consent.
6. Clinical Vignette
A 72-year-old client with left hemiplegia from a stroke arrives in a wheelchair. The therapist lowers the height-adjustable table to seat height and places the wheelchair at a 45° angle on the client's right (stronger) side of the table. Brakes are locked and the footrests swung away. The client scoots forward, places his right hand on the table, leans forward on the count of three, stands on his right leg, and pivots to sit, while the therapist guards at his hips with a gait belt and supports the left arm in a cradled position. After treatment, the transfer is reversed after he sits on the table edge for a minute to avoid orthostatic dizziness. He asks for help with his shirt; the therapist puts the left (affected) sleeve on first and records the assistance provided.
A client who can stand on one leg is moving from a wheelchair to a treatment table. Which setup is safest?
Angle the chair 30° to 45° to a lowered table, lock the brakes, move the footrests, and lead with the stronger side
Place the chair parallel to a raised table with the brakes off so it can roll into position
Lift the client under the arms and swing them onto the table in one movement to save time
Face the chair directly away from the table so the client can sit backward onto it without needing to turn or pivot at all
A client with right hemiplegia after a stroke needs help standing. Which practice protects the affected shoulder?
Ask the client to push up using only the right arm so it is strengthened during the transfer
Have the client hang the right arm off the table edge during the transfer to reduce tone
Cradle the right arm and guard at the hips or gait belt, never lifting by the affected arm
Pull the client up by the right wrist so the weak arm is stretched before treatment
A client with a painful left knee is learning to use a single-point cane. How should it be used?
Held in either hand, with the cane placed well behind the body to push forward
Held in the left hand, with the top of the cane at shoulder height for maximum leverage
Held in the right hand, with the top at about wrist-crease height
Held in the left hand and advanced after the right leg so the cane takes no load
A client with a stiff, painful right shoulder asks for help putting on a cardigan after treatment. Which sequence is correct?
Put the right (affected) arm into its sleeve first, then the left
Put the left arm into its sleeve first, then reach the right arm back into the second sleeve
Ask the client to lie prone so the cardigan can be pulled over the shoulders
Put both arms in at the same time while the client raises them overhead
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