What do family members need to know about how to assist with a wheelchair transfer after a spinal cord injury?

Families just need to keep a real open dialogue with the therapist. A lot of times we want the families to come in immediately, so that we can work on instruction. Sometimes a person isn’t going to be able to transfer independently by themselves; they might need to use a mechanical lifter. So we want to teach families how to use those as effectively as possible. If a patient can’t transfer by themselves, what we want to make sure is that they can instruct any single person they come into contact with on the most effective way and safe way to do it, so that everybody stays safe. With the families, sometimes we might want to have a family member wait until the person gets kind of geared up. It’s a very individualized basis, but we need the family support, just like the patient needs the family support. And once you have that great team together then really anything is possible.

I think the key things for family members to know in assisting with a transfer is that for safety, you want to be in front of the person and not behind the person. If I'm behind the person and I help lift their bottom higher in the air, I'm at risk at dumping them forward onto their head. If I am in front of the person, and I block their knees, it's very difficult for that person to fall. I want to understand how to provide that block at the knees so that they can't move forward and fall to the floor while also allowing them to bend far enough forward, or get the lean that they need to make their body efficient in the transfer as possible and the best lift possible. If you're in the wrong position, you can actually make it harder for someone to transfer, rather than helping them with that transfer. If you're helping them with a stand transfer it's a little bit different than in a wheelchair. Although there are some similarities-you still want to be in front of them so that they can't tip forward, you still need to stay out of the way of their head and their ability to lean their trunks so that they can stand appropriately. But maybe rather than blocking their knees, you're blocking their feet so that their feet don't kick out from under them accidently and they've got that good foot platform. And even in our transfer from a bed into a wheelchair where somebody is not standing, you also do need to be aware of their foot position and of the position of the wheelchair, and do you need to have foot on one side of the wheelchair to block the wheelchair for them so it doesn't move?

Well family members are very important for those patients who maybe don’t have the strength or the level of injury that would allow them to lift themselves into the chair. Sometimes patients may need to use a transfer board or a lift, and family members can be very helpful, and very key in being able to bring someone with a spinal cord injury back home again, versus needing a lot more help from outside the home. Family members are involved in inpatient rehab usually, maybe some outpatient training in order to get very good at assisting with these transfers, so the patient can be more independent, be able to go home, maybe just with minimal caregiver assistance. And then hopefully eventually be able to get stronger, and more independent with their transfers if they need something like a transfer board or lift. We also really encourage the patient to learn to direct their care, and direct family members as well as home healthcare workers to safely transfer them the best and most comfortable way for them.