Q. TRANSFERS

Q. TRANSFERS

My advice

The crucial one is getting in and out of bed. The next most important one is getting in and out of a car. The others, such as getting on sofas and other chairs, are optional.

My experience

For me the key is balance.

1. The first thing is to position the chair beside the target and make sure the brakes are on and that the chair will not move when you use it as a base to lift yourself across.
2. Next I move my buttocks forward in the chair by putting my hands behind my back and levering my hip bone forward using wrist extension
3. I then put my feet up on my target
4. I put one hand on the seat of the chair and the other on the target surface.
5. Then I lean forward and use my shoulder muscles  via my locked arms, because I have no triceps, to push down which shifts my weight from resting on my buttocks to resting on my locked arms and on my feet.
6. Then I can use my head and shoulders to swing my buttocks across from the chair to the bed or car

In the first few months after my accident I did try lots of options for getting onto beds, including sliding boards and the legs down technique. I found the above system was much faster, safer and reliable than the others.  So I practiced it every day with the physios,  and whenever I got in and out of bed, until I could do it safely and reliably. Likewise,  I experimented with lots of ways of getting into cars until I settled on one. My memory is that this was more challenging, particularly as every car is different. Nevertheless I kept doing it until I had a system that was safe and reliable.

I also experimented with getting into my chair from the floor for several years. I met a quad shortly after my accident who could do it. He had good triceps, unlike me, but otherwise he was much the same as me so I thought maybe I could do it. I never did manage to go directly from floor to chair, unfortunately. It would have been handy for those times when I fall out of my chair away from home. I did manage to do it in a step wise way – up on to a sofa then up on to my chair – so I am Ok if fall out at home.

My transfer technique may not be suitable or possible for everyone. However, transferring is a foundational skill on the road to increased independence. For this reason if you are wanting increased independence it will be necessary to persist with experimentation until you find a technique that has the potential to become sufficiently safe and reliable to do when no-one is around. Having found a technique with potential, you will then need to persist with practice until it actually becomes safe and reliable.

There may be many other ways of achieving this objective including sliding boards. However, it does seem to me that legs up has a clear advantage in terms of safety and reliability compared with legs down.

When I was learning I found that if I failed with my legs up all that happened was that I didn’t reach my target. I could then simply re-set and try again. If I failed with my legs down however I ended up  on the floor. So it was not something I could practice on my own.

Once you have mastered legs down it is effective in the sense that it gets you to your target.  However, even then it remains a much higher risk strategy for C6 quads. We C6s have no back, stomach or triceps so its extremely difficult to keep our balance with our legs down. That means it is easy to lose balance and fall forwards out of the chair onto the floor if your legs are down.

For this reason the legs down technique is not well suited to C6 quads wanting to be independent. To be independent your transfer needs to be very safe because you will be doing it with no-one around most of the time. Not only that, you will be doing when you are in a hurry, tired, sick, drunk, hung over, heart broken, whatever. For me legs down does not fit that description.

My understanding is that the experts recommending legs down are doing so due to their fears about shoulder pain. Transferring has never been a source of shoulder pain for me. Legs down may be fine for C7s or T1 or T2 paras that have triceps, and can therefore balance much more effectively, but I don’t think its a good strategy for C6s.

Pictures:

Bed transfers

getting on a bed

getting off a bed

CLICK HERE to see some other video of me transferring on to a bed

CLICK HERE for video of a guy successfully doing a legs down transfer. He does it well. However  even as good as he is with this technique, he still can’t lift his bum clear of the surface, he can only slide. That is because with legs down you can’t lean forward far enough to lift your bum off the surface without over-balancing and falling forward. In contrast with legs down you can lean as far forward as you like and lift with all your strength, and get well clear of the surface.

Car Transfers

To see me get myself and my chair in and out of my car co to the car page

CLICK HERE for some videos of other quads getting in and out of cars. They do it a bit differently from me.

CLICK HERE for a guy doing a car transfer in much the same way as me

Here’s what the experts say

CLICK HERE for video showing how the experts seem to recommend we do it, which is legs down. The video clearly illustrates my point that it is not really safe to do it this way on your own, as the therapist is standing in front of the guy waiting to catch him in case he falls.

CLICK HERE for another site explaining legs down. This one clearly shows that their reason for recommending the technique is fear of shoulder pain. It also shows they have C7s, T1s and T2s in mind not C6s. C6s simply cannot do some of the moves they recommend such as ‘grabbing’ the edge of the bed.

CLICK HERE for a website with exercises to build strength to assist with transfers

Rule number 17 – Experimentation, practice and perseverance are the keys to success.