Bed Mobility and Transfers in Spinal Cord Injury

Original Editor - Eugenie Lamprecht Top Contributors - Eugenie Lamprecht, Anas Mohamed, Naomi O'Reilly and Kim Jackson  

Introduction

Spinal cord injury (SCI) rehabilitation occurs in different stages and may take weeks, months, or even years. Rehabilitation can start as early as inpatient therapy while preventing and managing medical complications. Initial therapy includes maximizing independence with basic activities such as dressing, bed mobility, wheelchair management and transfers. Further rehabilitation includes training of caregivers, wheelchair seating, and progressive gait retraining if applicable. Education regarding medical complications, pressure relief, as well as bladder - and bowel management, is also an essential aspect of the rehabilitation process [1].

Bed mobility and transfers are extremely important functional activities which individuals with SCI require to master for independent mobility and QoL. The SCI level and whether or not the SCI is complete or incomplete is directly associated with the individual’s ability to perform certain functional activities. The knowledge of the specific motor functions attainable to each level of SCI is important for therapists to work towards and when setting goals.

5 Functional activities that C6 tetraplegia and paraplegia should be able to perform:

  1. Rolling.
  2. Mobilizing from supine to long sitting.
  3. Unsupported sitting.
  4. Lifting vertically.
  5. Transferring.

When we perform and practice these activities it’s important to determine the underlying impairments in order to obtain the functional activity. Common impairments are;

  • Strength.
  • Balance.
  • Spasticity or Range of motion.
  • Skill and/ or Knowledge of the specific activity.

When retraining these functional activities it is important to include strength training, practice often, practice sub-tasks, and make sub-tasks progressively more difficult[2]. Also remember to provide sufficient feedback and appropriate instructions, demonstrations, and manual guidance.

Bed Mobility & Transfers

1. Rolling

Importance
  • pressure relief,
  • transferring to sitting,
  • dressing, and
  • changing position in bed.
Sub-tasks
  • Swinging the ULs towards the opposite direction of the roll, while lifting and rotating the head. -  creating momentum.
  • Swinging the ULs towards the direction of the roll, while lifting and rotating the head. (These 2 sub-tasks may have to be repeated to gain sufficient momentum.)

Individuals with SCI are required to use their head, neck, and upper limbs to generate momentum in order to roll because of the paralysis in their LLs and/ or trunk

Modifications for individuals with C6 tetraplegia

Individuals with C6 tetraplegia will require to modify their technique due to paralysis of the triceps. They rotate the shoulders externally to keep elbows extended.

[3]

2. Mobilizing from supine to long sitting

Importance
  • Dressing.
  • Prep for transferring to a wheelchair.
Sub-tasks
  • Roll to side-lying and lifting trunk off the bed by pushing through one or both ULs.
  • Straighten ULs and transfer COG over hips.
Modifications for individuals with C6 tetraplegia

Individuals with C6 tetraplegia will require to modify their technique due to paralysis of the triceps and inability to straighten their ULs as they push themselves up into sitting. They will walk on the elbows towards their LLs and pull themselves into sitting.

[4]

3. Unsupported sitting

Importance
  • functional activities with ULs,
  • dressing, and
  • transfers

Unsupported sitting can either be short sitting with legs over the edge of the bed or long sitting with legs straighten.

Modifications for individuals with C6 tetraplegia

Individuals with C6 tetraplegia will require to modify their technique when supporting themselves with their ULs by externally rotating shoulders and locking elbows in extension. Long sitting is often easier for individuals with C6 tetraplegia than short sitting, due to the bigger BOS, but it’s important to position the trunk or COG anterior of the hips.

4. Lifting vertically

Importance
  • Transfers.
  • Pressure relief.
Sub-tasks
  • Positioning hands close to the body.
  • Lifting by extending the elbows, depressing and adducting shoulders.

Sub-tasks for individuals with C6 tetraplegia

  • Placing the hands just anterior to the hips and externally rotating shoulders to lock elbows into extension.
  • Depressing the shoulders.
  • Flex the trunk forwards in order to increase height during the lift.

This functional activity can be performed in short - and long sitting.

5. Transfers

Horizontal transfers

Importance
  • transferring from bed/ chair to the wheelchair.
  • transferring from wheelchair to car/ toilet/ chair etc.
Sub-tasks
  • Move to the front sitting surface and position the wheelchair closer.

Paraplegia: elevate through arms

Tetraplegia: place the palms on the lower back and push the pelvis forwards.

  • Position the feet

Paraplegia: legs down

Tetraplegia: legs up (with elbow flexion hook)

  • Position the hands

One hand on the bed and the other on the wheelchair wheel.

  • Lift and shift across the bed

Vertical transfers

Importance
  • transferring to the floor from the wheelchair or
  • transferring to the wheelchair from the floor

Sub-tasks

  • Position the legs.
  • Position the hands with the lead hand forward and away from the trunk and the trail hand close to the hip.
  • Lift and rotate the body.
  • Position the buttocks in the wheelchair.
  • Move into an upright position.

Online Resources

eLearnSCI.org - Physiotherapists

References

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  1. Taylor-Schroeder S, LaBarbera J, McDowell S, Zanca JM, Natale A, Mumma S, Gassaway J, Backus D. Physical therapy treatment time during inpatient spinal cord injury rehabilitation. The Journal of Spinal Cord Medicine. 2011 Mar 1;34(2):149-61.
  2. Taylor-Schroeder S, LaBarbera J, McDowell S, Zanca JM, Natale A, Mumma S, Gassaway J, Backus D. Physical therapy treatment time during inpatient spinal cord injury rehabilitation. The Journal of Spinal Cord Medicine. 2011 Mar 1;34(2):149-61.
  3. Vincent Long.Rolling for a patient with C6 Tetraplegia. Available from: https://www.youtube.com/watch?v=qGA53hWgYgc [last accessed 23/6/2020]
  4. QuadFitness. Rolling & Supine to Long Sit. Available from: https://www.youtube.com/watch?v=wODJMAVvnWE [last accessed 23/6/2020]
  5. College of Rehabilitation Sciences - Pines City Colleges. Floor to Wheelchair backwards transfer - Independent. Available from: https://www.youtube.com/watch?v=uJd_JGANVK0 [last accessed 23/6/2020]
  6. Life After Spinal Cord Injury. Paraplegic Person Practising Floor To Wheelchair Transfer - Life after Spinal Cord Injury. Available from: https://www.youtube.com/watch?v=DdlzOL69jt4 [last accessed 23/6/2020]