Bed Mobility and Transfers in Spinal Cord Injury

Original Editor - Eugenie Lamprecht Top Contributors - Eugenie Lamprecht, Naomi O'Reilly, Kim Jackson, Ewa Jaraczewska, Anas Mohamed, Lucinda hampton and Angeliki Chorti  

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 maximising independence through 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.

Bed mobility and transfers are extremely important functional activities that individuals with a spinal cord injury need to master for independent mobility and QoL. The level of the spinal cord injuryand whether or not the injury 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 at each level of spinal cord injury is essential for therapists to work towards and during goal setting.

Bed Mobility and Transfers

1. Rolling
2. Mobilising from supine to long sitting
3. Unsupported Sitting
4. Vertical Lifting
5. Transferring

In most cases, individuals with a spinal cord injury from C6 and below may be able to perform these types of transfers with rehabilitation. When we perform and practice these activities it’s important to determine the underlying impairments to obtain the functional activity. Common impairments are;

• Strength
• Balance
• Spasticity
• 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. 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
• 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 two 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 to roll because of the paralysis in their LLs and/ or trunk.

Modifications for individuals with C6 tetraplegia

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

2. Mobilising from Supine to Long Sitting

Importance

• Dressing
• Prep for transferring to a wheelchair

Sub-tasks

• Roll to side-lying and lift the 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 be required to modify their technique due to paralysis of the triceps and the inability to straighten their ULs as they push themselves up into sitting. They will walk on their elbows towards their LLs and pull themselves into sitting.

3. Unsupported Sitting

Importance

• Functional activities with ULs,
• Dressing
• Transfers

Unsupported sitting can be in a short position with legs over the edge of the bed or a long position with legs straight.

Modifications for individuals with C6 tetraplegia

Individuals with C6 tetraplegia may have to modify their technique when supporting their upper limbs by externally rotating shoulders and locking elbows in extension if tricep function is impaired. Due to the bigger BOS, long sitting is often easier for individuals with C6 tetraplegia than short sitting, but it’s important to position the trunk or COG anterior of the hips.

4. Vertical Lift

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

• Place the hands anteriorly on the hips and externally rotate the shoulders to lock the elbows into extension.
• Depressing the shoulders.
• Flex the trunk forward 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 forward.

• Position the feet

Paraplegia: legs down

Tetraplegia: legs up (with elbow flexion hook)

• Position the hands

One hand is on the bed, and the other is 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