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Honestly, what if a patient was too heavy for you to assist by yourself but there was nobody else to assist you at the time.

Dr. Marcin- if it was unsafe I would not do it but I would make arrangements for assist for the next session.  We will have to provide the pt. recourses or find the clinician who can help them

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an example of somebody you wouldn't put a gait belt on is a patient that just had abdominal surgery. and I believe that you would just take regular precautions because all the gait belt does is to help control the fall not prevent it.

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What type of patient would not be able to use a gait belt? And what method would one us for those specific types of patients?

Dr. Marcin- see Haley response also pregnancy or low back sx.

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I think that you would place your hands in the same position of where the belt would be around their hips.

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I would also like to know how often the Hoyer lift is used and with a patient that uses the lift often would you remove the lift pad after treatment every time or would it stay under them?

Dr. Marcin- see my response to Brooke.  I would remove the pad if I am concerned of skin irritation.  If not I would leave it.

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I believe that you should probably just have the belt on the patient just in case and then make the decision on how much assistance is needed.

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How would you transfer a patient with wounds around the abdomen area from a recent surgery?

Dr. Marcin- I would not use a gait belt.  I would avoid pressure on this area. I would utilize the pelvis to encourage weight shift

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How often would the Hoyer lift be utilized? Would we really be expected to use it all the time even for a simple transfer or more often than not would you just be able to assist? I do not remember the exact number that Dr. Marcin said a Hoyer lift is usually "required" in a hospital, but I do remember that it seemed like it sounded extreme.

Dr. Marcin- I typically use the hoyer about 3-5 x year in a hospital and that is working 1 weekend a month.  At my hospital our policy is that if a pt is more than mod assist we place a hoyer pad under them but that does not mean we use it.  It really is a judgment call.  I will use the hoyer for max assist when the pt has poor trunk control.  I typically do not use the hoyer for max assist if the pt has good trunk control and can follow commands.  Each therapist will make judgment calls based off their ability.

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I believe this is not something that you would be expected to complete by yourself. If there was not a device there to assist, I'm sure you would have multiple people working together to lift the patient.

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When you are dealing with a patient who is unable to use a gait belt, then where is the best hand placement for a seated transfer? Or any transfer for that matter?

Dr. Marcin- the best place to guard a pt is the pelvis or the shoulder girdle

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I believe that if a patient refuses to get up, then they are refusing to consent to treatment. As a therapist you have to accept that and in no way should you force them to do something they don't want to do.

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I believe this deals with the patients permission, we cant force a patient to do anything they don't want to. We would simply explain the purpose, benefits, and risks associated with the transfer and let them decide.

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When performing any type of transfer should a gait belt always be used with the patient or is it just based off of the type of assistance they need?

Dr. Marcin- Textbook answer would be use a gait belt any time the pt is a fall risk.  In the clinic it is up to the PT or PTA as they are responsible for the pt.

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Does anyone know how we would get a patient up that doesn't want to get up?

Dr. Marcin- the pt has a right to refuse.  We should explain the risk and benefits of not doing PT.  If the pt is competent then we would document the refusal

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I know in the hospital setting nursing staff always uses the bed to sit the patient up. The beds at the hospital I work at can fold into a chair. If the larger individual has any upper body strength they sometimes use a bar hanging from the ceiling that the patient can grab to help.

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that's a good question! maybe try and use their legs to push up?
Amy-I was curious about this same thing!

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I'm thinking that they only way to ensure the safety of the patient and yourself would be to either use a Hoyer lift or get help from some coworkers or caregivers/family, depending on whether you are working in a formal facility or a patient's own home. I wonder about this myself, because I will not be able to muscle up the patient and my arms are very short and they wouldn't even be able to reach the posterior portion of the gait belt, if I'm lucky enough that the patient is even wearing one. I guess, when working home health it's very important that we are able to be teachers so that we can successfully articulate to the caregiver and family at home what to do if we need help with the patient.

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When a patient has no upper body strength are they still given a sliding board in order to assist them when going from a wheelchair to a higher surface such as a bed?

Dr. Marcin- if they can assist with the trunk or legs then yes I would try the sliding board as it would not been unsafe.

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What do you do if you are doing contact guard assist for sit to stand, and you are blocking that outside leg and holding onto the gait belt and the patient has a change in status and passes out or has a seizure? Do you try to shift your foot stance to block both knees and lower them back to a sitting position, or do you just try to reverse to movement you just performed and lower them back into a sitting position? Then, once you have them seated, should you try to get them supine? I guess if you are getting them out of a wheelchair, they would just be seated, but, the edge of a bed seems a bit trickier. I'm trying to figure out the best way to maintain both the patient's and my safety in this situation.

Dr. Marcin- Let me know if I do not answer all the questions.  If a patient is having a seizure then if you lower them to the floor and remove unnecessary clutter and do not attempt to restrain the pt.  To lower the pt. I would avoid extremities but utilize the pelvis or shoulder as these are key points of control

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An electrical lift maybe appropriate in this situation or you could always seek help from several coworkers.

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What steps should be taken if a patient falls during therapy?

Dr. Marcin-  Goal is to regain balance if possible but if not lower the pt to the floor.  If a pt falls, even a controlled fall, you will need to complete an incident report as per the facility policy and procedure

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My question is about how to get a patient from a supine to sitting then sit to stand if they are extremely obese? Sure I can muscle some people up but what if muscling them up isn't an option?

Dr. Marcin- I would use the hospital bed to sit them up and then move the legs as segments.  if someone has that hard time moving they will have adaptive equipment such as a hoyer lift

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I think having someone there just in case is based on each situation. If a patient is completely dependent then I think you should have someone else in the room or a call away just in case. But if they are able to do everything by themselves then i think it's safe for you to be the only one in the room.

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I think that they should avoid getting on the floor but if they fall, they need to know how to get up.I think that you would start to work on their upper body strength so that they could start working on getting themselves off of the floor. Until then, you could also teach them to use a transfer board to try to slide their body from the floor to a higher surface.

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Ashleigh in response to Janelle Lauttenbach

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Ashleigh in response to Janelle Lauttenbach

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You want your patient to use their body or the object their moving from for stabilization but if in the mist of moving then you are using your body to hold them back. You use the leg block to block them from buckling. Now when they are fully dependent you hold over the back to control the trunk and then leg block with your legs.

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So when transferring a patient, is it better to always have someone there to assist if needed?

Dr. Marcin- Not really because that could be a waste or resources.  I use a second person for safety (i.e. pt. is not oriented and cannot follow commands or lines and tubes that need monitoring) or if I need help lifting.

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Any therapist although it could be difficult should be able to work or at least assist in transfers. Just remember you always want to make sure you are going through the process safely. Don't be afraid to ask for help or use an assisted device!

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Im still a little confused on the proper ways to to stabilize our pt. through the different transfers. If someone could clear this up it would be great!

Dr. Marcin- In general we stabilize the knee, pelvis and shoulder. How much we stabilize depend on the pts level of assist.   If there is a particular transfer you need assist for stabilization please seem

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I would think they would because if not than you would either not be able to transfer the patient or have to wait for someone to come help and never know how long that might take. I could be wrong but that's my guess. interested to find out the answer.

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I missed class on Monday, so I wasn't there for the best mobility and transfers I have read the chapter, I was just wondering if there was anything that was covered in class that wasn't in the text book?

Dr. Marcin- not really - look at the video and handout and see me with questions

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What if you were in a home health setting and were unable to transfer a patient safely on your own? Do companies take into consideration the size of the patient when they select the therapist that will treat them?

Dr. Marcin-  When doing home health the caregivers also have to be able to do a transfers.  Typically if the pt. is dependent then they would have a lift.  You should never do something that you feel unsafe to do.

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With a post-surgery, bilateral knee replacement patient, what techniques would you need to use to help them with transferring to and from the floor, if they do not have good upper body strength?  Just tell them not to get down there in the first place, or get a life alert? �

Dr. Marcin- well what if the pt. falls - we should work on improving arm strength to assist with floor transfers.  I am not saying we do floor transfers with all pts but it is a good ideal to try

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For a patient with a recent surgery and inability to flex the hip past 90 degrees with bilateral upper extremity weakness. How would you teach them to get up off the floor.

Dr. Marcin- most likely not but eventually yes.

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You could use a sliding board to transfer a patient.

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With sit to stands, where you are only giving min, mod or max assist, It does not matter which leg you use to block, because you are just helping them stand up and no “walking” or movement is happening.  With transfers from a bed to a chair (pivots) or using a slide board, you will want to block with your leg furthest away from the chair so that your other leg can aid you in good body mechanics throughout the lift, and help with “stepping” to transfer the patient to the chair.

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There are other devices that you can use to help with patient transfers. Gait belts can be used to help a patient move through different positions. Also devices such as walkers can be used to help a patient transfer to standing positions. I'm sure there are even more that can be used, and the devices used would be determined by the patients functional ability

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One thing that is somewhat confusing to me is which leg the PT or PTA would use when blocking the patient's knee during certain transfers. I am usually able to figure it out when I think about it, but I was wondering if someone could help me clear this up or maybe put it into words that would help me visualize this. Thank you

Dr. Marcin- start by blocking the stronger side and eventually block the weaker side for sit to stand.  For pivot block the stronger leg and eventually the weaker.  When doing a pivot transfer block with your outside leg.

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I believe we would be more likely to teach the caregiver the proper way to maneuver the pt. I think we would teach more verbal and tactile cues to the pt as to what is happening and where we're going since the pt requires total assistance.

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What is the best way to teach a person to transfer from a wheelchair to a car who is dependent?

Dr. Marcin- if they are dependent than the caregiver would be doing 75% or more of the work so I would use a partial stand pivot or standing depending on the condition

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Are there other devices that can be used to transfer; if there are no sheets, hoyer lift, or sliding pad to put under patient?

Dr. Marcin-  there are many types of devices to help with transfers.  Your facility should orient you to the type of devices they have.  If it is a pt who has an transfer device that I am not familiar with I look it up and educate myself

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I believe so. Because in class we saw two different types of lift pads one that will extend up to the back of the head and one that only goes shoulder height, but the other parts near LE is the same.

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You can do the Hoyer lift by yourself, this lift helps when someone has a caretaker and is the only person around to take care of them. As PTA's working in a hospital it would be ideal to have another PT or PTA there to help us.

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Correct Gai, to my understanding standby assist is guarding with no contact due to the patient having a fair probability of needing assistance, for safety and motivation (usually with verbal cues). I'd say the referance to "tactile cues" is more like slight touch for reminding, not being hands-on.

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I am confused with “standby assistance”. It is said that “the patient requires tactile cues”, but “not touching”. The caregiver and patient together perform the transfer or “only patient performs, and the caregiver guards patient”?

Dr. Marcin- good question- tactile cues that you do not touch the pt such as pointing to the arm rest

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Are there different types of lift pads for certain conditions, like spinal cord injuries or morbidly obese

Dr. Marcin - I do not think different type of pads for condition but for body weight yes

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I would say we should always try to have assistance during a hoyer lift transfer. Especially when lowering a patient into a chair (seated position), another person can stand behind the back of the chair, and pull the loop behind the patient’s back.

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That's a good question! My first thought would be to try and make sure the pt. is safe first, or positioned rather than being dropped at all possible. Then go and get help with whatever is injured. I'm sure this has happened before in the PT world, but hopefully it we use good body mechanics and the skills we are learning now, this can be avoided!

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Is the Hoyer loft something you can do on your own? Or should you always try to have assistance while moving the pt.?

Dr. Marcin- you can do it on your own but check the policy of the facility.  I prefer to have help but if I had to I could do a hoyer by myself safely

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What would you do if while performing a transfer you were injured?

Dr. Marcin good question- you would follow the policy and procedure of the facility on how to report an injury and how to receive medical assistance.