---

Patient Transfer Technique: Proper Procedure & Assessment

---

PART 1: PRE-TRANSFER ASSESSMENT

1. Assess the Patient

2. Assess the Environment

• Clear the path — remove obstacles, furniture, cords
• Bed height — adjust to the correct height (hips level or slightly lower than knee height of the nurse when standing)
• Locks engaged — lock wheels on the bed AND wheelchair/commode/stretcher
• Footrests removed — on wheelchair, swing away or remove footrests
• Non-slip footwear — patient wearing shoes or non-slip socks

3. Assess Equipment Needs

---

PART 2: TYPES OF TRANSFERS

A. Assisted Stand-Pivot Transfer (Most Common)

1. Explain the procedure to the patient — gain informed consent and cooperation
2. Position the wheelchair at a 30–45° angle to the bed, on the patient's stronger side; lock wheels, remove footrests
3. Raise the bed to a position where patient's feet are flat on the floor when sitting at the edge
4. Dangle the patient — assist to sitting position at the edge of the bed; wait 1–2 minutes, assess for dizziness or orthostatic hypotension
5. Apply a gait belt around the patient's waist (over clothing, snug — you should fit 2 fingers under the belt)
6. Instruct the patient to place feet flat on the floor, shoulder-width apart; lean forward ("nose over toes") to shift weight
7. Position yourself — stand slightly to the side and in front, with your knees bent, back straight, one foot forward (wide base of support)
8. Grasp the gait belt from underneath with both hands (never grab the patient's arms or clothing)
9. On count of three — patient pushes up from the bed, caregiver lifts using legs (not back)
10. Pivot together — patient pivots feet toward the wheelchair; caregiver pivots simultaneously
11. Lower the patient — instruct patient to reach back and feel the seat, then lower slowly; caregiver bends knees to lower
12. Position in wheelchair — ensure hips are back, feet on footrests, arms on armrests

---

B. Sliding Board (Lateral Transfer)

1. Position both surfaces at the same height; lock all wheels
2. Remove armrest closest to destination
3. Patient leans away from board; slide the board under the thigh (not under the ischium)
4. Patient places one hand on the board and one hand on the destination surface
5. Patient performs a series of push-ups and lateral scoots across the board
6. Remove board once transfer is complete

---

C. Mechanical/Hydraulic Lift Transfer

1. Select the correct sling size — check manufacturer's guidelines
2. Roll patient to insert sling — ensure sling is centered under patient's body (from shoulders to thighs)
3. Attach sling loops to lift hooks — shorter loops for head, longer loops for legs
4. Raise the lift slightly — check all attachments before fully lifting
5. Raise patient fully, ensuring comfort and stability
6. Roll lift to destination; lower patient slowly
7. Remove sling after proper positioning; document

---

D. Two-Person Lift / Logroll Transfer (Supine to Supine — Stretcher)

1. Three or more staff positioned on the same side of the patient
2. Use a slide sheet/draw sheet under the patient
3. On count, all staff roll/lift and slide patient simultaneously
4. Maintain spinal alignment throughout (especially head-neck-spine)
5. For spinal injury: one person dedicated to manual in-line stabilization of the head

---

PART 3: BODY MECHANICS FOR CAREGIVERS

---

PART 4: POST-TRANSFER ASSESSMENT

• Check patient positioning — correct alignment, no pressure on bony prominences
• Reassess vital signs if applicable (especially after first mobilization post-surgery or bed rest)
• Check all lines and tubes — confirm nothing was dislodged
• Ask about pain or discomfort — 0–10 pain scale
• Observe skin at friction contact points
• Document — method used, number of caregivers, patient tolerance, any adverse events

---

KEY SAFETY PRINCIPLES

• Never transfer alone if there is any doubt about patient stability
• Never lift by the arms of a patient — risk of shoulder dislocation
• Always use a gait belt for stand-pivot transfers
• Never rush — take time to communicate and set up properly
• Know your ergonomic limits — if the patient is too heavy for manual transfer, use equipment
• Reassess before every transfer — patient condition can change

---

---

ASIA Impairment Scale (AIS) — Step-by-Step Assessment

---

THE ISNCSCI WORKSHEET

---

BEFORE YOU BEGIN — PREPARATION

• Position patient supine for testing (standard position)
• Explain each test to the patient before performing it
• Test right and left sides independently
• Record results directly on the ISNCSCI worksheet
• Mark NT (Not Testable) if a limb is immobilized, amputated, severely painful, or has contracture >50% ROM
• Mark with asterisk (*) if a non-SCI condition affects the score (e.g., peripheral nerve injury, fracture)

---

STEP 1 — SENSORY EXAMINATION

Two Modalities Tested at Each Point:

Sensory Scoring Scale (each point):

Key Sensory Points (C2 → S4-5):

Maximum sensory score: 112 for LT + 112 for PP = 224 total

Sacral Sparing — Special Tests at S4-5:

---

STEP 2 — MOTOR EXAMINATION

Motor Grading Scale (MRC Scale, 0–5):

Key Muscle Groups:

Maximum motor score: 50 (upper) + 50 (lower) = 100 total

---

STEP 3 — DETERMINE SENSORY LEVELS (Right & Left)

The Sensory Level = the most caudal intact dermatome with a score of 2/2 for both LT and PP, with all levels above also scoring normal.

• Determine separately for Right and Left
• Record as e.g., Sensory Level R: C6, L: C7

---

STEP 4 — DETERMINE MOTOR LEVELS (Right & Left)

The Motor Level = the lowest key muscle with a grade ≥ 3/5, provided all muscles above it are graded 5/5.

• Determine separately for Right and Left
• In thoracic levels (T2–L1) where no key muscles exist → motor level = sensory level (if testable motor above is normal)

---

STEP 5 — DETERMINE NEUROLOGICAL LEVEL OF INJURY (NLI)

NLI = the most cephalad (highest) of all four levels (R sensory, L sensory, R motor, L motor)

---

STEP 6 — DETERMINE COMPLETE vs. INCOMPLETE

This is called sacral sparing — any preserved function at S4-5 = incomplete.

---

STEP 7 — DETERMINE AIS GRADE (A–E)

Is the injury COMPLETE? (No sacral sparing)
  ↓ YES → AIS = A

Is the injury Motor Complete?
(VAC = No AND no motor function >3 levels below motor level)
  ↓ YES → AIS = B (sensory preserved below NLI, not motor)

Are ≥ HALF the key muscles below NLI graded ≥ 3?
  ↓ NO → AIS = C
  ↓ YES → AIS = D

Are ALL segments normal (and prior deficit documented)?
  → AIS = E

AIS Grade Summary:

ND (Not Determinable): Used when levels or grade cannot be determined from exam results.

---

STEP 8 — ZONE OF PARTIAL PRESERVATION (ZPP)

• Only used in complete injuries (AIS A) where VAC = No AND DAP = No AND S4-5 sensory = 0
• ZPP = dermatomes and myotomes caudal to the NLI that retain partial innervation
• Record ZPP for sensory (R/L) and motor (R/L)
• If sacral sparing is present → ZPP is not applicable (NA)

---

QUICK REFERENCE SUMMARY TABLE