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Sit Pivot Transfer Performance in Patients with a Spinal Cord Injury

Kristen Cezat, PT, DPT, NCS, ATP/SMS

May 15, 2023

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Question

What muscles are necessary for sit pivot transfers, and what technique do you recommend for a patient with a lower cervical spinal cord injury?  

Answer

Muscles necessary for transfers include: 

  • Latissimus Dorsi (C6-C8)
  • Serratus Anterior (C5-C7)
  • Pectoralis Major (C5-T1)
  • Teres Major (C5-C7)

with preservation of tenodesis grasp with all transfer training.  

The technique matters.  Teaching should be structured and consistent.

There are four phases: Wheelchair set up, pre-lift, lift, and post-lift. 

Wheelchair setup includes:

  • Position the wheelchair relative to the transfer surface appropriately.  Where the client's knees are positioned is where the pelvis should land.
  • Angle the wheelchair 20 degrees to 45 degrees to the surface. This reduces large internal rotation of the lead arm.
  • Consider positioning casters in the forward position prior to locking wheelchair brakes.  This provides a larger base of support/stability when sitting on the front end of the chair.
  • Lock wheelchair brakes if brakes are present.

Set up for Pre-lift includes: 

  • Pelvis should be positioned on the front 1/3 of the seat, which is necessary to avoid the rear wheel and more evenly distributes the weight through both upper extremities. 
  • Legs should be in a stable position with a preferred position of on the ground supported in front of the footplate. Approximately 30% of body weight should be supported through feet.
  • The lead arm (the one reaching for the seat surface) is flexed and abducted with the elbow in slight flexion.
    • Handgrip should be used if within the base of support.
    • If not, hand is to be flat on the surface with avoidance of excessive shoulder internal rotation.
  • The trail arm is positioned close to the hip.  A higher percentage of body weight is supported through the trail arm.  
  • Trunk flexion and rotation away from the seat surface.

Lift phase:

  • UEs move rapidly in opposite directions.
    • Lead arm pulls, and trail arm pushes.
  • Lean forward over upper extremities, protract scapulas, and tuck chin

Post-lift: Rapidly decelerate as pelvis contacts seat surface.  Consider how hard your client’s landing is and whether it is controlled or uncontrolled. 

For more information on the therapist's role and other transfers, this Ask the Expert is taken from Course 2904. Transfer Training in Spinal Cord Injury by Kristen Cezat, PT, DPT, NCS, ATP/SMS

 


kristen cezat

Kristen Cezat, PT, DPT, NCS, ATP/SMS

Kristen Cezat is a Board-Certified Specialist in Neurologic Physical Therapy, a RESNA certified Assistive Technology Professional as well as Seating and Mobility Specialist.  She currently works as a clinical specialist at Orlando Health ORMC Institute for Advanced Rehabilitation where her specialties include direct patient care and program development for patients with SCI and other traumatic and neurologic diagnoses.  She received her Doctor of Physical Therapy degree from the University of Central Florida in 2011.  She serves as clinical faculty for the UCF-Orlando Health Neurologic Physical Therapy Residency Program.  She received the APTA’s Spinal Cord Injury Special Interest Group award for Clinical Excellence in Spinal Cord Injury Care or Service in 2020.

 


Related Courses

Outcome Measures in Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #3869Level: Introductory2 Hours
  'The detailed explanation of the use of the outcome measures were great;y appreciated'   Read Reviews
This course will review outcome measures commonly used in everyday clinical practice for clients with spinal cord injury and their importance in functional goals. Outcome measures discussed will include the ASIA Impairment Scale, 10 Meter Walk Test, 6 Minute Walk Test, Timed Up and Go, Walking Index for Spinal Cord Injury II, and Berg Balance Scale. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Gait Training in SCI: A Review of Current Research and Clinical Interventions
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #4165Level: Advanced2 Hours
  'Very good instructor with much experience w/patients with spinal cord injury'   Read Reviews
This course discusses current gait training evidence for clients with motor incomplete and motor complete spinal cord injury. High-intensity gait training, intervention selection for clients with motor complete and incomplete SCI, and assessing the effectiveness of interventions through the use of outcome measures are included. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Rehab Considerations for the Client with Incomplete Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #3702Level: Introductory2 Hours
  'Great presentation by instructor'   Read Reviews
This course will provide a basic comprehensive overview of the management of clients with incomplete SCI. This will include background information on incomplete SCI and acute medical concerns, evidence-based treatment strategies, gait training, wheelchair selection, and outcome measure selection to provide the clinician with basic knowledge/skills that are applicable to clinical practice. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Documentation in Spinal Cord Injury: Letters of Medical Necessity, Goals Setting and More
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #4481Level: Introductory2 Hours
  'The presenter was very knowledgeable and provided real life examples'   Read Reviews
This course will discuss documentation across the continuum of spinal cord injury with emphasis on documentation of short- and long-term goals, outcome measures, functional treatment interventions, and procurement of specialized DME including letters of medical necessity (LMNs) for wheelchairs.

Case Studies in Spinal Cord Injury
Presented by Kristen Cezat, PT, DPT, NCS, ATP/SMS
Recorded Webinar

Presenter

Kristen Cezat, PT, DPT, NCS, ATP/SMS
Course: #4520Level: Intermediate2 Hours
  'short and concise, to the point, relevant'   Read Reviews
This course discusses case studies of those with different levels and types of spinal cord injury. Case studies include evaluation, outcome measures, intervention selection, goal setting, and outcomes across the continuum.

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