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
