Dependent Pivot Transfer Technique

A dependent pivot transfers are best employed in scenarios where an individual lacks the strength, balance, or cognitive ability to participate actively in their transfer. This method is particularly useful for individuals with significant mobility challenges, such as those in the advanced stages of ALS that limits their ability to assist in their own mobility.

The decision to use a dependent pivot transfer is often based on a comprehensive assessment of the individual’s physical capabilities and the risk of injury to both the person being transferred and the caregiver. This transfer technique is ideal when the individual cannot bear weight through their legs, lacks trunk control, or when transferring from surfaces of similar heights, like from a wheelchair to a bed, chair, or toilet, where the caregiver can control the movement and ensure safety throughout the process.

Caregivers must be trained in the proper execution of a dependent pivot transfer to minimize the risk of falls and injuries. The technique requires careful coordination, strength, and the use of safety equipment, such as a gait belt, to support the individual’s weight during the pivot. It’s important that the caregiver maintains proper body mechanics to prevent personal injury, making this method suitable when the caregiver is physically capable of supporting the individual’s weight and effectively managing the pivot motion.

Ultimately, the use of a dependent pivot transfer is determined by the individual’s specific needs and circumstances, with the primary goal of ensuring a safe, dignified, and comfortable transfer. Regular evaluation of the individual’s condition is necessary, as changes in their ability to participate in transfers may necessitate adjustments to the transfer techniques used. It may become necessary to begin the use of a Hoyer Lift.

In managing ALS, caregivers often face challenges in safely transferring patients

Performing a dependent pivot transfer involves a series of steps designed to move an individual with significant mobility limitations from one seated position to another, such as from a wheelchair to a bed or chair. This method requires you to physically support the majority of your loved one’s weight during the transfer, making it essential for you to employ proper techniques to ensure safety and comfort for both parties involved.

Here is a detailed outline of the steps involved in executing a dependent pivot transfer safely and effectively:

Key Steps in Dependent Pivot Transfers

Preparation: Start by preparing the environment. Ensure the wheelchair is close to the destination surface to minimize the distance of the transfer. Lock the wheels of the wheelchair and remove any obstacles from the path including the footplates. If possible, remove the wheelchair armrest on the side you are transferring for more space. Keep the other armrest intact as it will provide increased support for your loved one with decreased trunk control. Communicate with the individual throughout the process to keep them informed and to gauge their comfort level.
Positioning and Safety Measures: Before initiating the transfer, position the individual at the edge of the wheelchair seat to facilitate an easier pivot. Apply a gait belt securely around the individual’s waist for additional support and safety. This provides a handle for the caregiver to grip during the transfer. Ensure the individual’s feet are flat on the floor, slightly apart for stability. You should also adopt a stable stance, with feet shoulder-width apart and one foot slightly in front of the other to maintain balance.
Initiating the Transfer: Encourage the individual, if able, to lean forward slightly to shift their center of gravity and keep their arms in their lap. You should then squat or bend at the knees (not at the waist) to maintain a strong, stable posture. Using the gait belt, lift the individual just enough for them to clear the seat of the wheelchair by straightening their own legs, keeping the individual’s body close to yours to minimize strain.
Pivot and Positioning: Once the individual is slightly lifted, pivot on your feet to turn the individual towards the target surface. It’s crucial to keep the movements smooth and to continuously communicate, ensuring the individual knows what to expect next. Carefully guide the individual to the chair or bed until they are fully over the surface.
Completing the Transfer: With the individual in the correct position, you can then lower them back down to the seated position. This should be done by squatting or bending at your knees while supporting the individual’s weight through the gait belt. Ensure the individual is safely and comfortably positioned in the chair or bed, making any necessary adjustments for their comfort.
Post-Transfer: After the transfer, remove the gait belt and perform any needed adjustments to ensure the individual is comfortable and secure. Check in with your loved one to ensure they are not experiencing discomfort or pain as a result of the transfer.

When Performing a Dependent Pivot Transfer

Things You Should Do:

Communicate Clearly: Always inform your loved one of what you're about to do before you start the transfer. This helps prepare them mentally and physically, reducing anxiety or resistance.
Check the Environment: Ensure the area around the transfer surface and wheelchair is clear of obstacles. This prevents trips and falls during the transfer.
Maintain Proper Posture: Bend at your knees and keep your back straight when lifting or lowering. This technique helps prevent injury to your back.
Secure the Wheelchair: Before starting the transfer, make sure the wheelchair is as close as possible to the transfer surface and that its brakes are locked.
Assess Your Loved One's Condition: Evaluate their level of mobility and strength on that day, as it can vary. Adjust your transfer technique accordingly.

Things You Shouldn't Do:

Don’t Rush the Transfer: Moving too quickly can lead to mistakes and accidents. Take your time to ensure each step is performed safely.
Avoid Lifting from the Back: Never lift using your back muscles. This is a common mistake that can lead to serious injury.
Don’t Ignore Comfort: If your loved one expresses discomfort or pain during the transfer, stop immediately and reassess the situation.
Don’t Transfer Without Assistance if Needed: If your loved one's weight or mobility level requires it, don’t hesitate to ask for help from another person.
Avoid Twisting Your Body: When pivoting, move your feet so your entire body turns, rather than twisting at your waist.
Don’t Skip Safety Checks: Always double-check that the wheelchair is locked and the area is safe before beginning the transfer.

Practice Makes Perfect

A dependent pivot transfer is a physically demanding process that requires strength, coordination, and careful attention to the principles of safe body mechanics. Proper technique and practice are essential for you to perform this transfer safely and effectively, minimizing the risk of injury to both you and your loved one being assisted.

By adhering to these guidelines, you can ensure a smoother, safer transfer process for your loved one.