Mastering this skill reduces reliance on others and minimizes the risk of falls and skin injury, which are common concerns during transfers. Consistent practice is necessary to develop the body mechanics and confidence required for safe movement. The goal is to achieve a stable and controlled transition, lessening the physical strain on the user.
Essential Pre-Transfer Safety Checks
Positioning the wheelchair close to the transfer surface, typically at a 30 to 45-degree angle to the toilet, facilitates the pivot action. Once positioned, both wheelchair brakes must be fully engaged and checked for stability to eliminate any possibility of the chair rolling or shifting during the transfer.
Footrests should be moved out of the way to prevent them from becoming a tripping hazard or obstructing the feet during the pivot. The transfer surface needs to be confirmed as clear and dry, as moisture significantly increases the risk of slipping. Finally, clothing should be managed appropriately by loosening or positioning garments to avoid snagging or interfering with the movement.
Self-Transfer Techniques: Step-by-Step Guide
The Stand-Pivot Transfer
The stand-pivot technique is appropriate for individuals who retain functional strength in their legs and trunk and can bear weight through their lower extremities. After positioning the wheelchair at the optimal 45-degree angle, the user should scoot forward to the very edge of the seat, ensuring their feet are flat on the floor and positioned slightly behind their knees. This forward foot placement is essential as it aligns the body’s center of gravity over the feet.
The user then leans their trunk forward, bringing their nose over their toes. Using their arms to push down from the armrests or a nearby stable surface, they push up to a standing position, or a partial squat if a full stand is not possible. Once upright, a small, controlled pivot is executed using the feet, turning the body until the back of the legs are in contact with the toilet seat.
This pivot should be a series of small, shuffling steps rather than one large rotation. With the toilet felt at the back of the knees, the user reaches back with one hand for a stable support—while the other hand remains on the wheelchair or a supportive surface. They then slowly lower their body in a controlled descent onto the toilet seat, keeping the movement slow to prevent a sudden drop.
The Sliding Board Transfer
The sliding board method is for individuals with limited or no weight-bearing capacity who rely on upper body strength to move their hips. The wheelchair is positioned as close as possible to the toilet, ideally with the wheels locked and the armrest on the transfer side removed or swung away. The user then shifts their weight away from the target surface, lifting one hip just enough to place one end of the sliding board beneath their upper thigh and buttocks. The other end of the board must rest securely and flatly across the toilet seat, bridging the gap between the two surfaces.
The user uses their arms to push down on the board and the wheelchair seat, lifting their hips and scooting across the board in short, controlled movements. To minimize the risk of skin shear, which is the friction that can damage skin tissue, the user must lift their hips rather than dragging their body across the board.
Proper hand placement involves one hand on the board ahead of the hips and the other on the wheelchair or a stable support, providing stability and leverage. Once fully on the toilet seat, the user must carefully lean away from the board so it can be removed from underneath them before proceeding with toileting.
Transfer Aids and Bathroom Modifications
Grab bars are the most common and simple aid, providing a stable, fixed point for pushing up or pulling across. These should be anchored directly into wall studs or blocking and are typically installed in both a horizontal and a vertical orientation near the toilet to accommodate different functional movements.
Raised toilet seats increase the height of the toilet, reducing the distance a person must travel vertically during the sit-to-stand or stand-to-sit motions. These risers often add between three and six inches of height, effectively bringing the toilet seat closer to the height of a standard wheelchair seat. Transfer benches are another useful modification, particularly in bathrooms with tubs or showers, as they provide a secure, flat surface that spans the edge of the tub.
Individuals who cannot safely perform these techniques, even with aids, may require assistance or mechanical support. For these situations, equipment like gait belts, which provide a secure handhold for a helper, or specialized mechanical lifts are necessary to ensure a safe transition.