Transfer Devices

INTRODUCTION
For individuals with spinal cord injuries, a primary chapter is that availability
goal of rehabilitation is learning the ability to and reimbursement by
successfully transfer between different surfaces or insurers is variable and often
pieces of equipment. Transfers can include, but are depends on strict criteria. If
not limited to, moving from the bed to the wheelchair, possible, it is important to
from the wheelchair to the commode, and from the trial equipment before
commode to bathing equipment. purchase because
obtaining incorrect
Some individuals will be able to perform transfers
transfer equipment could
without any medical devices, but many will require the
limit the independence of an individual and insurance
use of an assistive device, with or without a caregiver
may deny coverage for a second device.
assisting. In addition, the difficulty of the transfer (such
as the distance between two surfaces) may change the
level of assistance or the assistive device an individual
Ambulatory Assistive Devices
may require in that instance. Although most commonly thought of to help with
mobility, these devices are critical for many individuals
Table 1 illustrates expected transfer equipment by
to successfully transfer.
level of injury for individuals with motor complete
spinal cord injuries. Typical Users: These devices are most commonly
used by individuals with incomplete spinal cord
Motor Level Expected Transfer Equipment injuries or lower level spinal cord injuries, often in
C1-C4 Power or mechanical lift with sling. conjunction with bracing.
C5 Maximum assistance with transfer
board or with power/mechanical lift
C6 Possibly independently with or without
transfer board, may require some
assistance, especially for varying
surface heights.
C7-T1 Likely independent with transfer board
over uneven surfaces, potentially able
to transfer without equipment.
T2-T12 Likely independent with transfers with
or without transfer board.
L1-S5 Likely independent with transfers
without transfer board.
Table 1: Expected Transfer Equipment by Level for
Individuals with Motor Complete Spinal Cord Injuries

This chapter will give a comprehensive overview of

potential transfer equipment that may prove useful for
individuals with spinal cord injuries. One important
caveat when evaluating the different equipment in this
Gait Belt Lifting Belt Transfer Sling

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Contraindications and Cautions: Using Walkers
ambulatory assistive devices, particularly without
caregivers present, often requires significant upper Walkers are devices of variable designs that provide
extremity strength to help lift the body. This can lead a wide and stable base of support for individuals to
to degenerative changes of the shoulders and upper lean/push against in order to stand, transfer and
extremities. Individuals are also at risk of falls when walk. Essentially, the user is transferring weight from
using these devices. their legs to their arms. They can be used with both
sit to stand transfers and stand pivot transfers. When
Caregiver Manual Gait Assistive Devices: standing with a relaxed arm, the handgrips of the
Although relatively simple in design, a gait belt can walkers should be at the crease of the user’s wrist.
effectively be used to prevent falls in appropriate Walkers can generally be adjusted to the user but may
individuals. The person who is assisting with the require a junior, tall or bariatric walker in select cases.
transfer should stand with hands spread and securely
holding the gait belt. They should have a wide base of Standard/Basic Walkers: These walkers have
support and while assisting the individual should bend no wheels. Users need to lift the walker in order to
at the knees and not at the back. advance forward. Standard walkers tend to be the
most stable but can be difficult to advance.
Gait Belt/Lifting Belt/Transfer Slings: These
devices are generally a few inches thick and come in Two-Wheeled Rolling Walkers: These walkers
many materials such as canvas, nylon or leather. They have two casters on the front legs of the walker. They
can be secured with a buckle or a loop with teeth. provide for an easier and more natural gait pattern
There are variations of the gait belt that also include than a standard walker but are less stable.
leg loops, handles or a full chest harness. Others Three-Wheeled Rolling Walkers: These walkers
types do not fully lock around the waist and just have one swiveling wheel in front and two fixed
provide support with standing. wheels in the back. These are more maneuverable,
lighter and easier to transport compared to a four
Floor Stand-Transfer Systems wheeled walker.
Infrequently used in those with spinal cord injury, Four-Wheeled Rolling Walkers: Often known as a
the goal of these devices is to help individuals rollatortm, these walkers are also maneuverable. They
with adequate strength to stand but difficulty with often have a seat as well.
transferring. The person assisting with the transfer can
place their foot on the device to add stability. Platform Walker/Attachment: These walkers have
a platform (or attachments) that allows individuals
Turntable: Made of two discs that rotate over one to use a walker without having to use their hands or
another, these devices should be used with caution in forearms, which may be options for those with weight
those with spinal cord injury as they can lead to falls if bearing restrictions.
the individual is not closely monitored.
Pivot Transfer Mat: Non-stick mats, these provide Canes
a stable surface for individuals to stand on while Canes can be used to help with transfers for those
performing a transfer. with good lower extremity function but difficulty with
balance or standing from sitting.
They effectively assist with balance
by increasing the user’s base of
support. It should be used in the
hand opposite the weaker side
as it allows the user’s’ weight to
shift off the more involved leg.
Canes can also be used bilaterally
to provide even greater support.
When standing with a relaxed arm,
Turntable Pivot Transfer Mat the cane handle should be at the

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Walkers

Standard/Basic Walkers Two Wheeled Rolling Walkers Four Wheeled Rolling Walkers

Platform Walker Platform Walker Single Arm

Attachment
Canes

Hurry Cane™

Single Point Cane Tripod/ Quad Canes

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height of the crease of the user’s wrist. There are a The height of the handgrips should be adjusted to the
variety of shapes, materials, and modifications to the user’s hip, leaving a slight bend in the elbow. Axillary
handgrip of the cane for comfort or to accommodate are often used for more short term use compared to
grip preferences. Forearm/loftstrand crutches (see below).
Single-Point Cane: These canes come to a single Forearm/Lofstrand Crutches: Forearm crutches
tip (or point of contact with the ground). have a cuff that fits around the user’s forearm and
a handgrip. They are more portable than axillary
Hurry Cane™: Similar to single point canes, but they
crutches but require the most coordination and
have a 360 degree pivoting head with 3-point rubber
balance. Compared to axillary crutches, they are often
tip, which is non-skid and all-terrain.
for longer-term use and allow for a more reciprocal
Tripod/Quad Canes: These canes come to three gait pattern.
or four tips and have greater contact with the ground
Hands Free Crutches: These crutches are designed
which provides greater stability.
to provide maximum comfort and mobility support.
Unlike axillary/forearm crutches, they eliminate the
Crutches
pressure placed on the armpits, hands, and wrists.
Crutches are similar to canes and walkers, and can be Instead, pressure is distributed through the elbows
used to help those with lower body weakness transfer. and forearms.
They also take weight off the legs by providing weight
bearing through the arms. They generally require Transfer Boards
greater coordination and balance thean a walker.
One of the most commonly used transfer devices for
Axillary Crutches: Traditionally used to offload a individuals with spinal cord injuries, a transfer board
limb, axillary crutches can also be used for lower aids individuals in completing lateral transfers from
extremity support and balance. These axillary pad (top one surface to another. They work to bridge the gap
part of the crutch) should rest 1-2 inches below the between the two surfaces. Individuals should anteriorly
armpit and pressed against the ribcage to stabilize weight shift to avoid sheering across the board. It can
the crutch. Weight is placed through the handgrips. be helpful to go down a slope, if possible, to allow
the assistance of gravity. Slip-resistant pads, or friction
tape, can be adhered to the bottom, to increase
stability during transfers
Typical Users: Individuals with low tetraplegia (C7-
T1) or paraplegia. They are used when individuals
do not have sufficient upper body strength to fully
clear their buttocks between the two surfaces, as it
allows them to break the transfer down into multiple
small movements. They also may be helpful to
those experiencing fatigue, chronic pain, or joint
deterioration due to previous transfer methods.
Contraindications and Cautions: Individuals
are at risk of sheer injuries if they slide their buttocks
across the transfer board. Boards should be inspected
to ensure they are smooth, undamaged and splinter
free. Shear-free boards also have the risk of skin
getting pinched and torn.
Transfer Board: Transfer boards come in many
shapes, sizes and materials (such as wood or plastic)
to accommodate varying transfer conditions and
Axillary Crutches Forearm/Lofstrand individual sizes.
Crutches

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 Transfer Boards

Contoured Transfer Boards

Beasy Transfer Board™

Standard Transfer Board

Scooter Transfer Board

Notched Transfer Board

Standard Transfer Board: Average 8-12” wide x Shear-Free Boards: Designed for those that are
24-25” long. Shorter boards are easier to get under unable to adequately lift during transfers, shear-free
buttocks and reach to the secondary surface. Longer (or anti-shear) boards consist of a movable surface
boards are for wider gap transfers, such as wheelchair that does not require the individual to lift during
to car. These can come with or without slots, which transfers.
allow individuals with poor hand strength/dexterity to
• Beasy Transfer Board™: The most common
hold them. Weight capacities listed for commercially
type of shear-free board is the Beasy Transfer
available standard board models range from 300-
Board™. It is constructed with a sliding round disc
400 lbs. If the individual weighs more than 400lbs,
in the middle of a curved board that moves from
they will require a bariatric model. The bariatric
one end of the board to the other while the person
models are thicker to accommodate the increased
sits on it. An individual will require enough trunk
load.
control to maintain upright posture throughout the
Notched Transfer Boards: Notches to help transfer or it can lead to increased risk for falls.
stabilize on transfer surfaces (for example, the
• Scooter Transfer Board: These boards are
wheelchair).
made of a series of wheels that allow the user to
Contoured Transfer Boards: Contoured to fit slide on the board. These boards are generally
around a commode seat, they allow placement and contraindicated in spinal cord injury given the risk of
use while on the commode/toilet. pinching skin leading to the development of wounds.
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Lifts and Lift Slings 400-500 lbs. Bariatric models have capacities
between 600-1000 lbs.
Another commonly used transfer modality are
individual lifts. Individual lifts physically go underneath • Electronic Mechanical Lifts: These are
the individual and lifts them from one surface to composed of the same parts as a manual lift, but
another. They come in a variety of types based on are operated using a hand push button control.
individual needs and their environment. Another These lifts are battery powered and recharged
consideration is the need for an appropriate lift sling. using a standard AC outlets or a battery charger.
All devices should have an emergency stop and a
Typical User: Typically used in people with C1- manual emergency release lowering capability in
C6 tetraplegia who do not have the strength case of loss of battery power. These also come in
to independently transfer, bariatric individuals, standard or bariatric models. They also can have
individuals with weak upper extremities, and for various features (such as folding). These are often
individuals whose caregivers cannot provide the not covered by insurance, but are available to be
amount of assistance required for a safe manually purchased by the individual/caregiver for ease of
assisted transfer. Furthermore, lifts can help protect use in the home.
caregivers as frequently lifting the individual they are
Overhead Lift Systems: These systems are similar
caring for can put them at risk of injury. They are also
to floor lifts although they are mounted from a
helpful in those who have a history of, or currently
fixed point overhead. These systems are generally
have, skin breakdown on their buttock.
expensive and often limited to institutional settings.
Contraindications/Cautions: The biggest risk of They also generally do not allow the freedom of
using a lift is that the individual falls out of the lift transfer locations, unlike floor lifts, although custom
during a transfer which can lead to a serious injury. units can be made to encompass an entire room or
Caregivers are also at risk of repetitive stress injuries even multiple rooms.
by using a manual lift.
Ceiling Lift: These systems may be mounted
Floor Lifts: These lifts are placed on the ground. directly to a reinforced ceiling or joists, or through
They come in a variety of styles and sizes based on posts placed strategically in corners of the room
the needs of the user. Manual lifts are usually covered (or sometimes mounted to the walls). Ceiling lifts
by insurance if necessary for daily transfers within the are power operated. Weight capacities range from
home while other lift types are generally not covered. standard models 300-500 lbs. and bariatric models
up to 1000 lbs. These systems are advantageous as
• Manual Hydraulic Mechanical Lifts: These
they leave open floor space without a floor base unit
lifts are composed of a floor base, hand pump
to maneuver and can be used with beds/chairs that
mechanism, push handles to steer the lift, and
manual lift frames would not fit around. A structural
overhead cradle for attaching the sling. The base
engineer and permits are generally needed for home
legs have locks and are able to open laterally
installation to ensure safety.
and close inward to allow access under various
surfaces, such as a bed, wheelchair, toilet/ Slings: All lift systems require a sling to harness the
commode, or standard chair. The bases take transferring individual. There are a variety of slings
up floor space and are unable to be moved that can be used for multiple different purposes. Slings
under surfaces with less than 4” of clearance are available in both solid and polyester mesh (usually
from the floor. The overhead cradle may have used for bathing). Slings come in different sizes.
two or four hooks for sling attachment, which There are also padded varieties of the below slings.
varies depending on brand/model. To raise the
Split Leg or “U” Slings: These are suitable for a
individual into the air, the caregiver must crank a
wide variety of users and lifting operations including
lever.
from a seated or lying position. Split leg splints support
Specialty models are available that take up less the entire body. Some models offer additional head
space/fold, are portable or accommodate lower support. The sling is ideal for lifting, moving and
arm systems, allowing difficult transfers in tight positioning users who have reduced control of their
spaces, such as in and out of a car. Standard upper and lower body. These may be contraindicated
floor models have weight capacities ranging from in the setting of thigh and sacral wounds.
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Lifts and Lift Slings

Ceiling Lift Split Leg or “U” Slings Full Body (Hammock) Standing Slings
Slings

Manual Hydraulic Mechanical Lifts Electronic Mechanical Lifts Electronic Stand-Assist Lift

Full Body (Hammock) Slings: These slings Trapeze: These are generally a triangular shaped
are designed for lifting and moving people with metal bar that can be used to facilitate bed
diminished motor function as they support the entire positioning or transfers in and out of the bed to either
body and provide extra support around the hips and a wheelchair or shower/commode chair. These can
thighs. Unlike the split leg slings, this sling allows be stabilized to a metal overhead bed frame, to a
the hips to remain in a neutral position. Hammock
ceiling/wall, or to a portable frame base. If attached
slings can be solid (above) or can have a hole at the
to the bed or wall/ceiling, they are more secure, but
buttocks area to allow for use on the commode/toilet.
can only be used in that location. Despite being
Standing Slings: These slings attach to an overhead less secure, the portable frame base can be used in
lift system and are designed for individuals with sufficient multiple locations. There are also concerns about
leg strength to stand upright, but who have difficulty the biomechanics of overhead lifting when using a
balancing. These slings reduce the chance of falls during trapeze, related to repetitive stress shoulder injuries in
early mobilization for transfers and walking.
people with spinal cord injuries.
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Stand-Assist Lifts are designed to assist an Electric: A sling is positioned under the arms and
individual to a semi-standing position for transfer. around the individual’s thoracic region to provide
These devices include handles for the individual support. The sling system and hydraulic lift helps raise
to hold, at the same time their trunk and hips are the individual to a semi-standing position with feet
secured. These devices can be: secured on a footboard. An individual must be able
to tolerate weight through their legs and exhibit some
Manual: The individual uses the leverage of the
trunk control to be used safety. It is not recommended
device to help stand and then the caregiver uses the
for those post thoracic or lumbar spinal surgery due to
wheeled frame to help with the pivot portion of the
the distraction it provides to the spine.
transfer. An individual must have enough leg strength
to come to and maintain at least a partial stand to
use these devices. Common name brands of these
devices include: Molift Raiser™ and Sara Stedy™.

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