TRANSFERS

Wheelchair

LIFE

Most people inconvenienced by wheelchairs cannot rely on their legs when they transfer their bodies to or from their chair. Those with good upper body mobility and strength can do most transfers on their own. High-level quads, like me, need assistance. This section will deal with transfers for those who need assistance in and out of bed, and transfers to and from an airplane (with or without an aisle chair). I'll share transfer methods I've learned and modified. They may work for you ... they may not. If you have another method, or hints to share, please send Feedback.

Into Bed

This method was designed to allow people with moderate strength to transfer a fairly sizable person (I am 6 feet tall and weigh about 180 pounds), by themselves, without a Hoyer® type lift. First, the wheelchair of the person being transferred needs to be positioned as close to the side of the bed as possible, as close to the head of the bed also. The side of the wheelchair needs to be taken off. Then the person assisting grabs the ankles of the person being transferred and lifts the legs to straighten them and set them on the bed (that is preferably the same height as the wheelchair seat. If the top of the cushion and the bed are different heights, the transfer can still work, it may just be more difficult ... either on the way in or on the way out). When the legs and feet are on the bed, the feet need to be positioned in enough from the edge of the bed to make sure they won't fall off during the transfer. We usually move my feet in from the side edge of the bed about eight to 10 inches. Then, I get leaned forward by the back of my head all the way, straight over my knees. Then I stretch in that position, for a few moments. When I don't feel like I'll pop back up, I'm ready for the "flop." At that point, the person assisting pushes me by the side of my torso or shoulder (while I'm still leaned all the way forward), as far across the bed as they can. It is very important to push hard, and push directly sideways across the bed (not too the transferee's side). Otherwise, there is a high risk of falling back down between the chair and the bed. From there, the assisting person grabs the bottom of my pants and pulls my legs straight across the bed until my hips are in the middle. Here it is important not to pull the legs toward the foot of the bed... just 'across.' Once my hips are in the middle, my feet are walked to the middle of the foot of the bed. Then my hip and shoulder are pushed to the middle of the bed, in line with my feet – or the hips are pulled to the middle with a turn sheet. From there I can be pushed up in bed by the bottom of my feet. Then, my legs are swung back and forth to get aligned. After that, my ankles are pulled so my feet are off the bed. Then my hips get adjusted by pulling on the turn-sheet. It will likely take some getting used to. But the transfer works very well.

Out Of Bed

Once I'm dressed in pants and shirt, I'm ready to be transferred into the chair. The person assisting places my chair as close to the side of the bed as possible – with the front edge of the cushion even with the foot of the bed – and locks it in place. Then they grab my ankles and walk them to the middle of the cushion. They then grab the bottom edge of my pants and slide me so that my butt is right next to the chair. Then they put my outside leg on the outside wheelchair armrest, and my inside leg down so that the leg sits on the wheel chaircushion, the knee is in front of the chair, and the foot is on the wheelchair footrest. Then the outside leg is moved from the armrest, down next to the inside leg, making sure that both knees stay in front of the chair and the heels of both feet are all the way back as far as they can go in the chair. From there I'm set up by the back of my head over my knees. With the weight of my shoulders, upper body, and head out over my knees, my hips are then slid across (rather effortlessly), into the chair by pulling the waist-line of my pants, grabbing way forward on the side of my hip, and sliding my hips sideways, while also pulling up a little. Once my hips are in, I'm set up by my forehead and the side piece is put back in the chair.

Then my legs are lifted one at a time, parallel with the floor so that the side seams of my pants can be pulled straight, toward the ankle bones, and loose in the crotch. Then I'm leaned forward again, and pulled back and up into the chair by my waistline. It is extremely important to pull both up and back at the same time, using the waistline and/or belt as if it/they were a transfer belt. For some reason, the most difficult part of this transfer is pulling the sides of the pant legs out (don't pull the back), so they’re not riding up in the crotch. They slide out much easier if they are not gathered or bunched, and the seams are pulled directly straight toward the ankles.

Some people like to use transfer boards or ‘sliding boards’ [see left] to help get in and out of bed, or from chair to chair. But I’ve found they get in the way, and don’t really help much, unless the two surfaces are different heights.

Airline And Chair-to-Chair Transfers

Under the ACAA (Air Carrier Accessibility Act), airlines are required to provide assistance with boarding, deplaning and making connections (they need not hand-carry a person on board a plane with less than 30 seats whose physical limitations preclude the use of existing lifts, boarding chairs, or other devices)." This can be good news and it can be bad news. The good news is if you're traveling and do not have someone to help you board and de-board, the airlines are supposed to provide assistance. The bad news is they are being compelled to help, so some airlines do not necessarily put their best people on the job. I haven't been dropped, but have come awfully close. My arms and shoulders have been wrenched pretty badly, and my head has been bashed. It's a good thing I'm durable, and have a high threshold for pain. I travel quite a bit, and must say that I have had some really good transfers, and great folks to execute them. But I have been rather surprised at how bad some of the transfers have been, and how incompetent the particular airline staff chosen to execute the transfers have been (I was almost torn apart by 'Dumb and Dumber' in Fort Lauderdale). I had the idea of setting up a consulting and training service for the airlines. But I figured they would not understand the incentive ... that is, until they get sued for dropping some lady on her head, and get stuck with a several million-dollar verdict.

There are basically two methods utilized for airplane lift transfers, and two types of logistical setups. The first, and most common, method (but not most effective) we’ll call "One in Front and One in Back." That is, two people assist with the transfer; one stands in front of the wheelchair, the other stands behind it. After taking off the wheelchair side-piece and preparing the chair to be transferred into, the person in back reaches over or around the back of the wheelchair, reaching their arms under the arms of the person being transferred, and grabbing the wrists of the person being transferred. The person in front grabs the person being transferred under the knees. On the count of three, the two people executing the transfer lift the person being transferred up and over into an aisle chair (also known as a "straight back"). Then the same process is repeated from the aisle chair to the airplane seat. The transfer is much easier if conducted to and from a bulkhead seat (the seats in the row at the front of a section ... coach, business class, or first class). The bulkhead row also provides more knee room and makes it easier for people in the middle and window seats to move in and out.

On some airplanes, a wheelchair may fit temporarily on the plane and it can be positioned close enough (at an angle) to perform the transfer directly from the wheelchair to the airplane seat (and back), without the intermediary step up transferring to and from an aisle chair. When I was younger, and my friends were younger and stronger, I was even picked up directly from my wheelchair by a buddy, and set down in the airplane seat.

The other method, which I find works best (if the people executing the transfer will listen and allow themselves to be trained a bit) is the "One On Each Side" method. That is, one person stands to your right, the other person stands to your left. They each put one hand under your knee/upper thigh, and they each grab your upper arm, with their hand basically in your armpit. It is important that they do not just "hook" your arm with their arm. They need to actually grab a hold of your arm. Then using that hand holding your arm, they each lean you forward together, by your arms, keeping you bent over (like in a ball). Then, on the count of three, they lift you up by your arms and legs and transfer you to the aisle chair or the seat. This transfer method is easier on you, easier on the people executing the transfer, and offers more control.

At trick I learned, when faced with a very long flight, is to remove the airplane seat cushion, and replace it with your wheelchair cushion. This allows you to sit more stably in the seat, with your thighs nearly parallel to the floor. It also provides protection against pressure-sores that we need. I have flown many, many times, and only twice have I run into an airplane captain who objected to this set-up. On both occasions, the captains were not very self-assured, and wanted to assert their authority (for no good reason). They didn't know the FAA (Federal Aviation Administration) regulations very well, so each reached for some vague reason why it might be a violation. Captains on literally hundreds of other flights have had no objection. Removing the bottom cushion is not an FAA violation as long as it is kept nearby to be used as a flotation device (like that will help). Anything permanently affixed to the airplane needs to pass FAA muster and burn tests. But your wheelchair cushion is not permanently affixed.

Finally, a very good friend of mine devised a clever way to help transfer his wife to and from her wheelchair, and to and from airplane seats. He took a Hoyer Lift sling and had hooks made to fit into the metal braces on the side of the sling. The hooks are designed to let him grab a hold and provide some length so he can lift her without bending over too much. He just stands in front of her, with the sling underneath her. Then he holds onto the hooks, clicks them into the metal braces on the side of the sling, lifts and pivots her around into her chair, etc. My friend is not only ingenious, but he’s one of the greatest guys you’d ever want to meet. [Pictured here]

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