The transfer into and out of the vehicle is a technique which each person develops according to their individual abilities. Practice makes perfect! In the early days after a SCI it can seem like an impossible task particularly when the individual has no balance, however as compensation techniques are learned so the transfer becomes easier.
Body proportions play a major role in the ease of transferring, long arms in relation to their body makes the transfer easier compared with short arms. Body weight to strength ratio is also key.
The important factors when learning to transfer are:
- Finding secure grips or leverage points to lean on for their hands.
- Having enough stability so that they do not lose their balance while transferring.
- Where to position their feet – inside or outside the car
- Having enough strength to lift their body over the space between the wheelchair and car seat.
- How to use the momentum of their body to limit the strength required.
Leaving their legs outside of the car while they do the transfer assists with their stability, however the effectiveness of this depends on the length of their legs and whether their feet are on the floor. Where the car seat is higher than the wheelchair seat it also means that the weight of the legs needs to be pulled up into the vehicle as they lift themselves up onto the seat. Leaving the legs out can also provide stability for loading the wheelchair while reaching to take the wheels off.
Placing their legs inside the vehicle first before they start moving in reduces the amount of weight that they need to lift during the actual transfer. It also enables a straighter transfer thus reducing the amount of twisting of the shoulders as they move into the car. It is important to make sure that there is enough space underneath the steering wheel so that their knees do to not get caught on the steering column or hand control as they move in, the knees must be slightly bent while doing this transfer.
Placing one foot inside the car and the other one outside can provide a good compromise where the space for the legs is limited in the car or where the individual’s legs are not long enough to give the stability of both feet on the floor.
Tips and caution:
Shoulder pain is very common in wheelchair users due to the fact that they rely entirely on the upper limb for both ambulation and weight bearing tasks. The shoulder is poorly designed for his purpose, as it has a greater range of motion than any other joint in the body which unfortunately results in it being less stable than other joints putting it at a far greater risk of injury. A person, who depends exclusively on a wheelchair for ambulation exposes their shoulders to increased stresses and imbalances, predisposing it to a variety of overuse problems. Research has shown that two major areas where injuries are likely to occur are when transferring between surfaces of different heights, and when lifting heavy objects above shoulder height. These include the transfer into and out of a vehicle as well as loading a wheelchair into and out of a vehicle. The correct ergonomics for these two activities are essential in order to prevent further injury to his shoulders. Move wheelchair as close as possible to the seat of car to limit the distance of the transfer. Ensure feet are in a comfortable position for the transfer where they will not get hooked while the body is being moved. Find a suitable secure grip to position hands when lifting self into vehicle – if possible avoid the shoulders being lifted above 90˚ and avoid any twisting action of the shoulders while carrying the full weight of the body as these actions are most likely to cause injury to the shoulders.
Transfer boards are excellent while learning to transfer and they are also being used a lot more to prevent overuse syndrome in the shoulders. This enables the individual to slide across the board instead of having to lift their full body weight. When being assisted with transfers it also means that the helper does not need to lift the full body weight of the individual being transferred.
Standard transfer boards are available from most wheelchair companies.
The Quadrislide is a transfer board that has a seat that moves on a track of two rows of marbles, which reduce the friction and enables it to slide easily between two surfaces. It is particularly useful when transferring between surfaces of different heights, such as a car transfer. Go to www.transferboard.co.za or call 0726109260.
A Transfer Platform / Tip Up Plate is a board that is fitted next to the driver’s seat which swivels down into a horizontal position between the driver’s seat and the wheelchair, and provides a fixed transfer board. When not in use it can either be removed or swivelled up into a vertical positon between the door and seat. These are available from Shoprider, EZ Drive and Easy Drive WC.
Where there is a significant difference in the seat height of the car compared with the wheelchair, an electronic version of the Transfer Platform / Tip Up Plate is available. The platform sits at the level of the door sill for the individual to transfer onto it, it then lifts them up to the seat height, thus facilitating the transfer onto a higher seat.
The AutoAdapt Turny seat and Guidosimplex Transfer System lift the car seat with the occupant through the door and lower them to the height of the wheelchair. This system can only work on the driver’s door where the vehicle has a very wide opening, e.g. the Ford Ranger Super cab and Toyota FJ Cruiser where the B-pillar has been removed. These systems are available from Shoprider, EZ Drive and Easy Drive WC.