The Impact of the Transfer

How the "Other" Surfaces Your Clients Encounter Can Present Skin-Integrity Dangers

TransfersYou spend every day — not to mention a lot of weekends and evenings — determining the optimal positioning for your clients, and then recommending or building the custom-fitted seating & mobility systems that best meet their very individualized needs.

In the course of a typical day, you discuss wheelchair backrests and cushions, lower-extremity positioning, tilting and reclining. You anticipate how a child will grow, and how your clients’ conditions will progress.

You do home assessments, ask what environments the wheelchairs will be used in, check doorway widths and talk to your clients about barrier-free entrances and roll-in showers.

If you’re in a rehab facility setting, you may also be instrumental in teaching and coaching your clients to perform weight shift s and transfers — from bed to chair in the morning, from chair to bed when the day is done.

But even after receiving all that diligent and personalized service, some of your clients will still develop pressure sores — debilitating injuries that are timely and costly to heal, and can rob wheelchair users of their independence and mobility as they recuperate.

How does it happen?

Sometimes, the “other surfaces” in your clients’ lives — the surfaces they sit on when not in their wheelchairs — are part of the problem.

A Prevalence of Pressure

When they’re not sitting on the seating system you and other members of your rehab team have recommended and provided, where are your clients sitting?

Potentially…just about anywhere:

  • In a bed or a lift chair/recliner for sleeping
  • In automotive seating: driver’s or passenger’s seat, or a car seat
  • On the floor, either carpeted or non-carpeted
  • On other “non-rehab” types of furniture, such as couches or beanbag chairs
  • On transfer benches or boards
  • On toilet or commode seats — standard types and raised versions
  • On bathtub/shower chairs or benches

Because these sitting surfaces oft en don’t have built-in means of weight shifting or pressure relief — such as tilt-in-space or recline features — clients’ risk of skin breakdown can quickly climb.

In a 2005 report on prevention and treatment of pressure sores, the National Institute for Health & Clinical Excellence — which is based in London and works with the National Health Service in the United Kingdom — said, “Pressure ulcers can develop very quickly in some people if the person is unable to move for even a very short time — sometimes within an hour.”

That fact makes it critical for clinicians and ATPs to consider the non-wheelchair sitting surfaces their clients come into contact with every day.

ADLs in the Bathroom

Of course, for many clients, those “other” sitting surfaces are often in the bathroom, where so many mobility-related activities of daily living take place.

In addition to the toilet and bathtub or shower at home, clients may also use toilets at work, school or other caregiving environments.

Wade Lawrence, national accounts manager at Clarke Health Care Inc., says, “It’s very important to consider the bathroom surfaces that (wheelchair users) sit on while using the toilet or bathing. For example, if you have someone who needs to do a bowel program, they could be sitting there for over an hour for one bowel movement.”

In that case and during that time, Lawrence adds, a padded toilet or commode seat “may be the only source of protection for them if there is not a tilt-in-space” feature on the commode.

Cali Thomson, business manager, bath safety & walking aids, Invacare Corp., says clinicians devising skin integrity programs do need to consider all the surfaces their clients come into contact with.

“The overall plan for skin integrity is essential to minimize skin shearing and pressure ulcers,” Thomson notes. On such surfaces as raised toilet seats, shower chairs and transfer benches, Thomson says clinicians and ATPs should “identify any possible pinch points in the product.”

She also suggests, “Identify any possible sharp edges. Consider the transfer method that allows for patient assistance or the use of proper equipment, (such as a) sling or lift. Consider the ease of use of the transfer equipment, whether it be a transfer bench or lift /sling.”

Making the Right Choices

With all the transfer and bath safety equipment available — some being sold by mainstream retailers such as Walgreens and — it can be difficult for consumers with more complex or progressive medical conditions to choose products that meet their needs. That’s especially true if they require positioning or postural support, or are at higher risk of skin breakdown.

So what advice should clinicians give to consumers who are shopping for transfer assistance?

“Safety should be the absolute number-one consideration when shopping for any bath safety item,” Thomson says. She also suggests looking for products that are easy to use and install, and ones that will be easy to clean and maintain.

“Consider portability of an item, if (the consumers) travel frequently,” she adds. “Assess the bathroom and how the product will or will not fit in the space.”

Lawrence says, “Consider ergonomically shaped seats to help provide support and correct hip positioning. Also, look for seating that is soft and comfortable, and provides no pressure around the recess.”

As a safety consideration, he suggests considering “something that is Gore-Tex: This will keep it completely waterproof from the outside. Look for something that is a non-slip texture; this will help in a wet environment.”

Both Lawrence and Thomson agreed that product durability is a key feature to keep in mind.

“Cheap products are not always the cheap alternative,” Lawrence emphasizes. “If you buy a cheaper, inferior product, it (might) only last a year before rusting out. Look for products (with) water-tight materials, like stainless steel or hard-blown plastic, as opposed to steel.”

Finally, Thomson suggests looking for “product that combines safety with aesthetics.” After all, the happier consumers are with their purchases, the more likely they are to use their equipment diligently and over the long term. And doing that can help to maintain healthier skin even when they’re outside their wheelchairs and seating systems.

This article originally appeared in the March 2013 issue of Mobility Management.

In Support of Upper-Extremity Positioning