Wheelchair Transfer: Tips for You and Your Caregiver by Jamie L. Miles (Source: Pierson FM, Fairchild SL. Principles and Techniques of Patient Care. 3rd ed: W. B. Saunders Co.; 2002: pp.127-166.) Transferring to and from a wheelchair can be a challenging for a person with ALS. As the body changes, altering the transfer method may be necessary. If your current method is no longer working, ask your physical therapist for transfer training. Below are some tips to help with the process. Remember, safety takes precedence. If you are unsure of your ability to carry out any of these recommendations, please do not attempt them. For all transfers: Your wheelchair should be positioned at a 45° angle to and midway between the head and foot of the transfer surface. For manual wheelchairs, lock the brakes and have the caster wheels positioned facing forward. If the caster wheels are facing backwards, the wheelchair loses stability. For power wheelchairs, turn the power off once the wheelchair is in the proper position for the transfer. Remove or swing away the footrests and the armrest closest to the transfer surface. Position your buttocks forward in the wheelchair and place your feet on the ground. Your caregiver should avoid pulling on any weakened extremities, because the muscles do not adequately support the joint. Do not grab clothing to assist in the transfer, as this may compromise your safety and comfort. Do not hug your caregiver’s neck while transferring, as this will place undue strain on his neck. Once a transfer is complete, your caregiver should not leave you unsupported until you are stable on the transfer surface. To return to the wheelchair, the procedures described are reversed. Make sure the wheelchair is positioned and locked, and that you move forward on the transfer surface. Stand-Pivot Transfer: Position your wheelchair and body as described above. Your caregiver should partially squat and place his legs around your legs. If possible, hug your caregiver’s middle or upper back, while he hugs you securely or positions his hands beneath your buttocks. Count to three while rocking back and forth to gain momentum. On "three," stand up with his assistance, and allow him to stabilize your knees by pushing in and forward. Before you pivot, you should be in a position high enough to clear your wheelchair and the transfer surface. Sliding Board Transfer: Position your wheelchair and body as described above. Shift your weight to one side, placing the sliding board under your thigh, in front of the drive wheel, so that it extends from the wheelchair seat to the transfer surface. Your caregiver should partially squat and position his legs around your legs, and position one hand beneath your buttock and the other on your upper trunk. Place the hand closest to the transfer surface on the sliding board, 4- 6 inches away from the thigh, with the fingers flat. Do not wrap your fingers around the edge of the sliding board, as you risk crushing them when your weight is shifted onto the board. Place the other hand next to the other thigh. With your caregiver’s assistance, perform a push-up and quickly move your hips towards the transfer surface. Repeat the push-up as you move along the board until you are on the transfer surface. Then shift your weight to one side, and remove the sliding board from under your thigh. Two-Person Lift Transfer: Position your wheelchair as described above. The taller and stronger caregiver should stand behind the wheelchair, putting his arms underneath your armpits and grasping your opposite forearms. The the other caregiver should remove your feet from the footrests and swing the footrests away, then place his arms underneath your thighs, grabbing hold of his forearms. On the count of three, both should lift you simultaneously. They should place you gently onto the transfer surface. An alternative method is to have caregivers standing on either side of you. Both caregivers should squat and place one arm under your thighs and one under your shoulder and around your back. They should then grasp each others forearms for stability. Both caregivers should count to three, and on "three," lift you simultaneously. They should place you gently onto the transfer surface.