Submitted by: Jeremy Nelson PT
5.0 transfers – Part 1
Functional outcome tools like the Berg provide a useful framework for documenting change over time. However answering the question of why that changed happened, and what were the causes of the changes observed requires the unique skills of the movement professional. The functional outcome tools provide a framework for identifying progress over time, as each scoring matrix demonstrates improvement towards a desired level of function. However those data points require further translation making explicit the relationships that give rise to the behavior being observed. Only after this reconstituting of the goal into the component parts can these elements become data points to organize a change effort around.
In the rehabilitation market today, the question “Is the intervention provided the cause of the change observed?” is the so called $50,000 question. Did the change occur as it would have any way, such as the natural progression through the inflammatory phase? Or was the change a result of another intervention, such as the elimination of pain through medication? Functional tools such as the Berg assist in identifying the desired levels of change however more is to be done by the rehabilitation specialist. The role of the rehabilitation specialist is to take that observable and measurable task and then examine and evaluate its constitute relationships. These relationships not only occur between person and the environment but include relationships between body segments and within those segments at the level of individual joints and muscles.
If the medication was the cause of the improvement, then what about the contributing body segments? Is there an acceptable level of organization to produce movement that is nondestructive? This question, motivated by the value of prevention, is a valuable use of the rehabilitation professional’s time. Are the body segments coordinated enough to provide safe movement in other typically environmental demands? Again the rehab professional has the unique tools to comment on the movement of a patient that has had the initial problem of pain reduced to provide improved function.
Consider the fifth component of the Berg, the Transfer. Transfers are basic staple of the work that is done by rehabilitation professionals. It seems so basic and simple, and yet when evaluating and working to improve transferring, the complexity can often be overwhelming. Up and to this point, the berg test has examined the COG in motion or maintained in a position relative to a static BOS. True, the sit to stand and stand to sit does include a change in BOS, however the transfer includes the change of BOS at the level of the extremities as well.
Observing a transfer from one chair to the other both the COG and BOS control is on display, the neuromuscular system ability to control the center of gravity while also organizing a changing base of support . Within a base of support that may include upper extremity support and given that it is a pivot transfer and is not necessarily stand pivot transfer what we may be observing is a use of the upper extremities to compensate for an inability of the core musculature to control the center of gravity. The rehab professional is uniquely qualified to comment on how the transfer is taking place, describing quality of movement. Just because a patient demonstrates movement consistent with a a defined score, it may not be in way that is safe over the long run.