Submitted by: Jeremy Nelson PT
5.0 Transfers – Part 2
Examining the scoring matrix for this component a wide level of capacity is documented. At the lowest levels the patient “needs two people to assist or supervise to be safe” when moving from one surface to the other. This can have a number of causes and would include inadequate control of the COG to promote any level of stability. Although a higher level of function when the patient “needs one person to assist” there continues to be a lack of COG control. As discussed earlier, these scores do not provide an explanation for why what is occurring, is actually occurring. Any intervention to move towards the next level of function would include an explanation of the body segments contribution to the critical tasks of the movement, in this case inadequate.
To be “able to transfer with verbal cuing and/or supervision” the patient now demonstrates a capacity to control the COG to initiate a weight shift, although continues to require verbal instruction on how to sequence and complete each critical task. The difference between a squat transfer and a standing pivot transfer is the ability to shift the body weight to unweight one of the lower extremities to change position. Transferring requires the center of gravity be maneuvered within the base of support the patient needs to be able to shift their body weight throughout that base of support. The control of the COG to produce the weight shift likely includes critical tasks already performed in the seated and sits to stand motions. Having completed those elements, the patient would be better positioned to orchestrate the complex movements in order to change and establish a new BOS.
Why would a patient be “able to transfer safely definite need of hands”? The upper extremities are extension of the COG control. With the upper extremities supporting weight or providing more information to the brain through touch, the nervous system can better organize the weight shifting and positioning of the COG relative to the changing BOS. Again here the rehab professional is well positioned to describe the use of the upper extremities, whether for support and control of the trunk or simply for touch. Each level of upper extremity supports provides data to support the interventions planned and to document changes as a result of the intervention.
When the patient demonstrates being “able to transfer safely with minor use of hands”, the Berg component is satisfied. However the movement professional may not be as through collaboration with the patient it is learned that the transfers required by the patient to participate in life in a way that matters to the patient are not as simple as moving from one chair to the next. In life, there are varying surface heights, hand positions, motions to be made in addition to the one previously described. As the demands change, the scoring matrix can still be employed as behaviors seen and documented. And having had developed a clear record of what interventions were causative in restoring the capacity of the body to produce the critical task movements to give rise to the functional movement, the movement professional can review their notes and be well positioned to develop progressions on behalf of the patients desired level of function.