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ver had the experience where you were asked to evaluate and care for an individual who had very brittle bones due to osteoporosis or who had little or no ability to transfer under his or her own volition due to paralysis? If you are a healthcare provider, especially a nurse, physical therapist, or occupational therapist, the answer would be a resounding yes! In fact, this is an everyday occurrence in extended care and rehabilitation. Luckily, there are a number of products and various new technologies available to assist with transfers, bathing, and gait training. These products enhance both the comfort and safety of individuals who are not independent in their mobility as well as provide protection for caregivers from work-related injuries, such as back strain.

Figure 1. The transfer disk is used to rotate an individual during transfers when he or she is unable to pivot. This approach prevents injury due to twisting of the lower extremities.

       Mechanical lifts have certainly advanced since the first prototypes were marketed. They have evolved from machines used to transfer an individual from wheelchair to bedside to more sophisticated models that can be utilized to provide graduated levels of assistance during ambulation as well as calculate and track client weights. Today, mechanical lifts are used for many different types of transfers, including transfers to wheelchairs/chairs, beds, toilets, showers, baths, bathing tables, aquatic pools, and even horses during hippotherapy or therapeutic riding sessions to name a few uses.

Figure 2. The BeasyTrans is used to decrease friction and shear forces during seated transfers.

       Assistance in transfers is graded according to individual needs. The need for assistance during transfers can range from none to maximal assistance of multiple staff. Individuals may fall anywhere on this continuum. Individuals requiring less intensive assistance may need only manual support and the use of transfer devices, such as gait belts/vests, patient transfer slings, transfer disks (see Figure 1), or the BeasyTrans from B-Medical, Inc., Burbank, California (see Figure 2). These devices are used to decrease friction and shear forces that induce tissue damage during bed mobility activities and transfers, as well as to reduce impingement injuries that might occur to structures, such as the individual's brachial plexus with manual lifts.

Figure 3. The Encore(TM) by Arjo Inc. is used to assist individuals with standing and gait activities.

These devices also enhance the individual's quality of life, independence, and safety through an increased ability to move in bed, transfer from chair to bed, wheelchair to car seat, etc. As can be seen in Figure 1, the individual stands on the transfer disk and is then rotated from the wheelchair to bedside rather than performing a stand-pivot transfer. The transfer disk eliminates the risk of lower-extremity joint injury, such as a fracture due to twisting of a planted or stationary limb in individuals unable to safely perform stand-pivot transfers. Similarly, the BeasyTrans allows for a smooth, nontraumatic transfer of an individual from one surface to another by sliding a circular disk on a board with a tracking device (see Figure 2). These devices eliminate the need for any manual lifting and thereby increase the independence of the individual as well as decrease potential injury of the caregivers. Both of these devices are lightweight, easy to transport, and fairly inexpensive (< $100.00 for the transfer disk and < $400.00 for the BeasyTrans).

Figure 4. The Hoyer Hydraulic Lifter is another example of a mobile lift system with a rolling base that can be placed around objects and under bedframes during transfers.

       For those individuals requiring a higher level of assistance, mechanical lifts are an excellent option. Individuals who are candidates for mechanical lifts or transfer devices are typically persons that are medically fragile due to muscle weakness, poor endurance, severe osteoporosis, or medical conditions that require multiple lines, tubes, or other appliances. Presently, there are a number of mechanical lifts available. Some of the common mechanical lifts that are on the market today include the Encore(TM) from ARJO Inc., Roselle, Illinois, (see Figure 3), the Hoyer Hydraulic Lifter from B-Medical, Inc., Burbank, California (see Figure 4), the Invacare Lift from Invacare, Elyria, Ohio (see Figure 5), the SureHands systems from SureHands Lift and Care Systems, Pine Island, New York (mobile lift, see Figures 6a and 6b; overhead/ceiling lift, see Figure 7), and Waverley Glen ceiling-mounted lift systems from Waverley Glen Systems LTD, Concord, Ontario, Canada.

Figure 5. The Invacare Lift is a mobile mechanical lift system that also comes with a rolling, adjustable base that will accommodate most seating equipment during transfers.

       These mechanical lift systems can be divided into overhead/ceiling lifts or mobile lifts. Some advantages that have been suggested for the use of ceiling-mounted lifts versus mobile lifts include 1) ease of use; 2) no floor space required; 3) no turning area required; 4) ability to pass through narrow spaces; 5) smooth transfer with no bumping; 6) less set-up time; 7) no need for lift-base clearance; 8) requires less personnel for safe operation; and 9) ability to reach over large furniture, pools, bathing tables, spas, etc.1 Similar arguments have been made for the wall-mounted versions of mechanical lifts versus mobile models. However, the facility must have an adequate infrastructure to support either ceiling or wall-mounted mechanical lift systems, and this may increase the overall cost of initial installation compared to that of mobile lift systems that do not require reinforced or special infrastructure.

Picture 6a. The SureHands Mechanical Lift System is a mobile lift that is electronically controlled. It comes with both a sling apparatus for transfers as shown above and a transfer frame as demonstrated in Figure 6b. The advantage of the sling system is that individual slings may be ordered for individuals and then carried with them throughout a large facility or campus if similar equipment is used in most patient areas.

Figure 6b. The SureHands Mechanical Lift System with transfer frame.

       In comparison to fixed lift systems, such as ceiling or wall-mounted lift systems, mobile mechanical lift systems can be used in multiple rooms in a single building or can be moved from one building to another. Additionally, new lightweight mobile lifts are available, such as the transportable(TM) by Waverley Glen Systems, LTD. This system is approximately the size of a suitcase and can be transported in an individual's car or in a transport vehicle for use in community outings. Mobile mechanical lifts also allow individuals to be transferred to and from almost any surface. They can also be used to assist individuals in standing and for gait training. For example, the Encore mechanical lift shown in Figure 3 can be adjusted to promote increasing levels of independence in ambulation by removing supporting straps and blocks.

Figure 8. Example of a weighing attachment for mobile mechanical lift systems.

Figure 7. Overhead/ceiling lift for transferring individuals to toilets, bathtubs, bathing slabs, etc.

       Mechanical lift devices also come with numerous attachments, such as a weighing apparatus (see Figure 8). This apparatus allows individuals' weights to be acquired quickly, comfortably, and accurately without having to take weights of nonambulatory individuals in wheelchairs. This attachment is particularly attractive when beds with weighing devices are not available.
       Various types of slings are available to be used with mechanical lift systems. They include standard four-point slings with and without head support; padded slings for added comfort; mesh slings for bathing, showering, and air circulation; toileting slings with head support; four-point amputee slings; and walking jackets for use in gait activities. Some systems can also be outfitted with both slings and support frames (see Figure 6a and 6b).
       Correct utilization of slings and adherence to safety procedures are paramount to safe handling of individuals. One approach used in our facility to enhance safety during transfers is the practice of double looping the sling loops onto the side bars (i.e., placing two loops on each support bracket) in case of slippage or tearing (see Figure 9). In our facility, we also endorse the presence of two or more staff during all mechanical lift transfers so as to ensure maximal safety of our individuals. Assignment of a responsible person for monitoring all lifts and slings and dating of slings upon receipt so that sling life can be followed are additional safety practices utilized in our facility.

Figure 9. Sling loops used to attach the sling to the sidebars. Use of double or two loops for attachment is an increased safety measure in case of slippage or breaks. Use of the outer loops for support places the individual in a more recumbent position while use of the inner loops places an individual in a more flexed position.

       Optimally, purchase of lift devices should be coordinated throughout the facility to maximize efficiency. Use of similar devices allows for the interchange of equipment and attachments, less training for staff due to decreased variability in lift systems, and decreased costs for repairs and replacement parts, since fewer maintenance contracts have to be negotiated. However, several different lifts may be needed in a large facility including a combination of mobile and overhead/ceiling-mounted systems. Therefore, when purchasing equipment, a team or committee approach is recommended, since it allows for the most optimal equipment to be purchased for the facility.

Acknowledgements
       We would like to express our appreciation to Debbie Hair, Scott Hardy, and Charlotte Rouse for their assistance in demonstrating transfer techniques.