transfer assessment instrument 4.0 – independent transfers
TRANSCRIPT
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TransferAssessmentInstrument4.0–IndependentTransfers
Thistoolisdesignedtoobjectivelyunassistedtransfers.Thetoolbreaksdownthetransferintothreecomponents:wheelchairsetup,bodysetup,andflight/landing.Scoringdiffersbasedonwhethertheuseristransferringfromamanualorpowerwheelchair.Eachsectionofthetoolshouldbecompletedbeforeadvancingtothenextphase.Itiswritteninuser-centeredlanguagebutcanbeutilizedbyendusers,theircaregivers,andclinicians.Spaceisallottedtoscoreatransfertoandfromasurface(2totaltransfers),howeveronlyonetransferisnecessarytousethetool.
SelectWheelchairType:cPowerwheelchairManualwheelchairDoyouuseaslidingboardwhentransferring?YesNo
1. Usingaruler(ifavailable),measurethedistancefromthefrontcornerofyour
wheelchairtotheobjecttowhichyouaretransferring.Whatisthedistance?a. Lessthan3inches [score1]b. 3-5inches [score0.5]c. Greaterthan5inches [score0]
2. Whatistheanglebetweenyourwheelchairandthemat?Useananglemeasurementtoolifpossible(seeappendix).
a. 0-19degrees [score0mwc,score1pwc]b. 20-45degrees [score1mwc,score0pwc]c. 46-90degrees [score0]
3. Didyoulockthebrakesonyourwheelchair?a. Yes,Iengagedthebrakes(manualwheelchair) [score1]b. Yes,Iturnedmywheelchairoff(powerwheelchair) [score1]c. No [score0]d. Notapplicable,mywheelchairdoesnothavebrakes [scoreN/A]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
PhaseI:WheelchairSetup
Setupyourwheelchairtotransfertoanothersurface(bed,mattable,couch),thenanswerthefollowingquestions.
2
4. Didyouremovethearmrestfromyourchair?a. Yes [score1]b. No,butmywheelchairdoeshavearmrests [score0]c. Notapplicable,mywheelchairdoesnothavearmrests [scoreN/A]d. Notpossible,mywheelchairhasarmrestsbutthey
cannotberemoved(boltedin,welded) [scoreN/A]
5. Didyouremovetheclothing/sidesguardsorposturalsupports(thighguides,lateralsupports)fromyourchair?
a. Yes [score1]b. No [score0]c. No,howevermyclothing/sideguardsdon’tgoanyhigherthanmywheel[scoreN/A]d. Notapplicable,mywheelchairdoesnothaveclothing/sideguards[scoreN/A]e. Notpossible,mywheelchairhasclothing/sideguardsbutthey
cannotberemoved(boltedin,welded) [scoreN/A]6. Wasyourtransfersetuptobelevel(topofcushionislevelwiththesurfaceyouare
transferringto)?Usearuler(ifpossible)tomeasurethedifferenceinheightbetweenthetopofthefrontcorneryourcushionandthesurfaceyouaretransferringto.Whatisthedistance?
a. Mycushionheightiswithin1inchofthesurface [score1]b. Mycushionismorethan1inchhigher [score0]c. Mycushionismorethan1inchlower [score0.5]d. Notpossibletoadjustheightofwheelchair/transferdestination[scoreN/A]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
3
7. Whereareyourfeet?a. Bothonfootplate [score0mwc,1pwc]b. Oneonfootplate,oneontheground [score0.5]c. BothuponthesurfaceIamtransferringto [score1]d. OneuponthesurfaceIamtransferringtoandoneontheground/footplate[score0.5]e. Bothonthefloor [score1]f. Oneonfloor(Iamasinglelimbamputee) [score1]g. Oneonfootplate(Iamasinglelimbamputee) [score0mwc,1pwc]h. Nottouchinganysurface(Iamadoublelimbamputee) [scoreN/A]
8. Didyouscoottoyourhipstothefrontofyourseat,soatleast1/3ofyourthighwas
offthesurface?a. Yes [score1]b. No [score0]c. Notpossible,Iamunabletomaintainmybalanceinthisposition[scoreN/A]
9. Whereisyourleadingarm(seeimages)onceyoupositionittotransfer?a. OnthesurfaceIamtransferringtobehindmyhip [score0]b. OnthesurfaceIamtransferringtobetweenmyhipandknee [score1]c. OnthesurfaceIamtransferringtopastmyknee [score1d. Itisinmylap,Idon’tusethisarmduringmytransfer [scoreN/A]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
PhaseII:BodySetup
Positionyourbodyforthetransfer,adjustingyourhipsandlegsasyounormallywould,thenanswerthefollowingquestions
4
10. IdentifythetypeofsurfaceyoutransferredFROM.Then,checktheboxofthetypeofhandpositionthatmostcloselyrepresentsthehandpositionyouusedforyourpushoffhandwhenyourhipsweremovingbetweensurfaces.CHECKALLTHATAPPLY.
score: 1 1 1 000.5
score: 0 1 0 0.5
score: 1 0 00.5
score: 1 1 0 00.5
score:1 1if<6”fromBOS1if<6”fromBOS N/A
Bathroom
NotUsed
Scoring
Transfer1|Transfer2
A)TotalScore:B)Total#PositionsUsed:
Score=A/B
A)TotalScore:B)Total#PositionsUsed:
Score=A/B
Whe
elchair
Firm
Surface
Chair
SoftSurface
(Bed
/Cou
ch)
5
12. IdentifythetypeofsurfaceyoutransferredTO.Then,checktheboxofthetypeofhandpositionthatmost
closelyrepresentsthehandpositionyouusedforyourleadinghandwhenyourhipsweremovingbetween
surfaces.CHECKALLTHATAPPLY.
score:1 1 1 000.5
score: 1 0 0 0 0 0.5
score: 0 1 0 0.51 1if<6”fromBOS1if<6”fromBOS
score:s.score:1 0 00.5N/A
score: 1 1 0 00.5
NotUsed
Scoring
Transfer1|Transfer2
A)TotalScore:B)Total#PositionsUsed:
Score=A/B
A)TotalScore:B)Total#PositionsUsed:
Score=A/B
Whe
elchair
Firm
Surface
Bathroom
Chair
SoftSurface
(Bed
/Cou
ch)
SlidingBo
ard
6
13. Whenyoufinishedthetransfer,wherewasyourleadinghand(seeimage)inrelationtoyourhips?
a. Closetomyhip [score1]b. Morethan6inchesfrommyhip[score0]
14.Whenyoutransferredbetweensurfaceswhichwaywereyouleaning?
a. Iwasleaningbackward,towardsthesurfaceIwastransferringto[score0]b. Mybodyremainedupright [score0]c. Iwasleaningforward,awayfromthesurfaceIwastransferringto[score1]d. I’mnotsure [score0]
14. Whenyoutransferredbetweensurfacesdidyou(pleasecircleallthatapply):
a. Performthemovementinonesmoothandfluidmotion [score1]b. Usemultiple‘scoots’tocompletemytransfer [score1]c. Landorrestonthetire [score-1mwc,N/Apwc]d. Performthemovementinanabruptmannerwhereyouhad
tochangedirectionsorbodypositionsinrapidmannertoavoidfalling(unintentionallylandingonanundesiredsurface)[score-0.5]
e. Experiencedanearfall(unintentionallylandingonanundesiredsurface)[score-1]f. Experienceafall(unintentionallylandingonanundesiredsurface)[score-1]
15. Whenyoulandedonthetargetsurface(pleasecircleallthatapply):a. Noexcessivemovementoccurred(nolossofbalance) [score1]b. Experiencedexcessivemovement(lossofbalance)butdidnot
unintentionallylandonanundesiredsurface(experienceafall) [score-0.5]c. Experiencedexcessivemovement(lossofbalance)andsomepartofyourbody
unintentionallylandedonanundesiredsurface(experienceafall)[score-1]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
------(lowestpossiblescore:0)
------(lowestpossiblescore:0)
Transfer1|Transfer2
------(lowestpossiblescore:0)
------(lowestpossiblescore:0)
PhaseIII:Flight
Completeyourtransferbetweensurfaces,thenanswerthequestionsonthefollowingpages
7
16. Whenyoutransferdoyou:a. Alwaysleadwiththesamearm [score0]b. Alternatewhicharmyouleadwith [score1]
AssistiveTechnology
17. Iuseassistivetechnology(suchasatransferboardorlift):a. Never,Iamstrongenoughtoperformthetransfer
withoutastruggle [score1]b. Never,howeverIsometimesfeelthatIstruggleto
completethetransfer [score0]c. SometimeswhenIfeeltiredorweak [score1]d. Sometimes,duetopain [score1]e. Sometimesforsafetyortopreservemyarms [score1]f. Allofthetimebecauseoffatigueorstrengthlimitations [score1]
18. Ifaslidingisused,whenusingtheboarddoyou:a. Performthetransferasmultiple‘lifts’/‘scoots’,pickingup
yourhipsandplacingthemoverseveralsteps [score1]b. Slideyourhipsalongtheboard [score0]
TocalculatetotalscoreforIndependentTransfers:
1. SumallscoresforTransfer1items(BoxA)2. Count#N/AitemsforTransfer1(BoxB)3. CalculateascoreforTransfer1(BoxC):
a. 100%xA(19-B)
Ignoreremainingstepsifonly1transfercompleted
4. SumallscoresforTransfer2items(BoxD)5. Count#N/AitemsforTransfer2(BoxE)6. CalculateascoreforTransfer2(BoxF):
a. 100%xD(19-E)
7. Calculatethetotalscore:a. C+F/2
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
Transfer1Transfer1Transfer1TotalScore#itemsN/ATOTALA
B
C
Transfer2Transfer2Transfer2TotalScore#itemsN/ATOTALD
E
F
TOTAL
%
8
TransferAssessmentInstrument4.0–AssistedTransfers,NoMechanicalLift
Thistoolisdesignedtoobjectivelyevaluatebothassistedandunassistedtransfers.Individualsshouldcompleteatransfertoandfromasurface(2totaltransfers)forscoring.Thetoolbreaksdownthetransferintothreecomponents:wheelchairsetup,bodysetup(BOS),andflight/landing.Scoringdiffersbasedonwhethertheuseristransferringfromamanualorpowerwheelchair.Eachsectionofthetoolshouldbecompletedbeforeadvancingtothenextphase.Itiswritteninuser-centeredlanguagebutcanbeutilizedbyendusers,theircaregivers,andclinicians.
SelectWheelchairType:cPowerwheelchairManualwheelchair
1. Usingaruler(ifavailable),measurethedistancefromthefrontcornerofyourwheelchairtotheobjecttowhichyouaretransferring.Whatisthedistance?
a. Lessthan3inches [score1]b. 3-5inches [score0.5]c. Greaterthan5inches [score0]
2. Whatistheanglebetweenyourwheelchairandthemat?Useananglemeasurementtoolifpossible(seeappendix).
a. 0-19degrees [score0mwc,score1pwc]b. 20-45degrees [score1mwc,score0pwc]c. 46-90degrees [score0]
3. Didyoulockthebrakesonyourwheelchair?a. Yes,Iengagedthebrakes(manualwheelchair) [score1]b. Yes,Iturnedmywheelchairoff(powerwheelchair) [score1]c. No [score0]d. Notapplicable,mywheelchairdoesnothavebrakes [scoreN/A]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
PhaseI:WheelchairSetup
Setupyourwheelchairtotransfertoanothersurface(bed,mattable,couch),thenanswerthefollowingquestions.
9
4. Didyouremovethearmrestfromyourchair?a. Yes [score1]b. No,butmywheelchairdoeshavearmrests [score0]c. Notapplicable,mywheelchairdoesnothavearmrests [scoreN/A]d. Notpossible,mywheelchairhasarmrestsbuttheycannot
beremoved(boltedin,welded) [scoreN/A]
5. Didyouremovetheclothing/sidesguardsorposturalsupports(thighguides,lateralsupports)fromyourchair?
a. Yes [score1]b. No [score0]c. No,howevermyclothing/sideguardsdon’tgoanyhigher
thanmywheel [scoreN/A]d. Notapplicable,mywheelchairdoesnothave
clothing/sideguards [scoreN/A]e. Notpossible,mywheelchairhasclothing/sideguards
buttheycannotberemoved(boltedin,welded) [scoreN/A]6. Wasyourtransfersetuptobelevel(topofcushionislevelwiththesurfaceyouare
transferringto)?Usearuler(ifpossible)tomeasurethedifferenceinheightbetweenthetopofthefrontcorneryourcushionandthesurfaceyouaretransferringto.Whatisthedistance?
a. Mycushionheightiswithin1inchofthesurface [score1]b. Mycushionismorethan1inchhigher [score0]c. Mycushionismorethan1inchlower [score0.5]d. Notpossibletoadjustheightofwheelchair/transfer
destination [scoreN/A]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
10
7. Whereareyourfeet?
a. Bothonfootplate [score0mwc,1pwc]b. Oneonfootplate,oneontheground [score0.5]c. BothuponthesurfaceIamtransferringto [score1]d. OneuponthesurfaceIamtransferringtoandone
ontheground/footplate [score0.5]e. Bothonthefloor [score1]f. Oneonfloor(Iamasinglelimbamputee) [score1]g. Oneonfootplate(Iamasinglelimbamputee) [score0mwc,1pwc]h. Nottouchinganysurface(Iamadoublelimbamputee) [scoreN/A]
8. Didyouscoottoyourhipstothefrontofyourseat,soatleast1/3ofyourthighwasoffthesurface?
a. Yes [score1]b. No [score0]c. Notpossible,Iamunabletomaintainmybalanceinthisposition[scoreN/A]
9. Whereisyourleadingarm(seeimages)onceyoupositionittotransfer?
a. OnthesurfaceIamtransferringtobehindmyhip [score0]b. OnthesurfaceIamtransferringtobetweenmyhipandknee [score1]c. OnthesurfaceIamtransferringtopastmyknee [score1]d. Itisinmylap,Idon’tusethisarmduringmytransfer [scoreN/A]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
PhaseII:BodySetup
Positionyourbodyforthetransfer,adjustingyourhipsandlegsasyounormallywould,thenanswerthefollowingquestions
11
10. IdentifythetypeofsurfaceyoutransferredFROM.Then,checktheboxofthetypeofhandpositionthatmost
closelyrepresentsthehandpositionyouusedforyourpushoffhandwhenyourhipsweremovingbetweensurfaces.CHECKALLTHATAPPLY.
score: 1 1 1 000.5
score: 0 1 0 0.5
score: 0 1 00.5
score: 0 1 0 00.5
11. 12. score: 0 1 0 N/A
Bathroom
Chair
NotUsed
Scoring
Transfer1|Transfer2
A)TotalScore:B)Total#PositionsUsed:
Score=A/B
A)TotalScore:B)Total#PositionsUsed:
Score=A/B
Whe
elchair
Firm
Surface
SoftSurface
(Bed
/Cou
ch)
PhaseIII:Flight
Completeyourtransferbetweensurfaces,thenanswerthequestionsonthefollowingpages
12
11. IdentifythetypeofsurfaceyoutransferredTO.Then,checktheboxofthetypeofhandpositionthatmost
closelyrepresentsthehandpositionyouusedforyourleadinghandwhenyourhipsweremovingbetween
surfaces.CHECKALLTHATAPPLY.
score:1 1 1 000.5
score: 1 0 0 0 0 0.5
score: 0 1 0 0.511if<6”fromBOS1if<6”fromBOS.
score:score:0 1 00.5N/A
score: 0 1 0 00.5
Scoring
Transfer1|Transfer2
A)TotalScore:B)Total#PositionsUsed:
Score=A/B
A)TotalScore:B)Total#PositionsUsed:
Score=A/B
Firm
Surface
Bathroom
NotUsed
SoftSurface
(Bed
/Cou
ch)
Whe
elchair
Chair
SlidingBo
ard
13
12. Whenyoufinishedthetransfer,wherewasyourleadinghand(seeimage)inrelationtoyourhips?
a. Closetomyhip [score1]b. Morethan6inchesfrommyhip[score0]
13. Whenyoutransferredbetweensurfaceswhichwaywereyouleaning?a. Iwasleaningbackward,towardsthesurfaceIwastransferringto[score0]b. Mybodyremainedupright [score0]c. Iwasleaningforward,awayfromthesurfaceIwastransferringto[score1]d. I’mnotsure [score0]
14. Whenyoutransferredbetweensurfacesdidyou(pleasecircleallthatapply):
a. Performthemovementinonesmoothandfluidmotion [score1]b. Usemultiple‘scoots’tocompletemytransfer [score1]c. Landorrestonthetire [score-1mwc,N/Apwc]d. Performthemovementinanabruptmannerwhereyouhad
tochangedirectionsorbodypositionsinrapidmannertoavoidfalling(unintentionallylandingonanundesiredsurface) [score-0.5]
e. Experiencedanearfall(unintentionallylandingonanundesiredsurface)[score-1]f. Experienceafall(unintentionallylandingonanundesiredsurface)[score-1]
15. Whenyoulandedonthetargetsurface(pleasecircleallthatapply):a. Noexcessivemovementoccurred(nolossofbalance) [score1]b. Experiencedexcessivemovement(lossofbalance)butdidnot
unintentionallylandonanundesiredsurface(experienceafall) [score-0.5]c. Experiencedexcessivemovement(lossofbalance)andsomepartofyourbody
unintentionallylandedonanundesiredsurface(experienceafall)[score-1]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
------(lowestpossiblescore:0)
------(lowestpossiblescore:0)
Transfer1|Transfer2
------(lowestpossiblescore:0)
------(lowestpossiblescore:0)
14
17. Whenyoutransferdoyou:a. Alwaysleadwiththesamearm [score0]b. Alternatewhicharmyouleadwith [score1]
AssistiveTechnology
18. Iuseassistivetechnology(suchasatransferboardorlift):a. Never,Iamstrongenoughtoperformthetransferwithoutastruggle[score1]b. Never,howeverIsometimesfeelthatIstruggletocompletethe
transfer [score0]c. SometimeswhenIfeeltiredorweak [score1]d. Sometimes,duetopain [score1]e. Sometimesforsafetyortopreservemyarms [score1]f. Allofthetimebecauseoffatigueorstrengthlimitations [score1]
19. Ifaslidingisused,whenusingtheboarddoyou:a. Performthetransferasmultiple‘lifts’/‘scoots’,pickingup
yourhipsandplacingthemoverseveralsteps [score1]b. Slideyourhipsalongtheboard [score0]
TransferHelper
20. Duringmytransfer,Ifelt(pleasecircleallthatapply):a. ConfidentthatIwouldreachmyintendeddestinationwithout
Incident [score1]b. Incontrolofthesituation [score1]c. FearfulthatIwouldfall [score-0.5]d. Alackofcontroloverhowthetransferwasperformed [score-0.5]e. PainordiscomfortaboveandbeyondwhatIfeelinaresting
position [score-0.5]
21. Whencommunicatingwithyourassistant:(pleasecircleallthatapply):a. Doyoufeelcomfortablecorrectingtheassistantifsomethingis
performedincorrectly [score1]b. Doyoufeeluncomfortablespeakingupwhensomethingisdone
incorrectly [score0]c. Informationispassedbetweenyouandtheassistanceinaclear,
politeandeffectivemanner [score1]d. Communicationbetweenyouandyourcaregiverisunclearand
miscommunicationoftenoccurs[score-1]
22. Whenyourassistantprovidesyouwithhelphe/she:a. Pullsonmyarm,eitheratmywrist,forearmorupperarmwhen
movingmefromonepositionorsurfacetoanother [score0]b. Doesnotpullonmyarmsandplaceshis/herhandoneithermy
torso,hips,buttocksorlegswhenmovingmefromonepositionorsurfacetoanother [score1]
ScoringTransfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
------(lowestpossiblescore:0)
------(lowestpossiblescore:0)
Transfer1|Transfer2
------(lowestpossiblescore:0)
------(lowestpossiblescore:0)
Transfer1|Transfer2
15
TocalculatetotalscoreforAssistedwithoutMechanicalLift:
1. SumallscoresforTransfer1items(BoxA)2. Count#N/AitemsforTransfer1(BoxB)3. CalculateascoreforTransfer1(BoxC):
a. 100%xA(24-B)
4. SumallscoresforTransfer2items(BoxD)5. Count#N/AitemsforTransfer2(BoxE)6. CalculateascoreforTransfer2(BoxF):
a. 100%xD(24-E)
7. Calculatethetotalscore:a. C+F/2
Transfer1Transfer1Transfer1TotalScore#itemsN/ATOTALA
B
C
Transfer2Transfer2Transfer2TotalScore#itemsN/ATOTALD
E
F
TOTAL
%
16
TransferAssessmentInstrument4.0–AssistedTransferswithMechanicalLift
Thistoolisdesignedtoobjectivelyevaluatebothassistedandunassistedtransfers.Individualsshouldcompleteatransfertoandfromasurface(2totaltransfers)forscoring.Eachsectionofthetoolshouldbecompletedbeforeadvancingtothenextphase.Itiswritteninuser-centeredlanguagebutcanbeutilizedbyendusers,theircaregivers,andclinicians.
SelectWheelchairType:cPowerwheelchairManualwheelchair
1. Duringthetransfer,Ifelt(pleasecircleallthatapply):a. ConfidentthatIwouldreachmyintendeddestinationwithout
Incident [score1]b. Incontrolofthesituation [score1]c. FearfulthatIwouldfall [score-0.5]d. Alackofcontroloverhowthetransferwasperformed [score-0.5]e. PainordiscomfortaboveandbeyondwhatIfeelinaresting
position [score-0.5]2. Whencommunicatingwithyourassistantduringthetransfer(pleasecircleallthe
apply):a. Didyoufeelcomfortablecorrectingtheassistantifsomethingis
performedincorrectly [score1]b. Didyoufeeluncomfortablespeakingupwhensomethingisdone
incorrectly [score0]c. Informationwaspassedbetweenyouandtheassistanceinaclear,
politeandeffectivemanner [score1]d. Communicationbetweenyouandyourcaregiverwasunclearand
miscommunicationoccurred[score-1]3. Whenyourassistantprovidedyouwithhelp,he/she:
a. Pulledonmyarm,eitheratmywrist,forearmorupperarmwhenmovingmefromonepositionorsurfacetoanother [score0]
b. Didnotpullonmyarmsandplacedhis/herhandoneithermytorso,hips,buttocksorlegswhenmovingmefromonepositionorsurfacetoanother [score1]
4. Duringthetransfer,myhandswere:a. Onmylap [score1]b. Holdingontoaslingorhoyerbar [score1]c. Hangingatmyside [score1]
5. Regardingtheslingduringthetransfer:a. Itwassecurelypositionedandnoorveryminimaladjustmentsare
necessarymid-flight [score1]b. Moderateadjustmentswerenecessarymid-flighttopreventafall[score-0.5]c. Itwaspositionedpoorlyandthetransferhadtobeaborted
mid-flighttopreventafall [score-0.5]d. Itwaspositionedpoorlyandafalloccurredmid-flight [score-1]
Scoring
Transfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
Transfer1|Transfer2
17
TocalculatetotalscoreforAssistedwithMechanicalLift:
1. SumallscoresforTransfer1items(BoxA)2. CalculateascoreforTransfer1(BoxB):
b. 100%xA/7
3. SumallscoresforTransfer2items(BoxC)4. CalculateascoreforTransfer2(BoxD):
c. 100%xA/7
5. Calculatethetotalscore:b. B+D/2
Transfer1|Transfer1TotalScoreTOTAL
A
B
Transfer2|Transfer2TotalScoreTOTALC
+D
TOTAL
%