Push and Pull: a Guide to Transfer Devices and Equipment

Photo by Anna Shvets on Pexels.com

Loss of muscle strength, range of motion or flexibility, coordination or cognition may result in difficulty independently moving and transferring oneself. We often take for granted the number of times we change position throughout the day. Rolling over in bed, getting in and out of the car or bath, on and off the toilet or different seated surface can pose a significant challenge for anyone with a mobility impairment. 

Injuries can easily occur during these transitions both to the person trying to transfer and to those trying to assist. Poor body mechanics and insufficient tools can cause back or other injuries when attempting to help someone reposition and falls can happen if someone doesn’t have the support they need. Falls are a serious cause of injury and death, especially among the elderly. In the U.S. in 2018, one in four adults reported falling resulting in 88 deaths per day amongst older adults . In fact the CDC predicts the number of yearly falls will increase from 36 million to 52 million by 2030.  The medical costs for falls alone reached over $50 billion dollars and there is a high risk for increased morbidity after each fall (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2020). 

Luckily, an entire industry of adaptive equipment has been created to assist you in maximizing both success and safety during transfers. Check out some of the helpful devices and examples below and know that this is by no means an exhaustive list, but a place to get started. 

**IMPORTANT DISCLAIMER: this information is meant to alert you to the equipment that exists to help you but is not intended as a training module to use it safely. Please contact the manufacturer of each device or a qualified therapist to help you select devices most appropriate to you and to teach you how to use it safely.

**This post may contain affiliate links from Amazon Associates or other affiliate programs through which I may earn a portion of qualifying purchases

Gait/Transfer Belts

If you’ve ever spent any time in the hospital you have likely seen the yellow bands adorning the wrists of many patients. “Fall Risk!”, they shout at any staff or passersby. Somewhere along the lines some crafty individual figured out that if we could just hold onto these folks we could hopefully avoid any untimely collisions with the floor and thus the gait (transfer) belt was born. 

These belts secure around a person’s waist, or in certain circumstances when that area is unavailable, around the upper chest and provides a place for a caregiver or attendant to grasp the person and both steady them and provide a point of leverage to help with transfers. The Cloth Gait Belt secures around the torso and is secured with a buckle mechanism that consists of teeth to hold the belt securely in place. These can be easy to locate but not necessarily easy to clean.

Click on the photo to see this in detail

Another option is the wipeable gait belt made of vinyl material that can be easily sanitized. This is an obvious benefit and may be best in some occasions. You can purchase one with a plastic clasp or metal teeth. I tend to prefer the metal teeth over the plastic clasp as I find it can be difficult to pull the belt tight enough and secure it using the plastic clasp. 

Finally, we have looped transfer belt which is constructed with a serious of loops attached along the length of the belt to allow a caregiver or family member to provide assistance with scooting, standing or transferring from, for example, a wheelchair.

Click on the photo to see how to purchase this or similar devices

Transfer boards

A simple yet genius piece of equipment. The transfer, or slide board as it is sometimes called, is typically a rectangular or oblong piece of wood or other plastic that helps to cover the gap that exists between two transfer surfaces. The space between the seat of a wheelchair and the seat of a toilet has never looked so vast until you are attempting to scoot over there and your legs aren’t helping much. 

Transfer boards come in various sizes and shapes but the basic concept remains the same. The board is somewhat slick to allow a person to slide more easily across its surface. It prevents the need to fully stand up and allows even persons with no functional use of their lower extremities to move between surfaces. One end of the board sits on the surface you are moving to and the opposite end get’s tucked under your bottom. If you have one of those fancy gait belts on someone can even help you to scoot across it. 

One piece of advice, (don’t ask me how I learned this the hard way) as tempting as it may be, do not loop your fingers through the handy dandy hand hold opening on the end of the board that you are sliding toward. Though it seems like a great way to get a firm grip, undoubtedly as your weight shifts onto that side of the board you will only succeed in smashing your fingers beneath the weight of your body. Just. Don’t. Do it. 

Click on these photos to see these boards in detail

Transfer Sheet

Much like the transfer board, the transfer sheet is a slippery piece of material whose primary goal is to move a person from here to there. These devices are primarily used to help reposition a person in bed without having to lift them. 

In one version of the transfer sheet there are actually Two sheets stacked on top of one another which are placed beneath the person by rolling them onto their side and tucking it underneath. By grasping the top sheet one can reposition the person on the bed as the top sheet slides easily across the bottom sheet thus reducing friction.

The second option is a Single transfer sheet with handles. This typically consists of a single sheet but is also placed beneath the person and used to more easily slide them laterally or up and down on the bed. 

Depending on the person and the device you may find it easiest to have a second person available to help.

Transfer Disc

A transfer disc or pivot disc allows a caregiver to transfer a patient between surfaces without them needing to take a step. Picture a lazy susan that you would put on the dining room table and spins 360 degrees to give everyone access to the goodies. Instead of on the kitchen table, however, this device sits on the floor in front of the person transferring and their feet are placed on the disc. As the person stands (partially or fully) the caregiver can direct the person’s hips toward the adjoining surface and their feet will simply come along for the ride as the disc turns. As one can imagine this device may pose a risk for falls if one does not control the transfer well so this is a good one to practice with the help of a trained professional first! 

Mechanical Lifts

Mechanical lifts come in many forms and brands. These are large in-home devices that typically consist of some sort of sling that is placed under the person being transferred which is then attached to a lift device overhead. The mechanical lift then raises the person up into the air and the device can be turned or moved throughout the house to reposition the person elsewhere such as in a chair or bed. As you can imagine these devices are costly, take up quite a bit of space and require appropriate training to use safely but some insurance plans may pick up all or part of the cost of the device and can make the difference between someone living comfortably with their loved ones in their home or in a skilled nursing facility. For insurance authorization a physician’s prescription is most likely always necessary. Make sure to do your research or talk with a DME company to determine which device is appropriate for you.

These devices are appropriate for individuals that require more than 75% assistance for transfers or who aren’t able to safely or effectively bear weight through their legs. Here are several examples of mechanical lift devices and you can click on them to see these devices and similar ones in detail.

Stand Assist Devices

The final device we are going to talk about today is a category of equipment called a stand assist device. These can be electric or manual and provide assistance to pull a person up into standing. The manual devices such as the Lumex Stand Assist Patient Transport Unit roll in close to the person and provide a set of handles from which they can pull themselves into standing and block the lower legs to keep the knees from buckling. Typically, some type of seat is available to flip behind them and then they can rest into the seat. These devices are on wheels so once the person is secured in the device it can be moved throughout the home as necessary. The electric devices look similar in design except a sling is placed behind the individual and the electronics of the device lift the person into standing for those that do not have the strength to pull themselves up. These devices may also be covered by insurance and would need a prescription from a physician. For an example, check out the Graham-Field Lumex Sit-to-Stand Battery-Powered Patient Lift 


Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. “STEADI—Older Adult Fall Prevention.” Centers for Disease Control and Prevention, 2020, https://www.cdc.gov/steadi/. Accessed 16 10 2020.

Health Partners and Equipment in Neurologic Rehabilitation Part II

In most cases a neurologic disease or injury occurs suddenly and without warning. The impact can be sharp and wide reaching and few people are prepared for the aftereffects. Recovery and management of such diseases and injuries can be daunting if you do not know what to expect. Many people experience needs or issues that they are unfamiliar with and often are not aware of the various resources and providers available to help them with their needs. Below is a list of resources and community partners you may be able to access where you live to support your recovery and improve your quality of life. By no means is this list exhaustive and I would recommend reaching out to some of the people in your immediate community for more specific guidance. You’d be surprised what resources lie close to home if you know what you are looking for!

If you haven’t checked out Part I of this blog its a great place to start.

Adaptive Equipment

Performing daily tasks such as dressing, walking, meal prep or work tasks may be difficult with a neurologic injury or disorder. Luckily there are creative types out there who have been crafting adaptive devices for almost anything you can think of. A quick internet search may help you find what you are looking for but Occupational, Physical and Speech therapists are also great resources for these devices. Adaptive equipment exists to help with small tasks such as grasping a fork or buttoning a shirt, for bigger tasks such as inserting or removing a urinary catheter, for holding weights during a workout session and many more tasks. 

Splints, bracing and orthotics

Splinting and bracing may also increase your efficiency and independence. Many people view bracing and splinting as a sign that they haven’t recovered or as something that will hinder their recovery but the truth is that when utilized appropriately splinting and bracing may improve your safety, decrease the need for help from others, increase energy, reduce pain and increase ability to walk. Again, physical or occupational therapists are trained in prescribing splints and braces. If you would benefit from a custom brace or splint you may be referred to an Orthotist who will not only work with your insurance to determine if they may pay for some or all of the device but can order an off the shelf brace or build a custom brace to meet your specific needs. A prescription from your physician will be needed if insurance coverage is sought. 

Community Partners and Allied Health Professionals

In addition to your therapy team and medical specialists there are many community partners and allied health professionals that can support you in many ways. Here is just a short list of resources you might find helpful

-Mental/Psychological Support: licensed-clinical social workers, psychologist and psychiatrists can be imperative in supporting mental and emotional wellbeing. Coping and adapting during life with a neurologic injury or disease can be challenging and taking care of your mental and emotional health (that includes caregivers too!) is important. Local support groups are also a great way to find others who share your experience. Everyone of us could use a strong support system and sometimes reaching for support outside of your closest family and friends is important and can help reduce feelings of overwhelm, anxiety or depression.

-Neuropsychologist: Neuropsychologists are different than traditional psychologists. Neuropsychologists study brain and behavior changes that occur following a neurologic trauma or disease. They work specifically to understand the cause and severity of memory difficulties, mood disorders, learning difficulties and nervous system dysfunction. They can assess components such as problem-solving abilities, reasoning, and so forth. They utilize interview, possibly imaging and formalized testing to assess these and many other different areas. Neuropsychological evaluation can give you a deeper understanding of your condition and can help develop a treatment plan to help improve or rehabilitate these impairments. 

-Neuro Ophthalmologist: Neuro Ophthalmologists take care of visual problems related to the nervous system. The brain is highly involved in vision related tasks and any injury or disease that affects the brain or nerves may affect your vision. Neuro Ophthalmology may be beneficial to diagnose visual changes and provide a treatment plan to improve or compensate for your vision impairments.

-Vocational Rehabilitation: Vocational Rehabilitation Programs provide services and support in order to assist persons with disabilities to meet their employment goals. If you have a physical or mental disorder that presents a significant impediment to employment you may qualify for a vocational rehabilitation program. Vocational Rehabilitation Programs are often run or funded by the state and eligibility is determined based on need. An internet search for Vocational Rehabilitation Programs in your state may provide you with the information you need for referral and eligibility to a program. 

Health Partners and Equipment in Neurologic Rehabilitation Part I

In most cases a neurologic disease or injury occurs suddenly and without warning. The impact can be sudden and wide reaching and few people are prepared for the aftereffects. Recovery and management of such diseases and injuries can be daunting if you do not know what to expect. Many people experience needs or issues that they are unfamiliar with and often they are not aware of the various resources and providers available to help them with their needs. Below is a list of resources and community partners you may be able to access where you live to support your recovery and improve your quality of life. By no means is this list exhaustive and I would recommend reaching out to some of the people in your immediate community for more specific guidance. You’d be surprised what resources lie close to home if you know what you are looking for!

Photo by Streetwindy on Pexels.com

During Hospitalization

Nurse case managers and social workers can often be accessed in a hospital or rehabilitation setting to help organize post-acute care and advise you on resources to support you in your community. During hospitalization, decisions about where you or your loved one will be discharged should begin. While getting home is always the ultimate goal sometimes an intermediate level of care is necessary to ensure that return to home is safe and successful for everyone involved.

Post-Acute Care

Several levels of rehabilitation are available to support you in returning to your home and prior level of function. If you can tolerate 3 hours of therapy per day (speech therapy, occupational therapy and/or physical therapy) you may qualify for a stay at an intensive inpatient rehabilitation facility in your area. If you do not meet the qualifications for inpatient rehabilitation or have finished your stay there but are not ready to return home you may be transferred to a skilled nursing facility where you will continue to receive some therapy services and also any continued medical care. Once safe to return home you typically have two options for rehabilitation: home health therapy and outpatient therapies. Which program is right for you depends on many factors but those who can leave the home without difficulty may not qualify for services in the home.

Transportation Services

Several options exist to help transport you to appointments and other important places and likely vary depending on where you live. You may qualify for subsidized transportation through local services like Dial-A-Ride or others like it. Your insurance company may also be able to connect you with a free or low cost ride service based on your needs. Community-based services such as Uber or Lyft may be an option for those that can transfer in and out of a car relatively easily and are safe to travel and navigate this system alone. Reach out to your insurance company and find out what they can offer. Whenever possible, don’t let transportation difficulties stand in the way of getting the care you need.

Mobility Devices

If a mobility device such as a wheelchair, cane or walker is needed before leaving the hospital, often the hospital staff will arrange to have this ordered for you. Wheelchairs may be purchased or rented depending on the need. 

Durable Medical Equipment (DME) companies provide custom wheelchairs, standing frames, gait trainers and other equipment that can assist you in your mobility. Often this type of equipment requires a prescription from a doctor, a formal physical or occupational therapy assessment and formal paperwork to submit to insurance. Depending on your insurance plan they may cover some or all of the cost of this equipment but there are typically limitations on how often large pieces of equipment such as these can be purchased through insurance. If you think you may benefit from a piece of equipment such as this talk to your physician and set up an appointment with a neurologic rehabilitation facility who performs equipment evaluations. 

For smaller devices such as walkers, canes or crutches individuals are often responsible for purchasing these on their own. There are many options out there, however, and if you are unsure which one is best for you talk with your therapist. They may have a variety of assistive devices at their clinic that you can try and they can advise you on what might be best for you at a particular stage of your recovery.  

Return to Driving

Determining when it is safe and appropriate to return to driving is a question that many people face. Driving is a highly skilled activity that requires high level physical and cognitive abilities and has the potential to injure the drivers and others around him/her if undertaken inappropriately. There may be several resources in your area that can assist in determining readiness to drive. The first step is to speak with your physician and gain clearance from them. You may also need to reach out to your local Department of Motor Vehicles for re-licensing or testing. Local Occupational Therapist facilities may have formal return-to-driving assessment programs that can assess various aspects of driving or there may be local companies who specialize in driving assessment and training after injury or illness.

Another consideration is adaptation to the traditional driving mechanisms. Most cars can be adapted with hand controls or other modifications for those that cannot use their hands or legs to drive in the traditional way. Wheelchair accessible vans are also an option for wheelchair users and may be fitted with ramps or options to drive from the wheelchair itself. Search the internet for adaptive driving companies locally or ask your physical or occupational therapist for a recommendation. 

Home Modifications

Oftentimes after a neurologic injury or event individuals may require adaptive equipment and home modifications. A great first step is to ask your rehabilitation team to recommend equipment that may be beneficial for you and your family. Local medical supply stores and even amazon.com are great resources for equipment. You may need to find a handy friend or a licensed contractor to make bigger installations such as ramps, stair lifts or grab rails.  

As you can see, there are many resources out there to assist you in returning to your home and your day to day life. Check out Part II of this Blog to see even more ideas.