Question

An inpatient recovering from Guillain-Barré syndrome has Fair plus (3+/5) to Good minus (4-/5) strength in both lower extremities. The patient typically completes stand-pivot transfers with minimal assistance. During one transfer, the patient sways backward and falls back into the wheelchair seat. What should the OTR instruct the patient to do to avoid this occurrence when the patient repeats the transfer?

Answer 1

To avoid falling backward during a stand-pivot transfer, an inpatient recovering from Guillain-Barré syndrome should engage core muscles, find balance before pivoting, ensure feet are shoulder-width apart, use visual and proprioceptive cues, and perform gait and balance exercises as instructed by an Occupational Therapist Registered.

Step-by-step explanation:

An inpatient recovering from Guillain-Barré syndrome who has Fair plus (3+/5) to Good minus (4-/5) strength in both lower extremities typically completes stand-pivot transfers with minimal assistance. To prevent swaying backward and falling back into the wheelchair during transfers, the OTR (Occupational Therapist Registered) should instruct the patient in several safety strategies.

Firstly, the OTR should encourage the patient to engage their core muscles and use their arms to help stabilize during the transfer. Secondly, it may be beneficial to teach the patient to pause and find their balance before starting the pivot motion to avoid ataxia and swaying. Thirdly, ensuring the patient's feet are properly placed shoulder-width apart for a stable base, and instructing on how to evenly distribute weight can help maintain balance. Instruction may also include techniques to increase the use of visual and proprioceptive cues for better postural control. Lastly, integrating gait and balance exercises could improve overall stability and confidence during transfers.

It is important for the OTR to assess and address any balance and coordination issues, which may include exercises such as tandem gait or standing on heels or toes, and to modify the approach based on the individual patient's abilities and recovery progress.

Answer 2

The OTR should instruct the patient to use the following strategies to avoid falling during stand-pivot transfers:

Make sure the patient is wearing appropriate footwear with good traction to prevent slipping.
Have the patient position their feet close to the chair and evenly distribute their weight before initiating the transfer.
Instruct the patient to lean forward over their feet while shifting their weight forward to initiate the transfer. This will help prevent them from falling backward.
The patient should also use their upper body to assist with the transfer, keeping their arms close to their body for stability and support.
The OTR can also recommend the use of a gait belt to provide additional support during the transfer.
The OTR should encourage the patient to take their time and proceed with caution during the transfer.
It is also important for the OTR to assess the patient's overall strength and balance during transfers to determine if any modifications or additional training are necessary to prevent future falls.