Save Your Back! A Guide to Lifting and Transferring at Home

You should consult with a physical therapist or nurse about lifting and transferring techniques as you begin to care for a person with muscle weakness at home.

In addition to the specifics that can be supplied by a professional, a few general principles can help prevent injuries and keep you and the person with a neuromuscular disorder safe.

Transferring tips

• To prevent back injury, bend at the hips and knees, not at the waist, as you prepare to lift someone; then straighten at the hips and knees as you lift.
• Keep a wide base of support by spreading your feet apart. If you're transferring someone from one place to another (the usual purpose of a lift), stagger the feet in a walking position, and shift your weight from front to back as you lift, while keeping the person as close to you as possible.
• When turning, pivot on your feet or move the feet, don't twist at the waist. This will save your back.
• Wear shoes with low heels, flexible, nonslip soles and closed backs to help you keep your balance.
• Use mechanical devices to help you whenever possible. These can be as simple as a homemade transfer board or strong belt or as elaborate as a motorized lifting system. They can all, when properly used, save your energy and save you from injury.
• Plan ahead when lifting and transferring a person from one place to another. Know where you're going and how you're going to get there, and make sure the liftee knows also. Move everything out of the way, and make sure the brakes are engaged on any wheeled devices.
• If the person you're lifting starts to fall, ease him down onto the nearest surface — a chair, bed or even the floor. Don't stretch to complete the intended transfer. You're likely to lose your balance, strain your muscles and injure both yourself and the person you're transferring.
• Tailor your lifting and transferring techniques to the type and degree of weakness in the person you're caring for. Needs may change over time — for example, as a child grows or as weakness progresses.

Transferring to a higher target surface A common maneuver in the home or elsewhere is a wheelchair-to-higher surface lift and transfer. Here's a typical transfer for a person with severe leg weakness, who can't stand on her own, but who has fairly good upper body control. Make sure everything is out of the way. Position the wheelchair at a 45-degree angle to the target surface (the table). If possible, remove the arm of the chair nearest the target surface. As you prepare to lift, bend at the hips and knees and put your arms around the person. Stagger your feet, and keep your weight on your front foot. Move her to the front of the chair, with as much assistance from her as she can give. She should put the arm nearest the target surface on the target surface and the other arm on the armrest of the chair. (Here, the liftee has her arm around the caregiver. Some people find this comfortable, but you get more leverage by pushing against a firm armrest, and there is a risk of injuring the caregiver if the liftee holds onto her.) As you lift and transfer the person, shift your weight from the front to the back foot. Move your feet to reposition yourself. Don't twist at the waist. After the person has been transferred to the target surface, help her to stabilize. Keep her close to you so that you don't hurt your back.

Using a mechanical lift

If you can afford it, a mechanical lift can save a lot of wear and tear on your back. There are many types now on the market, ranging in price from about $1,200 to several thousands of dollars. Private insurance companies and Medicare will often cover all or part of the rental or purchase of one of these lifts. (You can also check with your local MDA office to see whether any lifts are available through a "loan closet.")

First, you have to get the person into the device (see "Using a sling" below).

It's not as hard as it looks, and the manufacturer will provide you with detailed instructions, often including a video. The retail dealership should also provide you with expert help, including showroom or in-home demonstrations, and, of course, you can consult with a physical therapist or nurse for more help.

For a completely immobilized person (someone in the advanced stages of ALS or Duchenne muscular dystrophy, for example), you'll have to use a rolling maneuver to help him into many types of available slings used in lifting devices. (Some slings come in two parts, and those are a little easier to use.)

Many people with weakness from neuromuscular disease can manage to wriggle onto a sling from a lying position, or at least can assist you as they move onto it.

For the person who needs help getting into a one-piece sling and has very limited muscle power, the technique shown in "Using a sling" is useful. You'll need either a bed with siderails or a second person stationed on the other side of the bed.

Using a sling Assist the person to roll toward you. Roll up half the sling against his back, leaving the other half unrolled on the bed. In most cases, you'll want the sling to extend from the middle of the liftee's back to his knees. If the liftee has no head control, you'll need a special sling with support for the neck and head. Assist the liftee to roll to his other side, over the rolled-up part of the sling. You'll need either a siderail on the bed or someone stationed on the other side of the bed to keep the person from falling. Pull the rolled-up sling out from under him. Assist him to a back-lying position on the sling, and hook the sling to the lift. To remove the sling after use (not shown), set the person down on the bed with the sling under him. Detach the sling from the lift. Reverse the rolling technique described above. The device pictured above is a CareGuard 9805 from Invacare of Elyria, Ohio. All photographs of this lifting device were provided courtesy of Western Medical of Tucson, Ariz.

Floor and ceiling model lifts

Lifts are generally either floor models, designed to be stationary or moved on wheels from room to room, or ceiling models, designed to run on a ceiling track from room to room. Prices vary, with ceiling models considerably higher than floor models.

However, keep in mind that floor models lack maneuverability in homes with tight spaces, lots of furniture or heavy carpeting. Ceiling models can be used almost anywhere, but they require expert (and expensive) installation, which is generally provided by the manufacturer. Seating styles vary, and some lifts can be used with multiple seating arrangements.

Parts of this story were prepared with the help of Carol Stumpf, a physical therapist at University Medical Center, Tucson, Ariz., who has many years of experience with neuromuscular disorders.