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Mobilization: Transferring

Safety aspects

  • The casters should point to the front, in order to make sure the wheelchair does not tip over.
  • Lock the brakes – in case the brakes do not work properly, the tires might lack air or the brakes could be bent.
  • Fold out anti-tip wheels if available
  • The wheelchair should always be positioned facing the bed at an angle, never parallel to the bed.
  • Make sure the transfer board is placed horizontally in front of the wheel, not above the wheel.
  • In order to protect the skin of the patient, you might use a wheel protection or small pillow.
  • Try to adjust the height of the bed and wheelchair as even as possible.
Transfer wheelchair to bed 1
Transfer wheelchair to bed 1


  • The feet of the patient should be touching ground (footrests of the wheelchair, floor etc.) – this helps carry the body weight.
  • When transferring, it is important to lean forward until the buttocks are relieved.
  • The head faces the bed and the buttocks slide down towards the wheelchair.
Transfer wheelchair to bed 2
Transfer wheelchair to bed 2

What do I need to consider with regard to the shoulders?

The shoulder is the most heavily loaded joint with regard to mobilization – that applies to sitting up and transferring. It is therefore important to protect the shoulders whenever it is possible, e.g. the patient should never be pulled on his/her arms to help him/her sit up or should not pull himself/herself up with a trapeze or a bar.

How can other people help with transferring?

When transferring, caregivers should stand in front of the wheelchair, in order to be able to react immediately in case the patient loses his/her balance and falls. It is important not to restrict the mobility, and therefore independence of the patient, by standing too close.


Poor transferring bears a high risk of injury, e.g.:
  • skin damages
    • shear forces, which can cause skin cracks
    • abrasions
    • injuries affecting the deeper layers of skin, that can cause pressure sores
  • falls with health consequences
    • bruises, abrasions, contused lacerations
    • fractures


Why should I never allow anybody to pull on my hands to help me sit up?
This movement is harmful to your health and the health of the caregiver – this way, your shoulders are heavily loaded which can cause serious long-term damage. For the caregiver, this could result in back problems. When sitting up this way, you are not able to assist, and therefore also not able to control your movements.

When someone helps me with transferring while travelling, people always lift me by putting their arms under my shoulders – this causes me shoulder pain. What should I do?
When being lifted it is important to press down your shoulders in order to stabilize them. If you cannot do this or already have problems with your shoulders, never allow anybody to lift you up by putting his/her arms under your shoulders! In this case, a gait belt can help.
A gait belt is a wide belt, equipped with lifting handles, that is put tightly around your waist and enables the caregiver to lift you up without straining your shoulders.

About the author:

  • Christa Schwager is a specialist in movement science in the Department for Nursing Development and Education at the Swiss Paraplegic Centre in Nottwil/Switzerland, where she has worked since 1994. She is co-author of the key publications in the field of spinal cord injury "Paraplegie. Ganzheitliche Rehabilitation" (eds. Guido A. Zäch & Hans Georg Koch) and "Pflege von Menschen mit Querschnittlähmung" (ed. Ute Haas).

updated: December 2013