Chapter 10—The Art of the Transfer

“Those who try to put their lives back together exactly
as they were remain fractured and vulnerable.”
-Dr. Stephen Joseph, What Doesn’t Kill Us

May, 2007. MCV/VCU Medical Hospital. Richmond, VA.

“It’s all about the weight-shift, really.” Gregg added, putting a bow on his introduction on The Art of the Transfer.

“The concept’s simple. You just have to go for it. Commit fully to the movement, and remember to account for a few details, and boom! That’s it!”

If the magnitude and importance of this first major lesson of mine hadn’t hit home, Gregg made sure of it.

“Again. Transfers. They’re absolutely paramount. Without transfers, you’re stuck.

You can’t get in your chair or out. You can’t get on the commode or off. You can’t get in and out of the shower, your car.

And you certainly can’t be independent.”

To regain independence, mastering the transfer is an absolute for paraplegics.

Transfers are how you do pretty much everything.

There is a lot to learn, do, and master to go from accident to independence and transfers are one of the first steps for an SCI patient’s bag o’ tricks.

They are both necessary and difficult, requiring upper body strength, precision and patience for mastery, and mastery for independence.

And independence for a life.

This is the essence of occupational therapy (OT), the day-to-day things to live, whereas the strength and functional component comes from physical therapy (PT), whether you’re in-patient or out.

Transferring began week one at the big blue padded therapy table during early PT with Gregg.

Sitting beside me on the table he had run through his opening spiel about why learn transfers and how they are done.

Demonstrating, he returned to what he considered the crux of it all: weight shift.

“Your body can be used as a fulcrum,” he explained, “which will allow you to do things and move parts of your body that no longer move.”

He sat flat on the edge of the table, squared his feet on the floor, and placed his hands on the table at his side and pushed up.

Gregg was tall, towering, and quite friendly.

“If I lift myself like this…and want to scoot to the left, I can only do it if I shift my weight. Watch what happens when I throw my head to the right…”

Slow and deliberate, he did so, demonstrating the basic principle of the action.

His butt hovering just off the table, he threw his head to the side and pushed with his arms. His head went one way, butt the other.

“See what happened there?”

I nodded slowly, watching his every move with laser focus.

He continued, “Your head and eyes are the key ingredient for the weight shift to make the fulcrum work and the transfer possible. Whichever way you want your lower half to go your head goes opposite.

“Shift weight...eyes...fulcrum...head goes the opposite. Got it.”

“Good. Now let’s get you on here.

We’ll start simple and work on going back and forth on the table, so you can get comfortable with the technique.”

“Sounds good to me.”

I unlocked my brakes and positioned my chair perpendicular to the table and locked them again. Gregg looped his therapy belt around my waist and synched it tight.

Gregg used the belt to do a chair-to-table transfer for me, since I hadn’t yet graduated to the transfer board. That would take weeks to get to.

I was as green as they come so transfers were 110% in the hands of my therapists.

As instructed, I scooted to the edge of my seat. Gregg moved to stand in front and looked down.

“You want to watch your feet as well. Even though you can’t feel it, your feet and legs still hold and take weight. If they’re back beneath you and you lean forward, you could easily fall flat on your face.”

“Ahh yes, good call. Wouldn’t want that.”

“Watch the placement of the feet, too. Other than falling, the last thing you want during transfers is to have your body and legs going one way while your feet don’t and get left behind.

You could easily break an ankle.

And then you’d really be up Shit’s Creek, paddle free.”

He gave me another look and cocked a brow.

I responded with a look of my own. “Yikes.”

“Yeah.” Gregg proceeded.

Mother’s Day as an inpatient. Richmond, VA. May 2007

Leaning over me, he grasped the belt firmly at the back by my kidneys. I got a face full of shoulder as he readied himself.

Then, slowly at first, Gregg rocked me, gradually building that other important factor:

Momentum.

Then, with surprising ease, he hauled me up and over and placed me soundly on the mat, my feet planted squarely on the tile.

Gregg let go and stood. He exhaled, happy with the landing.

Away from my wheelchair I was instantly struck by a sense of exposure and vulnerability with nothing around to hold myself up.

I grabbed fast at the table’s edge for balance, all reflex, and held tight.

As soon as I felt comfortable, I explored the boundaries of my new body with tiny weightshifts and flirted with disaster using increased leans as my ability-barometer.

I learned by doing and failing.

“Okay, you got yourself?”

“Yup,” I said with assurance.

He stood back.

“Start with this. From right there, just try lifting yourself up off the mat so you can gauge your balance and get used to that.”

He crossed his arms and watched as I followed orders. I could sense his focus and knew he was locked on with that analytical PT eye of his.

It took me a few sessions before I could confidently scoot left and right.

After nailing down the theory of it, I now had to put in the hours.

Over time, millimeters became centimeters, and inches became more inches, taking me from one end of the table to the other faster and faster, each time with less single scoots.

My confidence and capabilities grew to the point where I could casually lift my body up and throw my head and torso one way with enough force and momentum so that my ass would clear the table, shift opposite my head and land far enough over where inches then became a foot or more per scoot.

“Well done! Well done, indeed.” Gregg said approvingly.

“I think you’re ready for the transfer board.”

The transfer board was used to span the gap between a wheelchair and your transfer landing zone or vice versa.

A bridge.

Gregg showed me how it was used and identified things to be careful of before we got into it.

“Whether you’re in your chair or sitting on the side of the bed, always make sure the board is placed so that enough of each end rests solidly in place.

You wouldn’t want it to slip off halfway across mid-scoot.”

“Makes sense. Noted.”

“Getting it in place is pretty straightforward, too. Just lean far enough over one way to free up the weight on your butt so you or someone else can wedge the board under a cheek.

Watch your clothing. You can easily catch shorts or pants under the board. Keep an eye on that before you scoot or you’ll get snagged.”

“Also noted. Got it.”

We started with the table, going back and forth from chair to table to chair before moving on to more practical stuff like hospital beds.

From there, again, it was a matter of practice.

Seeing signs of progress in something as important as transfers was a huge boost in morale—

Boosts that became instrumental in helping to manage all the stressful newness of my situation.

Little daily victories like these led to a certain clarity of my mind and a constantly replenished reserve of motivation so I could stay focused on controlling my so-called uncontrollable diagnosis.

I didn’t have power over much, but I had the power to do at least that—

To make the conscious decision to build something new from the broken, severed pieces of me leftover…

Something new and beautiful.