As people with Disorders of Consciousness (DoC) work through stages of recovery, the burden of caregiving can be impacted by several factors. The size of the person with the brain injury (e.g., weight, height) in contrast to the caregiver, the level of arousal and awareness, and the level of motor restlessness all play a role in the safe completion of tasks.
It is important to make sure your loved one is positioned in the bed and in the wheelchair to maintain joint alignment and also to, prevent skin issues and prevent joint contractures (see Complications). Proper positioning also facilitates an optimal environment for ongoing recovery. In addition, it is also important as a caregiver to protect yourself from injury. Proper positioning also facilitates an optimal environment for ongoing recovery. Throughout the rehabilitation process, you will learn about special techniques for your loved one, and over time these techniques will progress and change. Practicing the techniques with the assistance of professionals throughout the recovery process will help you feel more comfortable and confident when you transition home or to another environment. Below are some things to consider. Techniques you may learn can include:
- How to position your loved one in bed
- How to help your loved one transfer from bed or a chair into a wheelchair
- How best to position your loved one while they shower or bathe
- How to care for your own back while lifting your loved one or assisting with transfers
Disclaimer: Techniques listed are individualized to each patient and the recommended approach may look different based on the location of care (facility vs. home), the clinician you are working with, and level of your loved one's needs. Some methods used include a specialized approach to help with neurologic recovery. If you have not had training in techniques, please seek out assistance from a trained professional to prevent injury.
How do I position my loved one?
Positioning in Bed Guide (PDF)
From Shepherd Center
Below is a guide and video to help with positioning in a wheelchair.
- Wheelchair Positioning Guide (PDF)
From Shepherd Center - Wheelchair positioning video:
Wheelchair Assessment
From Shepherd Center on Vimeo
Below is information on safely positioning for showering and bathing.
- Successful Bathroom Transfers
From Today's Caregiver - Video demonstrating a tilting shower chair:
Best Tilt in Space Shower Chair with Wheels - TotalCare Chair
From Platinum Health on YouTube
How do I safely lift my loved one?
Performing daily care for a person with DoC creates additional strain on the caregiver. It is important to utilize safe techniques throughout all caregiving tasks to reduce strain and prevent injuries to the caregiver(s).
Disclaimer: The techniques listed are individualized to each patient and the recommended approach may look different based on the location of care (facility vs. home), the clinician you are working with, and level of your loved one's needs. Some methods used include a specialized approach to help with neurologic recovery. If you have not had training in techniques, please seek out assistance from a trained professional to prevent injury.
A guide providing tips for Caring for your Back (PDF)
From Shepherd Center
A guide providing tips for Caregivers Assisting with Bed Mobility (PDF)
From Shepherd Center
A guide providing tips for Caregivers Assisting with Transfers (PDF)
From Shepherd Center
How do I safely transfer my loved one?
Performing daily care for a person with DoC creates additional strain on the caregiver. It is important to utilize safe techniques throughout all caregiving tasks to reduce strain and prevent injuries to the caregiver(s).
Disclaimer: The techniques listed listed are individualized to each patient and the recommended approach may look different based on the location of care (facility vs. home), the clinician you are working with, and the level of your loved one’s needs. Some methods used include a specialized approach to help with neurologic recovery. If you have not had training with these techniques, please seek out assistance from a trained professional to prevent injury.
Transfer is the word clinicians use to move a person with any disability from one surface to another. The type of transfer recommended depends on the patient’s functional level, strength and coordination, equipment, and the environment. The status of the caregiver is also very important in deciding which type of transfer is best. As recovery occurs, the type of transfer and equipment used may change. Some transfers also include other aspects of care that may require extra hands and/or additional training. (E.g., removing clothing and completing personal hygiene when toileting.)
Transfers can include:
- Pivot transfers
- Sliding-board transfers
- Wheelchair-to-bed transfers
- Wheelchair-to-tub transfers
- Wheelchair-to-car transfers
The following guides and videos from Shepherd Center detail how to perform transfers safely.
- How to safely perform a Pivot Transfer (PDF)
- How to safely perform a Sliding Board Transfer (PDF)
- VIDEO: How to safely perform a wheelchair-to-bed transfer: Pivot Transfer - Bed
- VIDEO: How to safely perform a wheelchair-to-toilet transfer: Pivot Transfer - Toilet
- VIDEO: How to safely perform a wheelchair-to-tub transfer: Pivot Transfer - Tub
- VIDEO: How to safely perform a wheelchair to car transfer: Pivot Transfer - Car
What kind of equipment is available to make transfers easier?
Throughout the recovery process, equipment needs will shift and change based on your loved one's level of function. Equipment used in the hospital setting is recommended based on medical needs, level of functioning and to reduce the burden of care on caregivers. The equipment recommended for the home setting such as beds, wheelchairs, and lifts, is individualized based on your loved one’s level of functioning, caregiver status and needs, and the home layout/environment. The equipment shown here are examples for training purposes but do not represent all the equipment there is and may look different than your own equipment. New types/styles of rehabilitation equipment are always emerging, so you may also find equipment that is unique.
Disclaimer: The techniques and equipment listed are individualized to each patient and the recommended approach may look different based on the location of care (facility vs. home), the clinician you are working with, and level of your loved one's needs. Some methods used include a specialized approach to help with neurologic recovery. If you have not had training in techniques, please seek out assistance from a trained professional to prevent injury.
The following guides and videos from Shepherd Center detail some of the possible equipment you might use with your loved one.
- How to safely use lift equipment and positioning - Lift Transfer: Equipment & Positioning (PDF)
- How to safely perform a Bed to Wheelchair transfer using a lift - Lift Transfer: Bed to Wheelchair (PDF)
- VIDEO: How to safely perform a Hoyer Lift Transfer - Guldmann Sling
- How to safely perform a Wheelchair to Car transfer with a lift - Lift Transfer: Wheelchair to Car (PDF)
- VIDEO: How to safely perform a Wheelchair to Car Transfer with a lift - Car Transfer
- How to safely perform a transfer To and From the Floor with a lift - Lift Transfer Floor (PDF)
- VIDEO: How to safely perform a Floor Transfer with a lift - Transfer On/Off Floor
Equipment for Home Care
Durable Medical Equipment Catalog (PDF)
From Shepherd Center
This guide lists many types of equipment used in the home setting. It includes features on different items and starter resources (vendors) to acquire the equipment.
Please Note: Not all pieces of equipment are covered by insurance and may require an out-of-pocket expense. Many items require a Letter of Medical Necessity written by a physician, and it does not guarantee coverage.