Getting a wheelchair into a car

• Make the wheelchair as light as you can.
• Remove the footplates. The latch is usually just under or to the side of the footplate.
• Remove cushion.
• Armrests can also be removed to give extra space in a small car. The latch is usually at the front of the armrest.
• Fold the chair by pulling the middle of the seat upwards. Tilt the wheelchair towards you so gravity helps you.
• Lower the back rest into the folded position by releasing the latch on each armrest.
• Take off the wheelchair brakes and wheel the chair to the car boot to avoid lifting the chair.
• Put brakes on.
• Bend your knees, keeping your back straight but not rigid.
• Take a firm hold of the wheelchair rims, tilt the wheelchair towards you slightly and lift in one smooth movement.
• It can help to place an old towel or rug in the back of the car to protect the boot sill from damage as you lift the chair. This is also useful to dry the seat and wheels if the wheelchair gets wet.
• Adjust the wheelchair to fit into the boot space.
• Place the wheelchair cushion between the wheelchair and the boot door. This will help to stop the wheelchair moving about in the boot when driving. You could also use one of the rear seatbelts threaded through the wheelchair to help anchor it while driving.

After a stroke the person’s position is important to help with their recovery. They may have to sit or lie in one position if they are unable to move the affected side for themselves.

This short film shows how to help reposition a person in a chair and the correct way to support their affected arm using pillows.

Notice how Isobel is sitting. She has little support for her affected right side. Her bottom has slid forward in her chair seat. This will put pressure on her lower back, shoulders, and the back of her legs. She is holding on to the chair arm with her left hand for support but this is also making her twist in her chair. She has a gap between the chair and her back.

To help Isobel into a more comfortable and supported position, the therapist helps her to lean forward so her weight is over her hips. She then shuffles from side to side while pushing back a little at a time until her back is level with the back of the chair. She places her hands on Isobel’s hips to guide her, not force or lift her back. She moves her body at the same time as Isobel to help this movement. Isobel also helps by supporting her affected arm on her lap with her left hand.

Isobel supports her own wrist while the therapist places the pillow to support her forearm and elbow. She makes sure Isobel’s hand, wrist and fingers are supported and the fingers are comfortably flat and slightly separated. She asks Isobel to support her hand while she gets a rolled towel to fill the gap behind the arm for extra shoulder support

Isobel is now sitting upright with her arm and back well supported and her weight evenly spread across her body.

This short clip shows how to position the person in bed with extra pillows for support when lying down.

The pillows are arranged into a V shape with extra pillows below and on top of the V. This gives support for the head, neck and shoulders while the bed supports the back.

Isobel has another pillow to support her affected right arm in a comfortable position. The arm is placed slightly away from the side of the body.

Some people like to have another pillow under their knees to support the legs while in bed or a pillow between the knees if there is a lot of increased muscle tone in the legs.

This film shows the basic tasks and use of a PEG tube. PEG stands for Percutaneous Endoscopic Gastrostomy. This is a tube which goes directly in to the stomach following a simple surgical procedure. It is used as the main way to take food, drinks and medicines for people who are unable or who have an unsafe swallow by mouth after a stroke. Wash your hands before using the PEG tube.

Here are all the items you will need

• The correct medication.-(Most medications will be issued in liquid form. Some are not available in this form and you will be given instructions from the hospital staff on how to prepare them for giving by the PEG tube.)
• Ready made feed at room temperature.
• A clean jug.
• Medicine containers.
• Small and large syringes which can be used for 1 week. They are washed in hot soap water and air dried. They are also dishwasher safe.
• Disposable wipes/ paper towel.
• A clean towel.
• Medicine measuring spoons.
• Water in a clean container.

These are the parts of the PEG tube.
The Y connector. This has two parts. The feed port and the medication port.

Further down the tube is the clamp which can be pressed in to close the PEG tube or released to allow the feed or medication to pass down the tube.

This model shows the fixation device which holds the tube close to the skin. It is important that this should be released and cleaned each day.

The Fixation device should be loosened so that the skin surrounding it can be cleaned gently but thoroughly with unscented soap and water. Do not apply creams or powders to the area unless advised to by your doctor.

Disposable wipes (not baby wipes) or clean gauze should be used and the skin should be Rinsed and dried well. Do not to pull on the tube as you clean this area.

Remember to replace the tube in the fixation device and rotate the tube 360 degrees each day. This will prevent the hole from closing or sticking and it will be more comfortable. Reconnect the fixation device.

How to give medication
First start by clamping the tube this will stop any stomach contents from spilling from the tube. Always start and end any feeding or medication giving by flushing the tube with 30 ml of water. For this volume we use the FEED port.
Open the feed port and attach a clean large size syringe. Use 30 mils of water to flush the tube before giving any medication. Unclamp the tube until the water has drained down the tube. This method is called GRAVITY Close the stopper and re-clamp the tube.

Depending on the thickness or type of medicine, you may have to dilute it so it will pass easily down the PEG tube.
Here we see a thick suspension. This could block the tube or be difficult to flush unless it is diluted with water. Stir well.

Thinner medicines may still need to be diluted. It is important to measure the correct dose carefully. This is a syrup Once the water is added, stir well.

If the person has been given fizzy or soluble medicine as an alternative to tablets, these should be made up with the recommended amount of water. Make sure they are fully dissolved before putting into the syringe these can be given just like the 30ml flush, using GRAVITY because of the volume of liquid.
Crushed tablets should NOT be put down a PEG tube unless you have been instructed to do so by hospital staff. They could cause a blockage. If in doubt ask your local pharmacist which medications can be crushed or diluted.

For smaller volumes of medication Use the smaller syringes if you wish. Make sure all the medicine is in the syringe. Remember to squeeze as much air out of the syringe as you can without spilling any medicine. Putting air into the PEG tube can make the person feel uncomfortable and bloated and air could block the tube.

Clamp the tube Take the stopper off the medication port. Attach the syringe unclamp the tube then push the medication in to the tube slowly with the plunger. Give each medicine separately with a 10 mil flush of water between each one. Remembering to clamp and reclamp the tube between each medication and flush of water. Replace the stopper at the end of the medication port.

After giving all the medication, you should put another 30 mils of water into the tube to flush through any remaining medicine. Close the feed port and the clamp. The end of the Y connector may be sticky so clean it with wet wipes or clean damp disposable gauze. Wash your hands.

To give a feed
There are two ways of feeding- PUMP feeding and BOLUS feeding. You will have been instructed on the best methods for you by hospital staff.
The feed comes ready made in sealed containers like this. This method is called Bolus feeding. The person should be sitting in an upright position. See the instructions on the package for storage instructions. Check the use by date on the pack before giving the feed.
Pour the correct amount for one meal into a clean jug. The amount required at each meal will be instructed by dietician.

Clamp the PEG Tube Remove the stopper from the feed port, attach a large syringe. Flush the tube with 30mils of water first. Clamp tube then fill the syringe with the feed and unclamp the tube. As you can see the feed will drain slowly with gravity. It is important not to try and rush this. It should take about the same time as it would to eat a normal meal, about 15 to 25 minutes.

You can use the clamp to regulate the speed which the feed goes down the tube- (or add this part below)

Remember to leave a few mils of the feed in the syringe so no air goes down the PEG tube. Add more of the feed to the syringe. Repeat until all the feed has gone. You should then flush the tube with 30 mils of water before clamping the tube. Replace the stopper on the feed port and clean the Y connector.

If you have any questions about PEG feeds or giving medication via a PEG tube ask to speak to your nurse, dietician or doctor.

To store the feed

• Unopened feed at room temperature.
• A cool dry cupboard is ideal.
• Not near heat or direct sunlight.
• Not outside as in winter it may freeze.
• Once opened, store in fridge but remember to take the next “feed” out of the fridge to warm to room temperature.
• Opened Sterile feed can be kept for up to 24 hours.
• Discard any unused feed which has been opened after 24 hours.

In this short film you will see a how to get someone in and out of a car safely. These are general tips, if you have any concerns about the person you care for, ask for individual advice from a physiotherapist, occupational therapist or stroke nurse.

If using a wheelchair, park the chair as close as possible to the car. Open the car door as wide as it will go. Make sure the wheelchair brakes are on and the footplates have been removed or folded back. You should allow enough room beside the car door so you can both move easily. You may need to move the car seat back to give more room for the legs.

Get the person to slowly stand then step round so their back is towards the car. They should hold on to the car in the most secure but comfortable place. This may be the door frame, the edge of the car seat or the edge of the dashboard depending on the side of their stroke.

Support their hips or shoulders as they start to bend to sit down. To protect their head from bumping on the door frame, place your hand gently over their head as they sit.

Get the person to shuffle back in to the seat then help them to lift their affected leg over the door sill. This method is much safer than attempting to step in on one leg. Make sure they are in the middle of the car seat before you help to fasten their seat belt.

Getting out of the car.

Have the wheelchair ready to use with the brakes on. Open the car door as wide as you can.
Get the person to shuffle towards the open door holding on to what ever is the most secure and comfortable surface. Help to lift the legs out on to the ground then shuffle forward in the car seat before standing. Step round towards the wheelchair and sit.

• Think about where you park.
• Avoid high pavements.
• Avoid drain covers or uneven ground.
• Park on the level not on a slope.
• You may need space for a wheelchair.

In this film we see how to manoeuvre a wheelchair up and down a kerb or raised surface using the tip bar.
You will need to use your legs and back rather than just your arms to tilt the wheelchair back. It is important that you know your own limitations. If you do not feel safe or if the person is heavier than you, you will need help. If moving a wheelchair off a kerb on to a road, be aware of traffic and other road dangers and take extra care.

Therapist:

“OK Joanne and Fran.” “What we are going to do today is we’re just going to go over the technique of how you would manoeuvre up a small kerb when you are out and about in the wheelchair Fran OK.” “So you would, obviously come forward towards the kerb.” “Now you need to get the wheels as far forward as possible, just until you feel them touching against the kerb.” “As you can see there are two tilt bars on the back of the wheelchair, one on either side.” “Now that is just to assist with lifting the front of the wheelchair slightly higher so you can accommodate kerbs and bumps in the road, when you are out and about” “So what you want to do , as I’ve said , the small wheels are right up against the kerb.” “You pop your foot on the back of the tilt bar and gently push down and that just raises the wheels up and you just travel forward with the chair on to the road.”

Therapist:

“OK Joanne if there’s ever a time where you need to, you’re coming across an area where you need to change level in the wheelchair, it’s always safest to take Fran down backwards in the chair.” “So I’ll just show you how to do that.” “We’d come back just nice and slowly, let the back wheels come down just controlling it.” “Again you can use the tilt bar just to allow the front wheels to come down nice and gently, so the manoeuvre is nice and smooth.”

Therapist:

“OK Joanne, what we are going to do today is go through the process of how Fran will transfer from the bed to her wheelchair.” “OK” “Now one of the main things we need to do Fran is make sure you are as far forward as possible on the bed so that it makes the transfer that wee bit easier.” “So if you can just get yourself forward to the edge of the bed.” “That’s excellent.” “Now we just need to bring the wheelchair in Joanne.” “Now one of the main things we need to do is get the wheelchair as close as possible to the bed, OK.” “So in order to do that we need to probably remove the footplates.” “Now some wheelchairs have footplates which swing out to the side and that can sometimes give you as close to the bed as possible.” “But some wheelchairs don’t, so it’s always best I feel to remove the footplates out the way.” “We’ll just take those footplates off.” “That will then allow us to bring the wheelchair in nice and snugly to the bed.” “Then we just need to pop the brakes on at that point so that it’s nice and steady.” “OK we then want to remove or on this wheelchair we can actually slide.” “The side of the chair comes back to this point so it’s not actually been removed.” “But, again on some wheelchairs you might need to take the whole side of the chair out,” “Ok but on this particular one it slides back to give access in.” “OK Fran, what we’re going to do next is we’re going to pop the slide board in, just to make the transfer from the bed to the chair nice and smoothly for you OK” “So what I need you to do is take your weight gently over to your left hand side so that I can put the board in under your right hip.” “OK is that comfortable for you Fran?”

Fran:

“Yes”

Therapist:

“OK now at this point Joanne, it’s now over to Fran who is going to transfer from the bed over on to the chair and she can do that really well on her own.” “But I would say it’s better to always have someone there at this stage, just in case you need a wee bit of assistance or a bit of confidence just along the way.” “But you are really not needing to pop your hands on; you just need to be in front of Fran at this point.” “So Fran you’re going to gently edge your hips along the transfer board.” “Now where you’ve popped your hand is probably not the best place to put your hand because your fingers are underneath the board.” “And as soon as you put weight onto the board, your fingers will get caught between the board and the wheelchair.” “So just have them towards the edge but not across the edge of the board.” “Now very short, small movements across the board Fran whenever you are ready.” “That’s excellent.” “And again.” “Super now stop there.” “Now what you can do at this point is bring your hand up on to the arm of the chair and you can use that just to guide yourself slowly in to the chair.” “So Fran is controlling this manoeuvre very, very well.” “Now do you feel like you could take your hips slightly further back in to the chair?” “And again it’s a nice manoeuvre, both sides going back in to the chair.” “Now we need to remove the board.” “So Fran can take her weight over on to her right hip again and we can very gently remove the board.” “Are you comfortable Fran?”

Fran:

“Yes”

Therapist:

“OK so all that’s left to do now is we need to put the side back down on the chair and the footplates back on.” “So if we put the side down first.” “Make sure that’s secure in place.” “Then we just need to get the footplates and put them back on.” “Bring you foot forward for me Fran, excellent.” “And then your left one.” “OK, well done.” “And just making sure her heels are well back on to the supports there at the back of the footplates.” “And then we can just release the brakes on the chair and Fran is set to go.”

In this film we see the use of a slide or glide sheet. If you have been given a slide sheet to use at home, you should have been given instructions about how to use it safely. This film is a guide only.

Therapist:

“Now Joanne, we looked at John moving across the bed by bending his knees up and allowing allowing him to lift his bottom over.” “When John’s feeling a bit tired or maybe when he is having an off day, it might be a good idea to think about using a sliding sheet to move him across the bed,” “It’s easier for John just to slide by pushing his bottom across or by you actually physically sliding him across using the sheet.”

“So we put this under and we’ll just have a look at that.” “So raise the bed again so it’s a practical height for us to work at without straining ourselves.” “OK put that down just now.” “So John, we are going to roll you towards Joanne so I can get the slide sheet in.” “So just bend this knee up a little bit, just the one, let the other stay down John.” “That’s fine.” “If you can take care of your arm.” “Take hold of your arm.” “I’ll just put the slide sheet in so it’s sliding on itself sideways.” “I’ll push that as far through as |I can.” “Now John, if you come back on to the sheet OK.” “This time you are coming to me, well done.” “Nice and slowly OK.” “OK that’s you well and truly on it.” “So let’s bring you back into the centre again.”

“OK Now John we are just, we are in preparation for coming out of the bed again.” “So just going to slide your bottom over towards me.” “OK.” “So Joanne’s going to guide you across and I’m going to do the sliding.” “OK so after ready, steady.” “Ready, steady, slide.” “OK, that’s far enough.” “What we do John is if you can just roll towards Joanne a little bit, and I’ll just take the sheet out altogether.” “Just remove it by taking it out from underneath, nice and gently.”

“Now John, we are just going to lower the bed so when you roll over on to the side to sit up that you’re not in mid air.” “OK so just bear with us.” “OK I’ll just come round Joanne.” “Ok John we are just going to help you up into sitting.” “We are going to bring your legs over the side of the bed first.” “So you are actually on your side already.” “I’ll hold on to your legs.” “OK now Joanne is going to help you to sit up.” “You can push up with your left hand.” “Try and keep your weight coming forward John.” “Can we bring this leg round?” “We are just about there.” “OK if we can try and keep you coming straight up from your side that’s the easiest way.” “As soon as you start to lean back, that’s when it becomes difficult to sit up.” “And what we’ll do is help you get your bottom round.” “Can you jiggle your bottom forward a little bit?” “Can you bring this side forward?” “Let me just help you with your hip.” “That’s it.” “Both feet on the ground John.” “You feeling OK?” “Just give you a wee minute for your head to get used to being upright again.” “You’re OK.”

“So we are going to transfer you back on to the wheelchair using the turner.” “So we will just get everything organised.” “I’m just going to walk the turner in towards you John.” “Just put that foot slightly further on.” “OK thank you.” “Now if you just sit still for a second, while I get the wheelchair into position.” “I think what I’ll do is put the wheelchair straight in front of you John just to demonstrate how we can actually get him in to the wheelchair without it having to be at ninety degrees.” “I’ll leave it here.” “Then we can move it when we need to.” “OK so if you can assist John up into standing again and just get his trunk.” “I’ll counter balance at the front again.” “Nice and upright John. “ “Nice and upright John. “ “You can try and bring your tummy forward so you are well tucked in at the back.” “OK I’m just going to move the turner round keeping nice and upright.” “All the way round and just you stay there for a second.” “I’ll just get the chair in behind you.” “Now Joanne, at the moment we’ve got no space at the front of the turner to counter balance it from the front.”

“So what we need to do is just counter balance the turner from each side with our foot on it at the side” “OK John we ready to sit down nice and slowly.” “Stick your bottom right out behind you, bend in the middle and down you go.” “Just watch this arm.” “OK, I’m just going to take the chair away from the turner and take the turner away.”

Here are some points to consider when using a slide sheet.

• Roll the person on to their side. (the person may need help to do this. Bending one knee will help the person to roll.)
• Position the slide sheet. (Push the sheet as far under the person as you can then roll them on to the other side and pull the slide sheet through. The sheet should be under the person when they are lying flat again.)
• Are you both ready? (Tell the person before you start to pull.)
• Let the sheet do the work. (A firm, controlled pull on the top layer of the sheet is enough to move the person across the bed. Take care with your own posture, keeping your knees slightly bent and your back straight but not rigid.)
• Remove the slide sheet. (You should remove the sheet after it has been used. Pull on the lower layer to remove the sheet Pulling a little at a time. Do not leave the person lying on a slide sheet as they may move and slip off the bed.)

In this film we will give guidelines for some basic moving and handling for carers.

Each person is an individual and they may have different moving and handling needs. Sometimes the person may be able to assist more than at other times, such as when they are tired. How you are feeling as the carer is just as important when you are moving and handling someone. If you have any individual concerns about moving and handling the person you care for or your own ability to do this safely, please ask to see a physiotherapist, occupational therapist or stroke nurse for individual advice.

John is a stroke patient; he is working with his physiotherapist and his carer.

Therapist:

“OK Joanne we are going to be transferring John on to the bed.” “It’s just worth remembering that the bed should be as good a height as possible for transferring somebody.” “Ideally we are looking at a bed height for transferring a patient on it should be about 19 inches from the floor.” “In this situation the bed is a bit higher because we’ve got a special bed with a special mattress which is making it slightly higher.” “So really all we can do is get it as low as possible and just take extra care when we are transferring John on to the bed.” “So I’m just going to alter the bed to go as low as we can first of all.” “Just get that out of the way.” “We’ve got the pillows organised.” “We put the last pillow so we get an armchair of pillows to give John a little bit of support there.” “Bearing in mind that it’s his right side we need to give more support than his left side.” “So if you can position the wheelchair almost at right angles to the bed as far up the bed as you can.” “So that when John is transferred in to the bed, or on to the bed, his bottom is as high up the bed as possible.” “ So when we turn him round, and assist him to get into bed, he’s not coming too far down the bed because normally what you find is when somebody transfers on to the bed, they slip down a little bit.” “So you really need to go as high up as you possibly can.” “Now John’s transferring with a patient turner.” “So what we need to do is get his feet off the footplates to begin with.” “Just actually remove these.” “Just give him a little bit of help with his right leg.” “Clear these out of the way so they are not in the way.” “Make sure the brakes are both on.” “OK and we’ll just position the patient turner in front of John.” “Now John, are you going to manage to help a little bit?” “With these turners it is important that you don’t lift them because they are very heavy pieces of equipment.” “So although you can push them on their wheels to a certain extent, when you come to position it underneath somebody’s feet, you have to actually just walk them in underneath the person’s feet.” “You must not lift them.” “Now if you can come and stand in front to counter balance the turner.” “John, just make sure your right foot is properly on.” “John is going to pull himself up and I’m just going to guide him forward from behind and give him a little but of position, a bit of stability in his leg as well.” “Got to make sure he’s nice and steady in standing.” “Which I think you are.” “OK, so we are going to turn the turner round.” “Maybe just move the wheelchair out of the way there actually.”

Joanne:

“Do you want me to move it?”

Therapist:

“OK that’s fine.” “If you can stand with John, I’m just going to move the bed in a little bit.” “Just going to move this bed a little bit closer to John.” “To make sure that he sits exactly where we want him.” “Always remembering to put brakes on before you move someone on to something that’s got brakes.” “Now will I go in front and counter balance the front of the turner again.” “If you can assist John with your hands on his upper trunk.” “And just sit down nice and slowly John.” “OK ““Now Joanne if you stay with John there to make sure he is nice and steady.” “I’ll gently remove this from under his feet.” “Again, just sliding it out.” “Just get that foot back there.” “Then we can roll it away.” “Now because John has got quite long legs, the height is not an issue with this bed at all.” “OK if you were a shorter person you might find that your feet were dangling a wee bit.” “So we would just have to take more care for getting him into bed.” “So what we are going to do is we’re going to help you in to bed OK.” “Joanne is going to help you down with your top half OK.” “Making sure this arm is looked after as you transfer as well and I am going to help you get your legs up on to the bed John.” “OK. “ “So we are going to do it nice and gently.” “If you can start to lean towards your left side and I’ll help you lift your legs up.” “Just bring his shoulders over Joanne.” “OK now if I help you bend this knee up John, just one second.” “Ok have you got your hand?” “Now first of all I think what we’ll do.” “Can you manage to hold on to your hand for me?” “Can you manage to lift your bottom over in to the centre of the bed?” “OK” “Now stay there for just a second while we put the height of the bed up a little bit.” “Just so we can actually reach you easier.” “OK” “I’ll be round this side.” “So you are assisting someone to move their bottom it’s really important that both knees are bent up.” “From a rehab point of view and from a functional point of view so he is managing to get a better effort to move his bottom across the bed.” “So now you’ve got your knees bent up, can you manage to lift your bottom over?” “OK hold on.” “Just let this leg come down.” “This one down as well.” “So Joanne if we just gently help John bring his shoulder across in to the centre.” “Just get that pillow there.” “Now can you manage to let go of your hand now?” “You should be reasonably comfortable there John.”

John:

”Aye that’s alright”

Therapist:

“Is that alright there?”

John:

“Aye”

Here are some points to consider

• Check the height of the bed. (Is it adjustable? Is it at the correct height for the person? If it is not adjustable could it be raised or lowered to a more suitable height by using bed raise blocks or removing castors.)
• Correctly position the wheelchair. (Apply the brakes, allow enough room for each person to move, you may have to try to make more space.)
• Correctly position the turner. (Do not lift the turner, use the wheels until you are close to the person and then walk or shuffle the turner into position.)
• Remember to apply brakes. (the bed may also be on wheels and these brakes should also be applied before moving.)
• Sit near the pillows. ( By sitting near the top of the bed the person will be in the correct position when lying down.)
• Ask the person to help you. (Some people will be able to help themselves and you if the movements can be coordinated and smooth. Even holding on to their affected arm can help.)
• Take your time. (Make sure you are not rushed. Think and plan what you are going to do before you attempt the move.)
• Is everyone ready? (One person usually takes the lead so that everyone knows exactly what they are going to do and when to start the movement. The lead person could sometimes be the person themselves giving the carer instructions.)