Kinaesthetics & transfer in the Kenntnisprüfung

After a stroke, Mr D. has right-sided hemiplegia. Where do you place the wheelchair for the transfer out of bed — and why?

• On the right (affected) side — Mr D. grips the armrest with the paralysed hand and pulls himself across
• On the left (less affected) side — there Mr D. can support himself and actively help
• Directly in front of the foot of the bed, so that Mr D. stands up straight ahead and the direction stays neutral
• The side does not matter; what counts is locked brakes and a nurse who lifts him

Explanation: In the standard transfer with hemiplegia, the wheelchair stands on the less affected side: the patient can support himself with the strong leg and the healthy hand — this uses his resources and is much safer. Locking the brakes and folding away the footrests are always part of it too. In the Bobath concept, transfers are also made over the affected side – therapeutically and by trained nurses; the team decides which variant. But using the paralysed hand as a pulling grip is always wrong.

How do you guide a patient kinaesthetically to sit up on the edge of the bed from lying down?

• You take the patient under both armpits and pull her straight up into a sitting position with momentum
• The patient crosses her arms over her chest and is lifted en bloc by two nurses
• In stages: turn onto the side, legs over the edge of the bed, raise the upper body via elbow and hand
• The head section is raised electrically to 90 degrees, then the legs are swung round quickly

Explanation: Natural movement happens in partial steps and via the side — not straight up “en bloc”. The stages side-lying → legs out → pushing up over the elbow use the patient’s own strength, avoid shear forces and protect the nurse’s back.