Body Mechanics for Dependent Weight Shifts for Caregivers

General Considerations

• Allow the patient to help as much as possible.
• Estimate the patient’s weight and mentally practice. 
• Make sure that the floor is free of any obstacles or liquids.
• Keep your feet shoulder width apart. 
• Keep the person (or object) as close to your body as possible.
• Tighten your stomach muscles.
• Bend knees and hips, and keep your back straight throughout the movement. 
• Lift with your legs, NOT your back. 
• Do not twist your back as you lift. To turn when lifting, pivot your feet.
• If you have doubts, ASK FOR HELP! 

Key Points for Body Mechanics during DEPENDENT WEIGHT SHIFTS

Weight shifts are very important for skin care to prevent costly skin breakdown due to pressure ulcers. They should be performed as prescribed by your doctor or therapist.

If your loved one needs assistance to perform a weight shift, here are some methods to help perform weight shifts safely and efficiently, while protecting your loved one's skin integrity.

If your loved one is in a manual folding (or rigid) wheelchair and requires assistance to weight shift:

1. Ensure that the lap belt and chest strap (if applicable) are securely fastened. 
2. Position the patient’s wheelchair in front of you while you are seated in a sturdy, non-wheeled chair. When possible, you can position the chair against a wall or non-moving surface to increase stability during this weight shift.
3. Lock the wheelchair brakes.
4. Flip up or remove the anti-tip bars in the back of the wheelchair.
5. Grip your hands on a non-moving part of the wheelchair frame (there is often a crossbar or two upright bars located behind the patient’s back cushion; the push handles are also acceptable).
6. Keeping your back straight, push down on the handles to tip the wheelchair backwards until the chair is resting in your lap. If you are having difficulty, you can step on the bottom of the back of the wheelchair frame to help tilt backwards, but avoid putting any pressure on the anti tip bars. If you are having trouble tilting the wheelchair back from a sitting position, you can also start in a standing position, and then sit down as the wheelchair tilts back.
7. Support the person’s head and neck as needed against your chest.
8. Ensure that you have tilted the wheelchair far enough back that the weight has been relieved from the patient’s bottom.
9. After one minute, slowly return the chair to upright.
10. Flip the anti-tip bars back down into place.

Two alternative methods to weight shift in a manual wheelchair are:

1. Side to side shift, and

2. Forward weight shift

Side to Side Shift

1. Ensure that all of the chair’s wheels are locked. 
2. Unfasten the lap belt and chest strap (if applicable), and move any laterals out of the way.
3. Flip back or remove the armrest on the side to which the weight shift will be performed.
4. Kneel or sit at your loved one’s side; keep your back straight.
5. While keeping your back straight, cradle the head onto your shoulder and lean the person slightly forward.
6. Transition your loved one’s head to your outside shoulder, then lean your loved one over to one side until their ischial tuberosity (the bone that you sit on) clears the cushion on the opposite side. 
7. If their ischium is not off of the cushion, take your free arm to pull the hip up and over to relieve pressure from the ischium.
8. Hold this position for one minute. Keep your back straight and your knees bent throughout this weight shift. 
9. To return to an upright position, support the head, and return the trunk to upright.
10. Repeat the procedure for the opposite side.
11. Once the weight shifting is finished, ensure that the lap belt, chest strap, laterals and armrests are all secured back in place (if applicable).
12. If seated in a chair, repeat the above procedure. The only exception is that your loved one’s head should be placed on your outside forearm rather than your shoulder. All other steps remain the same.

Forward Weight Shift

1. Flip the casters of the wheelchair forward to extend the base of support for safety purposes.
2. Lock the brakes on both sides of the wheelchair.
3. Ensure that the lap belt is fastened.
4. Remove the chest strap, if applicable. 
5. Place your loved ones’ arms in their lap.
6. Keep your back straight and knees bent. Engage your abdominal muscles and stand as close as possible to your loved one.
7. Support your loved one’s head on your shoulder or forearm.
8. Begin to lean your loved one forward, going down on one knee when reaching the floor. Stop when their body is on their lap and their head is at their knees.
9. Continue to support the head throughout the process.
10. Hold this position for one minute. 
11. Placing your hands on your loved one’s chest or shoulders, assist them to the upright position while continuing to support their head.
12. Once finished, return arms to the armrests and replace the chest strap, if applicable.

 If your loved one is in a power tilt wheelchair, you can use the drive mechanism of the chair to fully tilt backwards. 

 If the power chair’s power source has run out or is malfunctioning, you can perform one of the alternative weight shifting options listed above for manual wheelchairs (forward or side to side).

If your loved one is in a manual wheelchair that can recline backwards:

1. Ensure that the small wheels in the front of your chair (casters) are facing forward.
2. Lock all wheels on the chair.
3. Raise the leg rests of the chair to a horizontal position. 
4. Stand behind the chair and locate the releases that recline the chair. Next, while keeping your back straight, knees bent and stomach muscles engaged, brace the back of the wheelchair with your body as you release the recline mechanism. Slowly lower the back of the wheelchair until it is in a fully reclined position. 
5. After one minute, bring the chair back to the upright position by bracing your body against the chair, squeezing the chair’s release mechanism and pushing the back of the chair into an upright position. 
6. Finally, lower the chair’s leg rests. 

If your loved one is in a manual wheelchair that tilts (versus reclining) backward, follow the same protocol as described above; however, the leg rests will move with the chair, and will not have to be adjusted independently.