At Desert Mountain SELPA in Apple Valley, California, we’ve discovered a creative solution for seated transfers with the TRAM. This method works really well, particularly for the more profoundly involved kids. Using the standard approach shown in the TRAM Quick Reference Guide (with a thigh strap placed separately under each leg) often results in the body support system riding up the student’s trunk while their buttocks slip backward and downward. Not so with this method, which we have dubbed “Red-White-Tight.” We place one thigh strap from red clip to red clip, raise the student slightly, and add a second thigh strap from white clip to white clip. This has even worked effectively for transfers to the toilet! Here’s how.
1. Bring body support system of TRAM up to student and secure strap around the back. It does not need to be tight. It works better if student can sit up straight.
2. Thread one thigh strap under both legs, midway between knee and hip. Then hook on red knob and tighten until knees and hips are about on same plane or equal height. The main body of the strap should be half way between buttocks and back of knees. As you tighten the straps, the student should be lifted slightly.
3. Get ready with strap number two. Lift student a few inches up from wheelchair and slide strap in from back under the hips. Hook it on the blue clips. (If student has no hips, has low cognition, or has tendency to wriggle, you may need to put it on the white clip.) Tighten until student’s hips are raised to secure level and student is not able to rock back or forward. The thigh strap attached to the blue or white clip may be tightened higher than the other so that the student leans forward over the front part of the body support system.
4. Roll student to toilet and lower the TRAM until the student is about two to three inches above the toilet seat. Double check that the thigh strap attached to the red clip is tight and the student is leaning forward. Then, loosen and remove posterior thigh strap from the blue knobs. Do initial adjustments of clothing, pulling the pants down to first strap. Lower the student onto the toilet. (You may need to support student on the back by pushing forward while you lower). When student is seated on toilet, remove the anterior thigh strap. Finish clothing adjustments.
Note: For some students, you may need to first seat them on the toilet seat, re-position body support system and straps, begin to loosen clothing, and then move the body support system up and down as needed so that student’s weight is off their clothes.
5. Unhook the back or thoracic strap and secure student while on the toilet. You could re-secure the student in TRAM with the body support system and brakes on if you have no other way of securing the upper body.
6. Then repeat steps in reverse to put student back in the wheelchair.
Back to Top** This post was originally published on http://www.rifton.com/adaptive-mobility-blog/blog-posts/2018/october/tram-toileting-transfer