The caregiver’s back — transfers at month four
| Patient | 67M, chronic phase |
|---|---|
| Injurysevere TBI; right hemiparesis with cognitive sequelae | |
| Severity | Worst GCS 6 |
| Days since injury | 120 |
| Before the injuryRetired postman. Married forty years; she was his whole support. | |
| Also on the chartRight hemiparesis; Post-traumatic impulsivity and memory impairment | |
| PrecautionsDependent transfers — mechanical lift; no manual lifting by the caregiver; Impulsivity — stand-by guarding within arm’s reach at all times; Wife osteoporotic — her lifting is the placement’s biggest risk | |
Test yourself
What does transfer training start with?
The teaching
Month four at home is where placements are won and lost, and the deciding variable is rarely the patient’s motor score — it is the caregiver. The evidence on caregiver strain after TBI is consistent enough to act on: protect the lifting, book the respite, track her markers like his. What you do with it: mechanical lift for dependent work, her health written into his plan, and the question about sleep and pain asked out loud every visit.
- Her back pain worsening or any near-drop during transfers — the lift goes in this week, not next
- Any talk of hopelessness or harm — caregiver depression is common enough to ask about directly
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Waters TR. When is it safe to manually lift a patient? Am J Nurs. 2007. Turner-Stokes L et al. Multidisciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev. 2015 · Kreutzer JS et al. Primary caregivers’ psychological status and family functioning after traumatic brain injury. Brain Inj. 1994. Turner-Stokes L et al. Multidisciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev. 2015