At Zebrafish Neuro, we believe that exercises using your own body and simple props on the floor is one of the best ways to improve and maintain health and wellness following a spinal cord injury (and other neurological conditions). 

Floor-based movement routines offer an opportunity for individuals with SCI to get more movement in their day without having to go to a therapy appointment or use fancy equipment. They are a safe, efficient and accessible option for anyone looking to improve hip and spine mobility, core strength and full body integration after SCI.

Floor-based movement offers many benefits for physical well-being and recovery.

In addition to physical health benefits, the ability to move well on the floor is transformative for independence after SCI. The floor-based movement practices and structure we use at Zebrafish Neuro have supported our client’s goals of improving functional tasks related to independent lifestyles such as:

• Picking things up from the floor while sitting in a wheelchair

• Reaching to grab something from a higher shelf

• Repositioning in a wheelchair chair or while lying in bed

• Transferring out of a wheelchair and onto the couch

Let’s not forget about the social and mental health benefits that arise from the ability to transfer from your chair to the floor (or other surfaces)! Picture this: 

It’s a summer’s day and you’re out with your kids or grandkids at a park. The kids are laying in the grass playing while you watch on from your chair. Now imagine you could get out of your chair and lay in the grass with them to get involved in the fun. 

You can also imagine similar situations at the beach, at home in your living room or even on a picnic for a date with a new love-interest. This is where confidence getting on and off the floor from the wheelchair is literally life-altering.

So, what’s holding you back from floor-based programs?

While floor-based programs may be a no-brainer for those living with SCI, the biggest barrier to entry comes down to the ability to get down (and up!) from the floor in the first place.

We understand how daunting it can be to think about how you will transfer to the floor safely and without a helper having to lift you. Our goal with this article is to offer you a few wheelchair-to-floor transfer options to be used as starting points for accessing the floor safely and with as little help as possible from a helper. 

In time, with practice and a strong home program implementing floor-based movements for improved whole-body connectivity and independence, it is our belief that the grass in the park, sand on the beach and picnic blanket don’t have to be a thing of the past, but a goal for your future.

One last thing to note: Regardless of your injury level and motor/sensory function in your lower body or trunk, these transfers are whole-body movements that will require some practice and training along with learning how to leverage the relationship between your head and ‘tail’ and how your legs can support your upper body movement and strength. After practicing the options below, we can help you further develop these skills through 1:1 remote coaching. Learn more about individualized support here.

Wheelchair to floor transfer strategies

To describe these transfers more clearly, we will go through each one as though the person is transferring to the right to get on the floor and transferring to the left to get back up to the chair.

Option 1: Step down

This option is most suitable for T-level injuries and lower, or C-level injuries with the ability to load their triceps and shoulders while maintaining hand placement during the movement.

Equipment needed: 

• An ottoman, step stool or box (many of our clients like to use this here) that is roughly half to two thirds of the height of your wheelchair seat.

• Exercise mat to land on.

Going from the wheelchair to the floor:

1. Place the box at a 45-degree angle by the front right caster wheel of your wheelchair.  

2. Scoot to the front edge of your seat and adjust your hips so that you are nearest the front right corner with your chest in line with the diagonal of the seat.

3. Place your feet about a quarter of the way between your current position and your ‘landing zone’ on the box. (Tip: angle your feet so that your toes point away from the box)

4. Work your right hand towards the box and make sure to leave space for your hips to land beside it.

5. Place your left hand in as close as possible to your left thigh and lean forward to shift weight into your legs and feet.

6. Using minimal momentum, lean further forward bringing your head down to the left in the direction of your footplate while pressing through your arms to lift the hips and swing them over to the right and down to the box. *This might feel scary since you are leaning so far forward! But you must drop your head low in order to lift your hips.

7. Repeat this same process to go from the box to the floor.

Going from the floor back up to the wheelchair:

This is often more challenging for people to achieve and may require another ‘step’. We recommend something like a yoga block or firm foam pad as the first step, and the box you used coming down as the second step.

1. Lift your hips up onto the first step and scoot in close to the box or ottoman so that you are at a 45-degree angle to the box (Tip: leave enough space so that your hips don’t catch the side as your transfer up).

2. Bring both knees closer to your chest so that your feet are flat on the floor (remember to angle them away from the box slightly)

3. Place your left hand on the box, leaving enough space for your hips to land and bring the right hand in close to your right thigh.

4. Lean forward while pushing down through the arms and bring your head to the right, and your hips to the left and up onto the box.

5. Gather your balance, get into position and repeat this process from the box to the chair. (Tip: give yourself space to clear the wheel if transferring to a manual wheelchair)

>> Watch Zebrafish Neuro founders Theo and Stephanie demonstrate this transfer here.

Option 2: Rolldown   

This option is most suitable for C-level injuries and lower, who can support and control their upper body weight using their arms and shoulders. 

Equipment needed: 

• An ottoman or box (we use this plyo box in the clinic) that is roughly half to two thirds of the height of your wheelchair seat.

• Exercise mat to land on.

Going from the wheelchair to the floor:

• Place the box alongside the seat of your wheelchair and scoot forward about halfway from your back rest.

• Position your legs over the front right corner of your seat and place your left foot in front of your right so that your lower legs are crossed over.

• Side bend to place your right elbow on the back end of the box on the side closest to your chair. 

• Pressing the elbow into the box for support, rotate your trunk to bring the left elbow over the far end of the box. Your hips will follow as your chest lands on top of the box and your knees roll to the floor (your head can hang over the back side).

• Crawl your arms to the edge of the box furthest from your chair & bring your left arm to the floor, followed by your right arm and adjust your knees as required. 

• From this quadruped (4-point) position alongside the front of the box, lower yourself down to prone or side-sit. *Take a note of this position for the transfer back to your chair!

Going from the floor back up to the wheelchair:

• Position yourself in prone or side-sit next to the box, similarly to how you finished the transfer down to the floor. (Your feet should be nearest the chair and your head at the other end of the box) 

• Bring yourself up into quadruped, with your right hip and shoulder alongside the front of the box. 

• Weight shift to the left so you can raise your right arm on top of the box and then pull your chest towards the top, front edge.

• Bring your left arm up and crawl forward with your arms towards the back left corner of the box - the key here is to crawl forward enough so that your stomach and hips are on the box.

• Bring the left hand back by your left hip and right elbow back by your right ribs. Rotate and prop yourself up into a seated position.

• Lateral or pivot transfer into your seat (Tip: as you get more comfortable with this transfer, you will be able to position yourself so the rotation into seated will actually have your hips land in your seat, if your box and seat are similar heights).

 >> Check out this video here for a visual on this transfer option.

Option 3: Reverse Slide Down from Bed/Therapy Mat

This option is most suitable for C-level injuries and lower, who need some support and control for their upper body and trunk. 

Equipment needed: 

• Exercise mat

Going from the wheelchair to the floor:

• Start by laying on your bed or therapy mat in a prone (on stomach) position with feet pointed at the side of the bed that you will transfer down from. 

• Have a helper pull your body by the legs (holding onto the knees) until your pelvis is at the edge of the bed with your helper holding your legs.

• Your helper will switch their support to your kness. Continue sliding off the edge as your helper guides your knees towards the floor below. Make sure that the feet are out of the way. Decelerate your decent through your arms. Your helper can switch support to your hips as needed. 

• Once your knees are on the floor, you will be in a tall kneel position with elbows on the bed. 

• Slowly drop the hips to one side so that you do not sit on your feet, ending in a ‘side sit’ position. Support the descent with your arm and your helper assisting at the hips.

Going from the floor to the wheelchair:

• With assistance from a helper, position a box, ottoman or step stool beside the bed. 

• Come into a seated position with your helper holding a gait belt or strap around your hips. 

• Organize your legs so that your feet are flat on the floor.

• Your helper will position themselves so that their knees squeeze your legs together and stop them from shifting forward as you lean into their midsection. With your shoulder on their midsection and head on the opposite side to the chair, wrap your arms around your helper’s hips.

• Your helper lifts your hips and pivots you up onto the box, being mindful of their own posture and positioning.

• From the box, reorganize and repeat the above steps to lift into the wheelchair. 

>> Watch our quick tutorial on this transfer here. 

Remember, these transfers take time and practice with a lot of communication between you and your helper. Allow yourself some grace and keep at it!

Watch several Zebrafish Neuro SCI athletes perform their versions of chair-to-floor transfers here!

We would love to hear about your first-floor transfer and movement session!

If floor transfers are something you would like more personal attention with, we would love to help you find a strategy that works for you and your helper. 

Book a [free] Discovery Call with us to learn how we can help you Move More On Your Own through 1:1 Remote Coaching!

About the Author of this Blog:

Barry Moore has worked with adaptive athletes in various settings since 2014. He blends his experience in adaptive sports, recreation, rehab and holistic wellness, with his formal education (MSc in Kinesiology) to offer well-rounded recovery programs for individuals of various types of neurological injuries and conditions. He fully believes in the phrase “Movement is Medicine” and enjoys finding new ways for his clients to experience movement.

Stephanie Comella has been working with individuals with spinal cord injuries since 2011. She blends her formal education in movement science, Pilates, and other mindful movement modalities with neurological science to provide an intuitive, hands-on style of teaching focused on body re-connection. Stephanie aims to empower both individuals with SCI and their trainers using a human-powered healing approach.