Cerebral palsy and transfers for OTs: the crunch point you are really assessing
You know the goal your CP clients are chasing, because they tell you. It is not gross motor scores. It is a normal life. In research with families of adults with cerebral palsy, one caregiver summed up what they wanted for their daughter simply: to "go out more, like any 27-year-old." They want what everyone wants - independence and community.
You also know where that goal most often stalls. Study after study of adults with CP moving toward independent living lands on the same barrier: not the wheelchair, not the house, but the transfer and the personal care around it. It is the point where a plan to keep someone at home, in their community succeeds or fails.
This is a look at how the transfer becomes that crunch point across the lifespan, and where a sit-to-sit device changes the maths.
The caregiver is part of the assessment
Families are candid about the toll, and it is worth reading in their own words. "I had to reduce my working hours to care for my daughter." "There comes a time when you get tired and worn out psychologically." And from caregivers who are ageing alongside the person they support: "We are getting older and older, and although we are still capable, there are some situations in which it is more difficult for us."
NZ caregiver data makes it concrete: 43% of home and residential care workers report being at risk of, or having had, a back injury, with lifting and poor transfer setups among the leading causes. Family caregivers do the same work with less training and no hoist.
How transfer needs change across the lifespan in CP
Childhood:
The load creeps up. A small child gets lifted, and families manage. The problem scales with the child. What is fine at 15kg is a strain at 30kg and a genuine injury risk beyond it. GMFCS also tracks the secondary changes that reshape a transfer: hip displacement risk rises steeply with level, roughly 15% at GMFCS II, 40% at III, 70% at IV and 90% at V across childhood, and it is often silent early, which is why NZ runs structured hip surveillance (see Starship's guideline). A migrating or painful hip, spasticity, evolving contractures and pelvic obliquity all change how a person can be positioned long before surgery is on the table.
| GMFCS level | Approx. hip displacement risk in childhood |
|---|---|
| II | ~15% |
| III | ~40% |
| IV | ~70% |
| V | ~90% |
Source: Soo et al., 2006.
Adolescence:
The sit-to-stand assumption breaks. This is the transition that catches equipment out. A young person can grow past 50kg while standing strength, selective motor control and reliable weight-bearing do not keep pace. A sit-to-stand aid depends on exactly those, so the device that worked at ten becomes unusable at fifteen, right when the young person wants more privacy and dignity in their transfers, not less.
Adulthood:
Function declines, and the transfer gets harder. Adults with CP commonly lose function earlier than their peers. The Cerebral Palsy Research Network reports that a substantial share of adults who could walk in adolescence lose that ability over the following two decades, driven by chronic pain, reduced strength and changing tone, with pain reported by 75% or more of adults with CP. Osteoarthritis, fatigue and falls are common. Practically speaking, an adult who used to stand-transfer or pivot may not be able to next year, and the caregiver supporting them is often ageing too. A transfer plan that assumes today's function will be wrong soon.
The through-line is that transfer needs in CP move one way, toward needing more support. The equipment plan should anticipate that.
Where a sit-to-sit device fits: between sit-to-stand and hoist
The Kera is a sit-to-sit transfer device: it moves a person between two seated surfaces, bed, wheelchair, toilet, shower chair, car, with a single caregiver and no requirement to stand or weight-bear. The person stays upright and supported, hands free. One of HT's own team, a wheelchair user for 39 years, describes the ordinary alternative bluntly, "exhausting, for everyone. They're clinical, awkward, and often require two people," and the difference a one-caregiver seated transfer made: being able to "sit with someone instead of near them."
Clinically, the Kera sits in the gap between two options that each leave CP clients stranded:
After a sit-to-stand aid, which needs the standing strength and weight-bearing that many people at GMFCS III to V do not have, or lose.
Before a full sling hoist, ceiling or mobile, which is a larger commitment, is often room-fixed, and can feel disproportionate for a household that still wants to move between rooms and out into the community.
That missing middle is where a lot of CP presentations sit: no longer a safe stand-transfer, but a full hoist is more than the situation needs. The Kera also travels, which matters for a population that is at home, at school, at work and away. There is a Kera Home for everyday use and a lighter Kera Travel, and the Kera has been funded in New Zealand for more than seven years.
To be precise about scope: this is a moving-and-handling device. It does not treat cerebral palsy, alter its course, or change gross motor function. What it changes is the safety, dignity and independence of the transfer, for the client and for whoever moves them.
FAQ section
Which clients is a sit-to-sit device suited to?
People who can no longer do a safe standing or pivot transfer but don’t need a full sling hoist. In CP, that often means GMFCS III to V, or clients whose standing ability is declining.
Does the person need to weight-bear?
No. The Kera transfers between two seated surfaces, with no standing or weight-bearing.
Can one caregiver do the transfer?
Yes. It is designed for single-caregiver transfers between the bed, wheelchair, toilet, shower chair and car.
Is it funded?
The Kera has been funded in New Zealand for more than seven years.
Trialing the Kera with a CP client
Because presentations vary so widely, and because the transfer is what the whole plan turns around, the sensible step is a demo in the person's own setting rather than a spec-sheet decision. If you are weighing options for a CP client whose transfers are getting heavier, or whose standing transfer is on borrowed time, a Kera demo will tell you, and their caregiver, more than any brochure.
Recommend a demo, and we will set it up with you and the family.
