You already know what your clients with muscular dystrophy are working toward, because it rarely changes. Staying at home. Staying in school or in work. Staying in the room where the family is, rather than in the one next to it.
You also know that the plan usually turns on the transfer. Not the wheelchair, not the house. In a study of people with Duchenne muscular dystrophy who were no longer walking, transfers were the single most reported functional problem: 72% named getting in and out of bed, and 56% named getting in and out of a chair. That is the daily moment where a home plan either holds or stops working.
This is a look at how transfer needs change across the condition, and where a sit-to-sit device fits in the equipment plan.
A note on what the evidence covers
Most of the strong published evidence is for Duchenne muscular dystrophy, the most common childhood muscular dystrophy. The staging and timing below come from that literature. Becker, congenital, limb-girdle and Emery-Dreifuss follow their own courses, and spinal muscular atrophy is related but distinct, so the arc below is a landscape rather than a template to lay over any individual client.
How the transfer need changes across DMD's five stages
DMD follows an internationally recognised five-stage path. It is worth reading as a transfer story rather than a mobility one.
Ambulatory stages
Weakness starts in the big proximal muscles, the hips, thighs, shoulders and upper arms, usually in early childhood. Those are exactly the muscles a transfer later depends on. Through the early and late ambulatory stages the child walks but tires over distance, and a scooter or manual wheelchair comes in to save energy rather than to replace walking.
Early non-ambulatory: the stage that reshapes the plan
The stage that reshapes the equipment plan is early non-ambulatory. Most boys move to a power wheelchair full-time and need help or mechanical support for anything involving the legs or trunk. Population data puts that around age 12, but treat that number carefully: corticosteroids and newer therapies push loss of walking 2 to 4 years later, so it is a median in a treatment era, not a date for any one child.
Late non-ambulatory: hoist-based care
At this point many young people can still manage an assisted standing transfer or a sliding transfer with aids. That is also when transfers become the highest-risk moments of the day, and when falls happen, both during the transfer and from the chair. By the late non-ambulatory stage, care has shifted to hoist-based transfers, and guidelines recommend a hoist and compatible slings available at home, at school or work, and in clinic.
The through-line for planning is that there is a real window between the point a standing transfer stops being safe and the point a full hoist and sling setup is the right answer. A lot of equipment plans have nothing to put in it.
The caregiver is half the assessment
The physical load does not rise evenly. It peaks in the teenage years, roughly 13 to 17, as wheelchair dependence sets in and the young person gets heavier while needing more help. A case-control study found caring for a teenager with DMD was the most challenging phase for exactly that reason.
The numbers are worth having in front of you when you are writing a case. Caregivers give a mean of roughly 33 to 44 hours a week of their own time to informal care, and 35% provide more than 50 hours a week. A systematic review across 21 studies in 15 countries links DMD caregiving to impaired quality of life, poor sleep, reduced family function, depression, pain and stress, with around half of caregivers reporting that they are moderately or extremely anxious or depressed.
That is the moving-and-handling risk in the file, and it sits on the person who is not your client. When the transfer fails the caregiver, the placement fails the young person.
There is also direct evidence that equipment helps. A 2023 systematic review and meta-analysis across 20 studies and 2,087 participants found that mechanical lifting and transfer devices significantly reduce musculoskeletal injury rates among the people doing the transfers. Being straight about that evidence: it studied professional and healthcare carers rather than parents at home, and while the same review found a favourable signal on lower-back pain specifically, that finding rests on two small studies and is not solid enough to lean on. The injury-rate finding is.
Where the Kera sit2sit fits
The Kera is a sit2sit 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, feet off the ground, hands free. There is no sling to fit.
Clinically, the Kera sits between two options that each leave people with muscular dystrophy stranded at some stage:
- After a sit-to-stand aid, which depends on the standing strength, leg power and reliable weight-bearing that the condition progressively removes. This is the device that works at 10 and is unusable at 15.
- Before a full ceiling or mobile hoist, which is a larger commitment, is often room-fixed, and can feel disproportionate for a household whose young person is still at school, still going out, still moving between rooms.
That middle window is where a lot of muscular dystrophy presentations sit for years, not months. The Kera also travels between rooms and out into the community, 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 Kera Travel, and it 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 muscular dystrophy, alter its course, or change muscle strength. What it changes is the safety, dignity and independence of the transfer, for the young person and for whoever moves them.
Recommending a demo/trial
Because the window opens at different times for different people, and because the transfer is what the whole plan turns on, the sensible step is a demo in the person's own home rather than a decision made off a spec sheet. If you are planning ahead for a client whose standing transfer is getting harder, or whose caregiver is starting to feel it, a Kera demo will tell you and the family more than any brochure.
Recommend a demo, and we will set it up with you and the family.
