Lesson 3 - Mobility
What you will learn in this lesson:
1. Using proper body mechanics to prevent injury.
2. Proper techniques and assistive devices for helping a client walk and transfer.
3. Why falls are a concern for clients, how to prevent falls, and what to do if a client has fallen.
2. Proper techniques and assistive devices for helping a client walk and transfer.
3. Why falls are a concern for clients, how to prevent falls, and what to do if a client has fallen.
Definitions
Assistive devices : Equipment that helps a person perform a task and maintain or regain independence
Body mechanics : A way of lifting to prevent injury
Mobility : Ability to move about
Positioning : How a person is placed when sitting or lying
Transfers : Moving a person from one place to another
Transfer belt/gait belt : A belt worn around the client’s waist to aid in transfers and walking
Transfer board : A flat board that enables a person to slide from one
Body mechanics : A way of lifting to prevent injury
Mobility : Ability to move about
Positioning : How a person is placed when sitting or lying
Transfers : Moving a person from one place to another
Transfer belt/gait belt : A belt worn around the client’s waist to aid in transfers and walking
Transfer board : A flat board that enables a person to slide from one
Proper Body Mechanics
Any time you help lift or move a client, use proper body mechanics to prevent stress and injury to your spine.
Many things can limit a client’s mobility, including:
Common problems that can occur when a client becomes less mobile include:
In addition, becoming less mobile can bring on feelings of helplessness, depression, and anxiety as a client’s independence is reduced
- Before lifting or moving a thing or person, test the weight of the load and make sure you can move it safely. Do not lift it alone if it seems too heavy.
- Spread your feet about shoulder width apart with one foot in front of the other to provide a good base of support.
- Bend at the knees instead of the waist.
- Keep your back as straight as possible.
- Bring the load as close to your body as you can.
- Lift with your legs, using your stronger set of buttock and leg muscles.
- Keep your back, feet, and trunk together and do not twist at the waist. If it is necessary to change your direction when upright, shift your feet and take small steps. Keep your back and neck in a straight line.
- Pull, push, or slide objects instead of lifting when possible
Many things can limit a client’s mobility, including:
- Balance problems
- Vision problems
- Hearing loss
- Pain
- Medication
- Certain disabilities
- Reduced sense of touch
Common problems that can occur when a client becomes less mobile include:
- Pressure ulcers
- Urinary problems
- Constipation
- increased stress on the heart
- Muscle weakness
In addition, becoming less mobile can bring on feelings of helplessness, depression, and anxiety as a client’s independence is reduced
Transfers
Transfers are very personal. A client knows what works and doesn’t for him/ her and will have a definite opinion about how he/she wishes to be transferred. Talk with the client about his/her preferences before you do any transfers. Be clear and confident with your directions. This helps the client feel more comfortable and secure.
Skill: Transfer Client From Bed To Chair/Wheelchair
1. S.W.I.P.E.S.
2. Position chair/wheelchair close to bed with arm of the wheelchair almost touching the
bed.
3. Fold up or remove footrests.
4. Lock wheels on wheelchair.
5. Assist client to roll toward side of bed.
6. Supporting the client’s back and hips, assist client to a sitting position with feet flat on
the floor.
6. Assist client to put on non-skid footwear.
7. Put on transfer belt, if necessary.
8. Assist client to scoot toward edge of bed.
9. With transfer (gait) belt:
12. Alert client you will begin transfer on the count of 3.
13. On signal, assist client to stand.
14. Assist client to pivot to front of wheelchair with back of client’s legs against wheelchair.
15. Flex your knees and hips and lower the client into the wheelchair.
16. Have client hold onto armrests for support.
17. Reposition client with hips touching the back of the wheelchair and good body
alignment. Remove transfer belt, if used.
18. Position client’s feet on footrests.
19. Wash hands as final step.
2. Position chair/wheelchair close to bed with arm of the wheelchair almost touching the
bed.
3. Fold up or remove footrests.
4. Lock wheels on wheelchair.
5. Assist client to roll toward side of bed.
6. Supporting the client’s back and hips, assist client to a sitting position with feet flat on
the floor.
6. Assist client to put on non-skid footwear.
7. Put on transfer belt, if necessary.
8. Assist client to scoot toward edge of bed.
9. With transfer (gait) belt:
- Stand in front of client.
- Grasp belt.
- Stand in front of client.
- Place arms around client’s torso under client’s arms.
12. Alert client you will begin transfer on the count of 3.
13. On signal, assist client to stand.
14. Assist client to pivot to front of wheelchair with back of client’s legs against wheelchair.
15. Flex your knees and hips and lower the client into the wheelchair.
16. Have client hold onto armrests for support.
17. Reposition client with hips touching the back of the wheelchair and good body
alignment. Remove transfer belt, if used.
18. Position client’s feet on footrests.
19. Wash hands as final step.
Transfer belt
A transfer belt is a belt made of sturdy webbing or twill with a buckle or clasp on it. The transfer belt is placed around a client’s waist and is used to help a client transfer or walk. A transfer belt is recommended for clients who need help to transfer.
A transfer belt can be purchased at a local medical equipment supplier. Medical coupons may be available for DSHS clients to cover the purchase of a transfer belt. Encourage the client to check with his/her case manager or talk with your
supervisor. If you do not have a store purchased transfer belt, you can use a regular wide belt with a clasp.
The following are general tips to remember when using a transfer belt.
Transfer boards improve a client’s ability to transfer with less assistance.
Transfer boards work well for clients that can use their arms to scoot from one side to the other.
A transfer belt can be purchased at a local medical equipment supplier. Medical coupons may be available for DSHS clients to cover the purchase of a transfer belt. Encourage the client to check with his/her case manager or talk with your
supervisor. If you do not have a store purchased transfer belt, you can use a regular wide belt with a clasp.
The following are general tips to remember when using a transfer belt.
- Place the belt around the client’s clothing, not his/her bare skin.
- The belt should be snug but not too tight. You should be able to comfortably put the flat of your hand under the belt.
- Make sure a woman’s breasts are not caught under the belt.
Transfer boards improve a client’s ability to transfer with less assistance.
Transfer boards work well for clients that can use their arms to scoot from one side to the other.
Safety with transfers
If the client cannot help with the transfer at all, you need special training and/or adaptive equipment (e.g. a Hoyer Lift) to lift and move him/her. Depending on where you work, talk with your supervisor or
the client’s case manager about how to get this special training.
The client should never put his/her arms around your neck during a transfer. It can pull you forward, make you lose your balance, and/or hurt your back.
If you feel a strain in your lower back, stop the transfer and get help.
The following are general tips to remember when helping a client to sit on the side of a bed.
The following are general tips to remember when using a drawsheet to lift.
Lifting a client with a drawsheet requires two people. Use a draw sheet (a regular sheet folded in half) placed under the person between his/her knees and shoulders.
The following are general tips to remember when transferring a client from a wheelchair into a car.
A large, plastic garbage can liner can also be used to make it easier for the person to slide.
the client’s case manager about how to get this special training.
The client should never put his/her arms around your neck during a transfer. It can pull you forward, make you lose your balance, and/or hurt your back.
If you feel a strain in your lower back, stop the transfer and get help.
The following are general tips to remember when helping a client to sit on the side of a bed.
- Make sure the client is not too close to the edge of the bed.
- Instruct the client to bend his/her knees with their feet flat on the bed and to roll onto their side towards you. Watch closely.
- Have the client bring his/her legs off the bed and push up with their arms to a sitting position.
- Encourage the client to use hip walking if able (scooting forward one hip at a time) when scooting towards the edge of a bed.
- Assist the client, if needed, by placing one arm under her/his shoulder and your other arm over his/her thighs. Swing the client’s legs off the bed.
The following are general tips to remember when using a drawsheet to lift.
Lifting a client with a drawsheet requires two people. Use a draw sheet (a regular sheet folded in half) placed under the person between his/her knees and shoulders.
- Roll up each side of the draw sheet to the client lying in bed, and then lift the client up in bed. Be careful not to drag the client’s heels.
- If the client is able, he/she can also assist by bending his/her knees and pushing up while the caregivers use the drawsheet.
The following are general tips to remember when transferring a client from a wheelchair into a car.
- Position the car away from the curb so the client stands on level pavement, or have the car close to the curb so the client will not have to step down onto the pavement from the curb.
- Have the car door open.
- Position the car seat as far back as possible. The front passenger seat is preferred.
- Make sure the wheelchair is in the locked position.
- Have the client put his/her right hand on the car door.
- Have the client use his/her left hand to push off on the wheelchair to a standing position.
- Have the client turn, face the door, and place his/her left hand on the seat back or door frame and sit down sideways onto the seat.
- Have the client turn in the seat and assist him/her, if needed, in placing one, then the other foot, in the car.
- Reverse this process if transferring the client out of car.
- Non-friction upholstery such as vinyl or leather helps the client to slide easily.
A large, plastic garbage can liner can also be used to make it easier for the person to slide.
- Avoid parking the car on an incline.
- Have the car engine off—put the car in park with brakes set.
Helping a Client Walk
Helping a client walk includes helping steady the client while he/she is walking, assisting with difficult parts of walking (e.g. climbing stairs), and helping with assistive devices (e.g. walkers).
1. S.W.I.P.E.S.
2. Put on and properly fasten non-skid footwear on the client.
3. Stand in front of and face client.
4. Brace the client’s lower extremities.
5. With transfer (gait) belt:
8. Wash hands as final step.
Helping a client walk includes helping steady the client while he/she is walking, assisting with difficult parts of walking (e.g. climbing stairs), and helping with assistive devices (e.g. walkers).
The following are general tips to remember when helping a client walk.
Clarify with the client where he/she wants to go and assess the client’s abilities before assisting the client to walk.
Before assisting a client to stand, encourage him/her to:
Never help a client stand by pulling on his/her arms. Never put your hands under the client’s armpits when assisting a client to stand.
The following are general tips when helping a client climb stairs.
1. S.W.I.P.E.S.
2. Put on and properly fasten non-skid footwear on the client.
3. Stand in front of and face client.
4. Brace the client’s lower extremities.
5. With transfer (gait) belt:
- Place belt around the client’s waist and grasp the belt while assisting client to stand.
- Walk slightly behind and to one side (weaker side, if any) of client for the full distance, while holding onto the belt.
- Place arm around client’s torso while assisting client to stand.
- Walk slightly behind and to one side (weaker side, if any) of client for the full distance with arm supporting client’s back.
8. Wash hands as final step.
Helping a client walk includes helping steady the client while he/she is walking, assisting with difficult parts of walking (e.g. climbing stairs), and helping with assistive devices (e.g. walkers).
The following are general tips to remember when helping a client walk.
Clarify with the client where he/she wants to go and assess the client’s abilities before assisting the client to walk.
Before assisting a client to stand, encourage him/her to:
- Lean forward;
- Use a rocking motion as momentum (if able);
- Move his/her legs off the bed;
- Push forward with his/her arms from the bed (if able).
- Keep the client’s body as straight as possible when lifting.
- If a client has a weak leg, brace your knee against it as the client stands.
- Once the client is standing, encourage him/her to:
- Stand a few minutes and stabilize his/her balance before walking;
- Stand straight, look forward, and keep a measured, smooth rhythm;
- Use his/her glasses and/or hearing aids;
- Avoid wearing skirts, robes, etc., that fall below the ankles.
- Clear pathways of clutter.
Never help a client stand by pulling on his/her arms. Never put your hands under the client’s armpits when assisting a client to stand.
The following are general tips when helping a client climb stairs.
- The client should step up with his/her stronger leg first.
- Stand behind the client when he/she is going up stairs.
- The client should step down with the weaker leg.
- Stand in front or at the side of the client when he/she is going down stairs.
- For safety, the client should always use a handrail.
- A transfer belt can also be used for support.
Assistive devices used for helping a client walk
Clients who can bear some weight on their legs but are unsteady and/or need help with balance use walkers.
The following are general tips for helping a client use a walker. Encourage the client to:
Pick up - do not slide - the walker;
Not lean into the walker;
Place his/her weight on the stronger leg and hands;
Not pull on the walker when standing up.
Straight canes are for balance and are not designed to bear weight. The client must be able to bear weight on both legs and hold the cane.
The following are general tips for helping a client use acane.
The following are general tips for helping a client use crutches.
Braces provide specific support for weakened muscles or joints or immobilize an injured area. The brace should be custom-made for the individual.
The following are general tips to remember when a client has a brace.
The following are general tips for helping a client use a walker. Encourage the client to:
Pick up - do not slide - the walker;
Not lean into the walker;
Place his/her weight on the stronger leg and hands;
Not pull on the walker when standing up.
Straight canes are for balance and are not designed to bear weight. The client must be able to bear weight on both legs and hold the cane.
The following are general tips for helping a client use acane.
- The cane should be used on the client’s strong side.
- The cane goes forward first, followed by the weaker leg and then the stronger leg.
- Stand on a client’s weaker side (if they have one).
- Crutches provide support and stability when a client can only bear weight on one foot.
The following are general tips for helping a client use crutches.
- The crutches should be adjusted to the client’s height.
- The crutches should have heavy, rubber suction tips.
Braces provide specific support for weakened muscles or joints or immobilize an injured area. The brace should be custom-made for the individual.
The following are general tips to remember when a client has a brace.
- The client may need protective padding.
- There may be a prescribed schedule for use and rest.
- Monitor closely for skin irritation or breakdown.
Falls
Falls are a major health problem for older adults and can be of concern for people with certain developmental disabilities.
Fall statistics
Things that lead to falls.
Many things can lead to falls for a client, including:
Consequences of a fall
There are many consequences of a fall for a client, including injury, fear, and loss.
Injury
Falls result in approximately 200,000 hip fractures in older adults each year. Half of these people remain disabled.
Fear and loss
Many clients fear falling (especially if they have fallen before) or lose confidence in their ability to move around safely. This fear can:
Fall statistics
- Approximately 75% of the falls in older adults occur in and around the home. The majority of these falls occur while walking or just turning around.
- Each year, 25% of people 65-74 years old that live in the community fall. The rate increases to over 35% among those 75 years and older.
- Older women experience significantly more falls than older men until age 75, when men and women fall at about the same rate.
- 50% of elderly persons who fall do so repeatedly.
- Unsteady shoes increase the risk of hip fractures 6 times
Things that lead to falls.
Many things can lead to falls for a client, including:
- Vision and hearing problems
- Impaired balance or awareness
- Reduced strength
- Alcohol or drug abuse
- Seizures
- Medications
- Poor hydration or nutrition
- Slowed reaction time
Consequences of a fall
There are many consequences of a fall for a client, including injury, fear, and loss.
Injury
Falls result in approximately 200,000 hip fractures in older adults each year. Half of these people remain disabled.
- Other injuries often include fracture to the wrist, shoulder, or spine.
- Over 50% of all fatal falls involve people 75 years and older.
Fear and loss
Many clients fear falling (especially if they have fallen before) or lose confidence in their ability to move around safely. This fear can:
- Limit his/her daily activities;
- Increase his/her feelings of dependence, isolation, and depression;
- Lead to a loss of mobility.
Fall Prevention
There are a great number of simple and practical things that can be done to reduce the risk of falling for a client. Report concerns you have about a client falling to the appropriate person where you work.
Encourage a client to:
Footwear
All clients should have sturdy walking shoes that support the foot. Shoes that tie or supportive sneakers with thin, non-slip soles and velcro fasteners to adjust for swelling of the feet are best. Slippers and jogging shoes with thick soles should be avoided.
Fall Prevention Tips
What to do if you see a client falling
Follow these steps if you see and can get to a client who is falling.
1. Don’t try to stop the fall. You could both be injured.
2. Try to support the client’s head and gradually ease the client onto the floor.
3. Keep your back straight, position your feet for a wide base of support. Flex at the knees and hips as you lower the client to the floor.
4. If you are behind the client, gently let him/her slide down your body.
What to do if a client has fallen on the floor
Follow your facility or agency policy about responding to falls. Below are recommended steps to take.
1. Ask the client how he/she feels.
Keep in mind, that most people are embarassed and may want to get up or tell you everything is fine even if he/she is hurt. Observe the person carefully.
2. If the client says he/she feels unhurt and comfortable getting up, observe him/her carefully as he/she does so.
Depending on where you work, you may be expected to assist the client back to his/her pre-fall position. Follow your employer’s policies and procedures. If the client has trouble getting up, you can help steady him/her, but do not lift him/her up.
If the client is injured, your role is to get the client medical help. Individual providers should call 911. Caregivers in adult family homes or boarding homes should know and follow their employer’s emergency policies and procedures.
Make the client as comfortable as possible and keep him/her warm by covering with a blanket until the EMTs or other medical help
arrives.
Do not give the client anything to drink or move him/her.
3. Document and report the fall to the appropriate person where you work.
Encourage a client to:
- Have routine eye exams and wear his/her glasses;
- Have routine hearing exams and wear his/her hearing aides;
- Do strengthening or balance exercises*;
- Use a walker or other needed assistive devices;
- Exercise; A client may require an individualized program designed by a doctor.
- Get up slowly after sitting or laying down;
- Reduce fall hazards in the home;
- Have medications reviewed by his/her doctor.
Footwear
All clients should have sturdy walking shoes that support the foot. Shoes that tie or supportive sneakers with thin, non-slip soles and velcro fasteners to adjust for swelling of the feet are best. Slippers and jogging shoes with thick soles should be avoided.
Fall Prevention Tips
- Keep walkways clear - especially to the bathroom.
- Remove throw rugs and any other things a client may trip over.
- Rooms and stairs should be free of clutter.
- All rooms should have good lighting, especially hallways and stairs.
- Stairs should have a strong hand rail.
- Vary the colors at floor level so you can see where steps and edges are.
- Use nightlights in a client’s room, in the hallway, and in the bathroom.
- Avoid long robes, loose-fitting slippers, and high heeled shoes.
- Keep things used most often on lower kitchen cabinet shelves.
- Use hand rails in tubs and next to toilets.
- Use hand grips to help steady.
- Use safety toilet seats to make standing and sitting easier.
- Use mats in showers and tubs.
What to do if you see a client falling
Follow these steps if you see and can get to a client who is falling.
1. Don’t try to stop the fall. You could both be injured.
2. Try to support the client’s head and gradually ease the client onto the floor.
3. Keep your back straight, position your feet for a wide base of support. Flex at the knees and hips as you lower the client to the floor.
4. If you are behind the client, gently let him/her slide down your body.
What to do if a client has fallen on the floor
Follow your facility or agency policy about responding to falls. Below are recommended steps to take.
1. Ask the client how he/she feels.
Keep in mind, that most people are embarassed and may want to get up or tell you everything is fine even if he/she is hurt. Observe the person carefully.
2. If the client says he/she feels unhurt and comfortable getting up, observe him/her carefully as he/she does so.
Depending on where you work, you may be expected to assist the client back to his/her pre-fall position. Follow your employer’s policies and procedures. If the client has trouble getting up, you can help steady him/her, but do not lift him/her up.
If the client is injured, your role is to get the client medical help. Individual providers should call 911. Caregivers in adult family homes or boarding homes should know and follow their employer’s emergency policies and procedures.
Make the client as comfortable as possible and keep him/her warm by covering with a blanket until the EMTs or other medical help
arrives.
Do not give the client anything to drink or move him/her.
3. Document and report the fall to the appropriate person where you work.