RespiteMatch.com Health Blog

Walking Although the client may show no signs of physical impairment, perceptual dysfunction can seriously impede her mobility. 􀂃 Walking through a crowded area is threatening for the client who is spatially insecure. If often helps if you offer her your arm and lead, rather than push, her through the area. 􀂃 A client may be able to move more securely if she is given a concrete visual target to head for, such as “the blue chair,” and if the route to the destination is clear of obstacles. 􀂃 It may be necessary to break down a long trip into several “legs.” 􀂃 Warning the client of obstacles and irregularities in the terrain may add to her security. 􀂃 A client who has an irregular gait or who has some physical impairment will walk more evenly if a rhythm is established. Take her arm firmly and use your body to set a somewhat exaggerated rhythm to the steps. This will encourage a more normal gait than verbal instructions alone would. 􀂃 A client who has difficulty coordinating the movement of a cane or a walker often responds well to instructions given in single words in the cadence of the walk, e.g., “Step, walker, step, walker.”

Rising from a Chair This can become a serious problem for the more severely motor-impaired client. It can be frustrating and time consuming for both client and staff. When the task is approached in a step-by-step fashion, some of this frustration can be alleviated. 􀂃 The first step in rising from a chair is to move forward in the seat. Therefore, before attempting to transfer a client from a chair, ensure that she is positioned well forward. 􀂃 The second step is to position the feet back slightly under the seat of the chair and flat on the ground. The heels may be raised slightly, especially if the client has tight heelcords. 􀂃 The next step for the client is to lean forward, bring her body weight out over the feet, and push off with her hands either from her knees or from the arms of the chair. It sometimes helps to give the client gentle but firm pressure on the nape of the neck (not the back of the head) to bring the head forward and bring her center of gravity over her feet just as she is making the effort to rise. Some clients find it easier to execute this maneuver on the count of three, so their efforts and the staff members’ efforts can be coordinated. 􀂃 If the client does not succeed in rising from the chair and standing on the first try, you may offer her a hand to help her balance herself, but avoid trying to pull her up. It may confuse her in her efforts to rise, and you may be left supporting her whole weight. This is not safe for you or for the client. Rather, let her back down gently and try again. 􀂃 A client who is very weak and who has poor balance is likely to need a walker for ambulating. Position the walker in front of her and let her pull up on it while you guide her as she shifts her weight.

Seating in a Chair or on the Toilet This is sometimes as difficult as rising and can be facilitated with the following techniques. 􀂃 Point out the chair as you approach it with the client. 􀂃 Approach the chair from the front and direct the client to bend slightly and place her hand on the chair arm on the opposite side. 􀂃 Then, while keeping her hand on the arm of the chair, direct her to “turn, turn, turn,” taking small steps until she is positioned with her back square to the chair. You may guide her by putting firm pressure on her hip and nudging her in the right direction. 􀂃 Once she is positioned, direct her to reach back for the other arm of the chair and ease herself down. 􀂃 Some clients have difficulty flexing their hips at this point. A little downward pressure with your hand on the nape of her neck may help get her down. 􀂃 For severely motor-impaired clients, a commode chair with arms placed over the toilet is very helpful. Some complex maneuvers, such as getting in and out of the car, become even more difficult if the client is given time to “think” about what she is to do. At this point, she may realize that she cannot remember how to go about it and may get “stuck.” It often helps to keep up a casual conversation as you approach the car with her, open the door, and gently and unobtrusively position her for entry into the vehicle. The long-established pattern of movement will often take over. In all these techniques, the principle applies of providing only as much help as the client really needs. Too much help can be as confusing as too little.
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