natcep day 13

Mobility and Ambulation Techniques

NATCEP Day Thirteen

Objectives• Identify safety precautions in the use of wheelchairs and

geriatric chairs• Identify/describe types and purposes of lifts• Identify safety precautions involved in the use of portable

lifts to move residents• Identify safe and proper use of walkers, canes and crutches• Demonstrate the safe way to assist a resident to walk

– SKILL: Ambulation using a Gait Belt– SKILL: Ambulation with a Walker

Safety Precautions: Wheelchairs or Geriatric Chairs (Geri-chair)

• Start with a Safety check!– Check the brakes! Make sure you can lock and

unlock – Check for flat or loose tires which will prevent

locking– Check wheel spokes – are they intact?– Do casters point forward? (balance and stability) – Blankets and tubing away from the wheels?


• Position the person’s feet on the footrests before moving.

• Do not let the resident stand on the footplates• Do not let the footplates fall back onto the

resident’s legs• Push the chair forward - do not pull it backward.• Lock both the brakes before you transfer a person

to or from the wheelchair.– Remind the resident to do the same if independent


• Make sure the resident has needed wheelchair accessories per care plan

• Remove the armrests (if removable) – when the resident transfers to the bed, commode,

tub or car– when lifting the resident from the chair

• Swing front rigging out of the way for transfers to and from the wheelchair.– Some front riggings detach for transfers


• Clean the wheelchair according to agency policy.• When using an elevator, the wheelchair should be pulled backward

into and out of the elevator.• When moving a resident down a steep ramp, you should take the

wheelchair or geriatric chair down backwards. – Glance over your shoulder to be sure of your direction and prevent collisions

and possible falls• Slow down at corners and look before moving the wheelchair to

prevent collisions with other residents, staff, etc.• Use the wheelchair that has been designated as appropriate for the

resident. • Use caution to prevent injuries to hands and arms when pushing

wheelchairs

Mechanical Lifts

• Types– Manual or hydraulic– Electric

• Purpose– Lifts are used to move residents • who cannot assist in their own transfer • and/or residents who are too heavy to lift safely

Mechanical Lifts

• Make sure you are trained in its use.• Make sure the lift works.• Make sure the sling, straps, hooks and chains are in

good repair.• Never operate the lift without the assistance of

other staff.• Lock all brakes after positioning the lift.• Securely fasten all locks and straps before operating

the lift• Lift and lower the resident slowly.

Ambulation Devices

• Walker– Skid-proof tips– Skid proof shoes – Stand still– Place walker forward with all four legs solidly on the

floor– Step forward to the walker– Repeat

Ambulation Devices

• Crutches– Should have some space between top of crutch and

axilla (arm pit).– Elbows flexed slightly– Weight supported on palms of hands

Ambulation Devices

• Cane– Regular– Quad (four legs): most stable– Weak side– Move forward, walk toward

Safety Techniques When Walking the Resident

• Non skid shoes• Change positions slowly to avoid dizziness• Assist on the weak side• Strong side toward hand rails• Assisting visually impaired, walk slightly ahead• Use gait/transfer belt• Stand straight with head up and back straight• Walk to the side and slightly behind• Encourage normal walking

– Not shuffling– Not sliding– Not on toes

Effects of Immobility

• Skin: increases breakdown• Bowel: decreased motility• Lungs: shallow breathing• Muscles: atrophy• Circulation: slows, clots• Kidneys: decreased function• Bladder: distension, infection

natcep day 13

Health & Medicine