12 m-care: mobility in people with disabilities and older people

Module: Mobility in people with disabilities and older people

Mobile Training for Home and Health Caregiver For People with Disabilities and

Older People

539913-LLP-1-2013-1-TR-LEONARDO-LMP

Unit 1

• Classification of walkers

• Selection of assistive devices

• Mobility issues to be aware of


Aims

• Independence of older people and

people with disability

– Accessible mobility

– Transfer methods

• Proper techniques for transfer activities

– Independence in daily living activities

• Activity and social participation in the lines of ICF

(International Classification of Functioning,

Disability and Health)


Clients are classified according to their potential for walking 1. Autonomous mobile: Can walk

autonomously, also on rough terrain outdoor,

can climb up stairs, does not need auxiliary

devices or goes with support of orthosis or

walking assistive devices (ICF-Code d460/d4550), (ICF-Code d460/d450)

2. Autonomous mobile with wheelchair:

Is mobile indoor and outdoor, does not need

help for transfers, to master stairs a lift is

needed

(ICF-Code d460/d450)

(Tachdjian,1990)


3. Partially autonomous: Needs help for

transfers / supply for auxiliary devices

(walker, cane, wheelchair) Autonomous

mobile indoor, but only short distances;

for long distances and outdoor, support

by a assistive person is needed (ICF-Code d460/d450)

4. Dependent: Transfer possible only with

support; mobile with auxiliary device

(Walker, walking frame) and assistive

person indoor and only short distances;

longer distance wheelchair and

assistance is needed; indoor mobile with

wheelchair (ICF-Code d460/d450)


5. Mobilisation in wheelchair -

dependent: Transfer only by an

assistive

person, mobilisation only

in a wheelchair,

motion in wheelchair indoor

and outdoor only with

assistance possible (ICF-Code d420)

6. Immobile –

no mobilisation possible: (ICF-Code d420)


Mobility should be targeted immediately after a solution has been found for basic medical problems of the client

Should not hinder the effectiveness of all interventions and treatments

Should be designed to protect and improve the existing potential of the client

Should be targeted to increase the client’s independence in their daily life

Selection of assistive devices


Mobility Aid Devices

•Cane •Crutches •Walkers •Rollator or scooter •Specially designed bicycle •Wheel chair •Specially designed stroller

http://www.levousa.com/levo-lcev-kid-junior.html


Issues to be considered in the mobility of

people with disabilities and older people

http://www.levousa.com/levo-lcev-kid-junior.html


Buildings should be designed for everyone, simple and easily understood (navigation), providing equally use for everyone and constructed in continuity.

But reality can/will

be totally different.

Be aware…


Guidance to prevent

accidents

for persons with

visually impairments

and concentration

deficiency


For the blind or visual impaired • 4 ways of mobility:

– alone depending on their residual eye-sight

– with a guide dog

– with a white cane

– with a sighted guide

• Guiding a person with visual impairment: – Let them know you are ready by addressing them and then touching their hand.

– Let them grasp you by the elbow. If they are tall, let them grasp you from your shoulder. If you guide a small kid, let it hold your hand.

– You lead, they follow. They should be, at least, one step behind and on your side, except at the top and bottom of stairs and to cross streets. At these places, pause and stand alongside the person. Then resume travel, walking one step ahead. Always pause when you change directions, step up, or step down.

– Check your surroundings, not only for steps or bad pavement but for “high obstacles” like AC units, road signs, tree branches etc

– Keep a pace with which you both feel secure.


• Guiding a person with visual impairment (continued): – Should you pass a narrow passage place your guiding hand behind

your back making them to stay behind you, until it widens again. – You should inform them when there are stairs, escalators, steps, etc. if

you haven't walked together before. The more you guide them, the less you need to alert them about obstacles beforehand. They will be able to notice them through your movement.

– The standard form of sighted guide technique may have to be modified because of other disabilities or for someone who is exceptionally tall or short. Be sure to ask the person you are guiding what, if any, modifications he or she would like you to use.

– When you are acting as a guide, never leave the person in "free space." When walking, always be sure that the person has a firm grasp on your arm. If you have to be separated briefly, be sure the person is in contact with a wall, railing, or some other stable object until you return.

– To guide a person to a seat, place the hand of your guiding arm on the seat. The person you are guiding will find the seat by following along your arm.


pavements and footpaths are blocked

the shape and slope of the footpath have been changed, making it

difficult to pass with a wheelchair or for a person with walking aids.

Inform the local representatives if:


• The width of the footpath in the city is narrower than 150 cm (to enable wheelchairs to pass, an absolute minimum width of 150 cm is required).

Inform the local representatives if:


• Ramps: departure from the crosswalk and sidewalk pavement starting at the end should both fully connect to the road.

Inform the client


Notice that… At the beginning and the end of the ramp, there should be an open space so you can manoeuvre the wheelchair


Unit 2

• Transfers

– Independent transfer methods

– Biomechanics rules

– Bed activities

• Moving/transfer

• Transfer from/to chair


Independent Transfer Methods

Basic Principles

• The transfer surfaces should be as uniform as possible

• The height of the transfer surfaces should be at an equal level

• Careful balance should be maintained during the transfer activity


• Transfer is easier on slippery surfaces

• Be aware of body mechanics while being

transferred

• Ask always to the client about the

preferred transfer method.

Photo by Stuart Miles, http://www.freedigitalphotos.net/


• If the client has a motor problem in his/her lower extremity: – Assist/support from the lower

extremities

• If the client has motor problem in his/her upper extremity: – Assist/support from the upper

extremities

• If the client has a lack of control in his/her trunk: – Support the client from the trunk – If needed or ordered; use external

support for a better trunk control in all activities


Biomechanics rules

Ensure correct body mechanics

low heeled

flexible, non-slip sole

closed-back shoes

Slippers should not be used for full foot support


• Aid tools are a great help in lifting

and handling, especially when being

alone

• Lifting and handling should be

performed in an upright posture

Inform your client


Basic biomechanics rules should be adopted Try to carry the weight near your body as much as you can


1. Be close to the client in all transfer methods

2. Use all your body parts, instead of using just the hands to

transfer the patient

3. If the client is too heavy, ask help from others


Aim of the bed activities

Bed activities allow a client to be transferred to or from

a bed or being moved with the help of a PCG:

• To provide maximum independence

• To improve strength, coordination and ability

• To prepare the person for the next functional level

(walking, climbing stairs etc.)

• To avoid complications and risks related to long term

immobilisation


Rolling inside the bed

• Legs should be crossed to the side where client is turned to

• Care giver should stand on the side where the client is turned to.

• Where possible, client can perform rotation by holding bars or

ropes taking place on the bed sides


• The client should get support from the armrest of the wheelchair

with hands, wrists and forearms

Getting into wheelchair


Sitting in the Bed

Be careful about the client’s…

• Legs position

• Raising of the head

• Support for the head and shoulders


Different steps to sit in the bed

• Weight bears on one of the

client’s arm, then returns to the

other arm by pushing the bed

• Slowly straighten the elbow

• Then lock the elbow by turning

the hand outside

• Then lock the other elbow the

same way


• If his/her pulling strength is enough, the patient

can sit by pulling the rope on the foot side of the

bed

• The client should return by the speed of the hip if

the leg strength is good enough.


Sitting on the edge of the bed and walk

• Set the bed height

• Set the bed brake

• Tilt the client in a side lying position

• Elevate the head side of the bed

• Separate your feet to be stable


• Support the head and the neck of the client

• Cross your arm over the hip of the client and place under the

knee

• Put the client’s legs on the side of the bed

• Inform the client s/he will be sitting on the side of the bed.


After having moved client out of bed:

• The walking distance and period is arranged according

to the client.

• If the client feels unsecure or gets tired, the care giver

supports from the trunk by using biomechanical

principles

• It is also recommended to use a walker for support.

• The client should be encouraged to look forward when

walking.


Hoists • Used for transfer or carrying of paralysed (but also

for overweight) individuals.

• Preferably when bathing, for the toilette, etc.

https://www.methodistonline.org/view-news/24900


Moving inside the bed

• A sliding board can be used to reduce friction.

• For facilitating the movement hand risers and sand bags can be

placed under the hand(s) of the client

• Supporting the leg by holding the heel reduces friction and

facilitates movement.


Movement of the patient in the bed with the help of two caregivers


Transfer with the Help of one caregiver

Backward movement inside the bed by holding the patient’s wrists


Fowler Position in the Bed (Sitting Position) Fowler position (when the head of bed is elevated

45-60 degrees) and semi-fowler position (when the head of bed is elevated 30-45 degrees) are important for moving in the bed. This position:

• Relieves the patient after some chest and abdominal surgeries

• Relieves the patient appropriately after breast surgery

• Relieves the asthmatics take breathe

easily

• Ease the work of the heart,

• Speeds up the work of the intestines


Sitting on the bed

• Go to one side of the bed to have the elderly

or disabled person sit up.

• Lower the bed borders (if in use).

• Client needs to lie on the bed with the face up.

• Head side of the bed rise 45-60° according the

mood of the patient.

• If the patient wants to sit upright, the

position of the angle should be 90°

between the back and hip.


• Support the back by a thin pillow

• If the individual has an impairment of the lower extremities, the client should be supported from the sides to prevent external rotation (rolling over).

• A thin pillow should be located under the knees

• For preventing the formation of bedsores, it is recommended to put a thin roll under the ankles


• If there is a neurological impairment, the paralysed extremities should be supported with a pillow (avoid leaving extremities hanging without support).

• The side safeguards of the bed should be raised.


Unit 3

• Standing

– Standing up from the bed

– Standing from a chair


Standing up from the bed

• Stand near the bed

• Use assistive device if needed

• If the individual has a drainage tube

or catheter it has to be turned off,

according to the guidelines of the

health care professional.


Standing from a chair

• Standing from a higher chair is easier than from a lower one.

• The sitting place of the chair should be hard rather than soft.

• The arm rests are important for giving a secure support in the

transfer.


• The trunk should move forward for a better standing.

• One leg should be positioned backwards for a stable standing.

• The client leans forward on the anterior leg and stands.


Unit 4

• Walking

– Walkers

– Crutches


Walkers • A walker or walking frame is a

tool for disabled or elderly people who need additional support to maintain balance or stability while walking.


• Crutches help clients in their transfer.

• The size of the crutches should be appropriate.

• The care giver should facilitate forward walking.

Walking with crutches


Unit 5

• Using a wheelchair – Caregiver Wheelchair Protocol

– Kind of wheelchairs

– Parts of a wheelchair

– Safety and maintenance of wheelchair

– How to Fold and Unfold a Wheelchair

– Keeping the wheelchair in a Car Boot

– How to tilt a wheelchair backwards

– Getting up and down the kerbs safely

– Getting up & down the Stairs Safely

– Going down a steep but short slope or ramp

– Maneuvering A Wheelchair

– DOs and DON’Ts


Unit 5

• Wheelchair transfers – Transfer from the bed

– Transfer from the wheelchair to the bed

– Autonomous transfer from the wheelchair to the bed

– Transfer to the bathroom and toilet

• Safety tips

• From wheelchair to shower chair

• From wheelchair to toilet

• Semi autonomous transfers (for active tetraplegics)

• Client falls of the wheelchair


Caregiver Wheelchair Protocol • Part of being a caregiver means learning ins and outs of wheelchair

etiquette. The most important element is to ask the wheelchair user how she or he prefers to be moved, lifted, etc

• Addressing someone in a wheelchair is a crucial part of the job. Always remember to speak to the person in the wheelchair and not the person next to him or her. Not directly addressing the person is an extremely rude thing to do as it completely disregards the person as not being competent enough to have a conversation with you.

• Remember that a wheelchair is seen as an extension of the person in it.

• Never grab the wheelchair and force the individual to go a certain direction. This can be looked at similarly to grabbing someone by their shoulders and forcing them to do something. It’s uncomfortable and inconsiderate.


Kind of wheelchairs Active wheelchairs Lightweight wheelchairs Sports equipment

Power Wheelchairs & add-on drives Children's Wheelchairs

http://www.ottobock.com/cps/rde/xchg/ob_com_en/hs.xsl/337.html


Parts of a wheelchair

http://www.mobilitydirect.com/v/vspfiles/images/wcterms.png


Safety and maintenance of wheelchair

• Handles or objects sticking out of wheelchair: – Remember that when in crowded places, handles or other objects

sticking out of the wheelchair can prove to be a hazard for people walking by.

– During a busy period, people can trip and fall on these objects leaving a potential for injury. Remember to safely position the wheelchair when sitting down at a restaurant or public place.

• Maintenance of wheelchair – Being a caregiver for an individual in a wheelchair involves

understanding exactly how the wheelchair works. This means having the knowledge to provide regular maintenance for the wheelchair: tires, handles, and cushions are all things that you should be familiar with.

– An improperly maintained wheelchair is prone to accidents so make sure that you are always taking the adequate amount precaution during checkup.


How to Fold and Unfold a Wheelchair

To unfold most wheelchairs…..

1. Push down on both sides of the seat, keeping fingers inwards.

2. Don’t force open the chair and never put your fingers between the frame and seat in case they get trapped.

http://hwa.org.sg/news/how-to-help-a-wheelchair-user/


How to Fold and Unfold a Wheelchair

To fold most wheelchairs…..

1. Remove cushion (if any)

2. Adjust the footrest, rotate them out or remove them.

3. Hold the midpoint of the seat at the front and back, pull upwards.



Keeping the wheelchair in a Car Boot • Remove cushions, armrest, footrest and

other removable parts

• Fold the wheelchair and engage brakes to prevent wheels from spinning

• Position folded wheelchair parallel to the boot

• Bend your knees keeping your back straight

• Grip the wheelchair by the frame

• Lift the wheelchair and balance it on the boot edge (your legs may be used to raise the wheelchair)

• Slide the wheelchair into the boot



How to tilt a wheelchair backwards

1. Always warn the occupant of your intention

2. Push down the tipping lever with your foot and at the same time, pull back and down on the handles



Getting up and down the kerbs safely

1. Getting up kerbs safely

• Position the wheelchair so that the front wheels almost touch the kerb

• Inform the occupant of your intention

• Grip handles firmly, tilt the wheelchair backwards and balance the wheelchair on its rear wheels

• Place the front wheels onto the pavement

• Push the wheelchair until it reaches the kerb

• Lift the wheelchair onto the pavement



Getting up & down the kerbs safely

2. Getting down the kerbs

• Position the wheelchair on top of the kerb

• Tilt the wheelchair and balance the wheelchair on its rear wheels and move backward

• Lower the rear wheels against the kerb while supporting some of the chair’s weight

• Make sure both rear wheels touch the ground gently and at the same time

• Gently lower the front wheels



Getting up & down the Stairs Safely

1. Getting up stairs safely Use a lift or ramp if one is available.

Do NOT go up single-handedly unless you must.

1. Back the wheelchair to the first step

2. Grip handles firmly and tilt the wheelchair back

3. Place one foot on the first step and the other one above

4. Lean back, taking the weight of the chair and gently pull chair up the first step

5. Always keep your weight and the wheelchair in balance as you move up the stairs



Getting up & down the Stairs Safely

2. Going down stairs safely Again, look for a ramp. If a ramp is not available, following steps should be applied

1. Take the wheelchair in a frontward manner down the steps

2. Grip the handles firmly and tilt the wheelchair, balancing on the rear wheels

3. Move the wheelchair to the top of the first step

4. Use your body as brake while gently lowering the wheelchair

5. Control the descend with your body, keeping the rear wheels tight against the stair edge and roll the wheelchair forward and down the step

6. Don’t let the chair drop unevenly or too quickly



Going down a steep but short slope or ramp

In case of a short but steep slope, it may be advisable to go down backward to prevent the person in the wheelchair from tipping out.

1. Make sure the path of travel is clear

2. Grip the handles firmly to prevent the wheelchair from sliding backwards

3. Take steps backwards one step at a time

4. Control the descend and ensure that the wheelchair does not roll down too quickly as you will loose control of it


Manoeuvring A Wheelchair • Navigating with a wheelchair can be tricky.

– As a caregiver you might often see yourself having issues with terrain.

– Remember to always use safe pushing techniques to avoid falls or injury.

– Small rocks or rocky terrain can cause many hazards for individuals in wheelchairs, so always be weary of the condition of the road you are travelling on.

– It is important to always pay attention while pushing someone as any distraction may pose hazards.

– Accidents and injuries mainly occur due to an absent mind.


DOs and DON’Ts • DOs

– Ask how you can help

– Talk to a person in a wheelchair at the same eye level

– Do inform the person in the wheelchair of your intention e.g. when tilting the wheelchair

– Make sure the seat belt (if any) if fastened before moving off

– Apply the brakes when the wheelchair is stationary, when transferring and when leaving the wheelchair unattended


• DOs (continued)

– Ask the person in the wheelchair if they are comfortable, especially if they have been transferred

– Always maintain at least one wheelchair length behind another “pusher”

– Ask for assistance if you cannot overcome an obstacle

– Look ahead to avoid sudden changes in level and other hazards

– Look out for drain gratings and approach in a diagonal manner

– Push the wheelchair on the walkway rather than on the main road (if possible)


•DON’Ts – Don’t talk to a disabled person through a third person

– Don’t race when you are with a wheelchair user

– Don’t force a wheelchair to move if it is stuck – see what the problem is and try to correct it

– Don’t use the escalator when you are with a wheelchair user if you are not sure how to handle it

– Never lift a wheelchair by the armrest, wheels or any detachable or movable parts

– Don’t go down a steep slope in a forward manner

– Never tip the wheelchair forward or too far back

– Don’t go down a short steep slope in a forward manner


Transfer from the bed

• Locate the wheel chair parallel to the bed on a side. • Elevate the bed at the height of the chair. • Elevate the head and stay on the side of the chair. • Lock the brakes of the bed • Support with one hand from the shoulders and neck,

and under the knees with the other hand.

• Ask the client to descend his/her legs from the bed and sit in upright position.

• Help the client to wear his/her slippers.

• Support the client carefully for sitting to the chair.


Transfer from the wheelchair to the bed

Precautions

• The bed and the wheelchair should be at the same

height

• A slide can be used to equalise the heights.


Autonomous transfer from the wheelchair

to the bed

1. The wheelchair should be moved close to the bed from the

front.

2. Put the legs on the bed one by one.

3. Move the legs on the bed.

4. Elevate the pelvis with the supports from the hands.

5. Slides can be used for an easier transfer.


• Move the wheelchair close from the side of the bed.

• Put both legs on the bed.

• Put hand on the wheelchair and the other on the bed.

• Elevate the hips by the support of both hands in elbow

extension.

Autonomous transfer from the wheelchair to

the bed from the side


Transfer from a wheelchair to a regular chair in

front, from the corner or from the side

• Move closer to the chair from the front

• Lock the brakes

• The client should use her/his arms to move forward

• Put your one hand on the chair and the other on the

armrest of the wheelchair

• By bearing your weight on the feet, rotate your pelvis and sit

on the chair.

Sitting from the floor on the wheelchair: method 1

• The client should sit in front of the wheelchair.

• Client ensures that the brakes are locked.

• Client puts both hands on the wheelchair.

• Client puts both feet on the floor while extending

elbows.

• Client rotates pelvis and sits on the wheelchair.


• The client should sit in front of the wheelchair.

• Client locks the brackets.

• Client puts both hands on the wheelchair.

• Client puts both feet on the floor while extending the

elbows.

• Client elevates pelvis and sits on the wheelchair.

Sitting from the floor on the wheelchair: method 2


Transfer to the bathroom and toilet

Safety tips

• Bend your knees and not your back when assisting the person to put their legs into or out of the bath.

• Do not use the towel rail, door knob, toilet paper dispenser, or soap holder as a grab rail—they are not designed to carry a person’s body weight.

• Use a non-slip mat in the bath and shower.


From wheelchair to shower chair

• Position the wheelchair so the distance of the transfer is minimal.

• Ensure the wheelchair brakes are on and any footplates are taken off or swung away.

• Assist to standing with one foot of PCG pointed in the direction of the transfer.

– Do not let the person grab you around the neck.

– A transfer sling (or transfer strap) can also be used in this transfer.

• Once standing, use your weight to balance the person.


• PCG’s knees should remain slightly bent with feet apart and maintain good back posture. Get as close to the client as possible.

• During this transfer the client needs to use their own upper and lower body strength to help.

– If the client cannot use their lower limbs, a hoist should be used.

• Ensure the client bends forward when sitting down to avoid ‘flopping back’ in the chair.

• You can move the chair closer if needed before guiding the person into the sitting position.


From wheelchair to toilet

• Position the wheelchair so the distance of the transfer is minimal.

• Ensure the wheelchair brakes are on and any footplates are taken off or swung away.

• Assist to standing with one foot of PCG pointed in the direction of the transfer.

– Do not let the person grab you around the neck.

– A transfer sling (or transfer strap) can also be used in this transfer.

• Once standing, use your weight to balance the person.


• PCG’s knees should remain slightly bent with feet apart and maintain good back posture. Get as close to the client as possible.

• During this transfer the client needs to use their own upper and lower body strength and may have support from the toilet rail.

• With the weight bearing at both feet, the client slips pelvis over the toilet.


Toilet frames and aids

• A toilet rail or over-toilet frame can be installed to assist with transfers on and off the toilet.

• The client –should be encouraged to transfer from the dominant side.


Semi autonomous transfers (for active tetraplegics)

• From wheelchair to bed: – There is a certain way for the client to do this, in order to preserve their back and work

with the knees.

– The wheelchair should not be parallel as mentioned before but rather in the smallest angle possible to where you want to transfer.

– In the first transfer you have to face your client and create a safety wall with your body preventing them of falling forward.

– You will use your body to transfer their body weight and you will mainly hold them from their pants (when there is to be a transfer our client should wear hard pants instead of soft fabrics or skirts/dresses).

– You can use a board to help you.

– Your client will help you with their hands so its essential to let them do their part and don't restrain their upper extremities unless you are instructed otherwise.

– Always discuss and cooperate with them to find the perfect way, they know better.

– If there are two PCGs, you could both help, one from the front working as a safety net and taking the body weight, one from behind grabbing the pants and direct the body towards the bed, again with the help of the client. Another way: One PCG hugs the client under the armpits and the other grabs both legs under the knees, the do the transfer.


• From wheelchair to the car: – The wheelchair should be in the smallest angle possible to where you want to transfer.

– In the first transfer you have to face your client and create a safety wall with your body preventing them of falling forward.

– The safety net is the door and you should stay behind your client.

– You will use your body to transfer their body weight and you will mainly hold them from their pants (when there is to be a transfer our client should wear hard pants instead of soft fabrics or skirts/dresses).

– You can use a board to help you.

– Your client will help you with their hands so its essential to let them do their part and don't restrain their upper extremities unless you are instructed otherwise.

– Always discuss and cooperate with them to find the perfect way, they know better.

– If there are two PCGs, you could both help, one from the front working as a safety net and taking the body weight, one from behind grabbing the pants and direct the body towards the car, again with the help of the client. Another way: One PCG hugs the client under the armpits and the other grabs both legs under the knees, the do the transfer.


Some helpful links

• How to Do a Dependent Stand Pivot Transfer

– https://www.youtube.com/watch?v=fXXXUnpM-Ss

• Car Transfer

– https://www.youtube.com/watch?v=Wbg7R2x1iUU

• Floor to Wheelchair Transfer

– https://www.youtube.com/watch?v=sV0UJHYqBcQ

https://www.youtube.com/watch?v=fXXXUnpM-Ss



https://www.youtube.com/watch?v=Wbg7R2x1iUU

https://www.youtube.com/watch?v=sV0UJHYqBcQ


Client falls of the wheelchair

• What do we do in case our client falls of the wheelchair. – We should check if they are injured, keeping in mind that

they may don't feel pain, so we have to do the evaluation.

– We should readjust their head and extremities if they seem in the wrong position and then we should discuss with them how we should proceed.

– If we need extra help we can call someone but we must, at all times, be in charge of the “operation” and don't let anyone act on their own.

– We must check that the catheter and all the hygienic “gear” are still in place.


Unit 6

• Using orthosis

– Putting on the orthosis

– Putting off the orthosis


Putting on your client’s ankle foot orthoses (AFO)

• Put on a knee-high, plain cotton sock. Smooth out any wrinkles.

• Bend the hip and knee. • Never put the AFO on a straight leg. • Stretch the ankle muscle by pulling down

on the heel and pushing up at the toes. Orthosis: an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system

Step 1 – Get the leg ready

http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/OrthosisPuttingOnChild-lw.pdf


Step 2 – Place foot in AFO

• With one hand, keep the knee and ankle bent at a 90 degree angle. • With the other hand, hold the AFO with the straps open. • Start with the heel firmly touching the toe plate of the AFO. • Slide the heel all the way down and back into the AFO



Step 3 – Fasten the straps

• Keep the heel firmly in the AFO

with your thumb.

• Thread the ankle strap through

the loop and fasten it.

• Fasten the top strap.

• Pull the sock out from under the

ankle strap to take out any wrinkles. http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/OrthosisPuttingOnChild-lw.pdf


Step 4 - Stop and check!

The sock has no wrinkles.

The straps are done up to the proper tightness.

There is no space behind the heel.

The tips of the toes are just inside the edge of the toe plate.




Be Careful!

The AFO must pass all these checks to be comfortable and prevent skin pressure problems. If the AFO ‘fails’ any of these checks, take it off and start again at Step 1.


References

1- http://www.megep.meb.gov.tr/?page=moduller 2- Handbook of Geriatric Nursing Care, 236. cilt, editor: Lippincott Williams & Wilkins 3- http://www.caregiverproducts.com/lifting-techniques-home-caregivers.html 4- http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/OrthosisPuttingOnChild-lw.pdf 5- http://www.biomedcentral.com/1471-2318/13/16 6- http://www.parentgiving.com/shop/senior-mobility-devices-98/c/ 7- http://www.ottobock.com 8- http://www.healthinaging.org/resources/resource:eldercare-at-home-mobility-problems/ 9- http://www.ozurlulervakfi.org.tr/docs/ozurluler.vakfi-mimari.erisilebilirlik.kilavuzu.pdf

http://www.megep.meb.gov.tr/?page=moduller




http://www.caregiverproducts.com/lifting-techniques-home-caregivers.html










http://www.hamiltonhealthsciences.ca/documents/Patient Education/OrthosisPuttingOnChild-lw.pdf







http://www.biomedcentral.com/1471-2318/13/16



http://www.parentgiving.com/shop/senior-mobility-devices-98/c/







http://www.ottobock.com

http://www.healthinaging.org/resources/resource:eldercare-at-home-mobility-problems/












http://www.ozurlulervakfi.org.tr/docs/ozurluler.vakfi-mimari.erisilebilirlik.kilavuzu.pdf

