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
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

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

Issues to be considered in the mobility of
people with disabilities and older people

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.mobilityd
irect.com/v/vspfiles/i
mages/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
http://hwa.org.sg/news/how-to-
help-a-wheelchair-user/

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

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

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

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

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

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.hami
ltonhealthscience
s.ca/documents/
Patient%20Educa
tion/OrthosisPutt
ingOnChild-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
http://www.hamilto
nhealthsciences.ca/
documents/Patient
%20Education/Orth
osisPuttingOnChild-
lw.pdf

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.hamiltonhealthscience
s.ca/documents/Patient%20Educat
ion/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.
http://www.hamiltonhealthsciences.ca/documents/Pati
ent%20Education/OrthosisPuttingOnChild-lw.pdf
http://www.hamiltonhealthsciences.ca/documents
/Patient%20Education/OrthosisPuttingOnChild-
lw.pdf

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/Ort
hosisPuttingOnChild-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

12 M-CARE: Mobility in people with disabilities and older people

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