Maintain mobility and ambulation!

1. Mobility and Ambulation
Techniques
NATCEP Day Thirteen

2. 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

3. 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?

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

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

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

7. 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

8. 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.

9. 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

10. Ambulation Devices
• Crutches
– Should have some space between top of crutch and
axilla (arm pit).
– Elbows flexed slightly
– Weight supported on palms of hands

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

12. Safety Techniques When
Walking the Resident
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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

13. Effects of Immobility
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Skin: increases breakdown
Bowel: decreased motility
Lungs: shallow breathing
Muscles: atrophy
Circulation: slows, clots
Kidneys: decreased function
Bladder: distension, infection