Mobility aids and access/egress

Transcription

1 Mobility aids and access/egress Criteria for mobility aids Service user is unable or has difficulty walking unaided. Service user is at risk of falling when mobilising. Provision will facilitate or maintain independence, safety and dignity and increase confidence in walking. Pain relief. Walking aids will only usually be provided for in and around the service user s home. Service users must be assessed by a suitably qualified / trained professional or assistant. Certain mobility aids e.g. elbow crutches will only be issued following assessment by a physiotherapist. Like for like mobility aids may be requested by social care staff e.g. a second zimmer for upstairs use. General considerations when prescribing mobility equipment Consideration must be given to the service user s environment especially around space and thresholds. Floor coverings e.g. laminate flooring or thick pile carpets may cause a wheeled walker move too quickly or make it difficult to move. Tripping hazards loose rugs, trailing flexes and/or cluttered floor space. The height of the stick/walking frame must right for the individual. The usual height is to the ulnar styloid, however the standing posture must be assessed at on an individual basis. If the walking aid is too high or too low this will force the posture out of alignment. For severely arthritic hands, moulded grips (Fischer sticks) may be more suitable. Consider rehabilitation potential and refer for a physiotherapy assessment, if appropriate. Specialist prescriptions will be considered on an individual basis e.g. gutter frames.

2 How to measure service user for the correct height stick Service user standing up straight. Arms by side elbow bent 30 (nearly straight). Measure wearing usual footwear. Measure distance from floor to the wrist joint this is your correct stick height.

3 Walking sticks Criteria Service user has reasonably good mobility e.g. still mobile outdoors but needs minimum amount of support. Service user has reduced confidence, poor exercise tolerance or increased frailty. Issued to ease unilateral joint pain e.g. OA knee. Walking Stick adjustable height 5.90 Code: WSL360 Lightweight: 360g Height approx: 720mm -1000mm (28-39 ) Maximum user weight: 19 ½ st (125kg) 1. Service user must have good balance. 2. How does service user manage stairs/ steps? 3. Must have good hand function / reasonable grip 4. Include height setting on Equipment requisition form 5. Service users who appear to need 2 sticks should be referred for physiotherapy assessment. Stick can be wiped down with warm/hot water and detergent or a mild disinfectant. Check that the stick has a rubber ferrule which is secure and has a good tread. Worn ferrules should be replaced. Check that any pin clips are secure with no metal part protruding which could catch on the user s skin. Periodically check the stick for any cracks or signs of rust.

4 Criteria As for adjustable height standard walking stick. Service user suffers from wrist / hand pain and/or a degenerative condition e.g. Rheumatoid Arthritis, Osteoarthritis in wrist / hand and standard walking stick grips / handles are not suitable. Adjustable height Fischer stick All 4.95 Codes: Left medium WFL001 Right medium WFR001 Height approx: mm (27-36½ ) in 25mm (1 ) increments Left tall WFL002 Right tall WFR002 Height approx: mm (32-42 ) in 25mm (1 ) increments Weight: approx 400g Maximum user weight: 19½ st (125kg) 1. Service user must have good balance. 2. How does service user manage stairs/steps? 3. Hand should fit comfortably on anatomically moulded handle. 4. Has the service user sufficient grip? 5. Include height setting on Equipment requisition form. 6. Specify right or left handed. 7. Service users who appear to need 2 sticks should be referred for physiotherapy assessment. Stick can be wiped down with warm/hot water and detergent or a mild disinfectant. Check that the stick has a rubber ferrule which is secure and has a good tread. Worn ferrules should be replaced Check that any pin clips are secure with no metal part protruding which could catch on the user s skin. Periodically check the stick for any cracks or signs of rust.

5 Walking frames Criteria for standard walking frame Service user: has poor balance and/or is unsteady on their feet is able to stand from sitting with minimal assistance can take weight through their arms has enough balance and strength to stand, pick up the frame and lift it forward fully understands how to use the frame safely. The home environment is suitable, particularly with regard to space, flooring and thresholds. Walking frames should not be provided for individuals who have a tendency to carry them or who walk too far into the frame. Using a standard walking frame The service user should: 1. Stand within the space of the frame. 2. Place the frame one step ahead. 3. Walk towards it using the weaker leg first. 4. Follow with the other leg, which should then step through they should not walk too far into the frame area as this can lead to overbalancing, backwards. 5. When steady, lift the frame and place a short distance in front and repeat the process from step 1. Criteria for wheeled walking frame Service user: has poor balance and/or is unsteady on their feet is able to stand from sitting with minimal assistance can take weight through their arms still needs support but can walk more efficiently will be enabled to adopt a more fluent walking pattern is unable to pick up the frame and lift it forward has poor exercise tolerance e.g. COPD, heart conditions fully understands how to use the frame safely. The home environment is suitable, particularly with regard to space, flooring and thresholds.

6 Using a wheeled walking frame When using front wheeled frames, the rear legs should be lifted slightly as the frame is wheeled forward as opposed to it being used as a wheeled rollator. Where a directional change is required the frame should be stationary and lifted at the rear in order to turn the frame. OR Use as for a standard frame where instead of lifting the frame is pushed forward and is held stationary while the user steps forward. How to measure a service user for the correct walking frame Service user standing up straight. Measure wearing usual footwear. Measure distance from floor to hip level. If the service user is kyphosed i.e. bent forwards and unable to straighten, a lower frame may be required. If the service user has a tendency to fall backwards, a lower frame may be required. If the service user has difficulty maintaining an upright body posture, a higher frame may be required. When adjusted correctly the user should be able to maintain an upright posture with the elbows slightly flexed. All walking frames have legs which are adjustable in increments of 20mm ( ¾ ) to a maximum of 100mm (4 )

7 Walking frames Ultra narrow adjustable height Code: WZN079 Handgrip height: 755mm 830mm (30-33 ) Max depth: 450mm (17½ ) Max width: 490mm (19½ ) Product weight: 1.75kg With wheels: Handgrip height: mm (31-34 ) Product weight: 1.8kg Maximum user weight: 25st (160kg) 1. Is a full physiotherapy / mobility assessment required? 2. The environment where it is to be used n.b. door width, room to turn round with frame, trip hazards. 3. Narrower model may be easier to manage where space is limited but may not provide sufficient stability. 4. Frame itself could become a tripping hazard. 5. Is the user or carer able to get frame up and down the stairs or will they require another for upstairs use? 6. Service user must be instructed how to use the frame, including sit to stand transfers. 7. With or without wheels? Frame can be wiped down with warm/hot water and detergent or a mild disinfectant. Check all ferrules are secure with a good tread. Worn ferrules should be replaced. Check that any pin clips are secure with no metal part protruding which could catch on the user s skin. Periodically check the frame for any cracks or signs of rust. Ensure all legs are set at the same height.

8 Standard with or without wheels (wheels extra see below) Max depth: 520mm (20 ½ ) Max width: 560mm (22 ) Weight: 1.9kg (2.0kg with wheels) Small Code: WZS072 Handgrip height: mm (26-29 ) Medium Code: WZS079 Handgrip height: mm (30-33 ) Large Code: WZS087 Handgrip height: mm (34-37 ) Maximum user weight: 25st (160kg) 1. Is a full physiotherapy / mobility assessment required? 2. The environment where it is to be used n.b. door width, room to turn round with frame, trip hazards 3. Broader base model provides greater stability but may be more difficult to manoeuvre. 4. Frame itself could become a tripping hazard. 5. Is the user or carer able to get frame up and down the stairs or will they require another for upstairs use? 6. Service user must be instructed how to use the frame, including sit to stand transfers. 7. With or without wheels? Frame can be wiped down with warm/hot water and detergent or a mild disinfectant. Check all ferrules are secure with a good tread. Worn ferrules should be replaced. Check that any pin clips are secure with no metal part protruding which could catch on the user s skin. Periodically check the frame for any cracks or signs of rust. Ensure all legs are set at the same height. OR Ensure wheels and legs are all set at the same height.

9 Walking frame wheels - pair 4.54 Code: WZW001 See Criteria for wheeled walking frame at the beginning of this section. Check wheels move freely and are free of dust, hair etc.

10 Tri wheel walker Criteria: Service user has good walking pattern but lacks confidence and needs something to lean on to improve steadiness. Provision may facilitate a more fluent walking pattern. A wheeled walking frame does not meet the assessed need Tri wheel Walker - adjustable height handles Code: WTW001 Weight: 9kg Height: 660mm (26 ) Width: 310mm (12 ) Depth: 710 mm (28 ) Maximum user weight: 17st (110kg) 1. Competence assessment by a physiotherapist is recommended. 2. Environment indoor / outdoor use, doorway widths, flooring etc. 3. Stability of the service user when using it balance test completed by physiotherapist on assessment. 4. Stairs walking aid for upstairs use? 5. Will the service user need to carry items whilst using the frame? (bags or baskets can be attached but this may alter the balance of the walker and in some circumstances may make the equipment unstable). Attention must be paid to the locking mechanism, which maintains the walker in an open position. If it is not properly secured or there is any mechanical failure this may result in the collapse of the walker. Height adjustment mechanisms and brakes should be checked regularly. Check for wear on the wheels - if wheels wear down the brakes will be compromised.

11 Elbow Crutches Criteria Should only be issued following physiotherapy assessment. Service user has limited ability to take weight through one leg. Service user must have a high level of coordination and balance. Service users require a high level of exercise tolerance. Elbow crutches are therefore not always suitable for elderly service users. Elbow crutches adjustable height 7.95 each Code: WCE000 Handle height: 750mm 980mm (29 ½ - 38 ½ ) Choice of three positions for the cuff Maximum user weight: 19st (120kg) 1. Designed to be used in pairs. 2. Bad leg moves forward with the crutches, then good leg swings through. 3. Because of the different gait patterns service users will need to be taught how to use their elbow crutches safely by a physiotherapist e.g. on stairs/steps and outside. 4. Please refer for physiotherapy assessment if you are considering the need for crutches Crutch can be wiped down with warm/hot water and detergent or a mild disinfectant. Check that each crutch has a rubber ferrule which is secure and has a good tread. Worn ferrules should be replaced. Check that any pin clips are secure with no metal part protruding which could catch on the user s skin. Periodically check the stick for any cracks or signs of rust.

12 Access and egress Criteria For temporary use e.g. to facilitate hospital discharge or to enable attendance at essential activities e.g. medical appointments, day care Where a permanent step will cause an unacceptable obstruction e.g. side door opening on to a driveway, blocking access to a garage. Langham half-step Code: GSM001 Length: 762mm (2 6 ) Height: 105mm (4 ) Width: 406mm (16 ) Max user weight: 29 ½ st (190kg) 1. General mobility and ability to manage steps/stairs. 2. Width of step. 3. Use of walking aid. 4. Is carer assistance required? 5. Additional minor adaptations grab rails? 6. Obstruction / tripping risk for others. 7. Ability of user or carer to lift, carry and store the step. Nylon feet should be adjusted to the level of the ground giving a safe level platform to step off or on to. Beware of sharp edges when lifting and moving. Ensure step is cleared of wet leaves, moss, ice etc before using. Wipe down with damp cloth and mild detergent or soapy water.

13 Criteria For temporary use e.g. to facilitate hospital discharge or to enable attendance at essential activities e.g. medical appointments, daycare. Where a permanent ramp will cause an obstruction e.g. side door opening on to a driveway, blocking access to a garage. Service user is wheelchair dependent or has very restricted mobility when stepping in/out of a property high risk of falls / injury. Suitcase ramps - 3 sizes, all 762mm (30 ) wide 914mm (3 ) Code: XSR mm (4 ) Code: XSR mm (5`) Code: XSR530 Max user weight (including wheelchair): 42st (272kg) 1. Choose longest ramp available for the space to minimise the gradient. 2. Ground surface / turning space at the bottom of the ramp. 3. Door thresholds / space inside the property. 4. Is the service user selfpropelling? 5. Is carer assistance required and can carer manage the gradient? 6. Ability of the carer to lift, carry and store the ramp. Ensure adequate overlap on to the door step / landing area. Check for any movement / slipping of the ramp before using. Potential to trap fingers/skin when folding ramp. Ensure ramp is cleared of wet leaves, moss, ice etc before using. Wipe down with damp cloth and mild detergent or soapy water.