Appendix 2 Strategies for specific situations

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1 Appendix 2 for specific situations Communication Making your initial approach Approach the person slowly from the front. Respect the person s personal space. Address the person by their preferred name, and make eye contact. Keep your hand and body movements smooth and unhurried. Speak clearly and respectfully. Use appropriate facial expressions. Be courteous. Verbal strategies Give the person plenty of time. Use short sentences. Make only one request at a time. Use repetition before changing the wording if necessary. Experiment with words and expressions. Word requests in a way that avoid inviting a refusal. Word requests in a positive way. Word requests in a way that produce an automatic response. Give step-by-step instructions if helpful. Use a relaxed tone of voice to suggest the ease of the task. Listen to how you sound, and watch the person s reactions. When there are two of you, make sure only one of you speaks at a time.

2 Appendix 2 for specific situations 115 Moving from sitting to standing Consider the type of seating and factors such as correct footwear, clothing, hearing aids, dentures and glasses. Assist at the person s side so that you are both facing in the same direction. Plan to succeed. Be positive and understanding. Think while you give help. Put a chair (or walking aid) in the space in front of the person. Ask them to stand up either firmly and politely, or lightly and casually to suggest the ease of the task. Use a gesture to indicate the need to stand up. Use a stationary touch cue, or sweep your hand up the person s back. Place their hands on the chair arms as a cue to the movement. Use a goal-based cue, such as Get your nose over your toes. Sit beside the person and lean forwards in an exaggerated way, to show them what they have to do. Provide a firm pillar of support for the person to push against for example, by using your own thigh as a substitute chair arm or to lengthen the chair arm. Use the palm-to-palm hold (or a suitable alternative) to stop the person from gripping the chair arms. Keep your hand support soft and relaxed. Remember that if two people go to assist, this may convey to the person that you expect the movement to be difficult so start with just one assistant. Throughout the process, give the person plenty of time, repetition and reassurance. Never pull someone out of their chair. If the person has a stiff, arthritic hip or knee, they may not be able to use the usual pattern of rising. If their knee does not bend, help them slide to the front of the chair to get their heel on the floor before rising. If their hip is stiff so they cannot bend forwards, help them slide to the front of their chair with their knee bent so that they can put their foot on the floor behind themselves.

3 116 Promoting mobility for people with dementia: a problem-solving approach Approaching a chair When helping someone to approach a chair, the main aims are to reduce their anxiety, and to anticipate and manage any misjudgements they may make. Assist at the person s side so that you are both facing and moving in the same direction. Encourage the person to approach the chair across its front using a curved pathway especially if they use a walking aid. Encourage the person to get their feet beyond the mid-line point on the ground, between the front legs of the chair, with the walking aid positioned even further ahead, before starting to sit down. Make sure the person keeps the chair in sight and sits down sideways on it. Give little taps to the person s hips to turn them towards the chair (a directional cue). Use your own thigh or knee to guide the person s hips safely into the chair. Always avoid blocking the person s view of the chair. This means that when two of you are helping, you need to make sure the person nearer the chair stays behind. If someone is recovering from a recently repaired hip fracture, they must not sit down sideways instead, the chair needs to be directly behind them. Because this means that they cannot see the seat, they may need more reassurance than usual before they sit down.

4 Appendix 2 for specific situations 117 Walking Before you consider helping someone walk, make sure they have comfortable footwear, the correct glasses and hearing aids, and that their clothing and any incontinence aids are secure. Assist at the person s side, so that you are both facing and moving in the same direction. Walk in unison. Aim to cover a short distance, to a seat that the person can see. Provide a resting place, such as a chair or stool, halfway. Give the walk a purpose for example, to eat a meal, watch TV, see a visitor, go to the toilet, or do some exercise. Give effective physical support, or provide a walking aid. Use the backs of a row of chairs for support and practice. Add to the sound of person s footsteps with your own (providing a sound cue). If the person tends to grab the furniture, walls, you or other people, give them something to hold in their free hand. Give them the opportunity to walk longer distances so they have time to get into the rhythm of walking. Reassure the person about the surroundings for example, if moving from hard to soft floor coverings. Encourage longer strides by using a goose step (providing a visual cue). If the person s feet shuffle, encourage them to march perhaps by singing a marching tune. If the person s feet stutter, stop and restart by stepping. If the person threatens to sit down on an imaginary chair, use the instruction Stay standing stand up, rather than Don t sit down. When guiding a falling person on to the floor, follow the technique of sliding a falling person down your body. Make walking an enjoyable experience by conversing with the person and paying them plenty of attention. Be aware that the person s abilities may change from hour to hour or may shift during the day. Never tow a person. If the person leans backwards, do not attempt a walk, as it could be dangerous. Discuss it with a physiotherapist as soon as possible.

5 118 Promoting mobility for people with dementia: a problem-solving approach Steps and stairs Make sure stairs and steps are well lit. Assist at the person s side so that you are both facing and moving in the same direction. Encourage the person to place their whole foot on each step. If the person is unsteady or breathless, make sure they place one foot on the step and then bring the other to the same step, rather than taking alternate steps. This will slow the person down and ensures better control. Step down the step just ahead of the person, to show the change in level (visual cue). Tell the person to hold on to the rail with both hands and come down sideways. This is a good gap-filling strategy that requires only one assistant. When you are using this strategy, you will be assisting the person from behind them. If two assistants are available and you need a gap-filling strategy, one of you can step down the flight of steps or stairs in front of the person to block the sight of the space ahead. Paint the edge of concrete steps with a wide stripe in a contrasting colour. Remember that even if someone does not need to be able to go up and down stairs, they still need to be able to manage steps.

6 Appendix 2 for specific situations 119 Transferring from one seat to another When you are helping someone to transfer from one seat to another the receiving seat should be positioned close to, and at about 90 degrees to, the chair the person is sitting on. Your assisting position will vary in this task. Place an extra (third) chair in the space in front of the person, as a gap-filling strategy. Demonstrate the side-to-side rocking movement if the person needs to move to the front of the chair (providing a visual cue). Tell the person to Sit here, please and slap the seat of the chair to make a noise (providing a sound cue). During the transfer, lightly tap the person s hips in the direction of the receiving chair (providing a touch cue). If you are assisting the person on your own, stand in the space between the backs of the two chairs to help the person s hips across more easily. If there are two of you assisting, one of you can help at the person s side while the other stands in the space between the backs of the two chairs. The most common patterns for transferring are to reach across and transfer, or to stand up and then transfer. Alternative methods of transferring include using a sliding board, and then sliding the person across it, or using a weight-bearing hoist if necessary.

7 120 Promoting mobility for people with dementia: a problem-solving approach Using a bed This section presents strategies for using a bed in four different ways: moving from lying down to sitting on the edge of the bed moving from sitting on the edge of the bed to lying down moving across the bed moving along the edge of the bed. For the first three of these, you may need to accept the person s own safe pattern. Some of these movements involve major changes of position, so the person will need reassurance and time to adjust to each change. for moving from lying down to sitting on the edge Say Get up, please, using a rising gesture (providing a visual cue). Say Sit on the edge, please (making a goal-based request). Make sure the person is lying with their knees bent up. Then, encourage them to roll onto their side by asking them to look at you, and to reach for the edge of the bed or your hand. Prevent the person from seeing the drop to the floor by using a gap-filling strategy. At the level of their head, you can either use your own body to block the view or place a pillow lengthways along the edge of the bed, or position a chair with its back against the side of the bed. for moving from sitting on the edge to lying down Say Lie down, please, and slap the pillows to make a noise (providing a sound cue). To encourage the person to lie down along the length of the bed, say Here s the pillow, and help the person to feel it (providing a touch cue). Ask the person first to lift their legs onto the bed and then to lie down. for moving across the bed Say Move across here, please, with a sliding gesture (providing a directional cue). Offer guidance through touch cues. Use a slide sheet to help the person move their hips across.

8 Appendix 2 for specific situations 121 for moving along the edge of the bed Say Move along, please, accompanied by a gesture (providing a directional cue). Sit beside the person and encourage them to use your thigh as a substitute chair arm. This enables them to raise their hips higher so they can move sideways more easily. Sit beside the person and move up very close against them. Then, move even closer, moving into their personal space, and say Move up (or along, or across), please. Alternatively, sit away from the person and pat the bed to encourage them to move towards you, saying Come and sit beside me. If the person seems to be afraid or unwilling to move, put a chair in the space in front of them, with its back towards them (as with the standing up and transferring strategies) as a reassuring gap-filling strategy

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