Disclaimer: If you think you have a medical emergency, call 911. The health tips and information we share on this blog are for educational purposes only and should not be considered medical advice. They are not a substitute for advice from your own doctor or healthcare provider.
A crucial aspect of ensuring the well-being and independence of individuals with intellectual and developmental disabilities (I/DD) is promoting safe and effective mobility, including transfers and ambulation. This blog post, inspired by our recent webinar presented by StationMD’s Vice President of Growth and Engagement, Geoff Musti, PT, DPT, GCS, highlights key considerations and strategies for caregivers and healthcare professionals.
Individualized Care: The Foundation of Mobility Support
Recognizing that every individual with I/DD is unique, their mobility needs are, by extension, also distinct. Our approach at StationMD centers on personalized care, always emphasizing and building upon what each person is capable of doing independently. It’s important to understand that over-assisting can inadvertently hinder progress. Therefore, we advocate for a mindful approach:
- Determine independent abilities: Observe and understand their current capabilities.
- Incorporate interests: Utilize their interests to make mobility activities more engaging and functional.
- “Reset” when needed: If frustration or confusion arises, take a break or shift activities. Remember, “Confusion = Frustration.”
Effective Communication and Cuing
Clear and concise communication forms the bedrock of effective support. When guiding individuals through transfers or ambulation, simplicity is key.
- Keep it simple: Use step-by-step cuing, carefully avoiding the delivery of multiple instructions at once.
- Be direct: Provide very direct verbal cues.
- Utilize visual cues: Demonstrate the activity and consider using visual aids like colored tape.
- Be mindful of physical contact: Individuals with I/DD can often be sensitive to it. While safety remains the top priority, minimize physical contact where possible.
Utilizing light tactile cues can offer additional safety and guidance, and demonstrating the activity several times can also be very helpful for the individual.
What TO Say (Concise Examples):
- “Stand up – Grab walker.”
- “Stand up – turn – sit.”
- “Turn – sit up.”
What NOT to Say (Examples):
- “Can you please stand up by pushing up from the armrests and then reaching for the Rolling Walker when standing?”
- “Please Stand Up by pushing on the armrests, turn around, and sit on the couch.”
- “Please turn on your side, push through your elbow, and sit up on the side of the bed.”
Prioritizing Safety: In and Out of the Home
Establishing and maintaining a safe environment is fundamental to preventing falls and injuries, both within and outside the home.
In the Home:
- Reduce obstacles and ensure there is ample room for movement, for instance, by maintaining clear pathways between furniture.
- Limit throw rugs, particularly in high-traffic areas like living rooms and bathrooms.
- Additionally, ensure a clear and well-lit path from the bed to the bathroom.
Outside the Home:
- Verify that outdoor furniture, such as patio seating, is stable and won’t slide.
- Confirm that vehicles are easily accessible, with appropriate seat heights and properly functioning doors.
- Always check for secure railings on any stairs.
Utilizing Assistive Devices
When a Physical Therapist, Occupational Therapist, or another authorized clinician prescribes an assistive device, its correct and consistent use is paramount. These devices are specifically designed to support safe mobility and can include a range of tools:
- Ambulation/Transfers: Walkers, canes, crutches, and bracing.
- Wheelchairs: Manual, power, or transport.
- Bed: Bed canes and bed rails.
- Toilet: Raised toilet seats, grab bars, and commode chairs.
- Shower: Shower benches, shower chairs, and grab bars.
Safe Transfer Techniques
Transfers, such as moving from a sitting to a standing position or navigating bed mobility, demand careful technique to ensure the safety of both the individual and the caregiver. Always use a gait belt; this provides a secure point of contact for assistance. In situations where a gait belt is unavailable, using the waistband of pants can be a last resort, but the priority should always be to seek additional assistance if there’s any uncertainty about safety. Maintain close proximity to the individual throughout the transfer. Encourage the individual to use their own strength by pushing up from a stable surface. A critical safety rule is never to pull under the individual’s arm, as this can cause injury. If an assistive device (AD) is ordered, cue the individual to grasp it when standing. For stand pivot transfers, ensure the individual is stable before turning and utilize an assistive device if ordered. Always cue them to reach back for a stable surface before sitting.
Safe Ambulation Techniques
When assisting someone with walking, it’s vital to ensure that any prescribed assistive devices are used correctly. Maintain a firm hold on the gait belt throughout the process. Reiterate the crucial safety rule: do not pull under the individual’s arm. Instead, focus on maintaining proper stability and providing consistent support to the individual.
Stair Management
Navigating stairs can present a significant challenge, and careful assistance is required. When assisting, grip the gait belt firmly and provide cues for proper technique. Ensure that the correct assistive device, if prescribed, is utilized. As with other mobility tasks, avoid pulling under the individual’s arm or maintaining an excessive distance from them; stay close and provide consistent support.
Supine to Sit Transfers
Helping an individual transition from a lying down (supine) position to a seated position requires a specific sequence to ensure safety. Encourage the individual to bend their knees to facilitate turning onto their side. Then, guide them to turn onto their side and push up through their elbow to sit. It is imperative to remember never to pull on the individual’s arm to help them sit up, as this can lead to injury.
When to Seek Additional Assistance
There will inevitably be moments when a transfer or ambulation feels unsafe. Recognizing these critical moments and prioritizing safety is paramount. Consider seeking additional assistance:
- If a gait belt is not present and you are uncertain about proceeding.
- If the distance to be walked is too far to do so safely.
- If the transfer itself seems inherently unsafe.
- If the individual is having a “rough day” and their functional status appears compromised.
- If there’s a rapid decline in their functional status, it’s essential to follow agency protocols for escalating the situation.
Functional Change Considerations After Hospital/Rehab Discharge
The period following discharge from a hospital or rehabilitation facility can often bring about significant changes in an individual’s cognitive and mobility status. To prepare for this transition, several pre-discharge considerations are important:
- Caregivers should aim to attend care management or therapy team meetings.
- Clearly describe the home setting to the care team.
- Discuss how the individual will safely enter and exit the home.
- Explore the potential need for Home Health Services.
- Ensure a clear understanding of the discharge date.
Post-discharge, cognitive changes can manifest as:
- A change in overall cognition.
- Decreased ability to follow cues.
- Increased agitation.
- Communication strategies may need to be altered to ensure effectiveness, and the individual might require re-orientation to their living situation and caregivers.
- In some cases, a change in living situation, such as a different room, bed, or even floor, or increased monitoring, may become necessary.
Mobility changes after discharge often include:
- An increased need for assistance with transfers and ambulation.
- The introduction of a new assistive device, increased cuing, or the use of a wheelchair.
- Stair management might also change, necessitating alterations to the home arrangement, such as removing obstacles, arranging different bed or seating options, or even setting up a first-floor living area.
- If the individual is receiving Home Health Physical Therapy, Occupational Therapy, or Speech Therapy, it is vital to diligently follow the orders provided to ensure the individual continues to make progress.
“Every patient is a unique puzzle, requiring a tailored solution.” By understanding these considerations and employing effective strategies, we can collectively promote safety and enhance the mobility and quality of life for individuals with I/DD.
StationMD offers specialized telehealth services that ensure timely access to healthcare and mental health support for individuals with I/DD. Contact us here for more related clinical education, questions, or speaker engagements.