Page 1 | Page 2 | Page 3

Warning! Movement of the wheelchair or commode when you stand up can cause you to fall and sustain an injury. Always ensure that the brakes are applied on the wheelchair and fold or turn the leg rests to the side so that they do not obstruct.

• The carer should stand on the side which is weaker or injured
• The person should push up on the armrests of the wheelchair to stand up
• Use the stronger hand to hold onto the walking frame
• Next, place the other hand on to the frame
• The person should always stand in the rear half of the walker
• This procedure will be the same when using a quadrapod or walking stick.

Walking With Aid [Three point gait]

With a Walker

• The carer should stand behind and on the same side as the weaker/ injured leg
• The person should pick up the walk and place it in front
• Do not slide the walker forward by pushing one side forward and then the other side without lifting the walker
• Check that all the 4 legs are on the floor
• The person should step forward with the weaker/ injured side
• Follow through the walk with the other leg

With a stick

• The carer should should stand on the same side as the weaker/ injured leg
• The person should hold the stick in the opposite hand and move it forward
• Follow by moving the weaker leg forward
• Follow through the walk with the other leg

Before renting or buying a wheelchair, these are some of the features you should consider whether you need:

• fixed arm and footrests (standard wheelchair)
• removeable arm and footrests
• standard or elevating legrests
• desk arms [fit easily under a table]
• standard or light-weight frame
• indoor/outdoor wheelchair
• seat belt - for poor sitting balance

Decide which features you need and how much you want to spend. If the wheelchair is going to be used every day, then you may decide to spend a little more money to get the features you need.

A Few Tips To Ensure The Person Fits The Wheelchair

• Seat width - You should be able to place two finger widths in between the side of the wheelchair and the person, on both sides
• Seat depth - You should be able to place three or four fingers in between the front of the wheelchair seat and the back of the person’s leg
• Leg length - You should be able to place two or three fingers easily under the person’s thigh, at the front of the wheelchair seat. The bottom of the footrest should be at least two inches from the ground
  

There are two types of commode chairs, those without wheels and those with wheels. When buying a commode chair, these are some of the features you should consider:

• 2 or 4 brakes
• plastic or padded seat
• removable swing away arms
• swing away footrests or foot plate
• back support
• frame durability e.g. stainless steel lasts longer
• whether commode chair is the same height as the bed

You may want to know that:

• Most falls occur at home
• The likelihood of falling increases with age, with the increase rising after the ageof 75, peaking at age 80 to 84, then decreasing in frequency after the age of 85
• Women fall three times more frequently than men
• 20 % of deaths are caused by falls amongst those over 65

Falls can be caused by medical problems such as:

• Balance problems
• Sensory deficits
• Cognitive impairment
• Generalised muscle weakness
• Blood pressure changes e.g. postural hypotension
• Medications e.g. causing dizziness
• Depression

What to do to minimise falls:

• Exercise regularly
• Have regular eye sight and medical checks
• Wear proper shoes, particularly for people with diabetes
• Change positions slowly e.g. lying to sitting, and sitting to standing
• Use mobility aids correctly
• Encourage social interaction

Environmental Factors Can Also Contribute To Falls. What To Do To Minimise Falls:

Bathroom

• Keep the floors dry
• Install grab-bars beside the toilet and shower area
• Use non-slip mats / non-slip strips on the floor
• Install adequate lighting
• Place items e.g. soap/shampoo close to hand
• Install sitting toilet or use a commode chair
• Use a shower seat
• A sliding door or door opening outwards gives more space in the bathroom

Bedroom

• Use night-lights
• Place the telephone beside the bed
• Place a lamp beside the bed
• Check the bed height - not too low or too high
• Use a firm mattress
• Place walking aid close to the bed
• Position a commode chair beside the bed, for night-time

Living area

• Keep electrical and telephone cords out of the way
• Remove rugs or secure them down
• Clear away clutter
• Arrange furniture so that there is a clear pathway
• Chairs should have arms and of an appropriate height
• Install adequate lighting

Equipment for the home

Consult your occupational therapist or physiotherapist on the appropriate aids or equipment that would assist the patient at home.

Assisting with Activities of Daily Living

Showering

• It may be safer for the person to sit whilst showering
• Use a standard shower seat or mobile shower commode chair
• Use assistive devices when needed eg. long handled washer or wash mitten
• Encourage the person to be as independent as possible and provide assistance only when needed

Dressing

• It may be safer to sit down whilst getting dressed
• Encourage the person to dress the weaker side first e.g. after a stroke
• Crossing the weaker leg over the stronger one assists dressing
• Use assistive devices to make the task easier e.g. dressing stick, long handled shoe horn and easi-reacher
• Encourage the person to be as independent as possible and allow plenty of time

Feeding

• Problems can arise when there is limited or loss of movement in the arms e.g. after a stroke
• There is a wide range of adapted cutlery, crockery, cups and non-slip mats available.

The Dangers Of Prolonged Bed Rest

• Chest infection - decreased air entering the lungs
• Pressure sores - constant pressure on the pressure points of the body
• Constipation - due to lack of movement
• Contractures - development of muscle tightness
• Joint stiffness - due to immobility
• Muscular weakness - due to prolonged lying down
• Osteoporosis - due to lack of weight bearing exercise e.g. sitting and standing
• Depression - can develop as life becomes dull and repetitive
• Disorientation - become less alert, due to lack of stimulation

• Personal Hygiene & Nutrition
  
• Incontinence
  
• Wound Care
  
• Exercise & Mobility
  
• The Psychosocial Aspect of Caregiving
  
• Medical Care
  
• Safe Use of Medicine
  
• Dying