May 18th, 2023

Promoting mobility in people with dementia

​Strategies for carers

​Promoting functional mobility with movement strategies

1. To overcome the person’s fear/reluctance of standing up, place the back of a stout dining chair in front of him, but not so close that he can pull himself up on it.  
 
 
 
 
 
 
 



2. To facilitate chair to chair transfers, use a dining chair as in 1. To fill the place in front of the person and offer reassurance during the manoeuvre.  

3. To facilitate rising to standing from the edge of a bed or settee: the carer(s) seated beside the person use their thighs as substitute chair arms for him to push against.  They both/all rise “in unison’.  Use a dining chair to fill the space in front, as in 

4. To encourage even strides while walking, close assistance is given and the carer(s) step/s ‘in unison’ with the person, with both/all using the same foot at the same time.  

5. To achieve moving from the front to the back of a chair, demonstrate the side to side rocking movement required in front of the person.  Ensure that both his hands are placed on the arms of his chair.  

6. To encourage walking, place a chair as a visible goal to mark the required distance.  

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​Communication Strategies
 
Treat the person as an individual with feelings and emotions.

• Approach the person slowly from the front.
• Respect his personal space.
• Attract his attention by addressing him by name and making eye contact.
• Keep your body and hand movements smooth and unhurried.
• Make use of facial expression.
• Speak clearly in a manner acceptable to an adult.

Verbal Strategies
 

• Use short sentences.
• Limit your requests to one at a time.
• Give the person plenty of time to understand.
• Repeat what you say using different words.
• Use words and expressions likely to be familiar to the person.
• Phrase requests positively eg ‘stay standing’ instead of ‘don’t sit down’.
• Tell the person politely and pleasantly what to do, rather than asking ‘would you like to do it?’  Offer choice when there is one.
• Use a goal-based request eg ‘come and have breakfast’ involves rising to standing, walking and sitting down to eat at the table.
• Give step by step instructions if helpful.

 
           

​                                                    T          -           time                                                                         
                                                    R         -           reassurance                                                                         
                                                    R         -           repetition
 THE PERSON NEEDS             E          -           empathy
                                                    C         -           courtesy                                                                                     
                                                    C         -           consistency
 

Non-verbal strategies and cues
 
To produce movement in a specific direction

• Invade personal space of person seated on edge of bed by moving up close against him and asking him to ‘move along’.

• Use gestures  to indicate direction: up or down, along or across.

• Touch cue to encourage standing up, sweep your hand lightly but positively up                                                                                  the person’s upper back, apply gentle pressure with your                                                                                                        hand in a forward and upward direction to indicate the direction of                                                                                      the movement.

• Touch cue to indicate which way he must turn to sit down, give gentle                                                                                                             intermittent pressure on the side of his hips.

• Auditory cue: to reinforce the request to ‘lie down please’ and to encourage                                                                                                        correct alignment along the length of the bed, slap the pillows on                                                                                       the end to make a ‘pillow noise’. Having attracted his attention to                                                                                        the pillows, encourage him to feel them.

• Auditory cue: to attract the person’s attention and to reinforce the request ‘sit                                                                                                     here please..in this chair’, pat the chair seat hard to make a ‘chair                                                                                     noise’. 

• Visual cue: to correct poor alignment of a person who has risen rom lying to                                                                                       sit on the edge of the bed, place his shoes on the floor in such a                                                                                                     position that when he puts his feet into them he will become correctly                                                                                                  aligned.
• Visual cue: to indicate the change in level of a step or kerb, move in advance of the                                                                                     person being assisted.

Some misinterpretations that may affect mobility or cause falls

• Picking up shafts of light from the floor.
• Stepping over or avoiding a deep shadow on the floor (interpreted as a hole?)
• Picking up patterns from the carpet.
• Interpreting the space between two chairs as a chair and siting down.
• Stepping over shiny threshold strips or stripes on flooring (taken as a step?)

 
To maintain sitting and standing balance

• SITTING BALANCE: Sit the person on the edge of a double bed or padded stool for 5 to 10 minutes daily.  Their feet must be flat on the floor, hips and knees bent to 90 degrees so that an upright posture is maintained. Stay with the person all the time.

• STANDING BALANCE:  Help the person to stand up with his feet apart.  Encourage him to balance to a support using both hands and then with only one.  Maintain balance to a support using both hands and then with only one.  Maintain balance for 30 to 60 seconds.

General considerations

• To avoid having your hand painfully squeezed when giving assistance, use the palm-to-palm thumb hold. The person can only grip your thumb, and it is easy for you to slide it out should you wish to release it. Or, adapt the palm to palm hold and keep your thumb close beside your fingers.

• To prevent the person from gripping onto the chair arms and impeding the rising movement, use the palm-to-palm thumb hold.  Then place the back of your hand against the chair arm - your hand is now between his and the chair arm.

 

• To overcome misjudgements when sitting down, allow the person to keep the chair/seat in sight throughout the movement and to sit down onto it sideways.

 

• To minimise the fear that may be experienced during changes of position, explain simply and clearly what you intend to do, reassure the person and then carry out the movement slowly and smoothly. 

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