The Home Physical Therapist

Caregiver Resources From A Home Mobility Expert

Caregiver Training: Bed Mobility

This is a short tutorial for any caregiver who may need training or information about bed mobility.  If your patient or caree is larger than you, or, if they are simply too weak to assist much in performing bed mobility tasks, this technique may be beneficial to you.



I have this available in pdf download. If you think it may be helpful and want a copy just let me know in the comment section below.

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4 Tips To Help Get Someone Out Of A Chair

laborer photo

“If you’re sweating you’re working too hard.”

This is what I tell a lot of caregivers I do training with. A lot of caregivers report that they struggle when they’re trying to get their loved one or the patient out of a wheelchair or off the commode we’re out of any seated position. There are basically four reasons that why this may be happening.  And if you keep these things in mind it will make the job of caregiving a lot easier.

1. Not working as a team.

It goes without saying that when two people are trying to accomplish something they get a lot farther when they work together. This is just as important in the job of caregiving. Both people need to be on the same page when they’re trying to do something.

Are you telling your loved one or your patient what you need them to do when you are trying to transfer them?  Are you working together?  Or are you going in opposite directions?  Make sure that you’re trying to work together when you’re trying to perform a transfer or get someone out of a seated position. It will make doing so a lot easier.

If you’re not working together you’re working too hard.

2. Incorrect positioning.

Simply from a mechanical standpoint we as humans need to be in a specific position in order to stand up from a sitting position. Did you know that it was impossible to stand up unless you’re shoulders are over your knees and your feet positioned slightly behind your knees? Well maybe not impossible but a whole lot easier if you were in this position.

A young strapping gymnast has to be in this position in order to stand up easily and efficiently without much effort.  If this is required for a young strapping gymnast how much more important is it for a elderly patient who may have physical limitations?

If your patient isn’t in the right position you will be working too hard.

3.The caregiver needs to be going in the right direction.

A common practice for caregivers is to grab a loved one or a patient under their shoulder through their armpit and attempt to lift them straight out of the chair. This can cause any number of injuries and is pretty uncomfortable for the patient. Especially if they’re frail or have chronic pain.

Remember we are humans and not rocket ships.  When we are standing up we do not go straight up.  Our direction is forward and up.  When a human being stands up from a chair they do not go straight up into the air.  They make an arcing motion forward and upward.

We want to continue with the idea that the patient has to be in the right position with the shoulders above the knees. From here the caregiver want to help the patient move further forward and then upward. This type of motion is totally different from what is commonly done. But it brings the body over the seat which are the base of support and lets the patient balance on their feet before trying to come to an upright position.

If you’re not helping your patient or loved one move in the right direction you’re working too hard.

4.The patient needs to push in the right direction.

While this is the last point it’s certainly not the least point. That’s because many caregivers get the wrong idea that their loved one or patient is actually resisting them when they’re trying to stand them up. They’re not resisting you they just happened to be pushing or moving in the wrong direction against you.

There are a couple of things that are going on with the patient or loved one when they’re trying to stand up. For one thing they are actually afraid of falling forward on to their face and so unconsciously they push backwards were they lean backwards. This makes it more difficult to stand them up when we’re trying to get their shoulders over there nice they are pushing backwards.

Now, at the same time they’re pushing back they’re actually trying to stand up.  However they don’t realize that when they’re pushing with their legs there pushing to the rear and not forward.

The combination of these two errors on the part of the patient makes it very difficult for a caregiver to help stand a person up from a chair or off of the bed, or, off  the toilet. Because when the caregiver is trying to bring them up and forward the patient is trying to push back and upward.

If your loved one or patient is pushing backwards while trying to stand, you’re working too hard.

So what’s the solution?

It goes back to the first point that I made. You have to tell your loved one or the patient exactly what you want them to do so that you’re working as a team. If you need them to bend forward ask them to bend forward or put their shoulders over there knees.

If you need them to push forward versus pushing backwards then ask him to push forward in order to bring the shoulders further over their knees. That way you both will be on the same page and it will not be such a struggle trying to get a person to stand up from a chair or from a sitting position.

Having patience on both parts is extremely important when both of you are trying to learn how to work together to perform a specific task like this. It should be practiced several times a day. Not just in times of necessity like when you’re going to the toilet or need to get up for an emergency. Take some time and practice together when you both can look at the technique and the specifics of it objectively.

Please let me know what you think by leaving a comment.

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Hangout On Air: Walker Accessories

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Walker Glides, Not Walker With Tennis Balls

Walker-With-Tennis-Balls

Please, please, please, don’t do this. There was a time when putting tennis balls on the back legs of walkers with wheels was a good idea and it solved more than a couple of problems. But, those days are long gone at this point.

We used to put tennis balls on the back legs of walkers because it was the rear legs that had the rubber “anti-slip” tips on them. Back in the 70s and 80s, most people who used walkers were actually in nursing homes. And, the floors in most nursing homes were covered with linoleum or tile.

Unfortunately, when these rubber tips on the rear legs of walkers came in contact with those linoleum floors, they made such a racket skidding across the floors that therapists had to come up with a solution that would make working there bearable (imagine a physical therapy room filled with seniors all using walkers trying to learn to walk again. It’s was a horrible racket. I remember).

Therapists came up with a simple solution: cut tennis balls to fit over the rear legs and voila! No more racket. Just the slight sliding sound or a felt covered tennis ball slipping across the floor.

And, these tennis balls worked great on solid smooth surfaces. However, they didn’t work too well on carpet or concrete surfaces. Thus, you couldn’t really use them in any other area than the nursing home or hosptial.

Fast Forward 30 years. Things had come a long way. While front wheel walker makers still used rubber tips on most folding walkers, they moved to a different option. That was a hard plastic tip which cuts down on the noise and drag that the rubber tips caused.

There was a  downside to the new plastic tips though. They didn’t hold up very long on rough or concrete surfaces. The sidewalks and driveways tended to grind them down relatively quickly. And, if you weren’t paying attention, the concrete would begin to grind down the aluminum legs of the walker. That tended to cause havoc on hardwood floors and carpeting.

Fast forward another 10-15 years and we have…

The solution are what are affectionately known as “walker glides” or “walker ski glides“.  They get the latter name from their resemblance to actual skis. These little walker accessories pop right on the rear legs of the walker with front wheels and make it just skate right along. Over carpet, tile, hardwood and even concrete.  And they hold up on concrete a lot better than the hard plastic caps.

I am not sure why they are not standard issue when you buy a folding walker, but they’re not. You have to buy them separately and apply them yourself. But, it’s not that painful. They don’t cost a lot either and they’re easy to put on.

So, let’s look at how it’s done.

Walker-Ski-Glides1

You can get these online at places like Amazon, or, you should be able to get them pretty cheaply at your nearest Walmart or pharmacy. They shouldn’t cost more than $10 US.

 

Walker-Glides-unboxed

As I said earlier, they look like little skis.

 

Plastic caps on walker

You just pop the plastic caps off the back legs of the folding front wheel walker and …

 

Walker Glides Applied

Install the walker glides. You may have to alternately press either side to get them to seat properly. Don’t try to push them straight in. It’s a hassle.

 

Walker can glide over carpet

And, voila! You are ready to rock and roll over hill and dale…

 

These little puppies really make using the walker a lot easier. They don’t drag, they don’t wear out fast. You can use them outside and inside. The only thing to keep in mind is that sometimes oxygen tubbing or the curled up edge of a carpet or rug can get caught on the ski. But, it’s usually easily taken care of.

If you’re therapist hasn’t suggested these, you may want to ask and see if they’re right for your situation.

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Front Wheel Walker Modification: Wheels

Front-Wheel-Walker

Disclaimer: This article is for educational purposes only and is not mean to be taken for medical advice. Please consult your medical professional before using any information attributed to this website.

“I’m Afraid He Might Fall”

Have you ever been nervous when you’ve seen someone who needs to be using a  walker to get around, but doesn’t for some reason? Sometimes it can be downright scary. You know it’s just a matter of time before they stumble and fall. But what can you do, right?

Well, one thing you can do is investigate why they’re not using their walker in the first place.

In some cases, it’s just plain stubborness. In others it can be outright denial.  But, still in other cases, the person actually can have a legitimate reason why their not willing to use a walker to get around their home.

It could be that the walker is too heavy or has a dragging feeling that makes using it a chore. If this is the case, inspect it to see if the wheels move freely or that the back legs have not worn down to the aluminum. Both of these problems can make the walker drag along and wear a person out when their pushing it from room to room.

Another legitimate reason that people tend not to use their walker is that it’s too big, gets in the way, or, they have a hard time getting it through their doorways or other tight spots. It may just be a matter of you getting the walker and pushing it around the home just to see what it’s like.

This last reason for not using a walker is common for people who live in older, or, small or cramped homes. This is specifically true for anyone living in a manufactured or mobile home. The doorways and hallways tend to be a little smaller than that of newer construction or larger homes.  So, it has to do with the width of the front wheel walker.

How Some People Work Around This Problem

Well, if this is the case for you I have a small hack that many people have used to make getting around their homes easier. It’s not difficult and it doesn’t cost any money. This hack is usually done on a folding walker with wheels.

If someone is having trouble negotiating narrow spaces with their walker, or, the wheels of the walker get caught on the door jams, moulding, or get tangled up in wires, it’s because they are on the outside of the walker.

What some people have done is to switch the front legs of the walker to the opposite sides. They take the right leg/wheel off and slip it onto the left side. Likewise they do the same with the left leg/wheel. The result is this:

Walker with wheels on inside.

Compare the two pictures in this article. Look closely and notice how much room is gained when the wheels are on the inside versus on the outside. This seems like it can make passing through a narrow doorway (typically and bathroom) a lot easier.

For some it’s a simple “hack” for a front wheel rolling walker that makes getting around the home a little easier.

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Home Physical Therapy or Outpatient Physical Therapy?

Homebound or Not?

Do you need outpatient physical therapy or with home care physical therapy be better for your situation? This can be it confusing question for some.
Let’s look at the differences between these two services in this article. It may help clarify what’s most appropriate for you and your situation.

For those using their Medicare benefit, they require that anyone receiving home physical therapy must be “homebound”.
That simply means is that it takes a lot of effort on your part or the part of the caregiver to get you out of the house.
This could mean that you need a wheelchair or walker to leave the home safely. And it could also mean that it may be unsafe for you to leave the house by yourself and you need someone with you.

But, just because you may qualify as “homebound” doesn’t necessarily mean you have to have physical therapy in the home. You can still go to outpatient therapy if that would be better for you.
One consideration to keep in mind about going to an outpatient clinic is that you’ll need reliable transportation. If this is an issue, home care may be your best option.
In general people who need home care physical therapy have difficulty moving around their home safely. Or, they may require special equipment and training on that equipment to help make living in the home more convenient or safer.
One other reason for home care physical therapy is for caregiver training or family caregiver training in the home environment. Oftentimes family caregivers can receive better training in the home with everyday routines.
Moving on…

Am I Ready For Outpatient Physical Therapy?

Outpatient physical therapy may be more appropriate for you if 1. you do not have difficulty moving around your home. Number 2. if your prime goal of physical therapy is strengthening. And, 3. if you have chronic pain issues.

The outpatient physical therapist usually has access to more equipment than the home care physical therapist. This equipment can range anywhere from exercise equipment such as weight lifting machines, exercise bicycles, pain relieving modalities like electronic stim machines or therapeutic ultrasound machines.
And most of the time there’s more room to do exercises and mat tables that exercises can be performed on or patients can be re-positioned on to do particular exercises.
From my experience doing exercises on the mat tables is a lot easier than doing exercise on your bed or on your floor at home.
Another frequently overlooked benefit of going to outpatient physical therapy is that of socialization. Physical therapists have long understood that patients perform better when they realize that they’re not alone with their health challenges.
Going to an outpatient physical therapy clinic allows a person to understand that there are other people with challenging problems too.
And because they get to meet these people they are able to form bonds and a camamraderie that helps them participate in physical therapy more fully.

The Bottom Line

So in summary whether you need home care physical therapy or outpatient physical therapy is really dependent upon your specific needs.
If you are not functioning well at home, or if you don’t have the right type of equipment at home, or if your family caregiver or hired caregiver needs training to help assist you with your mobility in the home, then a home care physical therapy referral is probably appropriate for you.
On the other hand if you are mobilizing at home fairly well, do not need any equipment, and your primary need for physical therapy is strengthening, and transportation is not an issue, then a referral to outpatient physical therapy is probably appropriate for you.

Make sure to talk with your doctor about each of these areas to make sure the best referral is made.

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