3 Mobility and Safe Movement

Assess and prepare

Safe movement supports independence, strength, joint function, circulation, and confidence. Assistance should match the person’s current abilities and care plan rather than assumptions based on diagnosis or past performance. Follow prescribed weight-bearing limits and transfer instructions, and obtain help or equipment if the person cannot move safely with the available assistance.

Prepare for movement

Before repositioning, transferring, or walking, consider the person’s strength, balance, alertness, ability to follow directions, pain, fatigue, dizziness, and ability to bear weight. Check for movement restrictions, attached lines or equipment, and the planned destination. Explain the steps, encourage the person to do what they safely can, and pause if they become dizzy, short of breath, unusually weak, or distressed. Reassess and report concerning changes.

Prepare the route and destination by clearing obstacles, providing adequate light, using nonskid footwear, and ensuring that the receiving chair or wheelchair is stable. Lock bed and wheelchair brakes as appropriate, and move wheelchair footrests out of the way before a transfer. Allow someone who has just sat up to pause and report dizziness before standing.

Position and reposition

Keep the person’s body aligned and supported, using pillows or other approved supports to reduce strain and keep limbs comfortably placed. Check that heels, elbows, hips, and other pressure-prone areas are not under prolonged, unrelieved pressure. Reposition regularly according to the individual care plan, skin condition, comfort, and ability to shift independently; inspect the skin as directed. Keep the call device and needed items within reach.

Common positions include supine, side-lying, and upright or semi-upright. Choose a position that supports breathing, comfort, care needs, and any medical restrictions. If the person cannot reposition independently, use appropriate assistance and repositioning aids rather than dragging them across the bed. Safe patient-handling equipment can reduce injury risk to both the person and caregiver.

Transfer safely

A bed-to-chair transfer may use a stand-and-pivot approach only when the person can follow directions and safely support the required weight. Bring the person to sitting first and check their tolerance. The approach assumes the person can stand on at least one leg; if they cannot stand, bear weight, or cooperate adequately, stop and obtain trained assistance and the prescribed transfer aid, such as a mechanical lift.

When the transfer is appropriate, use a gait belt only when indicated and permitted. Stand close with a stable stance, bend at the hips and knees, and pivot by moving your feet rather than twisting. Do not pull on the person’s arms or shoulders.

Assist with walking

For walking, provide the level of assistance specified in the care plan and follow the clinician’s instructions for weight bearing and device use. Take short, controlled steps and allow time to turn. If the person becomes unsteady or develops symptoms, stop and help them sit or lie down safely. If they begin to fall, guide them toward the nearest safe surface rather than trying to hold them upright by force.

Support joint movement

Range-of-motion (ROM) activities move joints through their available movement to help maintain flexibility. Active ROM is performed by the person; passive ROM is performed with assistance when the person cannot move a joint independently. Follow the plan of care or therapist’s instructions, support the limb near the joint, and move slowly and gently only through a comfortable range.

Never force a joint or continue through pain, marked resistance, or new distress. Stop and report unexpected pain or a change in movement. Encourage the person to do as much of the movement as they safely can.

Choose and use mobility aids

Mobility aids should be selected and fitted for the individual. A physical or occupational therapist or another qualified clinician can assess the person’s needs and teach safe use. A poorly fitted device, or one used without adequate balance or strength, can be unsafe.

• Cane: Commonly held in the hand opposite the weaker or affected leg. The cane and weaker leg generally advance together, followed by the stronger leg. Fit the cane so the elbow is slightly bent while holding the handle. Follow the person’s training and prescribed technique.

• Walker: Keep all required tips or wheels in contact with the floor as instructed. Do not pull on the walker to stand. Use only the prescribed walking pattern and weight-bearing level; ask a therapist to check fit and technique if uncertain.

• Crutches: Use the type, fit, and weight-bearing technique taught by a clinician. They may be prescribed to reduce weight through an injured leg, but require adequate strength and coordination.

• Wheelchair: Check the brakes before transfers and move the footrests out of the way. Ensure the person is seated securely and comfortably before moving.

• Other supports: Use transfer belts, sliding aids, and mechanical lifts according to the person’s needs, equipment instructions, and staff training. Do not use unfamiliar equipment without instruction.

Reduce environmental fall hazards by keeping pathways clear, securing or removing loose rugs, improving lighting, and using grab bars where appropriate.