Hands That Help · Seoyeon Kim
Chapter 6: Moving, Standing and Walking
A Common Situation
A man in his seventies helps his wife out of her armchair several times a day. He stands in front of her, takes both of her hands and pulls, and she rises with a little jerk. For a long time this seems to work. Then one morning he feels a sharp pain in his lower back as he pulls, and his wife, suddenly without support, nearly falls back into the chair. They are both frightened. Over the next weeks she begins to stay in her chair for longer and longer, because she does not want him to hurt himself again, and he notices that she seems weaker each week.
This situation is very common, and it shows two things that care textbooks teach. The first is that movement keeps a person strong, and that sitting still for long periods makes moving harder. The second is that there are safe ways and unsafe ways to help someone move, and the safe ways protect both people. In this chapter we will look at why staying active matters, at the basic principles of helping someone to move safely, and at how to help a person stand up, sit down, walk and move from the bed to a chair. We will also look at walking aids, at changing position in bed and in a chair, at caring for your own back, and at why it is so valuable to ask a nurse or a therapist to show you the right way in your own home.
Why Staying Active Matters
Muscles that are not used become weaker, and in later life this happens faster than many people expect. Care textbooks explain that even a short time in bed, for example during an illness or a stay in hospital, can make walking noticeably harder afterwards. The good news is that the opposite is also true: regular movement helps to keep muscles, joints and balance working. Movement does even more than that. It helps the heart and breathing, supports digestion and appetite, protects the skin, improves sleep and often lifts the mood. A person who moves about during the day is usually a person who feels more like themselves. For all these reasons, staying active is one of the most important parts of good care at home.
Chapter 1 described the idea of supporting what the person can still do, instead of doing everything for them. This idea matters especially for movement. When a person is slow to stand or walk, it is tempting to take over, because it is quicker and it feels kind. But every time the person stands up with their own effort, they are practising, and every time someone else does it for them, a little practice is lost. Over months, doing too much for someone can quietly take away abilities that they still had. So a good carer is often the one who waits patiently, gives a few words of encouragement and offers just enough help, rather than the one who lifts and carries.
Staying active does not need a special programme. Everyday life offers many chances to move: walking to the kitchen for a drink, setting the table, standing at the sink to rinse a few cups, watering plants, folding laundry, or taking a short walk outside to the gate or around the garden. Even a person who spends most of the day in a chair can do simple movements while sitting, such as lifting each foot, circling the ankles or straightening the knees. A physiotherapist, a therapist who specialises in movement, can suggest exercises that are safe for the person and that build strength and balance. If the person has health problems, it is a good idea to ask the doctor before starting a new kind of exercise. Activity is also easier to keep up when it has a purpose the person cares about, such as fetching the post or visiting a neighbour.
Let the person set the pace. Most people have good days and harder days, and energy may be different in the morning and in the evening. Short periods of activity with rests in between are usually easier than one long effort. It helps to watch the person's face and breathing while they move. A little tiredness after activity is normal, but some signs are a reason to stop and rest and to tell the doctor or nurse: unusual breathlessness, dizziness, pain, or feeling faint. Sudden chest pain, sudden weakness of the face, an arm or a leg, or great difficulty breathing are reasons to call the emergency number at once; Chapter 11 lists these urgent signs.
After a fall, or after an illness, many older people become afraid of moving, and fear can be as limiting as weakness. The wife in the opening situation began to sit still to protect her husband, and her strength faded as a result. Gentle encouragement helps more than pressure. Walk together at first, stay close, praise each small step, and let the person feel success in short distances before trying longer ones. A safe home, as Chapter 5 described, also builds confidence, because the person knows that the path is clear and the hand-holds are firm. Confidence usually grows with practice, little by little, and it is worth celebrating together when it does.
The Principles of Safe Helping
Care workers and nurses learn a small set of principles for helping someone to move, and these principles are just as useful at home. The first is to explain before you begin. Tell the person what you are going to do together and what part they can do themselves, and agree on a simple signal for starting, such as "ready, steady, stand". A person who knows what is coming can prepare their body and help much more. The second principle is to prepare the space before anyone moves: the chair close by, the brakes of a wheelchair on, the walking aid within reach, shoes on the feet and the floor clear. Most difficulties in moving start because something was not ready.
The third principle is to let the person do as much as they can, as described above, and to give only the help that is needed. The fourth principle is about the carer's own body. Stand with your feet apart, one foot slightly in front of the other, so that you have a stable base and do not easily lose balance. Bend your knees rather than your back, and keep your back as straight as you comfortably can. Stay close to the person, because reaching out with your arms puts great strain on the back. When you need to turn, turn with your feet, taking small steps, instead of twisting at the waist. Move smoothly and slowly, without sudden pulls or jerks.
There are also a few things that care textbooks teach us never to do. Never pull a person up by the arms or the hands, as the husband in the opening situation did, and never lift a person by putting your hands under their armpits. These ways of helping can injure the person's shoulders and skin, and they put a heavy, sudden strain on the carer's back. Never let the person hold you around the neck. If someone holding your neck starts to fall, they will pull you down with them, and your neck and back can be badly hurt. Instead, the person can hold onto a firm armrest, a rail or a walking frame, and the carer can steady the person at the side, with a hand at the lower back or the hip.
An important rule in care textbooks is that a carer should not lift the full weight of an adult alone. Human backs are not made for this, and both people can be hurt. If the person cannot take their own weight on their legs, even with help, then safe moving needs equipment, such as a lifting device called a hoist or a standing aid, and training from a nurse or therapist in how to use it. These things are chosen for each person by a professional. If a person who could stand before suddenly cannot stand, or cannot take weight on one leg, that is a change worth telling the doctor or nurse about quickly, and after a fall or a sudden change it may be a reason to call the emergency number.
Moving is also a moment of communication and respect. Ask before you touch the person, and tell them where you are going to put your hands. Watch the person's face for signs of pain or fear, and slow down if you see them. Move at the person's speed, not at your own. After standing up, pause for a moment and ask whether the person feels dizzy before taking the first step, because the body sometimes needs a few moments to adjust when going from sitting to standing. If the person feels dizzy, help them to sit down again and rest. Small words of encouragement, and thanks at the end, make each move feel like teamwork rather than something being done to the person.
Standing, Sitting, Walking and Moving From Bed to Chair
Standing up from a chair is easier when it follows a few simple steps that care textbooks describe. First, the person moves forward to the front edge of the seat, perhaps by shifting from one side to the other. Then both feet are placed flat on the floor, a little apart and slightly behind the knees. The hands go on the armrests. Now the person leans forward, so that the nose comes over the toes; this moves the body's weight over the feet, and it is the step that people most often forget. Then, on the agreed signal, the person pushes up with the arms and the legs together and stands, staying still for a moment to find balance. The carer stands at the side, not in front, with a hand at the person's lower back and the other hand ready to steady.
Sitting down safely follows similar steps in reverse. The person walks up to the chair and turns, in small steps, until the backs of the legs touch the front of the seat. That touch tells the person that the chair is really there. Then the person reaches back for the armrests, one hand at a time, leans forward a little, bends the knees and lowers themselves slowly into the seat. Dropping down suddenly into a chair can jar the back and can make the person miss the seat. Chairs with firm seats, armrests and a good height make both standing and sitting much easier, which is why Chapter 5 suggested looking carefully at the chairs used every day.
When you walk with someone, walk at their side and slightly behind, not in front pulling them along. If one side of the person's body is weaker, for example after an illness, walk on the weaker side, because that is the side towards which the person is more likely to lose balance. You can hold the person's forearm lightly, offer your arm for them to hold, or keep a hand near their lower back. Encourage the person to look ahead rather than down at the feet, and to take steady steps. Plan short distances with a place to rest at the end, such as a chair in the hallway. Doorways and corners are where people often lose balance, so take turns slowly, in small steps, rather than twisting on one foot. Walking outside brings uneven paths, kerbs, wet leaves and wind, so choose a familiar route at first, go at a quiet time of day and take the walking aid that the person normally uses.
Moving from the bed to a chair, or the other way, is one of the most common daily moves and one worth doing carefully. First the person sits up on the edge of the bed. A common way is to roll onto one side, bring the legs over the edge of the bed and push up with the arms into a sitting position; a nurse can show the way that suits the person best. The person then sits for a moment, feet flat on the floor. The chair is placed close to the bed, at a slight angle and on the person's stronger side, with the brakes on if it is a wheelchair and the footrests moved out of the way. Then the person stands, turns in small steps until the backs of the legs touch the chair, and sits down as described above.
Many people can move in bed better than their families expect, if they are given time and clear, simple instructions. To move up the bed or turn over, the person can bend the knees, push with the feet and use a firm handle or rail if one has been advised. Carers should avoid dragging a person across the sheet, because dragging rubs the skin and can damage it. Where a person needs a lot of help to move in bed, a nurse or therapist may suggest a smooth sheet that slides easily under the body, or other equipment, and will show how to use it. If the person cannot take weight on their legs at all, a board for sliding across or a hoist may be needed, and these should only be used after a professional has shown you how.
Walking Aids, Changing Position and the Carer's Back
Walking aids include walking sticks, walking frames, and frames with wheels and brakes. Each kind suits a different need, and the right aid at the right height can make a great difference to safety and confidence. The wrong aid, or one at the wrong height, can make walking harder and even cause falls. For this reason, walking aids are best chosen and adjusted with a physiotherapist or a nurse, and used in the way that the professional advised. An aid borrowed from a friend or left over from another family member may not fit. Check aids from time to time: the rubber tips on the feet of a stick or frame wear down, and the brakes on a wheeled frame need to work. A wheelchair, too, should have its brakes on every time the person gets in or out.
A person who spends much of the day in bed or in a chair needs to change position regularly. When the body presses on the same spot for a long time, the blood flow to the skin there is reduced, and the skin can become damaged. Changing position, even a little, takes the pressure away and lets the skin recover. Encourage the person to shift their weight often, to lean a little to one side and then the other, or to stand up for a moment if they can. A person who cannot move alone in bed will need help to turn, and pillows can be used to support the new position comfortably. A nurse can advise how often and in what way this should be done for the person. Chapter 8 says more about the skin and about pressure sores.
Sitting well matters too. A person who sits for long periods is most comfortable in a chair that supports the back, with the feet resting flat on the floor or on a low stool and the arms supported. Sliding down in a chair, so that the person is half lying with the back curved, puts strain on the back and on the skin, and it also makes breathing and swallowing harder. Helping the person to sit upright again, using the standing and sitting steps described above rather than pulling them up the chair, protects both of you. Cushions can make a chair more comfortable, and a therapist can advise on special cushions if the person sits for most of the day.
Your own back is part of the care too. Back injuries are common among people who look after others, and a carer with a painful back cannot help anyone for long. Use the principles described in this chapter every time, even when you are in a hurry, because injuries often happen in rushed moments. If the bed can be raised, raise it to a comfortable working height when you help the person in bed, and lower it again afterwards. Avoid twisting, avoid lifting, and avoid reaching far from your body. Keeping your own body strong with regular movement helps too. If your back starts to hurt, see your own doctor and ask for advice about the moves you make each day. Chapter 12 talks more about caring for yourself.
Reading about safe moving is a good start, but the best way to learn it is to be shown. In many places, a nurse, a physiotherapist or an occupational therapist can visit the home, watch how the person moves and show you both the safest way in that particular home, with that particular bed and chair. Ask to practise while they watch, and ask again whenever things change, for example after an illness or a stay in hospital. Chapter 14 describes the kinds of help that may be available. Good moving also prepares the person for many everyday moments, such as sitting upright and comfortably at the table for a meal, which the next chapter explains as part of safe swallowing.
A Question to Think About
Which moves in the day, such as getting out of bed, standing up from a favourite chair or walking to the toilet, does the person you care for still do partly alone, and how could you give a little less help and a little more time so that they keep that strength? You might think about this alone, talk about it with the person, or ask a nurse or therapist to watch one of these moves and share their ideas.