Hands-On Caregiving Demonstration

Millennia Personal Care Services

REDUCE RISK OF INJURYWHILE HELPING OTHERS IN NEED A healthy back has 3 natural curves (cervical curve, thoracic

curve & lumbar curve: see Fig 1), strong flexible muscles, flexible joints and healthy discs (Fig 2 & 3). It supports your upper body, protects your spinal cord and allows you to move freely.

Fig 1 Fig 2 Fig 3

REDUCE RISK OF INJURYWHILE HELPING OTHERS IN NEED Our lower back (lumbar region) is

most vulnerable to injury because: -We stand upright. -Lumbar region supports the weight of

our entire upper body. -It bears most of the load when we work. -Posterior longitudinal ligament is weaker

than the anterior longitudinal ligament.

REDUCE RISK OF INJURYWHILE HELPING OTHERS IN NEED Common Back Problems from

Damaged Disc besides Muscle Strains: (Fig 4 & 5)

-Degenerative Disc -Thinning Disc -Bulging Disc -Herniated Disc

Fig 4 Fig 5

REDUCE RISK OF INJURYWHILE HELPING OTHERS IN NEED Majority of back problems are preventable with good

posture and body mechanics. Good posture (Fig 6) and body mechanics (Fig 7) is the

safest, most efficient, and most comfortable way to move. You will have more energy and less chance of backache, stiffness or injury. Distribute the weight of the load evenly throughout your spine, lowering your risk of injury.

Fig 6 Fig 7 Fig 8

REDUCE RISK OF INJURYWHILE HELPING OTHERS IN NEED Bad Posture (Fig 8) is when the spine

is deviated away from the natural curves. Good Posture (Fig 6) is when your

ears, shoulders and hips are in a straight line. Keeping all 3 natural curves in their normal alignment; your weight is evenly distributed throughout the vertebrae and discs. Your back is least vulnerable to injury when you have good posture.

REDUCE RISK OF INJURYWHILE HELPING OTHERS IN NEED Poor Body Mechanics:-Even a light load held far from body can put

excessive strain on low back. -Reaching or bending from the waist forces your

back to support your upper body weight plus the load. (Fig 9)

Fig 9 Fig 10 -Over time can cause back strain, disc damage,

pain and lead to a herniated disc. (Fig 10)

REDUCE RISK OF INJURYWHILE HELPING OTHERS IN NEED Good Body Mechanic (Fig 7) is good

posture in motion. Whether you are standing, lifting, pushing, pulling, twisting or bending, good body mechanic will provide good back protection by distribute the weight of the load evenly throughout your spine, lowering your risk of injury.

Fig 7

How to decrease risk of injury NEVER STAY IN ONE POSITION FOR A LONG

PERIOD OF TIME! -Change positions, stretch and walk.

How to decrease risk of injury -Maintain proper posture and spine

curvatures in all positions and activities.

SLEEPING *use cervical roll

Poor Posture

Good Posture

How to decrease risk of injury

How to decrease risk of injury SITTING STANDING

WALKING

Poor Good: use Poor Good: rest foot on a low Poor

Good lumbar support stool to relax back

LIFTING/MOVING AN OBJECT or A PERSON When load is heavy, plan ahead and get help. Don’t

be shy to ask for help. Hold loads close to your body & tighten your

abdominal muscles. Keep back straight (neutral spine), feet apart

(shoulder width) & your knees bent, lift with your legs to reduce the stress on your back.

Lift objects only chest-high. Avoid quick, jerky movements.

If you have difficult time tightening your abdominal muscles then you should wear a back support when lifting. However, DO NOT wears the support all day because it can weaken your core muscles that support your back unless you have a condition that your doctor wants you to wear it all day.

LIFTING/MOVING AN OBJECT or A PERSON

Bad Good Bad Good Bad Good

LIFTING/MOVING AN OBJECT or A PERSON -Avoid bending trunk forward and twisting at the

same time. Move your torso-from your shoulders to your hips-as one solid unit by moving your feet. (Fig 11)

Fig 11 Fig 12

Bad Good Bad Good -Avoid reaching out over an obstruction to lift,

hold or lower an object as much as possible. If you have to reach across a bed, rest one knee on the bed to support your lower back. Then bend from hips but keep back straight not hunched over. (Fig 12)

LIFTING/MOVING AN OBJECT or A PERSON Push, instead of pulling as much as possible. (Fig 13) Fig 13 Fig 14

Fair Better REACHING OVERHEAD (Fig 14)

-Store heavy and frequently used items at waist height.-Reach only as high as is comfortable but don’t stretch; use a stool if you need it.-Test the weight of the load before lifting by pushing up on one corner.-Let your arms & legs do the work, not your back. Tighten stomach muscles as you lift.

OTHER WAYS TO REDUCE INJURY TO YOUR BACK Adequate hydration to hydrate the discs to

increase disc height. Stress can tighten your muscles, which in turn

narrows your disc space that may cause back pain. Reduce stress by taking a break from providing care every so often. Do things that help your muscle relax (i.e. stretching exercises, massages, watch a comedy show…).

Strengthen core muscles & legs: (Do minimum of 3x /week up to everyday 10 to 30x each)

OTHER WAYS TO REDUCE INJURY TO YOUR BACK Partial Sit Ups: Breathe in 1st.

Tuck you chin & belly in. Raise head and shoulders off the bed one spine segment at a time as you breathe out slowly for 10 counts then go down in reverse as you breathe in.

OTHER WAYS TO REDUCE INJURY TO YOUR BACK Bridging:

Lift buttocks off the bed. Hold for 10 counts

OTHER WAYS TO REDUCE INJURY TO YOUR BACK Alternate Arm & Leg Reach:

Hold arm & leg up for 10 counts each time.

OTHER WAYS TO REDUCE INJURY TO YOUR BACK Wall Slide:

Stand against a wall with your back and buttocks touching the wall. Place both feet about 6 inches from the wall. Tuck your belly in. Slowly lower your body by bending the knees & slide down the wall until the knees are flexed about 45 degrees. Pause 5 seconds and then slowly slideback up to the starting position. Keep the hips level and be sure you are using your knee muscles to perform the exercise.

Take care of yourself so you can take care of others

Good posture & body mechanics also apply to the ones that you care for.

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How to help someone who is not independent

Promote Independence Do range of motion to keep joints from getting

stiff. Encourage the person to range on their own as much as possible to ↑ circulation & prevent blood clot.

Do weight bearing activities (i.e. standing, walking) as much as possible to prevent loss of bone density and ability to sense what is up right posture.

Do resistive exercises to keep muscles strong and to prevent bone density loss but must consult with your physician & physical therapy first.

Promote Independence Always allow the person to do as much as

they are able so they will not become weaker. When they are weaker, it’ll become harder for you.

Provide help only when the person is not capable of doing it.

Use assistive devices (overhead trapeze, sliding board, draw sheet, hand rail, mechanical lift, hospital bed…) if available to make getting around easier for all.

To make sit to stand easier by scooting buttocks forward first, keep feet behind knees. Use both hands to push down on armrests or bed to assist with standing if able. (Discourage the person to pull up on the walker for standing as much as possible because the walker can fall back on/with them).

Communication -Always let the person knows what you

are going to do & how they can help you.

-If the person has dementia, keep instructions simple & meaningful. (i.e. Let’s go eat, let’s go check the mail or let’s go to the bathroom. Don’t say let’s go for a walk or stand up).

Safety Not to wear socks (unless it is non-slip) or

flip flops for walking. Always remind the person to feel the chair

or the bed behind both legs and reach for it with their hands prior to sitting down. Always stay close to prevent the person from falling.

Always repeat safety instructions every day to help the person remember. (i.e. don’t get up by themselves, always call for help if they don’t have good balance).

Safety During transfers, use a gait (transfer) belt. If no

belt available, use a dress belt with a secure buckle. Place belt around the waist line or pants line. Hold on to the belt and pants. Hold on to the pants if belt is not available; however, the pants should not be elastic.

During walking, stand to the side & slightly behind the person. Hold on to the belt on the back side of the person. The other hand should be ready to grab the shoulder in case the person loses balance.

If the person loses the balance & you are not able to hold on. Do not strain yourself. Lower the person to the ground slowly & safely.

Anything that has wheels should be locked or place against a wall or sturdy furniture.

If the person has breathing problems, keep head elevated at about 45 degrees to allow more room for oxygen exchange in the lungs. (A wedge pillow is often helpful).

If the person has a G-tube, make sure head is elevated > 45 degrees.

Not to allow the person to lie down right after meals, wait at least 30 minutes.

Pause after sitting up or standing up to ensure no blackout or dizziness from orthostatic hypotension (dropping of blood pressure) before moving on.

Safety If the person’s blood pressure becomes high, help

by doing the following relaxation exercises:1. Take a deep breath, pinch shoulder blades

together & count to 10 then exhale slowly. 2. Take a deep breath then roll shoulders backward

slowly 3 times.3. Take a deep breath, bring shoulders to ears &

make it very tight then count to 10. Exhale slowly as you lower both shoulders as low as possible & relax.

4. Take a deep breath.5. Close eyes and meditate for 3 minutes as you

breathe in and out slowly.

Comfort Position the person in 3 natural curves as

much as possible so the person can be comfortable and able to tolerate a position longer.

Place a small pillow at low back region when sitting.

Use a sit straight pressure relief wheelchair cushion that provides pressure relief on sitting bones & also to assist the person to sit up straight without a hammock effect.

Prevent Skin Lesion Turn and change position every 2 hours if the

person is not able to do it on their own to prevent pressure sores.

Do not allow both heels rest against the bed. Place a pillow under legs above the ankles to keep both heels away from touching the bed.

If has a hospital bed, raise the foot of the bed slightly to prevent the person from sliding down on the bed in order to reduce sheer force (friction) on the skin.

If the person has tendency of getting swollen limbs, elevate the limb above the heart & encourage the person to move actively such as ankle pumps or finger pumps if able (except when they have active deep vein thrombosis). Wear compression garment when out of bed to control the edema in order to prevent skin lesion.

Moving Up on a Bed Adjust bed height right below your waist if able. If not

able, put one knee on the bed. Work from side of bed, feet pointed in direction you’ll

move the person. Reach under patient’s shoulders and back and slide,

don’t lift. Ask the person to help by pushing against mattress with

feet and/or elbows. Keep your feet wide apart,

knees bent, back straight. When the person is not able to

help at all: Use a draw sheet & 2 persons lift. Lift in unison.

Turning in Bed Adjust bed height to mid or upper thigh. Put bed rail down if safe for the person. Cross the person’s arms on chest; cross

the legs. Put your knee on bed,

near person’s shoulder. If possible,

turn the person toward you.

Getting In/Out of BED If a person requires a lot of assistance

and has a hospital bed, raise head of the bed to make getting out easier.

Roll the person to their side then have them use elbow & hands to push up to sit.

Do above sequence on reverse when going back to bed.

Transfers Transfer toward the stronger side of the body

as much as possible. Allow the person’s head on the side of the

direction where they are heading so they can see where they are going in order to help you out as much as possible.

Always lock the wheelchair first. If coming out from bed to a wheelchair, raise

the bed higher than the wheelchair if able to make transfer & standing up easier.

If going back to bed from the wheelchair, lower the bed than the wheelchair to increase ease of getting into the bed if possible.

Transfers Support the person’s weak knee to

prevent buckling. Let the person know, on a count of 3 stand

& pivot (i.e. 1, 2, 3 stand & pivot). May use rocking motion to gain momentum to stand up if the person is extremely weak.

Make sure you keep your back straight, bend your knees, use legs to lift.

If the person must hold on to you, have they held your waist or shoulder, NOT NECK!

Sliding board transfers Place wheelchair parallel next to the bed. Raise the bed slightly higher than the

wheelchair if you are getting out of bed. Lower the bed slightly lower than the

wheelchair if you are going back to bed. Remove arm rest of the side of the bed. Have the person lean away from the

direction they are going to place the sliding board under that cheek.

Sliding board transfers Make sure the sliding board bridge the

gap securely. Have to person to push down with their

hands to scoot across the board if they are able. Make sure their fingers are not under the board.

Have your foot point towards the direction you’re going. Bend your knees. Keep back straight & help slide over.

Bath Tub Transfers Using Transfer Bench To transfer from a wheelchair to a bath bench,

place the wheelchair so that it faces the front of the tub, next to the bench. Remove wheelchair armrest of the side of the bench.

Transfer your torso from the wheelchair to the bench then lift each leg into the tub.

Slide over until you are sitting in front of the backrest in the center of the tub. Grab the arm rest to help you slide over, if needed. Move slowly and avoid twisting to prevent injuries.

To transfer back to the wheelchair, slide over to the edge of the bench, lift each leg over the tub wall, and then transfer your torso into the wheelchair.

Bath Tub Transfers Using Transfer Bench

To transfer to a bath bench from a standing position, sit down on the side of the bench that is outside the tub. Reach out and grab the arm rest for support, if needed.

Lift each leg over the side of the tub wall. Slide your body over to the center of the

bench, with the backrest behind you. To get out of the bathtub, slide over

to the edge of the bench, lift each leg over the tub wall, and push yourself up from the bath bench. Move slowly and avoid twisting to prevent injuries.

Car Transfer Open the door as wide as possible. (may place a plastic

bag on a seat under a towel to make sliding in and out easier.

Place wheelchair next to the car & lock the wheels. (make sure to have enough room for 2).

Stand pivot with then sit on the car seat then swivel legs into the car.

When coming out of the car; reverse the sequence. If able to walk with an walking aid: walk towards the car

seat, turn to back up to the seat then hold on to the car to sit then bring your legs in. Reverse the sequence when coming out of the car. Make sure not to place your hand at where it might get jammed.

Positioning in a Wheelchair Lock the wheelchair. Scooting a person back into a

wheelchair: have the person’s arms crossed then put your hands through under the armpits then hold onto their wrists or grab their pants to scoot back.

Place a small pillow at low back area to maintain a natural curve.

Positioning in a Wheelchair Rest feet on foot pedals. Knees should be

slightly higher than the hips to increase comfort for low back area (It the person had recent total hip replacement, the knees will have to be lower than hips).

It is best to lower wheelchair seat height so that the person’s feet can be flat on the floor with knees at the hip height in order to promote mobility & keep low back in natural curvature. (Should use foot pedals when moving the person in the wheelchair to prevent leg injuries).

Use leg rest to elevate both legs if has problem with edema in the legs.

Positioning in a Wheelchair

Falls If the person is having a lot of pain

& not able to move then call 911.

If the person does not have pain or pain is mild, then bring a chair that the person can grab to get up from the floor.

How to adjust walking devices -Elbow should be bending at about 25 to 30

degree angle to be more advantageous. -Or have the person stand with arms resting at

his or her sides and adjust it so that the handles are at the height of the person’s

wrist. -If the person’s posture falls backward then the

walking device is too tall; it the person bend forward then the walking device is too low.

-Make sure you are wearing the walking shoes when making the measurement.

How to adjust walking devices

How to use a rollator or a four wheeled walker with a seat safely Not to use it like a wheelchair & not to walk

with the walker far from you. Squeeze the brakes like the bicycle brakes

when walking down hills/inclines to slow down the walker. Always keep the wheels locked before sitting in it or standing up from it.

Best to have the walker against a wall or sturdy object to prevent the walker from moving since the brakes have tendency to fail.

Hold on to both handles & pull it towards your buttocks prior to sitting in it.