The Whitworths of Arizona, bringing science to you in everyday language.

Friday, March 21, 2014

Chairs, Getting Out and Staying In

Getting Out. A person with a Lewy body disorder (PwLB), either Parkinsons or some form of LBD, may lose their ability to lift themselves out of a chair. This loss of mobility or of knowing how to perform the task, is part of the disorder. At first all that is needed is a little assist. Then it gradually gets more difficult and eventually the caregiver must do most of the work. A major problem is that in trying to help, your loved one does just the opposite, leaning  back and stiffening up instead of leaning forward. Here are some suggestions. You can buy the gait belt, shelf paper and chair wedge from Amazon via the LBD Book Corner.

Use a pillowcase. The job of helping a PwLB stand is easier if he scoots forward in the chair first. However, many people have difficulty doing this. Some just don’t have the strength. Others misinterpret the directions do the leaning back and stiffening up thing. Try putting a pillowcase under in the chair before your loved one sits down. Then, standing at the side of his chair, reach across your loved one’s lap, grab the pillowcase and pull forward. This will slide him forward on that side. Then go to the other side and repeat the process. You may have to do this a couple of times to get him far enough forward.

Use a soft gait belt with handles. You should never try to lift anyone from a chair by grabbing under their arms and pulling up. This puts too much strain on your back and damage the liftee’s shoulder and underarm. Instead, use a gait, or transfer, belt. This belt, fastened around your loved one’s middle provides support for them while giving you a place to pull up safely. However, these belts can be uncomfortable and the PwLB may resist wearing one. Soft gait belts are more comfortable. They also have handles that are easier to use than just the belt.

Use automatic gestures. If you ask your loved one to lean forward and he does the opposite, its his mind sending out the wrong directions to his muscles. Change tactics. Instead of telling him, “OK, lean forward and I’ll help you out of the chair,” stand up straight, reach out one hand as though you are going to shake hands with him, and say, “Come on, let’s go.” He’ll automatically lean forward and reach for your hand. Grab it, and use the movement he’s started to help him stand. The reason this works is because it is automatic. He doesn’t have to think about it. We have been trained since we were small to reach out and take a person’s hand when they offer it. When thinking gets muddy, automatic actions often work much better.

Use the right furniture. Make sure chairs are high enough to get out of easily and have firm armrests. Situate the chair in a place where you can stand at either side and don’t have to lift from the front.

Take care of your back. Second only to caregiver stress, back injuries are a major risk of caregiving. When lifting, always stand with your knees bent and your feet shoulder-width apart. Use the muscles in your legs to lift, not the ones in your back. Stand to one side and use your body as a fulcrum so that and let your loved one do as much of the lifting as he can. Work with a physical therapist to learn the best way to lift your loved one. There are basics techniques but each person is different.

Go slow. This is always important but it is especially important if the people trying to lift your loved one aren’t well known to him. Going at normal speed, let alone fast, may feel like an attack. In such a case, it is natural to stiffen up and try to cling to the chair. Ask the staff to take their time and tell your loved one what they plan to do. Visiting and joking with him a bit helps as well. Family caregivers may have to educate the staff about the best way to do this for their loved one. You may feel that you are paying for them to know this—and you are. However, it is better to teach them and then know that your loved one is getting the care he needs in the gentlest possible way than to refuse to help and see him frightened and resistant.

Staying In. Sometimes the problem is that your loved one slips out of the chair. Tying them in isn’t necessarily safe, for the restraints can actually strangle a person if they slip too far. Here are a couple of suggestions from other caregivers. The down side to both of these suggestions is that you won’t be able to use either of these methods for staying in place AND the pillowslip for lifting. It’s one or the other!

Us e shelf liner: Find some rubberize shelf liner, cut a square and place it in the seat of the chair. This liner is used to keep things from sliding in motorhomes and it will keep your loved one from sliding too.

Use a foam wedge: Buy a firm foam wedge about 2-3” on the high side. Place in the chair with the high side at the front. This extra height may keep your loved one from slipping down.

Find more about LBD in The Caregiver's Guide to Lewy Body Dementia available on in the LBD Book Corner.

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