Managing movement difficulties

In the early days and when medication is effective, people with Parkinson’s can remain independent in most activities. But over time and when medication is not working well, movement difficulties generally emerge. You may then need to assist with walking, turning and getting out of a chair or bed.

Caution! This information should be adapted to suit your abilities and needs and those of the person you care for. This does not replace the advice of your healthcare professionals and you should always refer to them if you have any queries.

Strategies and cues to help with movement difficulties

When assisting with movement it is important for both of you that it is done safely, taking into account your individual abilities and limitations. Parkinson’s is different for every person and symptoms can vary from day-to-day and even hour-to-hour. Strategies that work for one person may not for another, so make a note of what seems to work for both of you. For examples of strategies that may be helpful see Coping Strategies.

As well as assisting the person you care for, using cues or other movement strategies can help protect your back as they minimise the physical effort involved by encouraging the person to be part of the movement.

For detailed information on cueing and movement strategies see How can I help myself? within Falls, Freezing, Gait and Rigidity.

Techniques and tips for safe movement

As Parkinson’s progresses cues may no longer work well and you may need to help much more with movement. Other treatments such as deep brain stimulation (DBS) or continuous dopaminergic stimulation  may be suggested but in the meantime, it is important to understand the risks of moving someone who is frail or unsteady and to plan any manoeuvre carefully. This will minimise the chance of falling, slipping or damaging your back.

One of the most important principles of helping someone to move safely is to allow them to do as much as possible themselves, and letting them control their movement as far as they are able. Avoid taking over or rushing; rather allow them to move in their own time and within their own abilities. If you think that you will be unable to safely help someone to move on your own, then ask for assistance before you try.

Never push or pull someone when they need to move and remember that people with Parkinson’s are often slow and must be given plenty of time.

Equipment

A wide variety of equipment has been designed to assist with safely moving another person, for example:

  • slide sheets to help roll, tilt or slide a person with minimal strain to yourself
  • standing and turning aids
  • electric recliner or riser chairs
  • electric beds which allow the height of the bed and the elevation of the head position to be adjusted
  • transfer boards for moving from one item of furniture to another
  • stair lifts.

Always allow the equipment to take as much strain as possible to protect your health, particularly your back. It’s hard to be a good carer if you are injured! An occupational therapist, physiotherapist, nurse or specialist back care adviser will be able to advise on specific aids and appropriate techniques to help you. Ask them to show you how to use the aids or oversee and correct whilst you do so. If ever you don’t feel safe or comfortable doing what is asked of you, then you should always say so.

Key points for safely helping someone move

  • Explain what you are going to do before you start moving the person
  • Let them know how they can help you, even if it’s just by relaxing and doing nothing at all!
  • Decide on the correct position for the manoeuvre, such as on the person’s least painful side or so that you can see their face if this helps with communication
  • Make sure that you have plenty of space and no obstacles where you plan to move to
  • Stand as close as possible to the person you are going to move as this will reduce strain on your back
  • Place your feet comfortably apart so that you are well balanced and in a solid position, also ensuring that you can move forwards and backwards as well as side-to-side
  • To reduce the risk of straining your back, always bend at the knees using your thigh muscles to take the weight and avoid twisting or bending at the waist
  • Use roll, tilt and slide techniques instead of lifting wherever possible
  • If the person you care for experiences muscular rigidity, then it is advisable to flex the limbs before attempting to move them. This is particularly important if they have been lying or sitting in the same position for some time. For example, if they have been sitting then flex the knees several times or if they have been lying down bend the legs.

Guide to helping someone transfer from a wheelchair to a bed

Caution! If you intend to move someone on your own, it is important that they can weight bear and move their feet a bit. If they cannot do this, you will need an extra person to help.

Using a slide sheet is the easiest way to help someone move in bed. If you don’t have one, then you can improvise in the short term by using a good quality plastic sheet or bag as a substitute (you will need to cut the sealed end off the bag to form a tube).

Step 1

 

Place the chair parallel to the bed, ensure that the brake is on, the footplate is up and, if possible, remove the armrest nearest to the bed.

Step 2

Stand on the other side of the person to the bed, facing the same direction and with your feet apart, one foot in front of the other.

Make sure that the person’s feet are positioned for standing.

Bend your knees and put your arm around them, placing one hand on the person's farthest hip and with your other hand take hold of their nearest hand.

Step 3

Ask them to lean forwards and together move forward and stand up.

Step 4

Once the person is stood upright, ask them to move around with you so that their back is facing and near to the bed.

Step 5

Bend your knees and help sit the person down on the side of the bed.

 

Guide to turning someone in bed

Important! Great care must be taken that the person does not roll out of bed when being turned. It is best if a second person stands at the other side of the bed or that something is placed there to prevent this occurring.

Step 1

Decide which way the person wants to face. The arm on that side should be bent at the elbow with the palm facing up at the side of their head.

Gently roll them onto one side and place the slide sheet under the person’s lower back, buttocks and upper thighs. Then roll on the opposite side to manoeuvre the slide sheet into position.

Step 2

Cross the ankles or bend the person’s knee on the opposite side to the way they will be turning.

Step 3

Stand at the side of the bed opposite to where the person wants to face, grasp the upper layer of the slide sheet and gently ease them over.

 

Guide for two people moving someone up a bed

The slide sheet should be positioned as before and used as follows:

Step 1

Ask the person to be moved to fold their arms across their abdomen or chest.

Step 2

Both carers should stand at either side of the bed facing each other.

Each of you should place your feet side by side with the foot nearest to the bedhead pointing in that direction with the knee slightly bent and your weight on the leg farthest from the bedhead.

Together both carers grasp the slide sheet and transfer their weight to the front leg bringing the person on the slide sheet with them.

Step 3

Stand at the side of the bed opposite to where the person wants to face, grasp the upper layer of the slide sheet and gently ease them over.

Always remove the slide sheet once the transfer is complete.

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