MOVEMENT DISORDERS, EXERCISE, AND HOME MODIFICATIONS IN TBI: AFO, WHEELCHAIR, CANE, WALKER

     Following are recommendations for adapting to and using equipment to assist with movement.

AFO (Ankle-Foot-Orthosis)

  1. Using your AFO
    • Your AFO helps keep your foot in position so you can walk better. Always wear the AFO as instructed by your therapist.
    • Always check you skin for redness after wearing the AFO. If the redness does not go away after 5 - 10 minutes, but continues, contact your doctor or the therapist to have the AFO revised.

  2. Caring for your AFO
    • Wipe your AFO with alcohol or with a damp cloth
    • Do not leave your AFO in a car, because the heat will change its shape
    • If your AFO breaks, contact the person, department, or organization that issued you your AFO

Wheelchair

  1. Sitting in Your Wheelchair - If you sit in your wheelchair for a long time, you need to shift your weight to prevent getting skin or pressure sores.
    • Weight shifting - Once every hour, shift your weight to one buttock and hold for about one minute
    • Push-ups - Place your hands on the armrests of the wheelchair and push down to raise your bottom from the seat.

  2. Using Your Wheelchair
    • Getting Out of Your Wheelchair -
      • Place your wheelchair next to the seat into which you are going, so that your strong side is next to the seat
      • Lock the brakes of the wheelchair and swing away the leg rests. If you need to, remove the armrest that is closest to the seat into which you are going
      • Using your arms (or the arm and leg of your strong side), lift your buttocks and scoot toward the seat, little by little

    • Getting Into your Wheelchair
      • If possible, ask someone to place the wheelchair so you scoot towards your stronger side to get into it
      • Make sure the brakes are locked and the leg rests are out of the way
      • Using your arms (or the arm and leg of your strong side), lift your buttocks and scoot toward the wheelchair, little by little

  3. Wheelchair Maintenance
    • Wash the cover of the wheelchair cushion in the washing machine, and then air dry it. Do not put the cushion cover in the dryer
    • If your wheelchair does not have a cushion cover, wipe the cushion with a damp cloth and spray it with disinfectant
    • If your wheelchair needs repair or a replacement part, contact the company that made the chair

Walker

  1. Using your Walker
    • First - Be sure you are wearing non-skid, flat-soled shoes that fit snugly (loose fitting shoes can be dangerous). Avoid wearing sandals or clogs because they do support your weight properly.
    • Place the walker in front of you and partially around you.
    • Adjust the height of the walker by pushing the button each of the walker's legs and sliding the shaft up or down. Make sure the buttons lock back into place and all the legs are the same height.
    • Scoot forward to the edge of the seat. Put one hand on the walker handle. Place the other hand on the seat for support as you get up. Do not place both hands on the walker while getting up or sitting down!
    • Keep both hands firmly on the walker handles, with the elbows only slightly bent, once you are standing.
    • Step forward with the weak leg first.
    • Then step forward with the strong leg
    • Repeat
    • When getting ready to sit down:
      • Turn slowly with the walker.
      • Position yourself so the walker is directly in front of you and you feel the seat behind both knees.
      • Reach back for the seat and slowly lower yourself to sit down.

    Remember: Place one hand on the seat and keep the other hand on the walker when getting up or sitting down.

    Also - You may feel a little dizzy when you first sit up or stand up. Take a few minutes and wait until the dizziness goes a way before walking. If the dizziness does not go away, sit back down and wait a while longer before trying to stand up. If the dizziness does not improve, call for help.

  2. Navigating Curbs with your Walker
    • Going Up Curbs
      • Position yourself in front of the curb
      • Place the walker on the curb. Make sure all four legs of the walker are on the curb
      • Step up with the strong leg
      • Then step up with the weak leg

    • Going Down Curbs
      • First - Place walker on the ground
      • Step down with the weak leg
      • Then step down with the strong leg

    Remember: Up with the good, down with the bad.

Cane

  1. Using a Cane
    • Hold the cane in your stronger hand
    • Adjust the height of the cane by pushing in the metal button and raising or lowering the shaft.
    • Wear non-skid, flat-soled shoes that fit snugly (loose fitting shoes can be dangerous). Avoid wearing sandals or clogs because they do not support your weight properly.
    • Place the cane about 4 inches to the side of your stronger leg and stand with your weight evenly balanced between your feet and the cane.
    • Bend your elbow slightly when you stand with the cane.
    • Move the cane forward
    • Step forward with the weak foot
    • Then step forward with the strong foot
    • Repeat

    Remember: Keep your head up, shoulders back, and back straight!

  2. Navigating Stairs and Curbs with your Cane
    • Going UP stairs and curbs
      • Stand directly in front of the curb or stairs
      • Step up with the strong leg
      • Place the cane on the step, and step up with the weak leg

    • Going DOWN stairs and curbs
      • First - Place the cane on the lower step
      • Step down with the weak leg
      • Then step down with the strong leg

    Remember: Up with the good, down with the bad.

Based on Brain Injury Patient Care and Education Manual, by Pinecrest Rehabilitation Hospital; Neuro section of the Trauma Manual, Jackson Memorial Hospital; and Recovering from Head Injury; a Guide for Patients, by Nova University Neuropsychology Service, and edited for PoinTIS by the Louis Calder Memorial Library of the University of Miami School of Medicine and the PoinTIS Advisory Committee, and on Rehabilitation of Persons with Traumatic Brain Injury, NIH Consensus Statement 1998 Oct. 26-28.