Experiencing falls, near misses, and being yelled at rarely prevents falls. The most effective prevention of falls is a regular daily schedule for sitting, standing and stepping forward for the sole purpose of preserving muscle strength and balance. Due to an inability to regain their balance when it is lost, falls must be prevented by the assistance of two people and equipment. Specifically designed standing tables or stepping forward supports with their weight on forearm rests are usually required. Preventing falls with this group is labor intensive and the equipment is usually expensive.
When functioning in ACL 2.0 and 2.2, they are not able to understand their risk of falling when they try to standup. The causes of the falls are poor balance and bending their knees. When they are awake, the number of attempts to standup per hour may be as high as 24 or once every 2½ minutes. Use a stop watch and record individual times.
Finding objects that will capture and sustain their attention is difficult, and hand-over-hand assistance is labor intensive. Pictures and coffee table books might help people stay seated for a little while. Pictures are apt to be more effective if they have personal meanings. For example, I have river rafted around that rock and would love to talk about it.
Startle reactions can occur during transfers. Care must be taken to avoid sudden postural adjustments, which may cause startle reflexes. The transfer procedures described in ACL 1 still apply.
Many people try to climb over the bed rails beginning in ACL 2.2, and a floor lying bed lowers the mattress to nearly floor height.
The person will not be able to use the pull cord or call for nursing help until they become goal directed in ACL 4.0.
A pressure sensor warns caregivers when the person has shifted off the mattress. If false alerts are made or the facility does not accommodate a bed mattress sensor, you may require a hard-wired alert system. If the bed sensor warning is only activated when the person has fallen, then other systems such as infrared devices that are activated when the beam is broken.
A lap tray or table can be used when seated in a chair / wheelchair when the person is engaged in doing an activity that requires the use of a horizontal surface to place material objects such as food and sensory stimulation supplies. Facility restraint policies may need to be updated to comply with the person's ability to function.
Startle and combative reactions are still a hazard if hands on assistance is too fast.
When functioning in ACL 2.4, they can walk. The bed rails go down because they may try to climb over them to get up and walk. The bed rails are considered a restraint in ACL 2.4 because the person is able to get out of bed independently and walk away. Within ACL 2.0 and 2.2, they want to get out of bed and walk away, but they cannot because they fall down immediately without support. Immediately is defined as in less than two minutes. Bed rails are not a restraint when they protect the person from self-injury.