The same safety precautions developed for children under the age of three are important because they will put anything in their mouth and when you least expect it. Spontaneous use of their hands is accompanied by putting everything in their mouth, along with the risk of choking.

Advise friends, family members and other caregivers that they are safer with objects that are about 1 inch (2½ cm) in diameter. Equivalent objects have equivalent, single action verbs such as reach, grasp, release, toss, drop, fold, sort, place, handover, wave and pinch.

Pointing out hazards in the physical environment plays a very limited role in fall prevention with severe cognitive disabilities because the person's ability to be careful is limited. Hazards below the knees can be pointed out, but the person's attention to the hazard and the necessary neuromuscular adjustments to be careful are rarely implemented by the person. Most fall preventions with hazards below the knees are done by another person who provides physical assistance.

Conflicts between the person's procedural memories and the management of their poor balance can escalate into battles if the person is forced to sit down to do things they have always done standing up. The need for force can be prevented by starting the procedure, such as taking off their pants and waiting for the person to experience feeling wobbly. Then, saying "please sit down" is usually greeted with relief to be able to sit down.

The ability to transfer off various surfaces at will reduces the risk of pressure sores.

Caregivers will still require to check for pressure sores due to poor fitting shoes and other clothes.

If the person has reduced sensation, caregivers will need to provide appropriate pressure care as the person is unaware of the secondary consequences of poor pressure care.

Ambulatory with Support Required

Lower limb weakness at this mode is it's "own entity" for physical therapy, as a challenge for gait training using assistive devices. The person cannot combine upper and lower body actions at the same time for the effective use of a rolling walker. Hands-free pelvis supported walkers are not easy to access for adults and constant supervision is still required. Schedule assisted walking with a care giver using a support belt or a forearm support frame for them to hold onto.

If the person is unable to transfer independently, hoisting and manual handling will need to comply with the risk assessment and work safety regulations of your facility.

Sturdy furnishings are required when the person is functioning in ACL 3 as they are unlikely to check this.

They are at risk of falls as they do not pay attention to surfaces or objects below knee height. Falls prevention strategies like removing trip hazards, slippery surfaces and confusing markings on the floor. The person can step over an obstacle if a caregiver points it out to the person.

The person is unlikely to remember mobility restrictions. They lack the awareness of an inability to weight bear.

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.

Hair & Nail Care

Prevent ingrown or broken nails by cutting and smoothing nails.

Assist with washing hair in the shower and make arrangements for haircuts. Remind to brush hair at routine times of the day.

Oral Hygiene

Provide objects at appropriate times of the day. Direct to sequence actions, if necessary. Cue to brush unseen surfaces. Clean dentures for them to ensure complete cleanliness/prevent infection. Floss teeth for them, if they agree and can tolerate it.

Eating is very slow and they may need two to three times the usual amount of time to eat. Food must be cut up into small pieces without strings because stringy and not chewed lumps are not noticed and choking is a hazard. Verbal encouragement to continue eating is often necessary.

Prevent spills by filling the cup half full.

Be sure that hot foods and liquids have cooled down before placing them in front of the person because they probably will not check them.

The additional use of grab bars means that they are able to stand while they are assisted with perineal hygiene and clothing adjustments. They can also learn to press down on the safety frame attached to the toilet to standup.

Provide short verbal instructions to wash their hands.

Because they recognize a need to void, they may start searching for a toilet and mistakes can be made. Camouflage items that are often mistaken for toilets. Establish a regular schedule for toileting. Limit the overuse of toilet paper and avoid flooding by providing adequate supervision.