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 caregiver 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.

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.

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.

Hair & Nail Care

Prevent ingrown or broken nails by cutting and smoothing nails.

Prevent hair matting by a short haircut or by brushing and braiding hair.

Within ACL 3.4, assist with washing hair in the shower and make arrangements for haircuts. Remind to brush hair at routine times of the day.

Oral Hygiene

Within ACL 3.0, prevent dental decay by brushing teeth for the person after allowing them to brush for a brief duration with constant directives.

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. Provide cues to wipe mouth.

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.

Reaching out can be encouraged by cuing them 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 if a schedule for toileting cannot be established.

When the floors are not slippery, a stable shower chair with armrests and non-slip rubber feet can be suggested. If the floors are extremely slippery when wet, recommend the use of a mobile shower commode chair or wipe the floor dry.

Offer the items one at a time at eye level. Assist with sequencing through the action of dressing by providing cues to move onto the next action. They will require assistance with small buttons and zippers. Larger buttons and modified fastenings maybe attempted in ACL 3.4.

Prevent falls by dressing while seated and removing loose fitting shoes or slippers.

The person requires assistance and constant supervision to complete their self-care activities.

Hands on assistance and constant cueing is required for toileting, showering, and dressing.

Small objects not allowed for children under 3 must be removed for the same reason, i.e. choking to death. This problem for people with a cognitive disability is probably at the worst in ACL 3.2 and 3.4.