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.

Managing the person's constant walking and protecting them from exhaustion is a real challenge. Designing an environment where they can keep walking with plenty of sturdy seating at regular intervals with regular drink and meal breaks will help balance their need for movement information and their other needs.

When the person sees a step, curb or a set of stairs as a barrier it is because they cannot imagine the vertical line that makes a connection between the placement of the feet and the changes in height. They do not know how to position their feet, which is frightening. If forced to step up or down, they are apt to have a combative reaction to protect their perception of their need for survival.

Some people develop a sense of confinement that results in endless banging on doors and the shaking of gates. There are others that caregivers misidentify as making "persistent attempts to escape" that may really be a fear of confinement. Both problems can be solved by taking them through the door for a short "walkabout" that brings them back to where they came from. Without a sense of direction, they will probably not realize that they are back or object if they do. Their goal was to get through the door, which is different than making an escape.

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

Caregivers are still required to check for pressure sores due to poor fitting shoes and other high risk areas.

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.

Ambulating individuals: Provide flat floors/walkways for walking; monitor for the avoidance of barriers above knee height and remove objects below knee height. Provide options to walk, sit or lie down. For group activity and exercise, can begin going on guided "walkabouts". Although capable of "walking", they may tend to just shuffle along due to not being able to fully perceive (and control) the relationship between their feet and external surface below their knees.

The person's ability to transfer independently from surfaces of adequate height and from chairs with arm rests may be present at this level of cognitive functioning if there are no other factors that reduce their physical function.

Use appropriate aids such as transfer belts or hoist if mobility is affected.

Without other physical deficits, the person is able to transfer on and off surfaces independently. The bedrails and lockable seat belts are now considered restraints.

A sense of losing their balance is followed by a reflex to grab on to anything for support. Because their balance is not very dependable, grabbing on is frequent. The furniture in their pathway must have hand holds and be sturdy enough to hold them up. Once they grab on it usually takes a few minutes before they are comfortable and stop holding on tight.

Hair & Nail Care

Prevent ingrown or broken nails by cutting and smoothing nails.

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

Oral Hygiene

Use oral swabs or a child's toothbrush training set for stimulating or desensitizing oral tissues, oral motor facilitation and cleaning their mouth. Use child toothpaste that can be swallowed, and place mouthwash on a cloth.

Nutritional intake and resting may be supported by providing places to sit and eat some favorite finger foods. Easily swallowed finger food such as marshmallows may sustain their attention for a few minutes when a rest period is needed.