Locating external objects includes people. When combined with increased awareness of the position of body parts and someone moves those body parts without adequate warning, that someone is apt to get hit. Spontaneous abilities to hit and kick are apt to hurt or break something or someone.

Sudden, unexpected movements of parts of the body are threatening to everyone. Within ACL 1.8, the information processing speed is so slow that the definition of sudden requires a new definition: less than 20 seconds is sudden.

The increased attention to the position of their body increases the risk of startle reactions during transfers. The temptation to hurry through a transfer needs to be avoided. When the transfer is done slowly, they can cooperate because their slow information processing speed is accommodated.

The ability to lift and hold usually slows caregivers down enough to wait for the lift. Moving quickly after that can still cause a startle reaction.

The signs of sensory deprivation include persistent jerking, shivering, and tremulous trunk and arm movements in bed for no apparent reason. Moaning, grunting, calling out "help", or "no" or swearing at odd hours for no apparent reason are verbal expressions of distressing sensory deprivation. When a word is used, it seems to be a semiconscious, automatic selection for a sign of distress. A loss of circadian rhythm is common. The signs of distress due to sensory deprivation are the same as the signs for pain, but without a cause for physical pain.

Preserving trunk muscle strength and balance requires daily time spent in an upright position. Data for the length of time and number of times per day is needed. An adequate time can be determined by a sense of well-being that lasts for several hours in the absence of signs of sensory deprivation.

Sensory deprivation occurs in chairs that support their head and trunk while their body is horizontal to the floor because this does not provide opportunities for trunk control to preserve muscle strength or their sense of balance.

Fear may be attached to a specific person or the color of clothing. Fear of everyone may develop if they are only approached for medical necessities. Positive experiences should be initiated as soon as possible because fears can increase and generalize quickly.

The person is aware of discomfort from pressure and may move to prevent pressure sores. Ensure adequate pressure care by careful observations of their skin integrity. Treat pressure sores with appropriate pressure relieving methods such as regular repositioning and use of pressure relieving devices.

Common pressure relieving devices are:

ACL 1.6

The person may sit in fully supported seating for two to three hours per day.

Without full support, the duration is only for a few minutes.

Avoiding fatigue prevents exhaustion and troublesome behavior in the following hours, which may be the next nursing shift.

ACL 1.8

The person may sit in a supported seating for three to four hours per day.

Warning: The longer duration requires pressure care, provided by shifting the weight over boney prominences. Exercising while sitting is a good solution.

Full assistance of two staff members is required with transfers as the person has poor postural control.

A hygiene / access / toileting sling which is easier to apply when in a seated position is preferred to a full body sing. Head support is required to assist with inconsistent head control and poor compliance with instructions.

Hoisting and manual handling will need to comply with risk assessment and work safety regulations of your facility.

Reduce the risk of falling by using bed rails. Prevent accidentally rolling out of bed during care giving by leaving the bed rails up.

Prevent startle reflexes and fear by moving slowly and counting 20 seconds for time to adjust to a new position.

Prevent negative reactions by cuing verbally and with gestures of intent to move, waiting for acknowledgement of intent, moving slowly and allowing time to feel secure before removing support in a new position.

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.