Daily passive range of motion exercises are given for a number of reasons, including the protection of skin integrity, facilitation of properly aligned positioning, comfort and a decrease in the risk of contractures.

To see passive range of motion exercises, click here. http://alsworldwide.org/assets/misc/RANGE_OF_MOTION_EXERCISES_WITH_PHOTOS_copy.pdf

With constant cuing every 20 seconds, attention can be sustained for one to five minutes. We need data about the length of rest periods in between sensory stimulation periods. We also need data on the number of sessions per day that are needed to prevent troublesome behavior.

The length of the sessions could be affected by the selection of cues. The question is: Is there a difference between the length of sessions when sessions A) alternate positive and negative cues or B) provide all positive cues? The longer sessions are the best for that person.

Startle reactions are quick and powerful causes of caregiver injuries that usually occur when the caregiver does not wait. Waiting is required to allow the person time to process the information that there is going to be a change in the position of their body. If the person does not have time to expect a change in position, the fear is for their physical safety. The fear is instant, and the reaction is swift. To prevent the fear, waiting after a command or a gesture as well as pauses during transfers are required.

A top priority goes to maintaining the person's sense of night and day with changes in light and dark as well as noisy versus quiet hours of time. Finally, most residential facilities turn the loud speakers and TVs off and the lights down at night.

The importance of regular schedules for sensory stimulation between meals and after the evening meal in maintaining circadian rhythms has not been established. Experience suggests that the schedule of the 24-hour cycle requires a regular sequence of all of the activities that happen to the person.

The benefits of regularly scheduled sensory stimulation sessions may have a carryover effect that helps to maintain muscle tone. Being alone and frightened flexes the muscles, which may explain why so many people curl up into a fetal position. A sense of contentment or comfort relaxes the muscles, which could prevent curling up and the associated complications such as pressure sores and finger nails growing into their fists.

Pain can become a habit. When nursing care is limited to painful procedures and no positive experiences are provided for days and weeks, an approach by anyone will be perceived as a threat. The recent solution to this problem has been placing them in a stupor with antipsychotic medications.

The person is at high risk of pressure sores as they are unable to spontaneously reposition themselves in response to discomfort. 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 1.0 - 1.2

The person is unable to sit upright. They will be more comfortable being left in bed with the use of an active pressure mattress with regular repositioning.

ACL 1.4

The person may sit in supported sitting for a few minutes to avoid fatigue.

Full seating support focuses on vertical posture:

Slow information processing speed requires time and patience from staff members. Manual handling requires firm pressure to the body part to be moved, followed by counting 20 seconds.

Hoisting usually requires firm shaking to gain attention, followed by slow movements with pauses during the set-up and a series of changes so the person can adjust to changes in position.

When done slowly, changes in position can be done without causing startle reflexes.

Poor postural control requires the full assistance of two staff members.

Poor head control requires head support.

Reduce the risk of falls by using bed rails. Bed rails should be left up during care to prevent accidentally rolling out of bed during care giving. If an extremity starts to slide off the bed, the effects of gravity may not be perceived or corrected. The rail protects them from sliding off the bed.

This is not a restraint because the person is unable to sit up to get out of bed independently. The rails offer protection during unexpected startle reactions.