Their inability to understand that they cannot weight bear is not going to change. Caregivers have been trying to change that for decades and nothing works; they still try to standup, walk and fall down.

There are four choices: walking with two people in forearm supportive frames, over sedation, falling down or keeping them busy.

Distractions with seated activities or wheeling them around to various locations in and out of doors may produce a slight decrease in falls. After walking, seated activities are more apt to capture and sustain their attention.

Two or three people walking one person twice a day for 30 minutes is labor intensive. The trouble is that that is still not enough for some people within ACL 2.2. Additional sensory stimulation will probably be required to prevent the yelling.

Medical necessities have been limited to biological needs and the psychological needs to be upright and walking is not currently a part of the quality of care. The quality of care is being expanded to include the quality of life.

Their loved ones may not know that they can voice an opinion about their preferences and may be happy to indulge their simple wishes.

Persistent yelling is alarming to family and friends and several explanations of what is happening may be required. If hand-over-hand assistance while sitting in a regular wheelchair is effective, they may be reassured and appreciate the opportunity to be involved in providing assistance.

They will probably be more successful in taking a regular wheelchair outside than a gel chair or tub because they are so heavy.

Ask the person yes / no questions for answers to questions about their food and comfort preferences using word and gestures like holding up only one item at a time and see if they nod at the item. Their preferences should be honored when possible.

Their use of language is similar to that of a 2-year-old child. Simple nouns and verb and short instructions such as "Let go", "Wipe your face" are understood. Long sentences and explanations are apt to be ignored.

Their use of language is apt to be limited to immediate experiences with real objects.

Persistent yelling is disturbing to everyone. Explaining the urge to walk and what is or is not being done about it helps some. Most people do not know that a person with a severe cognitive disability can have a decent quality of life.

Their attention to different parts of the body is accompanied by an increased awareness of the feel of tactile cues in different locations. Seated activities can use this awareness with tactile cues and different textures: fur, satin, rough fabric, velvet, feathers, balloons, vibrators, body lotion, facial mask, bubbles, and warm air or water.

They can spontaneously move from sit to stand and stand to sit. The universal gesture to sit on a different surface is to pat on the surface where you want the person to sit on. Standing up and trying to step forward is what they are apt to do. As their balance is poor, you will need to be ready with a walking frame and appropriate assistance.

Walking with a forearm support frame requires two people to maintain balance and guide the movement of their legs. A consistent schedule for walking may be learned in 2 or 3 weeks and reduces the yelling and efforts to stand. After that occurs, sitting and moving with hand-over-hand assistance may be more effective.

Walking with a forearm support frame should be scheduled for the morning and afternoon to meet the need to standup and walk. They can help determine the length of the session by telling caregivers when they are tired, which is usually about 30 minutes.

For the person, their expected task performance is determined by the schedule of opportunities to be sitting up, standing and walking.

Standing is not enough within ACL 2.2 and they need a sense of forward motion. Walking backwards and turning left or right are not possible.

Sustained attention to walking in a forearm support frame is usually about 30 minutes. Once in the morning and once in the afternoon is a common schedule that can prevent yelling.

If their attention can be captured to do something while sitting, they can usually sit in a chair for about 30 minutes without sliding out.