Retraining on how to correctly use walking aids requires constant prompting and supervision as they are relying on their procedural memory. Patience is required by carers. The use of bed and chair alarms to alert carers is required if supervision and assistance is needed to prevent falls.
Non-Weight-Bearing Adherence
Within ACL 4 Low, many people realise that their normal activity performance is impaired by a physical disability. They will usually cooperate with alternatives to walking.
Their learning of a transfer sequence with safety precautions is slow and by rote.
They follow a demonstration and usually try to follow it invariantly (e.g. avoiding falls caused by hypertension by always getting up slowly) with standby for minimum assistance to ensure safety.
Ambulatory with Support Required
A rolling walker is usually safest within ACL 4 Low.
If minimally involved, slow training to re-use a familiar cane or a push front-wheeled walker, but they will require constant supervision.
They may not note the changes in the terrain, a stair, or an object on the ground and may trip. They need to be accompanied to all new locations and environments that are highly stimulus laden or hazardous that they are apt to miss.
Wheelchairs may be preferred for ambulation disabilities as the person may not be able to safely use crutches (avoiding brachial plexus injury) or walkers (not attending to the environment while executing a new sequence of actions; "carrying walker" while walking).
Transfers
Balance tends to be unsteady within ACL 4 Low and a safety belt for transfers is recommended.
Transfers in and out of a wheelchair are a hazard because they rarely remember to lock their brakes.
If the person requires hoisting for transfers, someone else will need to be in-charge of the procedure. The person will likely not comprehend the falls risk involved as secondary consequences do not capture their attention.
Wheelchair Use
If this is a new skill, demonstration of how they can push forward and back is the beginning. Within ACL 4 Low, they will learn to move in a straight line but not a diagonal line. Turning sharp corners may not be possible within ACL 4 Low.
The person functioning within ACL 4 Low does not scan the environment to look out for hazards to avoid. Carers will need to remove dangerous objects and pad sharp objects to protect the person from accidents and skin tears.
Getting people to lock their brakes is also nearly impossible within ACL 4. People have tried bright yellow tape on longer handles, but the success rate is low. Standby supervision to lock the brakes is usually required. Telling them to lock the brakes 1,000 times is rarely successful in teaching them to do it spontaneously because they cannot imagine unintended movement of the wheelchair. As a result, independent transfers in and out of the chair are always a hazard within ACL 4.