Walking requires flat floors and sidewalks with no steps, curbs, thresholds or any other irregularities below the knees. Although capable of "walking," the reality is that they tend to just shuffle along.
They do not pay attention to lifting their feet and trip over large and small obstacles below their knees. When cued to these obstacles, they will probably ignore the cue because they are unable to pay attention to it. Provide open spaces with plenty of stable seating for them to sit on when they are tired. Ensure there are no unstable or fragile furnishings that can contribute to a fall.
Carers need to check for pressure sores caused by poor fitting shoes.
"Walking" the Wheelchair
Footplates maybe removed to allow "walking" their wheelchair for brief periods. The person may only be strong enough to effectively "walk" on the least resistive floor surfaces.
Contact with the floor is comforting ("grounding") and can be facilitated with seated rocking mechanisms that allow them to "push" both feet on and off the floor. They are able to create their own rhythmical rocking effect as they wish, which can also build some strength and endurance in the process.
If unable to propel themselves, agitation and yelling may be prevented or reduced by taking the person outside or on a tour of the building. A regular schedule for moving them around brings order to their quality of life which carries over into a sense of security and reduced yelling.
Ambulatory with Support Required
Lower limb weakness and hemiplegia are a challenge because they are unable to use a walker. The individual cannot pay attention to the voluntary grasp and release needed for the effective use of a rolling walker. Hands-free pelvis supported walkers are nearly impossible for most adults because they are so hard to get in and out of. Once in them, constant supervision is still required because they tip over.
Assisted walking is usually done with two people and a support belt.
The person may walk 2 or 3 yards (meters).