The Memory Unit OT

If the thought of trying to figure how well a human adult can stand up really freaks you out, you’re in the right place.

We’re going to start with the basics of transfer assessment, and then we’ll consider how this applies when working with individuals living with dementia.

Think back to your human development courses: first we learn to sit, then we learn to stand (in short).

When I approach a new-to-me resident or patient, the assessment process is the same. First we sit, then we stand.

If they’re laying in bed when I first enter the room, we’re starting off strong.

I’ll begin by assessing their ability to get to a seated position at the edge of the mattress, denoting how much assistance is required. I’ll then assess sitting balance (by first applying resistance to static sitting and then prompting a functional reach in all planes from this seated position).

Then it’s time to stand up.

I always ask about any prior assistive devices first (ie. “Do you use a walker or a cane at home?”), and will have either a standard or rolling walker with me to incorporate into the evaluation as needed. And of course, the gait belt is donned before any transfer assessment (just in case).

At this point I’m at an ‘if/then’ situation. If they can sit independently at the edge of the bed and don’t demonstrate or express any fear of falling, then I’ll give stand-by assist initially for the transfer, increasing the assist level as needed. If they can sit unsupported independently and do demonstrate or express fear, then I’ll give contact guard assist initially, again increasing the assist level as needed. If they require assistance to sit at the edge of the bed, then I’m definitely going to provide assistance for the transfer (starting at a min assist level and increasing as needed).

We’ll then try a pivot into a chair, followed by a stand-to-sit transfer, all the while denoting how much assist is require for each component of the transfer.

Okay, that all makes sense. But what if this person is living with dementia? What then?

First and foremost, evaluations on the memory unit don’t follow the checklist that other evaluations follow. Everything is mixed together and multiple areas are assessed simultaneously. But for me, the ‘if/then’ situation remains the same.

The resident is laying in bed and states “I’m hungry”. I’m going to say, “Okay, come with me I’ll show you were the snacks are”. If they can get to the edge of the bed independently, then I’ll give stand-by assist initially for the transfer, increasing the assist level as needed. If they require assistance to get to the edge of the bed, then I’ll provide assistance for the transfer (starting at a min assist level and increasing as needed).

I might bring the resident to a seat that doesn’t have back support. Then when I offer a snack, I might hand it to them just out of reach so that they have to weight shift (allowing me to assess dynamic sitting balance).

Everything’s functional. Everything has a purpose.

I’m not going to ask residents on the memory unit to stand up for no reason. I’m going to give the transfer a point, either to get somewhere or to reach something or to try out a new sitting surface. Again, all the while denoting how much assistance is required.

Remember too that any resident you encounter in the skilled nursing setting (or even a home health setting) is going to come with some background information. Talk with the family. Read the hospital notes. Get the verbal report from the nurses.

Use the supports you have. Co-evaluate with your physical therapists. Bring the rehab tech or the LNA in to the evaluation with you. You’re not the only one looking for this information. Work together. Collaborate. Use the safety techniques you’ve been taught all along. You’ve got this.