3.6 Mobility, Transfers, and Range of Motion

Why Mobility Is Heavily Tested

Falls and CNA back injuries are the two top sources of cost and harm in long-term care. North Carolina facilities are required to use safe-resident-handling policies, and the NNAAP skills test almost always includes at least one transfer or ambulation station — gait belt, sit-to-stand transfer, or wheelchair-to-bed with mechanical lift.

Body Mechanics for the CNA

Body mechanics is how you use your own body to move a load safely.

• Wide base of support — feet shoulder-width apart, one foot slightly in front of the other.
• Bend at the knees and hips, NOT at the back. Keep the back straight.
• Hold the load close to your body — the further the load from your center, the more strain on your spine.
• Push rather than pull when possible — pushing uses larger muscles safely.
• Pivot with your feet — never twist your back.
• Face what you are moving so the work is in front of you.
• Use the strongest muscles (legs and arms), not your back.
• Ask for help — never lift a resident alone if a two-person assist or mechanical lift is ordered.

Pre-Transfer Checklist

Before every transfer:

1. Check the care plan for weight-bearing status and required assist level.
2. Gather equipment (gait belt, transfer board, lift) and clear the path.
3. Lock wheelchair brakes; raise or remove footrests.
4. Lower the bed to a height where the resident's feet touch the floor.
5. Apply non-slip footwear.
6. Explain the steps; count out loud ("On three: one, two, three").

Gait Belt Use

A gait belt is a wide canvas belt that gives the CNA a safe handhold around the resident's waist during ambulation and transfers.

• Apply the belt around the waist, over clothing (never on bare skin).
• Check fit: there should be about four fingers of space between the belt and the resident's body — snug but not tight.
• Grasp the belt underhand (palm up) for a stronger grip.
• Do not use a gait belt on residents with abdominal incisions, ostomies, fractured ribs, severe respiratory conditions, or recent abdominal surgery — check the care plan.

Transfer Techniques

Stand-and-Pivot Transfer (Bed to Chair)

1. Position the chair on the resident's strong side, parallel or at a slight angle to the bed.
2. Lock the chair's brakes; raise footrests.
3. Help the resident to sit on the edge of the bed; let the resident dangle legs briefly (prevents dizziness from orthostatic hypotension).
4. Apply the gait belt.
5. Brace your knees against the resident's weaker knee.
6. On a count of three, have the resident push down on the bed with their hands while you lift up on the gait belt.
7. Pivot together with small steps until the back of the resident's legs touch the chair.
8. Have the resident reach back for the armrests and lower slowly.

Mechanical (Hoyer) Lift

• Always use two trained CNAs — one operates the lift, one guides and supports the resident.
• Verify the sling is correct for the resident's size and the task.
• Check that the resident's weight is within the lift's rated capacity.
• Position the sling smoothly under the resident, attach all four straps, raise just enough to clear the bed, and move slowly. Lower gently with the resident's feet supported.

Wheelchair Safety

• Lock both brakes before any transfer in or out of the chair.
• Raise or remove footrests before standing, so the resident does not step on them.
• Never tilt or push a wheelchair down a curb without checking the resident's balance and securing them.
• Back the wheelchair down ramps and into elevators; push forward up ramps.
• Check that the resident's feet rest flat on the footrests and arms are inside the armrests during travel.
• Do not leave a fall-risk resident alone in a chair without locked brakes or proper supervision.

Ambulation with Assistive Devices

The rules are short and high-yield for the NNAAP.

Cane

• The cane is held on the STRONG (unaffected) side.
• Sequence: cane forward → weak leg forward → strong leg forward.
• Cane height: top of the cane reaches the crease of the wrist when the arm is relaxed at the side.

Walker

• Sequence: walker forward (about 6 inches) → weak leg forward → strong leg forward.
• All four legs of the walker must touch the floor before stepping (unless the walker has wheels).
• Walker height: handles reach the crease of the wrist when the resident stands relaxed.
• Resident should stand inside the walker, not behind it.

Crutches

• Weight should be borne on the hands, not the armpits (axillary nerve damage and rash).
• Sequence depends on the prescribed gait (CNA does not modify); follow the physical therapist's plan.

Range of Motion (ROM)

ROM exercises move each joint through its normal range to prevent contractures, maintain circulation, and preserve joint function for residents with limited mobility.

Types

Key Joint Movements (and Where You Use Them)

• Flexion / Extension — bending and straightening (elbow, knee, wrist, fingers)
• Abduction / Adduction — away from the midline / toward the midline (arms, legs)
• Internal / External Rotation — turning a joint inward or outward (hip, shoulder)
• Supination / Pronation — palm up / palm down (forearm)
• Dorsiflexion / Plantar flexion — toes up / toes down (ankle)
• Inversion / Eversion — sole inward / sole outward (ankle)
• Circumduction — circular motion (shoulder, hip)

Safety Rules

• Support the joint above and below with your hands.
• Move slowly, smoothly, and only to the point of mild resistance — never force.
• Repeat each movement 3–5 times per joint, unless the care plan says otherwise.
• Work head-to-toe to be consistent and avoid skipping joints.
• Stop immediately for pain, swelling, redness, or a click/pop — and report to the nurse.
• Never perform ROM on a joint that is swollen, painful, red, or recently injured without nursing direction.

When to Stop and Call the Nurse

• Resident becomes pale, sweaty, dizzy, short of breath, or has chest pain
• A new pop, click, or swelling in a joint during ROM
• A fall — even if the resident says they are fine, do not move them; check for injury and call the nurse
• Equipment malfunction (lift, brake, walker)