The hand-under-hand technique is a gentle, supportive method for assisting a person with dementia, but its effectiveness depends heavily on correct body positioning. The best placement is to stand on the person's dominant side and slightly behind them. This approach is less confrontational than facing them directly and provides a more natural and secure way to offer guidance and support.
Why Body Placement Matters in Dementia Care
Body positioning fundamentally alters the dynamic of an interaction, especially for someone who may feel confused or threatened. When you stand on their dominant side and slightly behind, you avoid blocking their forward momentum and allow them to feel more in control of their own movement. A direct, head-on approach can feel intimidating and may trigger a defensive reaction, while a supportive position from the side fosters trust and a sense of partnership.
Furthermore, this placement leverages touch as a form of non-verbal communication. By placing your hand under theirs, you provide a tactile, secure connection that calms rather than controls. The hand-under-hand grip, where your hand is below theirs, turns the interaction into a 'doing with' rather than a 'doing to,' which is key for maintaining dignity. The person with dementia can rest their hand comfortably on yours, allowing them to feel supported without being forced.
Preparing for a Walk with Hand-Under-Hand
Before you begin walking, a proper approach is essential. Start by getting the person's attention from the front, at their eye level, with a calm, friendly tone. Verbally invite them to walk and offer your hand using the hand-under-hand technique. Once the connection is established, move to the optimal side-and-behind position. Clearing the walking path of any clutter, cords, or rugs beforehand is also a crucial safety measure to prevent falls.
Table: Optimal vs. Sub-optimal Walking Positions
| Feature | Optimal Position | Sub-optimal Position |
|---|---|---|
| Body Placement | On the person's dominant side, slightly behind them. | Directly in front, blocking their path. |
| Hand Connection | Hand-under-hand grip, your hand supporting theirs from below. | Grasping their hand from above in a traditional grip. |
| Non-Verbal Cues | Provides a secure, guiding touch; respects personal space. | Can feel threatening or restrictive; may cause anxiety. |
| Impact on Confidence | Enhances their sense of control and independence. | Can reduce confidence and increase resistance. |
| Communication Flow | Maintains an open, cooperative flow of movement. | Creates a sense of confrontation; less responsive. |
Maintaining Safety and Dignity During the Walk
Once walking, it's vital to maintain a patient pace, taking cues from their stride and stamina. If they have a weaker side, offering support from that side can provide additional stability. Your other arm can be placed on their shoulder or back to provide further support and guidance for turning. Speak in a calm, reassuring voice, offering simple encouragement. If they become agitated or want to stop, gently redirect their attention or find a comfortable place to sit and rest. The goal is to make the experience positive and reassuring, not a point of struggle.
Conclusion
Achieving the best placement of your body when walking using hand underhand with someone living with dementia involves more than just a physical technique; it is a holistic approach centered on respect and understanding. By positioning yourself on their dominant side and slightly behind, you foster a non-confrontational, secure environment that promotes movement while preserving the individual's dignity. This practice is a powerful form of non-verbal communication that builds trust and makes walking a positive, bonding experience, rather than a task. It ensures that the person with dementia feels supported and safe, allowing them to remain active and engaged for as long as possible.
Key takeaways:
- Position on the Dominant Side: Stand on the person's dominant side, which is the side they naturally use to reach out.
- Stand Slightly Behind: This placement avoids blocking their visual field and forward momentum, preventing a feeling of being rushed.
- Use Hand-Under-Hand Gently: Your hand supports theirs from below, providing a non-controlling and reassuring grip.
- Maintain Eye Level: When initially approaching or communicating, get down to their eye level to show respect and reduce intimidation.
- Avoid Pushing or Pulling: The goal is to guide, not force. Use the hand-under-hand contact to provide a stable, gentle cue for movement.
- Observe for Cues: Pay attention to their gait, speed, and body language to gauge their comfort and stamina.
- Use Reassuring Communication: Speak in a calm, soothing voice, offering simple words of encouragement throughout the walk.
