In the opinion of the NPM, more training of nursing staff with regard to assessment of pain and impact on pain intensity in cognitively impaired persons is urgently necessary, and the commissions have often called for this to occur. Residents, and sometimes their relatives who happened to be present, have indicated to the commissions that pain management is inadequate. The commissions have occasionally criticised that letting residents sit without movement for several hours in folding wheelchairs that are of limited suitability for this, missing headrests and a lack of attention with regard to beginning or advanced contractures (muscle shortening) due to pain-relieving postures, etc. promote pain and also the occurrence of decubitus. Retirement and nursing homes which do not recognise or neglect the problem of pain management deny the residents the quality of care that should be guaranteed.  It is necessary to recognise and assess the pain felt by residents on a regular basis and to counter this by way of measures to alleviate pain.  Professional treatment of pain requires cooperation between nursing staff and doctors, including the persons affected and their relatives.  Training of the entire nursing staff with regard to recognition and assessment of pain in cognitively impaired persons is absolutely necessary. 2.1.2.5. Danger of strangulation when improper restraint in a wheelchair is used During an unannounced visit in a retirement and nursing home, Commission 4 noticed the improper use of the belt of a robe to restrain a person requiring care in a wheelchair. The husband of the woman who was present confirmed that this was not the first time this had happened. At the concluding meeting, neither the head of the nursing staff nor the manager of the facility indicated that they were informed about this. It was explained to them in detail that this form of restraint is not only prohibited, but that it can be life-threatening. In most retirement and nursing homes and in hospitals, the use of medical products that restrict the individual freedom of movement of elderly and/or mentally ill persons who usually have dementia is still an integral component of everyday care. Restraints with straps are used primarily for persons with increased risk of falls, motor restlessness, agitation, intention to self-harm and danger of suicide. Questionable use of restraints using straps Therefore, all efforts must be directed towards enabling the natural need for movement to the greatest extent possible. Restraints using straps, in particular straps around the chest, the stomach or the pelvis, are not just accompanied by the loss of freedom and autonomy. They Ensuring freedom of movement 43