Assistive device

Overview of Assistive Devices: Crutches, Canes, and Walkers

• Importance of understanding assistive devices for nursing students, especially during exams.

Crutches

Proper Fit

• Adjustment: Crutches must be adjusted for the patient's height, with adjustable components on both the bottom and top.

• Gap Between Crutch Rest and Axilla:

  • Ideal gap: 2 to 3 fingers width (approximately 1 to 1.5 inches).

  • Purpose: Prevents pressure on the axillary nerves, which can cause discomfort and nerve damage.

• Hand Grip Height:

  • Hand grips should align with the top of the hip line.

  • Elbow should be slightly bent at approximately 30 degrees when using hand grips.

Types of Gaits with Crutches

• Importance of understanding gaits for exams, as descriptions may require identification.

• Safety: Patients should wear a gait belt before ambulating with crutches.

• Tripod Position:

  • Position where the crutches are set about 6 inches out diagonally from the feet, forming a triangle.

Gait Variations

1. Two-Point Gait

   • Points on the Ground: 2 (one crutch, one foot).

   • Movement:

     • Move the crutch on the injured side (e.g., right) and the left foot together, followed by the left crutch and the right foot together.

2. Four-Point Gait

   • Points on the Ground: 4 (two crutches, two feet).

   • Movement:

     • Move the right crutch, then the left foot, then the left crutch, followed by the right foot. Each point moves separately.

3. Three-Point Gait

   • Points on the Ground: 3 (two crutches, one foot).

   • Movement:

     • Move both crutches and the injured leg simultaneously, followed by the non-injured leg.

4. Swing Gait Variations

   • Swing-To Gait:

     • Move both crutches forward, then swing both legs to the placement of the crutches.

   • Swing-Through Gait:

     • Move both crutches forward, then swing both legs past the placement of the crutches.

Navigating Stairs with Crutches

• Up the Stairs:

  • Sequence: Good leg first (the strong leg), then crutches, then the bad leg.

  • Mnemonic: "Good Up, Bad Down."

• Down the Stairs:

  • Sequence: Crutches go down first, then the bad leg, followed by the good leg.

Sitting Down and Standing Up with Crutches

• Sitting Down:

  • Back up to the chair, position the non-injured leg in front of the chair, place crutches in position to facilitate sitting.

• Standing Up:

  • Push off from the chair using crutches, ensuring balance when transitioning from sitting to standing.

Canes

Proper Fit

• Adjustment: Canes must be adjusted height-wise before use.

• Fit Indicators:

  • Top of cane should be even with the greater trochanter of femur or wrist crease closest to the hand.

  • Elbow should be flexed at a 15 to 30 degree angle when holding the cane.

Walking with a Cane

• Safety: Gait belt should be used, and the nurse should stand on the patient's weak side for support.

• Positioning: The tip of the cane should be positioned about 4 inches from the side of the foot on the strong side.

• Ambulation:

  • Move the cane and the weak side forward together followed by the strong side.

Navigating Stairs with a Cane

• Up the Stairs:

  • Sequence: The good leg (strong leg) goes up first with weight placed on the cane, followed by the cane and bad leg.

• Down the Stairs:

  • Sequence: Move the cane down onto the step with the bad leg first, then the good leg.

Sitting Down and Standing Up with a Cane

• Sitting Down: Similar to crutches, back up to the chair and place the non-injured leg in front to facilitate sitting.

• Standing Up: Move the cane to a safe position and use it for balance while getting up from the chair.