Assistive Devices & Ambulation Study Notes
Overview of Assistive Devices
Assistive devices are prescribed when clients have altered gait or impaired mobility.
Primary goals: improve balance, correct/maintain posture, facilitate safe movement.
Devices covered: gait belts, crutches, canes, walkers.
Ambulation may be delegated to assistive personnel if circumstances are appropriate (RN remains responsible for assessment & safety).
Ethical/practical imperative: safety first during every transfer or ambulation episode.
Universal Safety Precautions Before Standing
Verify client is not dizzy/light-headed.
Have client sit at bedside for ≈ 1 minute before rising.
Ensure footwear: shoes, sneakers, or non-skid socks to reduce fall risk.
Position of the nurse/assistant while walking:
Stand behind and slightly to the side of the client.
If unilateral weakness exists, stand on the weaker side.
Continuous cues to client:
Look forward (not at the floor).
Lift each foot—avoid shuffling.
If client reports weakness/dizziness, return to bed immediately.
Gait Belt
Description: strong white belt placed over clothing at waist.
Application & Fit
Snug but allow fingers to slip underneath to avoid constriction.
Adjust location if abdominal incisions/drains present.
Transfer Technique (bed → standing)
Wrap belt while client is still seated.
Stand in front, hold belt on both sides.
Rock: count “1, 2, 3”; on 3 assist client to stand.
Ambulation
Hold client’s nearest hand + grasp belt posteriorly.
Walk behind & slightly lateral to client.
Crutches
Proper Fit
Crutch pads 1-2 in below axilla.
Handgrip at level of client’s hips.
Elbow flexion 15-30^{\circ}.
Body weight must be through hands, not axilla → prevents brachial plexus nerve damage.
Typically suited for younger adults with adequate upper-extremity strength.
Transition Bed → Standing
Place both crutches in one hand on strong (unaffected) side.
Opposite hand on bedside rail.
Push off with feet to standing.
Basic Standing Stance
Each crutch tip: 6 in lateral to, and 6 in anterior to feet—forms a tripod for balance.
Crutch Gaits
Four-Point (safest; requires partial WB on both legs & coordination)
Sequence: R-crutch → L-foot → L-crutch → R-foot.
Each step ≈ 6-10 in.
Three-Point (no WB on affected leg)
Move both crutches forward bearing weight on strong leg.
Swing strong leg forward to meet crutches; repeat.
Two-Point (partial WB on both legs)
L-foot + R-crutch simultaneously → R-foot + L-crutch; repeat.
Swing-To (full WB both legs; requires arm strength)
Advance both crutches → lift both feet & swing to level of crutch tips.
Swing-Through
Same as swing-to but legs swing past crutches.
Sitting Down
Back up until legs touch bed.
Place both crutches in one hand; opposite hand on side rail; sit.
Stairs Mnemonic
"Up with the good" (lead with strong leg when ascending).
"Down with the bad" (lead with affected leg when descending).
Cane
Sizing & Fit
Client stands with arms at side; cane top aligns with wrist crease.
Wear supportive shoes.
Acronym C O A L → Cane Opposite Affected Leg (hold cane on strong side).
Bed → Standing
Grasp cane in strong hand.
Other hand on side rail; push to stand.
Ambulation Pattern
Place cane 6-12 in ahead & lateral to foot.
Step sequence
Move weak/affected leg forward to be even with cane.
Move strong leg past cane.
Cane tip progression while walking: 6-10 in increments ahead of foot.
Walker
Fit
Client in shoes stands inside walker; arms hanging.
Wrist crease aligns with walker hand grips.
Bed → Standing
One hand on bed, other on side rail—do not pull on walker.
After upright, place hands individually on walker grips.
Walking Sequence
Advance walker + weak leg together 6-8 in.
Shift weight onto arms & weak leg.
Advance strong leg to be even with weak leg.
Contraindications: if unable to bear on weak leg, modify per PT guidelines.