AM

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.

Delegation & Professional Considerations