Mobility II: Assistive Devices and Sprains/Strains

Student Learning Objectives

• Safe Gait Belt Use: Identify the proper and safe application and utilization of a transfer/gait belt.

• Assistive Device Differentiation: Distinguish between the different categories and types of assistive devices, including crutches, canes, and walkers.

• Assessment of Use: Evaluate and assess the appropriate application of various assistive devices for patient care.

• Injuries - Sprains vs. Strains: Identify the clinical differences between sprains and strains and their respective medical treatments.

Transfer and Gait Belts

• Definition and Purpose: A gait belt is an assistive device used for transferring a person, assisting with the transition between sitting and standing, and providing help during ambulation.

• Application: The belt is secured firmly around the patient's waist. Caregivers grasp the belt to assist in lifting or moving the person.

• Pre-use Assessments: Prior to using a gait belt, nursing staff must complete specific assessments of the patient's condition.

• Contraindications: Use is contraindicated in specific patient scenarios (e.g., certain abdominal surgeries, specific injuries, or physiological conditions that preclude pressure on the waist).

Steps for Proper Gait Belt Utilization

• Preparation:

  • Assist the client into a sitting position with their feet flat on the floor.

  • Place the belt securely around the client's waist.

  • Firmly grasp the belt.

  • The caregiver must maintain a wide base of support with knees and hips flexed to prevent injury.

• Standing Procedure:

  • Gently rock the patient back and forth.

  • Initiate the stand on the count of three.

  • As the patient stands, the caregiver should brace the patient's weak knee with their own knee.

• Transferring to a Chair:

  • Have the client pivot on their back foot.

  • Ensure the client can feel the chair against the back of their legs.

  • Instruct the client to grasp the chair armrests as they lower themselves.

• Using with Assistive Devices:

  • The client must firmly grasp the assistive device (cane, walker, etc.) prior to initiating walking.

  • The caregiver must maintain a constant grip on the gait belt throughout the entire duration of ambulation.

• Safety Priority: Safety is the primary concern; caregivers should always ask for another person to assist if the transfer or ambulation seems unsafe for a single person.

Crutches

• Types of Crutches (Figure 26.6):

  • Axillary (A): The standard crutch that fits under the axilla (armpit).

  • Forearm (B): Also known as Lofstrand or Canadian crutches, featuring a cuff that encircles the forearm.

  • Platform (C): Used for patients who cannot bear weight on their wrists or hands, allowing weight to be borne on the forearm.

• The Tripod Position:

  • All forms of crutch walking begin from the tripod position.

  • Crutches should be placed a couple of inches in front of the feet.

  • The crutch points should be exactly $6$ inches from the patient's center.

  • In this configuration, the crutches and the body form a stable triangle.

Crutch Walking Gait Patterns

• Non-Weight Bearing (NWB) Lower Extremity:

  • Indications: Amputated, disabled, or severely injured leg.

  • Gait: Both crutches move forward simultaneously, followed by the weight-bearing (unaffected) leg.

  • Instructions:

    1. Stand in the tripod position with the affected leg held off the floor.

    2. Move both crutches forward.

    3. Bring the unaffected leg up to the level of the crutches.

    4. Maintain zero weight on the affected leg.

• Partial Weight Bearing (PWB) Lower Extremity:

  • Indications: Amputees with a new prosthesis, minor injury to one leg, healing injury, or specific PWB orders.

  • Gait: Both crutches move forward with the weaker (affected) leg, then the strong leg is moved parallel to the weaker leg.

  • Instructions:

    1. Stand with feet even.

    2. Advance both crutches and the affected leg at the same time.

    3. Advance the unaffected leg to meet them.

Ambulating with Canes

• Types of Canes:

  • Single point canes.

  • Quad Cane (provides a wider base of support with four points of contact).

• Ambulation Techniques:

  • Positioning: Place the cane on the strong (unaffected) side of the body.

  • Posture: Stand upright with the cane positioned $4-6$ inches to the side of the toes.

  • Movement Path: Move the cane forward approximately $6-10$ inches at the exact same time as the affected (weaker) leg.

  • Follow-through: Take the next step with the unaffected (strong) leg.

  • Stability Warning: Do not lean on the cane when getting out of a chair.

• Mnemonic (COAL): Cane Opposite Affected Leg.

Navigating Stairs with Assistive Devices

• Using Crutches:

  • Going Up Stairs:

    1. Place the strong leg on the stair first.

    2. Place the crutches on the stair.

    3. Put weight on the crutches.

    4. Bring the affected leg up to the stair.

  • Going Down Stairs:

    1. Place the crutches and the affected leg down onto the stair first.

    2. Bring the strong leg down to the stair.

• Using a Cane:

  • Going Up Stairs:

    1. Place the strong leg on the stair.

    2. Move the cane and the affected leg up to the step simultaneously.

  • Going Down Stairs:

    1. Place the cane and the affected leg down onto the stair first.

    2. Bring the strong leg down to the stair.

Walkers

• Types of Walkers:

  • Stationary walker (no wheels).

  • Wheeled or rolling walker.

  • Rolling walker with a built-in seat.

• Measuring for a Walker:

  • The patient should stand inside the walker with their hands at their sides.

  • The walker handles should be level with the patient's wrist.

  • Elbows should be flexed at approximately $30$ degrees when the walker is in use.

  • The patient rests hands lightly on the sides with the indicated flex.

• Mnemonic: "Wandering Wilma" (Walker Always Leads).

Ambulating with a Stationary Walker

• Standard Ambulation:

  • Stand within the frame of the walker.

  • Hold onto the padded handgrips with a light grip.

  • Pick up the walker and advance it forward approximately $4-6$ inches.

  • Step forward into the walker, but do not step to the very front, as this can make the patient unsteady.

• Ambulation with Partial Weight Bearing (PWB):

  • Hold the padded handgrips.

  • Pick up the walker and advance it forward $4-6$ inches while simultaneously advancing the affected leg into the walker.

  • Advance the unaffected leg into the walker to complete the step.

Sprains and Strains

• Sprains:

  • Definition: Overstretching that leads to a partial or complete tear of the ligaments.

  • Clinical Presentation: Mild tenderness to palpation and slight edema.

• Strains:

  • Definition: A partial or complete rupture of the muscle.

  • Clinical Presentation: Pain, bruising, edema, and decreased function of the affected side.

Interventions for Sprains and Strains: RICE

• Rest: Limit movement of the injured area.

• Ice: Ice the affected area for $20-30$ minutes. Provide $10-15$ minute breaks between applications. This is critical during the acute phase of injury (the first $24-48$ hours).

• Heat: Warm heat can be applied intermittently for $20-30$ minutes, but only AFTER the acute phase has passed.

• Compression: Apply a compression wrap to the affected extremity. Removal frequency depends on the degree and severity of the injury.

• Elevation: Elevate the affected extremity, attempting to position it above heart level.

• Pharmacology: Administer non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants to decrease pain and edema.

• Surgery: Surgical intervention may be necessary for severe ruptures or tears.

Ace Wraps

• Sizing: Ace wraps range in width from $1$ inch to $6$ inches.

• Selection: The size used is dependent on the person's physical size and the specific joint being wrapped.

• Guidelines:

  • $2$ inch wraps: Used for ankles or wrists.

  • $3-4$ inch wraps: Used for knees.

  • $6$ inch wraps: Used for status post above-the-knee amputations (AKA).