CEBU TECHNOLOGICAL UNIVERSITY

In consortium with
CEBU CITY MEDICAL CENTER- COLLEGE OF NURSING
N. Bacalso Ave. cor Panganiban St., 6000 Cebu City, Cebu, Philippines
Tel. Nos. (032)316-5128/(032) 4186105
Email address: ctuccmc_cn@ymail.com

ASSISTING WITH CRUTCHES, CANE OR

WALKER

Name: BONTILAO, JIMNAH RHODRICK M. Level: 3-B

Instructor in Charge: MRS. AISSA CARLIT Date materials checked:

Date performed:

I. Learning Objectives:
a. Define the terminologies related to this procedure.
b. Identify the indications that necessitate the need for crutch walking, cane
& walker.
c. Develop plan of care to restore, maintain and promote health for client
following this procedure.

II. Definition of Terms:

a. CRUTCH – a long stick with a crosspiece at the top, used as a support under the
armpit by a person with an injury or disability.
b. CANE – a long stick used especially by old, ill, or blind people to help them walk
c. WALKER – A walker is a type of mobility aid used to help people who are still able to
walk (e.g., don't require a wheelchair) yet need assistance. It is a four- legged frame
that allows a person to lean on it for balance, support, and rest

III.Purposes:

Client’s who cannot safely walk unassisted can use devices designed to aid them in
walking independently.
a. CRUTCH – can be used by clients who cannot bear any weight on one leg, clients
who can only bear partial weight on one leg, and clients who have full weight bearing on
both legs.
b. CANE – used by clients who can bear weight on both legs but one leg or hip is
weaker or impaired.
c. WALKER – used by clients who require more support than a cane provides. Walkers
are available with or without wheels.

IV. Materials and Supplies needed:

Gait belt and assistive device: crutches, cane, walker
 V. Procedure and Rationale:
PROCEDURE
1. Inform client that you will be assisting with
ambulation using the device chosen
RATIONALE
Reduces anxiety; helps increase
comprehension and cooperation; promotes
client autonomy. this step provides the patient
with an opportunity to ask questions and help
with the positioning.

2. Assess client for strength, mobility and range Helps determine the client’s capabilities and
amount of assistance required.
of motion (ROM), visual acuity, perceptual

difficulties and balance.

NOTE: The nurse and physical therapists work

together on assessment and choosing the correct

assistive equipment for ambulation.

3. Measure client for size of crutches and adjust Provides broad base of support for client.
Space between the crutch pad and the axilla
crutches to fit. While in supine prevents pressure on radial nerves. The elbow
flexion allows for space
measure client from heel to axilla. between the crutch pad and axilla.

4. Provide a robe or other covering as well as To provide client’s safety and to avoid injuries.

non – slip covering or shoes.

5. Lower the height of the bed. Allows client to sit with feet on floor for stability
and This prepares the work environment

6. Dangle the client at the side of the bed for Allows for stabilization of blood pressure, thus
preventing orthostatic hypotension.
several minutes. Assess for vertigo or

nausea.
7. Apply gait belt around the client’s waist if
Provides support; promotes client safety.
balance and stability are unknown or unreliable.

It is good practice to use a gait

belt the first time the client is out of bed.

8. Instruct client on method of holding crutches

while he/she remain seated. This should be with

elbows bent 300 while hands are on the hand Increases client comprehension and
cooperation.
drips and pads 1.5 – 2 inches below the axilla.

Instruct the client to position the crutches 4-5

inches laterally and 4-6 inches in front of feet.

This skill can be demonstrated on yourself to

increase

client’s understanding.

9. Assist the client to a standing position by

placing both crutches in the non- dominant hand.

Then using the dominant hand, push off from

Increases upper body strength.
bed while using the crutches for balance once

erect. The extra crutch can

be moved into the dominant hand.

10. Instruct the client to remain still for a few Standing for a few minutes will assist in
preventing orthostatic hypotension.
seconds while assessing for vertigo and nausea.

Stand close to the client to support as needed.

While the client remains

standing, check for correct fit of crutches.

11. The client’s body weight should be supported To prevent too much pressure on the axillary
area, that may cause damage to nerves and
on the hands and arms, not in vessels. Damage to nerves may cause
decreased in sensation or movement. Damage
the axillary area. to vessels may cause poor circulation.

FOUR POINT GAIT The four-point gait (used for partial or full
weight bearing) provides greater stability.
12. Position the client 4 – 5 to 6 inches to the side Weight bearing is on three points (two
crutches and one foot or two feet and one
and in front of each foot. Move the crutch) at all times. The client must be
able to bear weight with both legs.
right crutch forward and move the left foot,

even with the left crutch. Move the left

crutch forward 4.5 to 5 inches and move the

right foot forward, even with right crutch.

Repeat the 4-point gait procedure.

THREE POINT GAIT
13. Advance both crutches & the weaker leg
forward together 4 – 6 inches. Move the
The three-point gait (used for partial or non-
weight-bearing) provides a strong base of
support. This gait can be used if the client has
a weak or non-weight- bearing leg.

stronger leg forward, even with the

crutches. Repeat three-point gait

procedure.
 TWO POINT GAIT The two-point gait (used for partial weight
bearing) provides a strong base of
14. Move the left crutch and right leg forward 4 – support. The client must be able to bear weight
on both legs.This gait is faster than the four-
6 inches. Move the right crutch and left leg point gait.

forward 4 – 6 inches. Repeat the

two-point gait procedure.

SWING THROUGH GAIT The swing-through gait (used for non- weight-
bearing) permits a faster pace. This gait
15. This step is basically the same with the requires weight bearing on both legs, greater
balance, and more strength.
three-point gait. The difference is that on the

swing, whichever leg is moving will go past the

stationary point and set down in

front.

WALKING UPSTAIRS Standing beside & slightly behind the

client ensures that the patient is safe.
16. Stand beside & slightly behind the client. When walking up, the good leg must
always be stepped forward first to properly
Instruct the client to position the crutches as if support the entire body in pulling up.

walking. Place body weight on hands, and place

strong leg on the first step. Move the crutches &

the weak leg up to the first step.

Repeat the pattern for all steps.

WALKING DOWNSTAIRS Moving crutches down to the next lower

17. Position the crutch as if walking. Place
step first provides support for the patient.
Bad leg must be forwarded and stepped to
the next step first. The good leg on the
upper step will provide stability and support
while descending the stairs
weight on strong leg, move crutches down to the

next lower step. Place partial weight on hands &

crutches. Move the weak leg down to step the

crutches. Move total weight on arms & crutches.

Move strong leg to same step as weak leg and

crutches.

Repeat the pattern for all steps.

18. A second caregiver standing behind the To assist the other caregiver and to avoid
accidents.
client holding on the gait belt will further

decrease risk of falling.

19. Set realistic goals and opportunities for Crutch walking takes up to 10 times the energy
required for unassisted ambulation.
progressive ambulation using crutches.

20. Consult with a physical therapist for the The physical therapist is the expert on the
health care team for crutch-walking
client’s learning to walk with the crutches. techniques.

21. Wash Hands. Reduces the transmission of

microorganisms.

SITTING WITH CRUTCHES To ensure that the chair is already near to

the client and to reach it easily.
22. Instruct the client to back up to chair until it

is felt with the back of the legs.

23. Place both crutches in the non – To avoid being out-balanced.

dominant hand and use the dominant hand

to reach back to the chair.

24. Instruct client to lower slowly in to the To ensure that the client can sit properly
and to avoid accidents.
chair.

WALKING WITH A CANE To assess the client, to ensure the client’s

safety and for continuous procedure.
25. Repeat actions 1 - 7

26. Have the client hold the cane in the hand Promotes safety and cooperation. Promotes
client autonomy. By holding the cane on the
opposite the affected leg. Explain the safety and stronger side the client has more control and
strength for using it.
the body mechanics underlying

the use of a cane on the strong side.

27. Have the client push up from the sitting Increases upper body strength.

position while pushing down to the bed with

arms.

28. Have the client stand at the bedside for Allows the client to gain balance. The nurse
can check for strength and balance.
a few moments.

29. Assess the height of the cane, with the cane A 25%–30% bend at the elbow provides for
better muscle strength and support than if the
placed about 6 inches ahead of the client’s arm is straight.

body. The top of the cane should be at wrist

level with the arm bent 25% to 30%

at the elbow.

30. Walk to the side and slightly behind the client Allows the nurse to provide stability or
assistance if the client needs it.
holding the gait belt, if needed for

stability.

CANE GAIT The cane helps to provide a wide base of

support for the body when the weight is on the
31. Move the cane and the weaker leg forward at weaker leg.

the same time for the same distance. Place

weight on the weaker leg and the cane. Move the

strong leg forward.

Place weight on the strong leg.

SITTING WITH A CANE The cane provides additional support for the
client as she lowers herself into the chair.
32. Have the client turn around and back up to

the chair. Have the client grasp the arm of the

chair with the free hand and lower self in to the

chair. Be sure to place the

cane out of the way but within reach.

33. Set realistic goals and opportunities for Walking with a cane takes practice.

progressive ambulation using a cane.

34. Consult with a physical therapist for The physical therapist is the expert on the
health care team for cane-walking techniques.
client learning to walk with a cane.

35. Wash Hands Reduces the transmission of

microorganisms.
 WALKING WITH A WALKER To assess the client, to ensure the client’s
safety and for continuous procedure.
36. Repeat actions 1 – 7

37. Place the walker in front of the client Position the walker for use.

38. Have the client put the dominant hand on the Increases upper body strength.

front bar of the walker or on the hand grip for the

hand which is more comfortable. Then using the

dominant hand to push off form the bed and the

non- dominant hand for stabilization help client

to an erect position.

39. Have the client transfer hand to walker Allows the client to maintain balance while
transferring his weight.
hand grips.

40. Be sure the walker is adjusted so that the Provides maximum support from the arms while
ambulating.
hand grips are just below waist level and the

client’s arms are slightly bent at the elbow.

41. Walk to the side and slightly behind the Allows the nurse to provide stability or
assistance if the client needs it.
client holding the gait belt if needed for stability.
 WALKER Provides support for a weak or non-weight-
GAIT bearing leg by using arm and upper body
strength.
42. Move the walker and the weaker leg forward

at the same time. Place as much weight as

possible or as allowed on the weaker leg, using

arms for supporting the rest of the weight. Move

the strong leg

forward & shift weight to the strong leg.

SITTING WITH A WALKER Using the armrests of the chair is a more stable
support than using the walker.
43. Have the client turn around in front of the

chair and back up until the back of the legs

touch the chair. Have the client place hands on

their chair armrests, one hand at a time, then

lower self in to the chair using the

armrests for support.

44. Set realistic goals and opportunities for Walking with a walker takes practice.

progressive ambulation using a walker.

45. Consult with a physical therapist for The physical therapist is the expert on the
health care team for walker techniques.
clients learning to walk with a walker

46. Wash Hands. Reduces the transmission of

microorganisms.