Use of Assistive Devices
Identify client, provide privacy and explain
Purpose: Maintain or improve an individual’s
functioning and independence to facilitate
participation.
USE OF CRUTCHES
Time: 5-20 Minutes
Equipment: Prescribed outcomes
Indication: When removal of weight from one or
both legs is required, enabling the client to support
with the hands and arms.
Objectives:
 To improve balance
 To ambulate safely using crutches
 To relieve weight bearing to an affected
extremity
Prerequisites for Crutches:
 Good strength of upper limb muscles is
required
 Range of motion of upper limb should be
good.
 Shoulder Abductors
 Elbow and wrist extensors
 Finger Flexors
Proper Fit
 Adjusted based on the patients size
 There should be 2-3 fingers width (1-1/2
inches) gap between the crutch rest pad
and the axilla. Rationale: While the patient
is using the crutch they need to be putting
all their weight on the hand grips rather
than crutch rest pad to prevent nerve
damage.
 Hand grips should be even w/ the top of the
hip line (elbows flexed) -30 degree angle
Procedure
1. Wash hands
2. Check doctor’s order to confirm that the
client has the correct type of crutches.
3.
procedure.
Types of Crutches:
1. Axillary crutches/ underarm crutches
2. Elbow crutches or lofstrands crutches
3. Forearm support crutches (gutter crutches)
4. Be sure that crutches extend from 1.5-2
inches below axilla, 6 inches from the side
and 2 inches in front of the feet. Adjust the
handgrips to allow a 15- 30 degree elbow
flexure when standing.
5. Teach the following gaits where
appropriate.
a. Four Point gait- is for the client who can
bear weight on both legs
Sequence: Right crutch, left foot, left
crutch, right foot
b. Two point gait- is for the client with weak
legs, but good arm strength and
coordination
---Move crutch from the injured side
Sequence- right crutch and left foot at the
same time: then left crutch and right foot at the
same time.
c. Three point gait- is for the client who can
bear weight on one leg only.
Sequence: advance crutches and weak leg,
bring strong leg forward.
D. Swing to or swing through gait- is for the
client with complete paralysis of the hips and
legs.
 Swing to- the patient will move both
crutches forward then they will swing
both legs forward.
 Swing through- move both crutches
forward then they will move both legs
forward can’t swing both legs forward
but they will swing it pass the crutch
placement.
 Sequence: Advance both crutches at the same
time, bear weight on arms, and swing legs to or
beyond crutches.
6 inches out diagonally from the feet
2 inches – front
Proper positioning is important to: To prevent
nerve damage
Stairs: GOOD –UP , BAD- DOWN
Axillary Crutches
 They are made of wood/ metal with an
axillary pad, a hand piece and a rubber
ferrule.
 Two upright shafts connected by axillary
piece on top
 Hand piece in the middle
 Extension piece below
 Extension piece and shafts has
numerous holes at regular intervals so
the total length of crutch and height of
handle is easily adjustable.
6. To sit down, have the client hold both
crutches with the hand opposite the
affected and reach for the chair’s armrest,
with the other hand. Supporting weight
with both arms, the client can lower himself
into the chair.
7. To rise from a sitting position
a. Make sure the chair is stable and it must
have arms and back support
b. Have the client grasp both crutches in
one hand, grasping them by the
handgrips, position their tips flat on the
floor.
c. Instruct to hold on to the crutches on
one side and balance weight with the
other hand on the arm rest, and rise.
NURSE ALERT:
Clients tend to walk with their heads down instead
of looking up and forward. Remind the client to
keep his head up.
Use caution during the learning period because
falls are possible. Learning on crutches can cause
brachial nerve damage. Provide a well-lighted,
clutter-free environment. Use a back-pack for
carrying things,
Contraindication: Lack of balance, stamina, or
upper body strength.
8. Ensure client safety and comfort
Teaching: Client Care (Using crutches)
1. Follow the plan of exercises developed
2. Have health care professional establish the
correct length of your crutches and the
correct placement of the hand pieces.
3. The weight of your body should be borne by
the arms rather than the axillae (Armpits).
Continual pressure on the axillae can injure
radial nerve and cause crutch palsy, a
weakness of the muscles of the forearm,
wrist and hand.
4. Maintain an erect posture as much as
possible to prevent strain on muscles and
joints and to maintain balance.
5. Each step taken with crutches should be a
comfortable distance for you. It is wise to
start with a small rather than a large step.
6. Inspect the crutch tips regularly and replace
them if worn.
7. Keep the crutch tips dry and clean to
maintain their surface friction. If the tip
becomes wet, dry them before use.
8. Wear a shoe with a low heel that grips the
floor.
Rubber soles decrease the chances of slipping
Adjust shoelaces so they cannot come untied,
or reach the floor where they might catch on
the crutches.
Consider shoes with alternate forms of closure
(e.g. Velcro), especially if you cannot easily
bend to tie laces.
 Teach client how to ascend stairs.
1. Step up first with your stronger leg.
2. Shift your weight to the crutches and move
the strong leg and move the crutches and
the weaker leg onto the same step.
3. Repeat these steps until the stairs are
negotiated. The crutches always support
the weaker or affected leg.
When going up steps on crutches, lead with
your stronger leg. Keep the crutches on the step
where you’re standing.
Teach client how to descend stairs.
1. Shift your weight to the stronger leg and
move the crutches and the weaker leg onto
the lower step.
2. Shift your weight to the crutches and move
the strong leg onto the step.
3. Repeat these steps until the
Teach client how to get in and out of a Chair:
1. Stand with the chair behind you, making
sure that the back of the stronger leg is
against the chair.
2. Transfer crutches to your weaker side and
hold them, by the hand bar.
3. Grasp the arm of the chair with the hand on
your strong side, then lean forward and flex
your hips and knees while lowering yourself
into the chair.
4. To get out of the chair, move to the edge of
the chair and position the stronger foot to
support your weight when arising.
5. Hold both crutches by the hand bar, using
the hand on your weaker side. Hold the arm
of the chair with the hand on your stronger
side.
6. Push down on the crutches and the armrest
to push yourself out of the chair.
USE OF CANE
Time: 5-15 minutes
Equipment: Prescribes cane
Indication: For client with one sided weakness
or injury, loss of balance or increased joint
pressure.
Objective:
 To provide balance and support for
walking
 To reduce fatigue and strain on weight
bearing joints
Proper Fit:
 Top of cane even with greater trochanter or
wrist crease closest to hand.
 Elbow flexion 15-30 degree angle when
holding cane
Use Gait Belt and Stand on Patients WEAK SIDE
Procedure:
1. Wash hands
2. Identify the client, provide privacy and
explain procedure
3. Have the client hold on cane on the strong
side while grasping the chair’s armrests. The
strong leg is advanced slightly and the client
pushes against the armrest to rise.
Note. The cane will always be on the side of
the stronger leg.
4. When the client is in a standing position,
the tip of the cane should be 15 cm (6
inches) from the base of the little toe and
the handle should be level with the great
trochanter. The elbow should be flexed 15-
30 degrees.
5. When the client is walking, the length of the
steps should be equal and the timing even.
Move the cane forward about 30 cm (1ft) or
a distance that is comfortable while the
body weight is borne by both legs.
6. The client should advance the cane with the
weak leg and follow with the strong leg.
Lean weight through the arm holding the
cane is needed.
 7. For stairs, have the client hold the railing
near the strong leg. The client ascends by
advancing the strong leg and following the
weak leg; descends by advancing the weak
leg and following with the strong leg. The
cane is not used.
Remember, “UP with the GOOD, DOWN with the
BAD.
8. If the stairway has no railing, have the client
follow this sequence:
Strong leg, weak leg, cane (for ascending);
and cane, weak leg (for descending)
9. To sit, have the client back legs against the
front of the chair, pick up the cane, grasp
the armrests with both hands, and support
weight on the armrest to lower himself into
the chair.
10. Ensure client’s safety and comfort
11. Wash Hands
12. Chart: Document date, time, type of cane,
gait observed, the amount of help needed,
distanced walked and the client’s
understanding and tolerance of cane-
walking
NURSE ALERT: Use caution during the learning
period because falls are possible
Contraindications: The client with bilateral
weakness
Client Teaching: To recall which leg to lead with on
stairs, have the client remember “ The good (leg)
goes up first and the bad (leg) goes down”. “ Up
with the good, down with the bad or “The good go
up to heaven, the bad goes down to hell”, Use a
back pack for carrying things.
USE OF A WALKER
Time: as needed
Equipment: Prescribed walker with necessary
attachments
Indications: Provides stability to the client who
cannot use crutches or a cane because of
insufficient strength & balance, or to the weakened
client who needs frequent rest periods.
Objective: Promote Stabilized Ambulation
Procedure:
1. Wash Hands
2. Identify Client, Provide Privacy and explain
procedure
3. Position the open side of the walker in front
of the chair where the client is seated
Proper Fit:
 15-30 degree bend in elbows
 Hand grips even w/ wrist crease when arms
at side.
Position: Walker match up with the middle of their
foot
Use with Gait Belt & stand on patients weak side
Have the client do the following to ambulate:
a. Support weight on the stronger leg
b. Advance walker 6 inches
c. Move the weaker leg forward
d. Support weight with the arms to bring the
stronger leg even with the weaker leg
e. If weakness is bilateral, have the client
advanced the walker 6 inches, support
weight with both arms, and step or swing to
walker.
f. Transfer the other hand from armrest to
handgrip
g. Support weight with arms to bring stronger
leg even with weaker leg
h. Remember that you may have to lift the
client with bilateral weakness to the walker.
But, if the client’s arm are strong enough,
he can place both hands on handgrips and
push to a standing position
 1. Hold the affected (injured or weaker) foot
off the floor.
2. Lift the walker (roll it if you’re using a
wheeled walker). Move it forward about 12
inches.
3. Support your weight on your hands. Swing
the unaffected (uninjured or stronger) foot
forward to the centre of the walker.
Have the Client do the Following to sit.
a. Back the stronger leg against the chair
b. Support weight with stronger leg and
transfer hand on weak side to armrest
c. Transfer hand on strong side to armrest
d. Support weight with arms on armrest and
lower body into chair
e. Slide back into the chair
f. Remember that if weakness is bilateral, the
client may need assistance to transfer from
walker to chair.
NURSE ALERT: Remind the client to keep his head
up and to focus on an objects to promote stability
Contraindication: Upper arm and shoulder
weakness
Client Teaching: Instruct the client to pick up the
walker rather than pushing or drag it. Use a back-
pack for carrying things
WHEEL CHAIR SAFETY
1. Always lock the brakes on both wheels of
the wheelchair when the client transfers in
or out of it.
2. Raise the footplates before transferring the
client into the wheelchair
3. Lower the footplates after the transfer and
place the clients feet on them
4. Ensure the client is positioned well back in
the seat of the wheelchair
5. Use seat belts that fasten behind the
wheelchair to protect confused clients from
falls
6. Place your body between the wheelchair
and the bottom of an incident.