Date Performed: Final Grade:

Clinical Instructor:

ASSISTING CLIENTS WITH CRUTCHES/CRUTCHWALKING

Definition:

Objectives:

Safety/Security Measures:

Equipment:

RETURN
DEMO
STEPS DONE NOT
DONE

1. Inform client that you will be assisting with ambulation using the device
chosen.

2. Wash hands/Perform Hand Hygiene.

3. Assess client for strength, mobility, range of motion, visual acuity,

perceptual difficulties, and balance.

Note: The nurse and physical therapist often work together on

assessment and choosing the correct assistive equipment for ambulation.

4. Measure client for size of crutches, and adjust crutches to fit. While
supine, measure client from heel to axilla.

5. Provide a robe and nonslip foot coverings or shoes.

6. Lower the height of the bed.

 7. Allow the client the dangle the legs at the side of the bed for several
minutes. Assess for vertigo or nausea.

8. Apply gait belt around the client’s waist if balance is not steady. It is good
practice to use a gait belt the first time the client is out of bed.

9. Instruct client on method of holding crutches while client remains seated.

This should be with elbows bent 30o while hands are on the hand grips
and pads 1.5-2 inches below the axillae. Instruct client to position
crutches 4-5 inches laterally and 4-6 inches in front of feet. This skill can
be demonstrated on yourself.

10. Assist the client to a standing position by placing both crutches in the
non-dominant hand. Then, using the dominant hand, push off from the
bed while using the crutches for balance. Once erect, the extra crutch can
be moved into the dominant hand.

11. Instruct the client to remain still for a few seconds while assessing for
vertigo or nausea. Stand close to the client to support as needed. While
client remains standing, check for correct fit of the crutches.

Four-Point Gait:

12. Position crutches 4.5-6 inches to the side and in front of each foot. Move
the right crutch forward 4-6 inches and move the left foot forward, even
with the left crutch. Move the left crutch forward 4-6 inches and move the
right foot forward, even with the right crutch. Repeat the four-point gait.

Three-point Gait

13. Advance both crutches and the weaker leg forward together 4-6 inches.
Move the stronger leg forward, even with the crutches. Repeat the
three-point gait.

Two-point Gait

14. Move the left crutch and right leg forward 4-6 inches. Move the right
crutch and left leg forward 4-6 inches. Repeat the two-point gait.

Swing-through Gait

15. This step is basically the same as the 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
 16. Stand beside and slightly behind the client. Instruct client to position the
crutches as if walking. Place body weight on hands. Place the strong leg
on the first step. Pull the weak leg up and move the crutches up to the first
step. Repeat for all steps.

Walking Downstairs

17. Position the crutches as if walking. Place weight on the strong leg.
● Move the crutches down to the next lower step
● Place partial weight on hands and crutches.
● Move the weak leg down to the step with crutches.
● Put total weight on the arms and crutches.
● Move strong leg to same step as weak leg and crutches.
● Repeat for all steps
● A second caregiver standing behind the client holding on the gait belt will
further decrease the risk of falling.

18. Set realistic goals and opportunities for progressive ambulation using
crutches.

19. Consult with a physical therapist for clients learning to walk with crutches.

20. Wash hands/Perform hand hygiene.

Sitting with Crutches

21. Instruct client to go back up to the chair until it is felt with the back of the
legs.

22. Place both crutches in the non-dominant hand and use the dominant hand
to reach back to the chair.

23. Instruct client to lower slowly into the chair.

24. Assist client into a comfortable position.

25. Document client’s response before and after procedure.

Name and signature of Clinical Instructor:

Reference:
1. Sue C. Delaune, Patricia K. Ladner “Fundamentals of Nursing, Standards & Practice, 4th
edition, (Copyright 2010)”