demo USING CANES,WALKER,CRUTCHES USING CANES 1.

Hold the cane with the hand on the strongest side of the body to provide maximum support and appropriate body alignment when walking. 2. Position the tip of a standard cane (and the nearest tip of other canes) about 15 cm (6 in) to the side and 15 cm (6 in) in front of the near foot, so that the elbow is slightly flexed. When Maximum Support Is Required 3. Move the cane forward about 30 cm (1 ft), or a distance that is comfortable while the body weight is borne by both legs. 4. Then, move the affected (weak) leg forward to the cane while the weight is borne by the cane and stronger leg. 5. Next, move the unaffected (stronger) leg forward ahead of the cane and weak leg while the weight is borne by the cane and weak leg. 6. Repeat steps 3 -4. This pattern of moving provides at least two points of support on the floor at all times. AS YOU BECOME STONGER AND REQUIRE LESS SUPPORT 7. Move the cane and weak leg forward at the same, while the weight is borne by the stronger leg 8. Move the stronger leg forward, while the weight is borne by the cane and the weak leg. USING WALKERS When Maximum Support Is Required 1. Move the walker ahead about 15 cm (6 in) while your body weight is borne by both legs. 2. Then, move the right foot up to the walker while your body weight is borne by the left leg and both arms. 3. Next, move the left foot up to the right foot while your body weight is borne by the right leg and both arms. If One Leg Is Weaker Than The Other 4. Move the walker and weak leg ahead together about 15 cm (6 in) while your weight is borne by the stronger leg. 5. Then, move the stronger leg ahead while your weight is borne by the affected leg and both arms. USING CRUTHCHES 1. Follow the plan of exercises developed for you to strengthen your arm muscles before beginning crutch walking. 2. Have a health care professional establish the correct length for your crutches and the correct placement of the handpieces. Crutches that are too long force your shoulders upward and make it difficult for you to push your body off the ground. Crutches that are too short will make you hunch over and develop an improper body stance. 3. The weight of your body should be borne by the arms rather than the axillae (armpits). Continual pressure on the axilla can injure the radial nerve and eventually 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 comfortable distance for you. It is wise to start with a small rather than large steps. 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 tips become wet, dry them well before use.

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8. Wear a tie shoe with low heel that grips the floor. USING CANES 9. Hold the cane with the hand on the strongest side of the body to provide maximum support and appropriate body alignment when walking. 10. Position the tip of a standard cane (and the nearest tip of other canes) about 15 cm (6 in) to the side and 15 cm (6 in) in front of the near foot, so that the elbow is slightly flexed. When Maximum Support Is Required 11. Move the cane forward about 30 cm (1 ft), or a distance that is comfortable while the body weight is borne by both legs. 12. Then, move the affected (weak) leg forward to the cane while the weight is borne by the cane and stronger leg. 13. Next, move the unaffected (stronger) leg forward ahead of the cane and weak leg while the weight is borne by the cane and weak leg. 14. Repeat steps 3 -4. This pattern of moving provides at least two points of support on the floor at all times. AS YOU BECOME STONGER AND REQUIRE LESS SUPPORT 15. Move the cane and weak leg forward at the same, while the weight is borne by the stronger leg 16. Move the stronger leg forward, while the weight is borne by the cane and the weak leg. USING WALKERS When Maximum Support Is Required 6. Move the walker ahead about 15 cm (6 in) while your body weight is borne by both legs. 7. Then, move the right foot up to the walker while your body weight is borne by the left leg and both arms. 8. Next, move the left foot up to the right foot while your body weight is borne by the right leg and both arms. If One Leg Is Weaker Than The Other 9. Move the walker and weak leg ahead together about 15 cm (6 in) while your weight is borne by the stronger leg. 10. Then, move the stronger leg ahead while your weight is borne by the affected leg and both arms. EXERCISE FOR CRUTCH WALKING 1. Flexing and extending the arms in several directions. 2. Moving from supine position to sitting position by flexing the elbow and pushing the hands against the bed surface. This exercise strengthens the flexor and extensor muscles of the arms and the muscles that dorsiflex the wrists. 3. Lifting the body off the bed surface by pushing down with the hands and extending the elbows . 4. Tensing the quadriceps femoralis muscle 5. Straight leg exercises. The client lies supine with one knee bent and the other leg straight. The client tightens the quadriceps muscle in the straight leg and slowly raises it until it is parallel with the flexed leg. Hold leg for 5 sec. then slowly lower the leg. Repeat with opposite leg and do this 5 times. 6. Squeezing a rubber ball or a gripper with the hands. This exercise strengthen the flexor muscles of the fingers. MEASURING FOR CRUTCHES 1. The client lies supine, the nurse measures from the anterior fold of the axilla to the heel of the foot and adds 2.5 cm or 1 inch 2. The client stands erect and position the crutch in a tripod. Make sure that the shoulder

rest of the crutch is at least 3 fingers widths, that is, 2.5 cm below the axilla CRUTCH GAITS CRUTCH STANCE- TRIPOID -Place the crutches about 15 cm (6 in) in front of the feet and out laterally about 15 cm (6 in), creating a wide base of support. 1. Four-point alternate gait a. Move the right crutch ahead a suitable distance, such as 10 to 15 cm (4-6 in) b. Move the left foot forward, preferably to the level of the left crutch. c. Move the left crutch forward. d. Move the right foot forward. 2. Three-point gait a. Move both the crutches and the weaker leg forward b. Move the stronger leg forward 3. Two-point alternate gait a. Move the left crutch and the right foot forward together b. Move the right crutch and the left foot forward together 4. Swing-to gait a. Move both crutches ahead together b. Lift body weight by the arms and swing to the crutches Swing-through gait Move both crutches ahead together Lift body weight by the arms and swing through and beyond the crutches Getting into a chair a. Stand with the back of unaffected side centered against the chair. The chair can help the client during the next steps b. Transfer the crutches to the hand on the affected side and hold the crutches by the hand bars. The client grasps the arm of the chair with the hand on the unaffected side c. Lean forward, flex the knees and hips, and lower into the chair 7. Getting out of the chair a. Move forward to the edge of the chair and place the unaffected leg slightly under or at the edge t 11. Then, move the stronger leg ahead while your weight is borne by the affected leg and both arms. 9. 10. 5. a. b. 6.

11. 12. 13.