Assisting a Client

with Assistive
Devices
WMSU HAZEL TIAM WAT-UTUTALUM,R.N.,M.N.,R.M
Faculty

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Objectives:
• At the end of the lecture the student will be able to:
• Discuss the purpose of assistive devices.
• State the indications for ambulating with assistive devices.
• Define what is cane.
• State the purpose of using a cane.
• Describe the three types of canes.
• Name the basic parts of a cane.
• Describe three characteristics of appropriately fitted cane.
• Identify appropriate assessment skills prior to the procedure.
• Formulate relevant nursing diagnosis related to the procedure/ treatment/ therapy.
• Demonstrate the step-by-step procedure: Assisting a Patient with Ambulation Using a Cane, stating the
rationale for each steps.
• Describe “moving in and out” of a chair using a cane.
• Discuss the “going up and down” the stair using a cane.

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AMBULATORY ASSISTIVE DEVICE
• are orthotic devices that provide support, stability
and balance for users to able to move from one point
to another. Users can progress or retrogress from one
ambulatory device to another while some are permanently
fit on a particular device throughout lifetime.

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PURPOSE
• Maintain or improve an individual’s functioning and
independence thereby promoting their well being.
• They are used by people with disabilities and older adults
who want to remain independent as long as possible.

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FUNCTION OF AMBULATORY DEVICE
 Provides assist forward, backward and lateral movements
 Helps to increase balance, stability and coordination of the users
 Helps to reduce weight bearing on the affected lower limb
 Helps to increase confidence of the users
 Helps to correct poor posture
 Helps to reduce risk of fall.
 Helps to reduce pain on the affected limb
 Helps to augment muscular strength of the trunk and of the affected
lower limbs
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Indication for Assistive Devices
 Structural deformity,
 Amputation,
 Injury, or disease resulting in decreased ability to weight
bear through lower extremities
 Muscle weakness or paralysis of the trunk or lower
extremities
 Inadequate balance

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 CANES
is a walking stick used as a crutch or mobility aid.

are assistive devices, useful for patients who can bear weight
but need support for balance and stability.

 useful for patients who have decreased strength in one leg.

 provide an additional point of support during ambulation and
promotes greater independence.
 are made of wood or metal and often have a rubberized cap
on the tip to prevent slipping. Canes come in three variations:

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 Parts of A Cane

• Handle
• Collar
• Shaft
• Ferrule

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 Types of Cane
Figure 1. Types of canes.

A. Standard straight wooden C. Standard straight metal cane E. Tripod cane

cane with half-circle handle. with half-circle handle. F. Quad cane
B. Standard straight wooden D. Standard straight metal cane
cane with L-shape handle. with L-shape handle.
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Standard Cane
 single point canes designed to provide an additional
point of contact with the ground to help with balance.
They are best for people who need little to no upper-
extremity weight bearing. They are inexpensive, are usually
made from aluminum or wood and the length can be easily
adjusted.

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purpose
• Iis to improve balance by widening an individual’s base of
support. Standard canes are not appropriate for individuals
who need assistance with weight bearing (i.e., who need to
lean heavily on the cane because they can’t bear weight on
their legs).

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Offset canes

is known as the workhorse of all canes.

This is because it is extremely durable,
lightweight, and has a comfortable handle.
are similar to standard canes except the shape
positions the patient’s weight over the axis of
the cane. This allows the cane to be used for
occasional weight bearing. Offset canes are
often recommended for patients who have
arthritis in the hip or knee and occasionally
need to decrease the weight borne on a
painful lower extremity.
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QUAD AND THREE POINT CANES

feature wider bases with either three or four feet.

They are better for users who require a bit more support
and stability while walking, and subsequently feature a
bulkier base. 
designed primarily to balance more support with
greater comfort, distributing the user’s weight along the
cane and then through three or four separate feet
to promote better balance and a cane that can offer
greater support.

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 Fitting the Cane
• Make sure your cane fits the patient properly:
Figure 3. Fitting the Cane.

 Check your elbow bend. 

 Check your wrist height. 
cane tip about 3-4” from the
foot and at a 450 angle
B. Proper height of the
A. Elbow should
cane handle should
bend at a
align with the wrist
comfortable angle,
while standing erect.
15-30 degree.
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I: ASSISTING A PATIENT WITH AMBULATION USING A CANE

• Equipment:
• Cane of appropriate size with rubber tip
• Nonskid shoes or slippers
• Non-sterile gloves and/or other PPE, as indicated
• Stand-assist aid, if necessary and available
• Gait belt, based on assessment

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 ASSESSMENT:
• Assess the patient’s upper body strength, ability to bear weight and
to walk, and the need for assistance.
• Review the patient’s record for conditions that may affect ambulation.
• Perform a pain assessment before the time for the activity.
• If the patient reports pain, administer the prescribed medication in
sufficient time to allow for the full effect of the analgesic.
• Take vital signs and assess the patient for dizziness or light
headedness with position changes.
• Assess the patient’s knowledge regarding the use of a cane.

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NURSING DIAGNOSIS
Activity Intolerance
• Impaired Walking
• Acute Pain
• Deficient Knowledge
• Chronic Pain
• Risk for Injury
 

OUTCOME AND PLANNING:

• The expected outcome to achieve when assisting a patient with ambulation using a cane is that the
patient ambulates safely without falls or injury. Additional appropriate outcomes include the
following:
• the patient demonstrates proper use of the cane; the patient demonstrates increased muscle
strength, joint mobility, and independence;
• the patient exhibits no evidence of injury from use of the cane.
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 Goal: The patient ambulates safely without falls or injury.
STEP RATIONALE

1. Review the medical record and nursing plan of care for conditions that may influence the Review of the medical record and plan of care validates the correct patient and correct
patient’s ability to move and ambulate. Assess for tubes, IV lines, incisions, or equipment procedure. Identification of equipment and limitations helps reduce the risk for
that may alter the procedure for ambulation. injury.
2. Perform hand hygiene. Put on PPE, as indicated. Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based
on transmission precautions.
3. Identify the patient. Explain the procedure to the patient. Help the patient familiarize Patient identification validates the correct patient and correct procedure. Discussion
with the parts and use of the cane. Tell the patient to report any feelings of dizziness, and explanation help allay anxiety and prepare the patient for what to expect.
weakness, or shortness of breath while walking. Decide how far to walk.
4. Assist the patient to put on appropriate socks and shoes. Non slip-rubberized sole shoes helps provide steadier balance.

5. Encourage the patient to make use of a stand-assist aid, either free-standing or attached
to the side of the bed, if available, to move to and sit on the side of the bed.
6. Wrap the gait belt around the patient’s waist, based on assessed need and facility policy.
7. Encourage the patient to make use of the stand-assist device to stand with weight evenly
distributed between the feet and the cane.
Encourages independence, reduces strain for staff, and decreases risk for patient
injury.
Gait belts improve the caregiver’s grasp, reducing the risk of musculoskeletal injuries
to staff and the patient and provide firmer grasp for the caregiver if patient should
lose his or her balance.
A stand-assist device reduces strain for caregiver and decreases risk for patient injury.
Evenly distributed weight provides a broad base of support and balance.

8. Have the patient hold the cane on his or her stronger side, close to the body, while the Holding the cane on the stronger side helps to distribute the patient’s weight away
nurse stands to the side and slightly behind the patient. from the involved side and prevents leaning. Positioning to the side and slightly behind
the patient encourages the patient to stand and walk erect. It also places the nurse in a
safe position if the patient should lose his or her balance or begin to fall.

9. Ensure appropriate fitting of the cane. This manner provides support and balance.
(see fig. 3) Cane that is too long makes it harder to pick it up and move it. or too short cane can
Check the patient’s elbow bend. throw the patient off balance.
Check the patient’s wrist height.  
10. Tell the patient to advance the cane 4 to 12 inches (10 to 30 cm) and then, while Moving in this manner provides support and balance.
supporting his or her weight on the stronger leg and the cane, advance the weaker foot 18
forward, parallel with the cane.
11. While supporting his or her weight on the weaker leg and the cane, have the Moving in this manner provides support and balance.
patient advance the stronger leg forward ahead of the cane (heel slightly beyond
the tip of the cane).
12. Tell the patient to move the weaker leg forward until it is even with the This motion provides support and balance.
stronger leg, and then advance the cane again.
13. Continue with ambulation for the planned distance and time. Continued ambulation promotes activity. Adhering to the planned distance and
patient’s tolerance prevents the patient from becoming fatigued.
14. Return the patient to the bed or chair based on the patient’s tolerance and Balance activity and rest prevents fatigue and ensures the patient’s comfort.
condition. Make sure call bell and other necessary items are within easy reach.
15. Clean transfer aids per facility policy, if not indicated for single patient use. Proper cleaning of equipment between patient use prevents the spread of
Remove PPE, if used. Perform hand hygiene. microorganisms. Removing PPE properly reduces the risk for infection
transmission and contamination of other items. Hand hygiene prevents the spread
of microorganisms.
EVALUATION:
16. Evaluate Determines if the expected outcome is met or not, thus needs to be changed.
A. if the patient uses the cane to ambulate safely and is free from falls or injury.
B. the patient demonstrates proper use of the cane;
C. the patient exhibits increased muscle strength, joint mobility, and
independence; and
D. the patient experiences no injury related to cane use.
17. Document: Provides information with regards to patient’s progress to care and response to
A. the activity, any other pertinent observations, therapy.
B. the patient’s ability to use the cane,
C. the patient’s tolerance of the procedure, and the distance walked.
D. the use of transfer aids and the number of staff required for transfer.

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SAFETY TIPS
• Inspect cane on a regular basis. Make sure the cane has a
rubber top for shock absorption and grip to prevent slipping.
Always check the cane for worn tips and handles Always make
sure that cane is at proper height to avoid imbalance and bad
postures[

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 ASSISTING A PATIENT WITH AMBULATION USING CRUTCHES

CRUTCH - a mobility aid that transfers weight from the legs to the upper body.
It is often used by people who cannot use their legs to support their weight,
for reasons ranging from short-term injuries to lifelong disabilities.
Types of Crutches
1. Underarm or axilla crutches - used by placing the pad against
the ribcage beneath the armpit and holding the grip,
which is below and parallel to the pad.
 Used for short term injuries
 Provide support for patients who have temporary restriction
on ambulation-as in recovering from ankle or knee injuries.
Advantages:
 Underarm crutches are adjustable to a person’s height
 Come with arm pads and handgrips for comfort
 Easy to use.

Disadvantages:
• This type of crutch people tends to slouch while using them.
• May cause armpit injury. A condition known as crutch paralysis, or crutch palsy
can arise from pressure on nerves in the armpit, or axilla. Specifically, "the
brachial plexus in the axilla is often damaged from the pressure of a crutch...
In these cases the radial is the nerve most frequently implicated; the ulnar nerve
suffers next in frequency. 21
2. Forearm or Lofstrand Crutches
• also known as an elbow crutch, Canadian crutch or "Lofstrand" crutch has a cuff at the top that goes
around the forearm.
• Used by inserting the arm into a cuff and holding the grip.
• The hinged cuff, most frequently made of plastic or metal,
can be a half-circle or a full circle with a V-type opening in
the front allowing the forearm to slip out in case of a fall.
Used by users with long term disabilities.
Advantages:
 Encourage the user to use good posture,
and experience less back and neck problems.
 Increase upper body strength over time.
 Reduce strain and keep pressure off your wrist
while moving.
Disadvantages:
• Hard to use for beginners. 22
3. Platform or Gutter Crutches
- Less common and used by those
with poor hand or grip strength.

- The forearm rests on a horizontal platform

and is usually strapped in place with Velcro-
type straps that allow the platform or
trough to release in case of a fall.

- The hand holds an angled grip which,

in addition, should allow adjustment of length
from trough to grip and side-to-side sway
depending on the user's disability.

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 4. Leg Support
 Non-traditional crutches are
useful for users with an injury or disability
affecting one lower leg only.
 Function by strapping the affected leg into a support
frame that simultaneously
 Holds the lower leg clear of the ground while
Transferring the load from the ground to the user's knee
or thigh.

This style of crutch has the advantage of not using

the hands or arms while walking. A claim

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Parts of the Crutch Figure 5. A. Axillary crutch.

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B. Forearm crutch

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GAIT TRAINING: Principles
•Weight Bearing is the amount of weight that may be borne on a lower extremity during standing or ambulation. It is
determined by patient’s condition and medical management of that condition. Changes in weight bearing status are
determined by the patient’s physician.
•Types of Weight Bearing
1. None Weight Bearing: involved lower extremity not to bear weight or touching floor.
2. Toe Touch Weight Bearing: patient can rest toes on the floor for balance, but not to bear weight.
3. Partial Weight Bearing: limited amount of weight bearing permitted on lower extremity (example: 25% PWB =
25% of patient’s total body weight is allowed to be transmitted through the involved lower extremity.)
4. Weight-Bearing as Tolerated: patient allowed to place as much or as little weight through the involved lower
extremity, depending on patient’s tolerance.
• Full Weight-Bearing: The leg can now carry 100% of the body weight, which permits normal walking

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Standing with Crutches
•Tripod Stance is what provides your body with the most
support and keeps weight off of your injured leg when standing
still. Keep good foot firmly on the ground and place the crutches
in front, crutch tip 6” from the foot and at a 45-degree angle.

•ATTENTION!
•Be careful not to move the crutches too far away or too close to the
body since this will not provide the support you need.
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Tripod Position

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•

Measuring for the Crutches

•Standard axillary crutches need two adjustments--the length
of the crutch and the position of the handgrip. Prior to adjusting,
prepare the crutches with padding on the axillary bar and a rubber
tip on the end of each crutch.

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 •Lying:
 Have the patient lie supine, arms at sides, wearing a shoe
on the unaffected foot.
• Using a tape measure, measure from the axilla to the heel of
the shoe and add two (2) inches. Adjust the crutch shaft to this
measurement

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 •Standing:
 Crutch tip 6” from the foot and @ a 450 angle
 Hand grip @ the ulnar styloid process
 Elbow in about 20-30 degrees of flexion OR
 Hand grip @ the level of the greater trochanter
 Axillary distance to the top of the crutch, 2-3 finger widths

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Gait Patterns

1.  two-point gait: the client is partially weight-bearing on both

legs. (A crutch and the opposite leg are considered one “point.”
The other crutch and leg are the second “point.”) Gait speed is
faster than 4 point, but less stable as only two points are in
contact with floor and good balance is needed to walk with 2
points crutch gait. Low energy required by patient.

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• Pattern: advance right crutch & left foot together, then
advance the left crutch & right foot together.

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3 point gait
1.each crutch and only one leg support weight. (Each is considered
a “point.”) The other leg is non-weight-bearing. Used when
patient has one leg can fully bear weight and one leg can’t bear
weight. Most rapid gait speed, provides the least amount of
stability for the patient. High energy required by patient.
• Pattern: advance crutches & injured leg first, followed by
unaffected leg in a step through or step to pattern.

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 Partial Weight Bearing
oStep to: Progress the involved extremity to the
uninvolved extremity.
• Step through: Progress the involved extremity
past the uninvolved extremity

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• • None Weight Bearing
• o Swing-to gait: A person with a non-weight bearing injury generally
performs a "swing-to" gait: lifting the affected leg, the user places both
crutches in front of himself, and then swings his uninjured leg to meet the
crutches.
• o Swing-through or tripod gait, the client stands on the strong leg, moves
both crutches forward the same distance, rests his or her weight on the
palms, and swings forward slightly ahead of the crutches. Because this
gait is fast, the client should learn to balance before attempting it. The
client who is allowed to put weight on only one leg must hold up the other
leg, bending the knee (not bending at the hip).
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4 point gait
1.each crutch and each leg move separately. (Each of the four
“points” supports weight.) this gait pattern is used when there's
lack of coordination, poor balance and muscle weakness in both
LE, as it provides slow and stable gait pattern with three points
support. Provides maximum stability for patient and low energy
required by patient.
• Pattern: advance right crutch, then left foot, left crutch, right
foot.
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SKILL3: ASSISTING A PATIENT WITH
AMBULATION USING CRUTCHES
•Equipment:
 Crutches with axillary pads, hand grips, and rubber suction tips
 Nonskid shoes or slippers
 Nonsterile gloves and/or other PPE, as indicated
 Gait belt

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Review the patient’s record and nursing plan of care to determine the reason for using crutches and instructions for weight bearing.
Check for specific instructions from physical therapy.
Perform a pain assessment before the time for the activity. If the patient reports pain, administer the prescribed medication in sufficient
time to allow for the full effect of the analgesic.
Determine the patient’s knowledge regarding the use of crutches and assess the patient’s ability to balance on the crutches.
Assess for muscle strength in the legs and arms. Determine the appropriate gait for the patient to use.
•NURSING DIAGNOSIS
• Determine the related factors for the nursing diagnosis based on the patient’s current status. Appropriate nursing diagnoses may include:

Risk for Injury
Activity Intolerance
Impaired Walking
Acute Pain or Chronic Pain
Deficient Knowledge
Risk for Falls

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•OUTCOME AND PLANNING
•The expected outcome to achieve when assisting a patient with ambulation using crutches:
 the patient ambulates safely without experiencing falls or injury.
 the patient demonstrates proper crutch-walking technique.
 the patient demonstrates increased muscle strength and joint mobility.
• the patient exhibits no evidence of injury related to crutch use

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STEPS IN CLIMBING STAIRS

5 1

2
4
3
  3
 
2  

 
1 5
 

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 • CLIMBING UP THE STAIRS
 The patient places the unaffected leg on the first stair tread.
 The patient transfers his or her weight to the crutches.
 The patient moves the crutches and affected leg up to the stair
tread and continues to the top of the stairs.
 Have the patient stand in the tripod position facing the stairs.
 The patient then transfers his or her weight to the unaffected
leg, moving up onto the stair tread.

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GOING DOWN THE STAIRS

 The patient transfers his or her weight to the

crutches.
 Have the patient stand in the tripod position facing
the stairs.
 The patient moves the unaffected leg down to the
stair tread and continues down the stairs.
 The patient moves the crutches and affected leg
down to the stairs tread.
 The patient transfers weight to unaffected leg. 45
•ATTENTION!
 To climb the stairs, the patient should advance the STRONGER
LEG goes up the stairs first, followed by crutch and weaker
leg.
• To descend, the WEAKER LEG goes down first and crutch,
followed by the

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Steps in Sitting down and Getting up of the chair

•Stand to Sit/ Sitting down:

1.Stand in front of the chair with the seat of the chair touching
the back of your legs.
2.Place both crutches in the hand on the side of your injured leg.
3.Place the other hand on the arm rest or side of the chair.
4.Sit down and slide back.

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•Sit to Stand/ Getting up:
1.Hold both crutches in the hand on the side of your good leg.
2.Slide to the front edge of seat. Both feet flat on the floor (injured leg NWB).
3.Place your other hand on the armrest or side of the chair or side of the chair.
4.Push yourself up, placing weight on the good leg and the crutches.
• Transfer one crutch to the side of affected leg. Stand in tripod position,
before walking

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Walker
• A walker or walking frame is a tool for disabled or frail
people, who need additional support to maintain balance
or stability while walking, most commonly due to age-
related physical restrictions.

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•  used by those who are recuperating from leg or back
injuries. It is also commonly used by persons having
problems with walking or with mild balance problems.

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• Proper Walker Use
1.The height of the walker is adjusted to the patient. Walkers
should be at the hip level of the patient using it.
2.The patient’s arm should rest on the walker. The hand grips
should exhibit 20 to 30 degrees of flexion at the elbows.
3.The patient should wear sturdy and well-fitting shoes.

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Assisting Patients with Walkers

1.The nurse continually assesses the patient’s stability and

protects the patient from falls.
2.The nurse walks with the patient by holding him or her at the
waist as needed for balance.

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Ambulating with Walkers
• Ambulating with Walkers
1.The walker should be held on the hand grips for stability.
2.Instruct the patient to lift the walker and place it in front by leaning his or her
body slightly forward.
3.When walking with walker, the patient’s body weight should be supported by
the hands when advancing the patient’s weaker leg. This permits partial
weight bearing or non-weight bearing as prescribed.
4.The patient balances on his or her feet.
5.Lift the walker and place it in front again and continue the same pattern of
walking.
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