Collado, Karina Bianca M.

BSN 4-14B

ASSISTIVE DEVICES
Assistive devices for ambulation include canes, walkers and crutches. A. Canes Two types of canes are used today: the standard straight-legged cane and the quad cane, which has four feet and provides the most support. Cane tips should have rubber caps to improve traction and prevent slipping. The standard cane is 91cm (36 in.) long; some aluminum canes can be adjusted from 56 to 97 cm (22 to 38 in.). The length should permit the elbow to be slightly flexed. Clients may use either one or two canes, depending on how much support they require. Using Canes Hold the cane with the hand on the stronger side of the body to provide maximum support and appropriate body alignment when walking. Position the tip of a standard cane (and the nearest tip of other canes) about 15cm (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: Move the cane forward about 30 cm (1 ft.) or a distance that is comfortable while the body weight is borne by both legs. Then move the affected leg forward to the cane while the weight is borne by the cane and stronger leg. Next, move the unaffected leg forward ahead of the cane and weak leg while the weight is borne by the cane and weak leg. Repeat the steps. This pattern of moving provides at least two points of support on the floor at all times. B. Walkers Walkers are mechanical devices for ambulatory clients who need more support than a cane provides. Walkers come in many different shapes and sizes, with devices suited to individual needs. The standard type is made of polished aluminum. It has four legs with rubber tips and plastic hand grips. Many walkers have adjustable legs. Using Walkers When the maximum support is required: Move the walker ahead about 15 cm (6 in.) while your body weight is borne by both legs. Then move the right foot up to the walker while your body weight is borne by the left leg and both arms. 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: Move the walker and the weak leg ahead together about 15cm (6 in.) while your weight is borne by the stronger leg. Then move the stronger leg ahead while your weight is borne by the affected leg and both arms.

C. Crutches Crutches may be a temporary need for some people and a permanent one for others. Sometimes clients are discouraged when they attempt crutch walking. Clients confined to bed are often unaware of weakness that becomes apparent when they try to stand or walk. Clients realize that they can no longer take balance for granted when they must cope with the weight of a heavy cast or a paralyzed limb. Frequently, progress may be slower than the client anticipated. Encouragement from the nurse and the setting of realistic goals are especially important

1. Four-point alternate gait Move the right crutch ahead a suitable distance, such as 10 to 15 cim (4 6 in.) Move the left front foot forward, preferably to the level of the left crutch Move the left crutch forward Move the right foot forward

2. Three-point gait Move both crutches and the weaker leg forward Move the stronger leg forward

3. Two-point alternate gait Move the left crutch and the right foot forward together Move the right crutch and the left foot ahead together

4. Swing-to gait Move both crutches ahead together Lift body weight by the arms and swing to the crutches

5. Swing-through gait Move both crutches forward together Lift body weight by the arms and swing through and beyond the crutch

6. Going Up stairs Assume the tripod position at the bottom of the stairs. Transfer the body weight to the crutches and move the unaffected leg onto the step. Transfer the body weight to the unaffected leg on the step and move the crutches and affected leg up to the step. The affected leg is always supported by the crutches.

Repeat steps 2 and 3 until the client reaches the top of the stairs.

7. Going Down stairs. Assume the tripod position at the top of the stairs. Shift the body weight to the unaffected leg, and move the crutches and affected leg down onto the next step. Transfer the body weight to the crutches, and move the unaffected leg to that step. The affected leg is always supported by the crutches. Repeat steps 2 and 3 until the client reaches the bottom of the stairs.