RLE
LAB / NCM 112/113/114
CRUTCH WALKING
DEFINITION OF TERMS
A. REHABILITATION
• making able again; relearning skills or
abilities or adjusting existing function.
B. DISABILITY
• restriction or lack of ability to perform
an activity in a normal manner; the
consequences of impairment in terms
of an individual's functional
performance and activity.
• Disabilities represents disturbances at
the level of the person (eg, bathing,
dressing, communication, walking,
grooming)
C. ASSISTIVE TECHNOLOGY
• any item, piece of equipment, or
product system - whether acquired
commercially, off the shelf, modified or
customized- that is used to improve the
functional capabilities of individuals
with disabilities.
D. HABILITATION
• making able; learning new skills and
abilities to meet maximum potential.
E. IMPAIRMENT
• loss or abnormality of psychological,
physiological or anatomic structure or
function at the organ level; an
abnormality of body structure,
appearance, and organ system
function resulting from any cause.
GOALS OF REHABILITATION
• Its goal is to evaluate progress and modify
goals as necessary to facilitate
rehabilitation and to promote
independence, self-respect and an
acceptable quality of life for the patient.
1. Motivate patient
2. Help patient identify the safe limits of
independent activity.
3. Let the patient know when to ask for
assistance
4. The nurse should guide, teach and
support the patient.
5. Be consistent in giving instructions
and in giving assistance to facilitate the
learning process.
6. Offer a little ingenuity.
NURSING STRATEGIES APPROPRIATE FOR
PROMOTING SELF-CARE
• Then a distance of 5 cm (2 inches) is marked
on the floor, out to the side from the tip of
the toe; 15 cm (6 inches) is measured
straight ahead from the first mark, and this
point is marked on the floor. Next, 5 cm (2
inches) is measured below the axilla to the
second mark for the approximate crutch
length. If the patient has to be measured
while lying down, he or she is measured
from the anterior fold of the axilla to the
sole of the foot, and then 5 cm (2 inches) is
added.
• If patient's height is used, 40 cm (16 inches)
is subtractrd to obtain the approximate
crutch length. The hand piece should be
adjusted to allow 20 to 30 degrees of
flexion. The wrist should be extended and
the hand is flexed. A foam rubber pad on
the underm piece is to relieve pressure of
the crutch on the cage. For safety, crutches
should have large rubber pad and the
patient should wear firm-soled
DIFFERENT GAIT POSITION
A. 4 POINT GAIT
• Partial weight bearing both feet
• Maximal support provided
• Requires constant shift of weight
B. 3 POINT GAIT + KNEE-GAIT
• Partial weight bearing both feet
• Provides less support o
R.D.C / BSN 3 1
RLE
LAB / NCM 112/113/114
• Faster than a 4 point gait
C. 3 POINT GAIT
• Non-weight bearing
• Requires good balance
• Requires arm strength
• Faster gait
• Can use with walker
D. SWING TO
• Weight bearing both feet
• Provides stability
• Requires arm strength fan use with
walker
E. SWING THROUGH
• Weight bearing
• Requires arm strength
• Requires coordination/ balance
• Most advanced gait
NURSING STRATEGIES APPROPRIATE FOR
PROMOTING MOBILITY AND
AMBULATION AND THE USE OF
ASSISTIVE DEVICES
TEACHING CRUTCH WALKING
1. 1. The nurse or physical therapist
explains and demonstrates to the
patient how to use the crutches.
2. The patient learns standing balance by
standing on the unaffected leg by a
chair.
3. To help the patient maintain balance,
the nurse holds the patient near the
waist or uses a transfer belt
4. The patient is taught to support his or
her weight on the hand pieces. (For
patients who are unable to support
their weight through the wrist and
hand because of arthritis or fracture,
platform crutches that support the
forearm and allow the weight to be
borne through the elbow are
available.) If weight is borne on the
axilla the crutch can damage the
brachial pessure of producing "crutch
paralysis."
5. For maximum stability, the patient first
assumes the tripod position by placing
the crutches about 20 to 25 cm (8 to 10
inches) in front and to the side of his or
her toes. (This base of support is
adjusted according to the height of the
patient; a tall person requires a broader
basa of support than does a short
person). In this position, the patient
learns how to shift weight and
maintain balance.
6. Before teaching crutch walking, the
nurse or therapist determines which
gait will be best for the patient. The
selection of the crutch depends on the
type and severity of the disability and
on the physical condition, arm and
trunk strength, and body weight.
7. The nurse walks with the patient who is
just learning how to ambulate with
crutches, holding him or her at the
waist as needed for balance.
8. During this time, the nurse protects the
patient from falls and continually
assesses the patient's stability and
stamina, since prolonged periods of
bed rest and inactivity affect a patient's
strength and endurance. Sweating and
shortness of breath are indications that
crutch-walking practice should be
stopped and the patient permitted to
rest.
MUSCLE GROUPS IMPORTANT FOR
CRUTCH WALKING
A. SHOULDER DEPRESSORS
• to stabilize the upper extremity and
prevent shoulder hiking
R.D.C / BSN 3 2
RLE
LAB / NCM 112/113/114
B. SHOULDER ADDUCTORS
• to hold the crutch top against the chest
wall
C. ARM FLEXORS, EXTENSORS, AND
ABDUCTORS (AT THE SHOULDER
• to move crutches forward, backward,
and sideways
D. FOREARM EXTENSORS
• to prevent flexion or buckling;
important in raising the body for
swinging gait
E. WRIST EXTENSORS
• to enable weight bearing on hand
pieces
F. FINGER AND THUMB FLEXORS
• to grasp the hand piece
TEACHING MANEUVERING TECHNIQUES
TO STAND UP:
1. Move forward to the edge of the chair
with the strong leg slightly under the
seat. 2.
2. Place both crutches in the hand on the
side of the affected extremity. 3.
3. Push down on the hand piece while
raising the body to a standing position.
TO GO DOWN STAIRS:
1. Walk forward as far as possible on the
step. 2.
2. Advance crutches to the lower step.
The weaker leg is advanced first and
then the stronger one. In this way, the
stronger extremity shares with the
arms the work of raising and lowering
the body weight.
TO GO UP STAIRS: 1.
1. Advance the stronger leg first up to
the next step.
2. Advance the crutches and the weaker
extremity.
• Note that the strong leg goes up first and
comes down last.
• A memory device for the patients is, "Up
with the good, down with the bad.'
AMBULATING WITH A WALKER
• A walker provides more support and
stability than a cane or crutches. There are
two types of walkers: pick-up walkers and
rolling walkers. A pick-up walker (one that
has to be picked up and moved with each
step forward) does not permit a natural
walking pattern and is useful for patients
who have poor balance or limited
cardiovascular reserve or who cannot use
crutches
• A rolling walker allows automatic walking
and is used by patients who cannot lift or
who inappropriately carry a pick-up walker.
The height of the walker is adjusted to the
patient. The patient's arms resting on the
walker hand grips should exhibit 20 to 30
degrees of flexion at the elbows, The
patient should wear sturdy, w fitting shoes.
• The nurse walks with the patient, holds him
or her at the waist as needed for balance,
continually assesses the patient's stability,
and protects the patient from falls.
THE PATIENT IS INSTRUCTED TO AMBULATE
WITH A PICK-UP WALKER AS FOLLOWS:
1. Push off a chair or bed to come to a
standing position. Never pull yourself
up using the walker.
2. Hold the walker on the hand grips for
stability.
3. Lift the walker, placing it in front of you
while leaning your body slightly
forward. 4.
4. Walk into the walker, supporting your
body weight on your hands when
R.D.C / BSN 3 3
RLE
LAB / NCM 112/113/114

advancing your weaker leg, permitting cane in the opposite hand, the cane
partial weight bearing or non-weight may be used on the same side,
bearing as prescribed. 2. Advance the cane at the same time the
5. Balance yourself on your feet. affected leg is moved forward.
6. Lift the walker, and place it in front of 3. Keep the cane fairly close to the body
you again. Continue this pattern of to prevent leaning.
walking. 4. Bear down on the cane when the
7. Remember to look up as you walk. unaffected extremity begins the swing
phase
USING A CANE
TO GO UP AND DOWN STAIRS USING THE
• A cane helps the patient walk with greater
CANE:
balance and support and relieves the
1. Step up on the unaffected extremity.
pressure on weight-bearing joints by
2. Place the cane and affected extremity
redistributing weight. Quad canes (four-
up on the step.
footed canes) provide more stability than
3. Reverse this procedure for descending
straight canes.
steps ("up with the good, down with
• To fit the patient for a cane, the patient is
the bad").
instructed to flex the elbow at a 30-degree
angle, hold the handle of the cane about
level with the greater trochanter, and place
the tip of the cane 15 cm (6 inches) lateral
to the base of the fifth toe. Adjustable
canes make individualization easy.
• The cane should be fitted with a gently
flaring tip that has flexible, concentric
rings; the tip with its concentric rings
provides optimal stability, functions as a
shock absorber, and enables the patient to
walk with greater speed and less fatigue.
• The cane is held in the hand opposite the
affected extremity. In normal walking, the
opposite leg and arm move together
(reciprocal motion); this motion is to be
carried through in walking with a cane.
CANE-FOOT SEQUENCE:
1. Hold the cane in the hand opposite the
affected extremity to widen the base
of support and to reduce the stress on
the involved extremity. If the patient
for some reason is unable to use the

R.D.C / BSN 3 4