Assistive Devices

J.A.K.E NCMB 316 RLE

PRINCIPLES AND PRACTICES OF REHABILITATION 2) Put your hand on the handle of the walker closest to the
Rehabilitation stairs. Put your hand on the stair railing.
- Health-oriented process that assists an ill person or a 3) Put the first two legs of the walker on the first step
person with disability 4) Move your strong leg onto the first step
- To achieve the greatest possible level of physical, mental, 5) Lift your injured leg to the same step
spiritual, social, and economic functioning 6) Repeat going up each step starting with the walker,
- Nursing considerations: strong leg then weak leg.
• Physical Going downstairs
• Psychological 1) Turn the walker sideways so the front of the walker is
• Coordination beside your leg.
• Safety 2) Put your hand on the handle of the walker furthest from
• Resources the stairs. Put your other hand on the stair railing
3) Put the first two legs of the walker on the first step.
Assistive devices 4) Move your injured foot onto the first step.
• Wheelchair 5) Lower your good foot down to the same step.
• Walker 6) Repeat going down each step starting with the walker,
weak leg, then strong leg.
• Crutches
Going up with a folding walker
• Cane
1) Fold your walker and place it sideways on the step you
- Also known as “Mechanical Aids”
are on.
- Any item of equipment or product system that is use to
2) Push down on it for support and hold onto the handrail
improve the functional capabilities of individual with
with the other hand.
disabilities
3) Step up with your strong leg.
Walker
4) Bring your weak leg and the walker up to the same step.
- Purposes:
5) Repeat going up each step, starting with the walker,
• Maintain balance
strong leg and then weak leg.
• Provide additional support because of wide area of
6) At the top of the stairs, unfold the walker and set it on
contact with floor
the landing. Make sure you hear the walker click into the
• Allow for some ambulatory independence locked position.
- Advantage: Very Stable mobility aid Going down a curb
- Disadvantage: Bulky, cannot be used in small areas, in 1) Walk up to the edge of the curb
narrow stairs and crowded places 2) Put all four legs of the walker on the ground below.
- Types: 3) Step down with your weak foot, then your strong foot.
• Pick-up Walker Crutches
• Rolling Walker - Purposes:
- The height of the patient arm on the walker hand grip • Support body weight , assist weak muscles, and provide
should be 20 – 30 degrees flexion at elbows joint stability
- Use sturdy, well-fitted shoes • Relieve pain
- Proper use: handgrips is about wrist high when your
• Prevent further injury and provide for improvement of
arm is hanging at your side
function
1) Getting up with a walker
• Allow for greater independence.
2) It’s very important that you place both hands on the
- Types of crutch walking:
armrest of the chair and use your arm to push yourself
• NWB – Non Weight bearing
to standing before you grap the walker.
3) Set down on the chair. • TDWB or TTWB – Touch Down weight Bearing or Toe
Touch Weight Bearing
4) Reach both hands back grap the armrest of the chair
and sit carefully. • PWB – Partial Weight Bearing
5) Walk with walker wt. bearing and partial wt. bearing • WBTT – Weight Bearing to Tolerance
6) Move the walker forward-bad foot halfway-good foot • FWB – Ful Weight Bearing
7) Walk with walker with non-weight-bearing - Types:
8) Lift the bad foot off to the ground- move forward the • Underarm/ axillary crutch
walker - swing the good foot up to the bar of the walker • Loftrand crutch
- Going up stairs: • Platform
1) Turn the walker sideways so the front of the walker is
beside your leg.

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J.A.K.E Assistive Devices NCMB 316 RLE

• Do not lean on the top of the crutches as this can cause

your arms to have numbness and tingling ( this is assign
of pressure on the nerve, neuropraxia of the radial nerve
or brachial plexus )
• Remember to stand up straight
Four-point gait
- Indication: Weakness in both legs or poor coordination.
- Advantage: Provides excellent stability as there are always
three points in contact with the ground
- Disadvantage: Slowest and most stable gait pattern
- Requires the use of two assistive devices (crutches or
canes);
- Ex. Person’s with polio, arthritis, cerebral palsy
- RIGHT CRUTCH - LEFT LEG - LEFT CRUTCH - RIGHT LEG

Three-point gait
- requires use of two assistive devices (crutches or canes)
or a walker;
- indicated for use with involvement of one extremity , e.g.
- Crutch Stance lower extremity fracture,pain, amputation
• “Tripod Position” should be 4 inches anteriorly and 6 - must be able to bear the entire body weight on unaffected
inches laterally from the toes extremity; with right or left leg affectation
• Height may be adjusted according to patient’s height - both crutches and involved leg are advanced together,
- Safety tips using crutches: then uninvolved leg is advanced forward;
• Make sure the crutches have padding at the top of the - Note: one leg affection
crutch at the handle and on the bottom tip that are in - BOTH CRUTCHES WITH WEAK LEG - STRONG LEG
good condition
• Your doctor will tell you how much weight you’re
allowed to put through your injured leg
• After adjusting for height, make sure any nuts are tight
before using the crutches
• Always wear good supportive shoes or bare feet rather
than loose slip on footwear
• Avoid wet surfaces
• Remove any rugs that are easily moved to prevent
slipping
• Adjusting the ht. is done in standing
Two-point gait:
- Place the tip of the crutch about 10 cm or 6 inches
out from the side of your toes - requires use of two assistive devices (canes or crutches);
- At the top there should be 2 to 3 finger space allows for natural arm and leg motion during gait,
between the crutch and your armpit - There are always two points of support on the floor
- The handle is placed at the level of the wrist when - Note: requires more balance; most difficult
the arm straight down by your side - progression of four-point gait, resembles normal walking
- When you grip the handle your elbow is slightly bent - RIGHT CRUTCH WITH LEFT LEG - LEFT CRUTCH WITH
- When walking the angle of the crutches should be RIGHT LEG
just enough

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J.A.K.E Assistive Devices
Tripod gait
- This crutch gait pattern is taught to patients who will later
on use swing patterns. This is indicated for both leg
affectation.
- Note: for paraphegic patient
- learning to swing
- RIGHT CRUTCH - LEFT CRUTCH - DRAG BOTH LEGS
Swing-to gait
- both crutches are advanced forward together; weight is
shifted onto hands for support and both legs are then
swung forward to meet the crutches; requires the use of
two crutches or a walker; indicated for individuals with
limited use of both lower extremities and trunk instability.
- BOTH CRUTCHES ADVANCE- SWING BOTH LEGS (NOT
PASSING THE CRUTCH)
Swing-through gait
- both crutches are advanced forward together; weight is
shifted onto the hands for support and both legs which are
swung forward beyond the point of crutch placement;
requires the use of two crutches; both swing-to and swing-
through gaits are used for bilateral lower extremity
involvement, and trunk instability, (e.g. patient with
paraplegia, spina bifida.)
- Note: Not as safe as swing-to gait.
- fastest gait pattern
- passing thru crutches
- BOTH CRUTCHES ADVANCE- SWING BOTH LEGS
(GOING BEYOND THE CRUTCH)
Summary
• Four point gait – Slowest and most stable gait pattern
• Three-point gait pattern – one leg affection
• Two point gait pattern – most difficult , resembles normal
walking, Progression of 4 point gait pattern
• Tripod gait – For paraphegic patient, learning to swing
• Swing to gait – Not passing thru crutches
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NCMB 316 RLE
• Swing through – Fastest gait pattern, passing thru the
crutches
Canes
- Use with patient with greater balance and support
- Types:
a) One Tip / Standard Straight –legged cane
b) Quad Cane
- Should have rubber caps to prevent slipping
Walking with a Cane
1) Adjust the cane length so that when you are standing, the
handle of the cane is at the level of your greater trochanter,
30 degrees elbow flexion or wrist.
2) Hold the cane on the side of your good leg unless you’re
told you otherwise.
3) Begin by stepping forward with your cane followed by
injured or weak leg and, keeping the two in line with each
other.
4) Step forward with your good leg, bringing it ahead of your
injured leg.
Going Upstairs with a Cane
1) Grasp the handrail with your free hand. Begin by raising
your good leg up to the first step.
2) Bring your injured or weak leg and cane together up to the
same step. Keep your leg and cane in line with each other.
Going Downstairs with a Cane
1) Put your feet near the steps and step down first with your
injured or weak leg.
2) Place your cane on the first step down.
3) Bring your good leg to the same step.
4) Repeat until you are at the bottom of the stairs.
5) When using a cane to go up and down stairs, it is helpful to
remember “Up with the good and down with the bad”.