Assistive

Devices
Jam Valles Corros, SN
Assistive Devices 
■ Assistive devices are basically helpful products that improve a person’s
ability to function independently.

■ They are used by people with disabilities and older adults who want to
remain independent as long as possible
Indications for Ambulatory Assistive Devices 
■ Structural deformity, amputation, injury, or
disease resulting in decreased ability of Lower
extremities.
■ Muscle weakness or paralysis of the trunk or
Lower extremities
■ • Inadequate balance
Assistive devices
Commonly used Assistive devices for mobility includes :
■ Cane
■ Walkers
■ Crutches
Cane 
■ Cane is a hand held ambulation device made of wood
or aluminum •
■ Three types of canes are commonly used:
■ 1. The standard straight-legged cane;
■ 2. The tripod or crab cane, which has three feet
■ 3. The quad cane, which has four feet and provides
the most support
■ The Standard cane should have rubber caps to improve tractions
and prevent slipping.
■ The Standard cane is 91 cm (36 in) long: some aluminum cane
can be adjusted from 56 to 97 cm (22 to 38 in).
■ The length should permit the elbow to be slightly flexed.
■ Client may use either one or two canes, depending on how much
support they require.
Cane (Photo)
CLIENT TEACHING
USING CANE:
- 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 the canes about 15 cm
(6 in) in front if the near foot, so that the elbow is slightly flexed.

WHEN MAXIMUM SUPPORT IS REQUIRED

- Move the cane forward about 30 cm (1ft), or a distance that is comfortable while
the body is borne by both legs.
- Then Move the affected (weak) leg forward to the cane while the weight is borne
by the cane and stronger leg.
- 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
- Repeat the steps. This pattern of moving provides at least to points of support on
the floor at all times.
WALKERS
■ Walkers are mechanical devices for ambulatory clients who need more support
than a cane provices and lack the strength and balance required for crutches.
■ Walkers come in many different shapes and sizes, with devices suited to individual
needs.

a. Standard

b.Four-Wheeled

c. Two-wheeled
STANDARD WALKER
■ Standard Cane is made of polished
aluminum. It has four legs with rubber
tips and plastic hand grips. Many
walkers have adjustable legs.
■ The standard walker needs to be
picked up to be used.
■ The client therefore requires partial
strength in both hands and wrist,
stronger elbow extensors, and strong
shoulder depressors.
■ The client also needs the ability to bear
at least partial weight on both legs.
FOUR WHEELED WALKER
■ This do not need to picked up to be
moves, but they are less stable than
the standard walking.
■ They are used by clients who are too
weak or unstable to pick up and move
the walker with each step.
■ Some walker have a seat at the back
so tat the client can sit down to rest
when desired.
TWO WHEELED WALKER
■ An adaptation of the standard and
four-wheeled walker is one that has
two tips and two wheels.
■ This type provides more stability that
the four-wheeled model yet still
permits the client to keep the walker
in contact with the ground all the
time.
■ The legs allow the client to easily
push the walker forward, and the
legs without rollers prevent the
walker from rolling way as the client
steps forward.
■ The nurse may need to adjust the height of a client’s walker so
that the hand bar is just below the client’s waist and the client’s
elbow are slightly flexed.
■ This position helps the client assume a more normal stance.
■ A walker that is too low causes the client to stoop; one is too
high makes the client to stretch and reach.
CLIENT TEACHING
USING WALKERS
A. WHEN 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.

B. IF ONE LEG IS WEAKER THAT THE OTHER

- Move the walker and the weak leg ahead together about 15 cm (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.
CRUTCHES
■ Crutches may be a temporary need for some clients and a permanent one for
others. Crutches should enable a client to ambulate independently; therefore, it is
important to learn to use them properly.
■ The most frequent used type of crutches are the underarm crutch, or axillary
crutch with hand bars, and the Lofstrand Crutch which extends only to the
forearm.
■ On the Lofstrand crutch, the metal cuff around the forearm stabilizes the wrists
and thus make walking easier, especially on stairs.
■ The platform, or elbow extensor crutch also has a cuff for the upper arm to permit
forearm weight bearing.
■ All crutches require suction tips, usually made of rubber, which help to prevent
slipping on a floor surface.
■ In crutch walking, the client’s weight is borne by the muscle of the shoulder girdle
and upper extremities.
■ Before beginning crutch walking, exercise that strengthen the upper extremities
arms and hands are recommended.
Measuring Clients for Crutches
■ When nurses measure clients for axillary crutches, it is most important
to obtain the correct length for the crutches and the correct placement
of hand piece.
■ There are two methods of measuring the crutch length:
1. The client lies in a supine position and the nurse measures from the
anterior folds of the axilla to the heel of the foot and adds 2.5cm (1in)
2. The client stands erect and position the crutch. The nurse makes the
sure the shoulder rest of the crutch is at least three finger widths, that is
2.5cm to 5 cm (1 to 2 in), below the axilla.
■ To determine the correct placement of the hand bar:
1. The client stands upright and supports the body weight hand grips of the
crutches.
2. The nurse measures the angle of elbow flexion. It should be about 30 degrees.
A goniometer may be used to verify the correct angle.
Goniometer
CLIENT TEACHING
■ Follow the plan of exercise developed for you to strengthen your arm muscles
before beginning crutch walking
■ Have a health care professional establish the correct length for your crutches and
the correct placement of the hand pieces. Crutches that are too long force your
shoulder upward and make is difficult for you to push your body off the ground.
Crutches that are too short will make you hunch over and develop an improper
stance.
■ The weight of your body should be borne by the arms rather than the axillae
(armpits). Continual pressure on the axillae can injure the radial nerve and
eventually cause crutch palsy, a weakness of the muscle of the forearm, wrist and
hand.
■ Maintain an erect posture as much as possible to prevent strain on muscles and
joints to maintain balance.
■ Each step taken with crutches should be a comfortable distance for you. It is wise
to start with a small rather than a large step.
■ Inspect the crutch tips regularly, and replace them if worn.
■ Keep the crutch tips dry and clean to maintain their surface friction. If the tips
become wet, dry them well before use.
■ Wear a shoe with a low heel that grips the floor. Rubber soles decrease the
changes of slipping. Adjust shoelaces so they cannot come unties or reach the
floor where they might catch on the crutches. Consider shoes with alternative
forms of closure (e.g Velcro), especially if you cannot easily bend to tie laces. Slip-
on shoes are acceptable only if they are snug and the heel does not come loose
when the foot is bent.
Crutch Gaits

■ Crutch gait is the gait of a person assumes on crutches by alternating body weight
on one or both legs and the crutches.
■ Five standard Crutch gaits: Four point gait, Three-point gait, Two point gait,
Swing to gait, Swing-through gait
■ The gait used to depends on the following individual factors: (a) the ability to take
steps (b) the ability to bear weight and keep balance in a standing position on
both legs or only one, and (c) the ability to hold the body erect.
■ Clients also need instruction about how to get into and out of chairs and go up
and down the stairs safely. All of these crutch skills are best taught before the
client is discharged and preferably before the client has surgery.
Crutch Stance (Tripod position)
■ Before crutch walking is attempted, the client needs to learn facts about the
posture and balance.
■ The proper standing position with crutches is called the TRIPOD (TRIANGLE)
POSITION.
■ The crutches are places 15 cm (6in) in front of the feet and out laterally about 15
cm (6in) to create a wide base support.
■ The feet are slightly apart. A tall client requires a wider base than does a short
client.
■ Hips and knees are extended, the back is straight, and the head is held straight
and high.
■ There should be no hunch to the shoulders and thus no weight borne by the
axillae.
■ The elbows are extended sufficiently to allow eight bearing on the hands.
■ If the client is unsteady, the nurse place a gait/transfer belt around the client’s
waist and grasps the belt from above, not below. A fall can be prevented more
effectively if the belt is held from above.
Four-Point Alternate Gait
■ This is the most elementary and safest, providing at least three points of
support all the rime, but is requires coordination.
■ Clients can use it when walking in crowds because it does not require
much space.
■ To use this gait, the client needs to be able to bear weight on both legs.
Three-point Gait
■ To use this gait, the client must be able to
bear entire body weight on the unaffected
leg.
■ The two crutches and the unaffected leg
bear weight alternately.

1. Move both crutches and the weaker leg

forward.
2. Move the stronger leg forward.
Two-Point Gait
■ This gait is faster than the four-point gait. It
requires more balance because only two points
support the body at one time; also requires at
least partial weight bearing on each foot.
■ In this gait, arm movement with crutches are
similar movement during normal walking.

1. Move the left crutch and right foot

forward together.
2. Move the right crutch and left foot
together.
Swing-To Gait
■ This swing gaits are used by clients with
paralysis of legs and hip.
■ Prolonged use of this gaits results in
atrophy of the unused muscles.
1. Move both crutches ahead together.
2. Lift body weight by the arms and
swing to the crutches.
 Swing-Through Gait
■ This gait requires considerable skill,
strength, and coordination.
1. Move both crutches forward together.
2. Lift body weight by the arms and
swing through and beyond the crutches.
Getting into a Chair
■ Chairs that have armrest and are secure or
braces against the wall are essential for
clients using crutches.
1. Stand with the back of the unaffected
leg centered against the chair. The chair helps
the client during the next steps.
2. Transfer the crutches to the hand of
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. This allows
the client to support the body weight on the
arms and the unaffected leg.
3. Lean forward, flex the knees and hips,
and lower into the chair.
 Getting Up the Chair
■ For this procedure, the nurse instruct the client to
1. Move forward to the edge of the chair and
place the unaffected leg slightly under the edge of
the chair. This position helps the client stand up from
the chair and achieve balance, because the
unaffected leg is supported against the edge of the
chair.
2. Grasp the crutches by the hand bars in the
hand on the affected side, and grasp the arm of the
chair by the hand on the unaffected side. The body
weight is placed on the crutches and the hand on the
armrest to support the unaffected leg when the client
rises to stand.
3. Push down on the crutches and the chair
armrest while elevating the body of the chair.
4. Assume the tripod position before moving.
Going up Stairs
■ For this procedure, the nurse stands
behind the client and slightly to the
affected side if needed. The nurse
instructs the client to:
1. Assume the tripod position at the bottom
of the stairs.
2. Transfer the body weight to the crutches
and move the unaffected leg onto the step.
3. Transfer the body weight to the unaffected
leg on the step and move the crutches and
affected leg to the step. The affected leg is
always supported by the crutches.
4. Repeat steps 2 and 3 until the client
reaches the top of the stairs.
Going Down The Stairs
■ For this procedure, the nurse stands one
step below the client on the affected side
if needed. The nurses instructs the client
to:
1. Assume the tripod position at the top of
the stairs.
2. Shift the body weight to the unaffected
leg and move the crutches and affected
leg down onto the next step.
3. Transfer the body weight to the crutches,
and move the unaffected leg to the step.
The affected leg is always supported by
the crutches.
4. Repeat steps 2 and 3 until the client
reaches the bottom of the stairs.