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ASSISTIVE DEVICES FOR WALKING

Cane
A cane is used to help a patient walk with greater balance and support. Aside from the mentioned benefits a cane is also used to help relieve pressure on the weight-bearing joints by redistributing the weight of the body. Types of cane: Single or straight cane one-footed canes Tripod cane three-footed canes Quadripod cane four-footed canes. This type of cane provides more stability than the single canes. For safe cane use, this assistive walking device should be fitted with a gently flaring tip that has flexible and concentric rings. The tip with its concentric rings provides optimal stability which functions as a shock absorber and enables the patient to walk with greater speed but less fatigue. Proper Cane Use: The cane is fitted by instructing the patient to flex the elbow at a 30 degree angle. The patient should hold the handle approximately level with the greater trochanter. The tip of the cane should be placed 15 cm or 16 inches lateral to the base of the fifth toe. The cane is held in the hand OPPOSITE to the affected extremity. In normal walking: the opposite leg and arm move together, a movement called reciprocal motion. This motion should be carried through when walking with cane. Nursing Responsibility for Patients with Canes It is one of the crucial responsibilities of the nurse to continually assess the stability of the patient. The nurse should also keep in mind to consider patient safety all the time (protecting the patient from falls). When walking with a patient on cane, the nurse walks with the patient while holding at the waist as needed for balance. Tolerance of walking should also be assessed by the nurse. Rest periods should be provided as necessary. Ambulating with Cane: Cane-foot sequence The hand opposite to the affected extremity holds the cane to widen the base of support and to reduce stress on the affected limb. As the cane is advanced, the affected leg is also moved forward at the same time. The cane should be kept fairly close to the body to prevent leaning. When the unaffected extremity begins the swing phase, the client should bear down on the cane. Ambulating with Cane: Cane-foot sequence: Going Up the Stairs To go up the stairs, step up on the unaffected extremity. Place the cane and affected extremity up on the step. Ambulating with Cane: Cane-foot sequence: Going Down the Stairs To go down the stairs, place the cane and affected extremity down on the step. Step down the unaffected extremity.

Walker
When more support and stability is the issue, walkers are better provider of these features than a cane or a crutch. Unlike canes, walkers do not permit a natural reciprocal pattern which makes its an ideal walking assistive device for patients who have poor balance or limited cardiovascular reverse or those who cannot use crutches. Proper Walker Use The height of the walker is adjusted to the patient. Walkers should be at the hip level of the patient using it. The patients arm should rest on the walker. The hand grips should exhibit 20 to 30 degrees of flexion at the elbows. The patient should wear sturdy and well-fitting shoes. Assisting Patients with Walkers The nurse continually assesses the patients stability and protects the patient from falls. The nurse walks with the patient by holding him or her at the waist as needed for balance. Ambulating with Walkers The walker should be held on the hand grips for stability. Instruct the patient to lift the walker and place it in front by leaning his or her body slightly forward. When walking with walker, the patients body weight should be supported by the hands when advancing the patients weaker leg. This permits partial weight bearing or non-weight bearing as prescribed. The patient balances on his or her feet. Lift the walker and place it in front again and continue the same pattern of walking.

Crutches
A crutch is an ambulatory aid that provides support and balance to patients. It is a convenient method of getting a patient from one place to another. For crutch walking to be possible, good balance and erect posture are essential. Who can use crutches?

Patients who are prescribed partial weight-bearing or non-weight bearing ambulation may use crutches.

Who determines if crutches are appropriate ambulatory aids for the patient?

The nurse or physical therapist determines if crutches are appropriate ambulatory aids for the patient.

To promote safety when crutch walking the following is important to keep in mind: 1. Crutches should have large rubber suction tips. 2. Patients should wear well-fitting shoes that have firm soles. 3. Crutches must be adjusted to the patient. Before a patient walks using crutches, preparatory exercises are done. These exercises are aimed at strengthening the shoulder girdle and the upper extremity muscles which bear the patients weight when crutch walking. The muscle groups that are vital to crutch walking are the following:

Shoulder depressor muscles which stabilize the upper extremity and prevent shoulder hiking. Shoulder adductor muscles which hold the crutch top against the chest wall. Arm flexor, extensor and abductor muscles which move crutches forward, backward and sideward. Forearm extensor muscles which prevent flexion or buckling and are important in raising the body in swinging gait. Wrist extensor muscles which enable weight bearing on hand pieces. Finger and thumb flexor muscles which grasp the hand piece.

Measuring for Crutches The patient may be measured standing or lying to determine the approximate crutch length. The patients height may also be used. STANDING PATIENT

Position the patient against the wall with feet slightly apart and away from the wall. Mark out 5 centimeters or 2 inches to the side from the tip of the toe. Measure fifteen centimeters or 6 inches straight ahead from the first mark. Mark this point. Measure 5 centimeters or 2 inches below the axilla to the second mark for the approximate crutch length. LYING PATIENT Measure from the anterior fold of the axilla to the sole of the foot. Add 5 cm or 2 inches to this measure.

USING THE PATIENTS HEIGHT

Subtract 40 cm or 16 inches to obtain the approximate crutch length.

In general the hand pieces should be adjusted to allow 20 to 30 degrees of flexion at the elbow. The wrist should be extended and the hand is dorsiflexed. A foam rubber pad on the under arm piece may be used to relieve pressure of the crutch on the upper arm and thoracic cage.