Assistive Devices

• Rehabilitation is a health-oriented process that assists an ill person or a person with disability to achieve the greatest possible level of physical, mental, spiritual, social, and economic functioning.
• Nursing considerations in rehabilitation include physical, psychological, coordination, safety, and resources.
• Keep your leg and cane in line with each other.
• Bring your injured or weak leg and cane together up to the same step.
• When using a cane to go up and down stairs, it is helpful to remember “Up with the good and down with the bad”.
• Assistive devices, also known as “Mechanical Aids”, are items of equipment or product systems that are used to improve the functional capabilities of individuals with disabilities.
• A Walker is a mobility aid that maintains balance, provides additional support because of its wide area of contact with the floor, and allows for some ambulatory independence.
• The height of the patient arm on the walker hand grip should be 20 – 30 degrees flexion at elbows.
• Use sturdy, well-fitted shoes when using a Walker.
• Proper use of a Walker involves having the handgrips about wrist high when your arm is hanging at your side.
• When getting up with a Walker, place both hands on the armrest of the chair and use your arm to push yourself to standing before grabbing the Walker.
• Set down on the chair when using a Walker.
• Reach both hands back to grab the armrest of the chair and sit carefully when using a Walker.
• Walk with a Walker with weight-bearing and partial weight-bearing.
• Lift the bad foot off to the ground and move forward the Walker when going up stairs with a Walker.
• Turn the Walker sideways so the front of the Walker is beside your leg, put your hand on the handle of the Walker closest to the stairs, and put the first two legs of the Walker on the first step when going downstairs with a Walker.
• Types of crutches include Underarm/ axillary crutch, Loftrand crutch, and PlatformJ.A.K.E Assistive Devices.
• Going down a curb involves walking up to the edge of the curb, putting all four legs of the walker on the ground below, stepping down with your weak foot, then your strong foot.
• The purposes of crutches are to support body weight, assist weak muscles, provide joint stability, relieve pain, prevent further injury, and improve function.
• The height of crutches can be adjusted according to the patient’s height.
• Safety tips for using crutches include making sure the crutches have padding at the top of the crutch at the handle and on the bottom tip that are in good condition, knowing how much weight you’re allowed to put through your injured leg, making sure any nuts are tight before using the crutches, wearing good supportive shoes or bare feet rather than loose slip on footwear, avoiding wet surfaces, removing any rugs that are easily moved to prevent slipping, adjusting the height of the crutches in standing, and placing the tip of the crutches about 10 cm or 6 inches out from the side of your toes
• The four-point gait is indicated for weakness in both legs or poor coordination and provides excellent stability as there are always three points in contact with the ground.
• Types of crutch walking include Non Weight bearing (NWB), Touch Down weight Bearing or Toe Touch Weight Bearing (TDWB or TTWB), Partial Weight Bearing (PWB), Weight Bearing to Tolerance (WBTT), and Full Weight Bearing (FWB).
• The three-point gait requires the use of two assistive devices (crutches or canes) or a walker and is indicated for use with involvement of one extremity.
• The “Tripod Position” for crutches should be 4 inches anteriorly and 6 inches laterally from the toes.
• Fold your Walker and place it sideways on the step you are on, push down on it for support and hold onto the handrail with the other hand, step up with your strong leg, and bring your weak leg and the Walker up to the same step when going up stairs with a folding Walker.
• At the top of the stairs, unfold the Walker and set it on the landing when going up with a folding Walker.
• Going upstairs with a cane involves grasping the handrail with your free hand, beginning by raising your good leg up to the first step.
• Lower extremity fracture, pain, amputation require the ability to bear the entire body weight on the unaffected extremity.
• Three-point gait pattern involves one leg affection.
• Swing-to gait involves both crutches being advanced forward together, weight is shifted onto hands for support and both legs are swung forward to meet the crutches, requiring the use of two crutches or a walker, and is used for individuals with limited use of both lower extremities and trunk instability.
• Tripod gait is taught to patients who will later use swing patterns and is indicated for both leg affectation.
• Two point gait pattern is the most difficult, resembles normal walking, and is the progression of four-point gait.
• One leg affection requires the use of both crutches, one with a weak leg and one with a strong leg.
• Canes can be used with patients who have greater balance and support, and come in two types: One Tip/Standard Straight-legged cane and Quad Cane, which should have rubber caps to prevent slipping.
• With right or left leg affectation, both crutches and involved leg are advanced together, then uninvolved leg is advanced forward.
• Swing-through gait involves both crutches being advanced forward together, weight is shifted onto the hands for support and both legs which are swung forward beyond the point of crutch placement, requiring the use of two crutches, and is used for bilateral lower extremity involvement, and trunk instability.
• Two-point gait requires the use of two assistive devices (canes or crutches), allows for natural arm and leg motion during gait, and there are always two points of support on the floor.
• To use a cane, adjust the cane length so that when standing, the handle of the cane is at the level of your greater trochanter, 30 degrees elbow flexion or wrist, hold the cane on the side of your good leg unless told otherwise, begin by stepping forward with your cane followed by injured or weak leg, keeping the two in line with each other, then step forward with your good leg, bringing it ahead of your injured leg.
• Four point gait is the slowest and most stable gait pattern.