Mobility and Transfers

• When not to Mobilize

  • Cardio status
  • Neurological status
  • Respiratory status
  • Other
• When not to mobilize: Mean Arterial Pressure

  <65 or >110
• BP


  A drop is systolic pressure >20 mm Hg or below pre-exercise level OR a disproportionate rise (>200mm Hg for systolic or >110 mm Hg for diastolic)
• HR


  <40 or >130
• Hemodynamic


  Uncontrolled hypertension or active bleeding
• Acute or unstable cardiac status


  New MI, unstable rhythm
• Pulmonary embolus


  Discussion with physician required to determine suitability
• DVT


  May mobilize as tolerated after medication, need mobility order from physician
• When not to mobilize: Patient status

  Severe agitation, distress, or combative, not able to understand instructions
• ICP


  Increase >20mm Hg
• RR


  <5 or >40
• FiO2


  > 60 %
• Weightbearing Orders


  • Non-weight bearing (NWB)
  • Feather weight bearing (FeWB)
  • Partial weight bearing (PWB)
  • Weight bearing as tolerated (WBAT)
  • Full weight bearing (FWB)
• Non-weight bearing (NWB)


  Weight is entirely on unaffected leg
• Feather weight bearing (FeWB)


  Patient can touch floor with toes to aid in balance, but not for weight bearing
• Partial weight bearing (PWB)


  Affected leg begins to take prescribed amount of weight, less than 50% patients body weight
• Weight bearing as tolerated (WBAT)


  Patient bears as much weight as possible on affected leg without undue discomfort
• Full weight bearing (FWB)


  Patient bears full weight, may use aid for balance
• Mobility Aids


  • Walker
  • Crutches
  • Cane
• Walker


  • Most stable type of device
  • Elbow should be in 20-30 degrees of flexion when holding handgrips; measure to wrist crease in standing
  • No arm swing and unsafe on stairs
  • Used for patient with: generalized weakness, debilitating conditions, poor balance/coordination, unable to use crutches; common in elderly; patient has reasonable UE strength and needs max support/stability
• Walker


  • Standard walker
  • 2 wheeled walker
  • 4 wheeled walker
• Standard walker


  • Most stable as it has no wheels
  • Used for NWB, FeWB restrictions
  • Used in situations where maximum support is required
  • Slower walking speeds, needs to be picked up while walking
• 2 wheeled walker


  • Used for PWB, WBAT and FWB restrictions
  • Used when patient requires increased stability
  • Faster walking speeds, do not need to pick up back legs when walking
• 4 wheeled walker


  • Used for WBAT
  • Used for patients with mild balance impairments and do not need to put weight through walker
  • Fastest walking speeds
  • Can have a basket for carrying items
  • Brakes on handles
  • Least stable walker
• Crutches


  • Improves balance and lateral stability
  • Stairs: good leg up, bad leg down
  • Descending stairs: therapist is below patient
  • Ascending stairs: therapist is beside and slightly behind patient
  • Railing: if possible, use railing on affected side
  • Curb: see stairs
  • Turning: turn towards strong side using small steps and avoid pivoting
  • Strengthen: latissimus dorsi, trapezius and triceps (key for activating scapular depression and elbow extension)
  • Significant obstacle to independent ambulation with crutches = cognitive impairment
• Axillary crutches


  • Potential for injury in axilla due to pressure on brachial plexus; stability maintained by squeezing crutches against thorax
  • Most commonly prescribed in younger (<50 years old) patients with more acute issues
  • Fitting: 20-30 degrees elbow flexion (hand piece level with wrist crease in standing); 2" below axilla in standing
  • Used only if: at least one unaffected leg, adequate balance, functional UE and trunk strength
• Forearm (Or Lofstrand) crutches


  • Allows for use of hands, but requires strong UE
  • Often for patients with neurological conditions (MS, paraplegia), LE amputation, or long-term use
  • Fitting: top of the forearm cuff is 1-1/2 inches distal to the olecranon when the hand piece is grasped with wrist in neutral position
• Gutter


  • Used when contraindicated to WB through hand/wrist
  • Weight is distributed through forearms
  • Used for patients who cannot weight bear through hands – e.g. multi trauma, severe rheumatoid arthritis or weak grip
  • Fitting: adjust the height so the client's elbow is at 90 degrees when in contact with gutter attachment
• Cane


  • Least stable type of aid and patient needs to be nearing full WB
  • Used for: mild unilateral weakness and/or pain or mild decreased balance; require reasonable UE/LE strength
  • Held in opposite hand as affected leg
  • Gross measurement: measure from greater trochanter straight to the floor
  • Fitting: handgrip is measured to wrist crease (20-30 degrees elbow flexion when held)
• Cane


  • Single point cane
  • Quad cane
• Single point cane


  • Light weight, small and simple
  • Improves safety and balance
  • Least stable walking aid
• Quad cane


  • Unsteady if pressure not evenly distributed
  • Difficult on stairs
  • Larger base of support for additional stability
• Gait Patterns with Aids


  • 3 Point
  • Modified 3 Point
  • 4 Point
  • 2 Point
  • Modified 2 Point
• 3 Point


  • NWB or Feather WB
  • Standard walker or 2 crutches (axillary or forearm)
  • Walker OR 2 crutches advance forwards before OR with NWB or FWB limb
  • NWB limb floats in air
  • FWB limb lightly touches the ground (for proprioception only)
  • Weight is shifted onto crutches or walker
  • Unaffected limb advances forwards with either "step to" or "step through"
• Modified 3 Point


  • Partial WB or WBAT
  • Standard walker, 2-wheel walker, or 2 crutches (axillary or forearm)
  • Walker OR 2 crutches advance before OR with partial WB limb
  • Partial WB limb touches the ground with less than 50% of body weight
  • WBAT limb bears as much pain free weight as possible
  • Weight is shifted onto crutches or walker as well as affected limb
  • Unaffected limb advances forwards with either "step to" or "step through"
• 4 Point


  • WBAT or Full WB
  • 2 crutches (axillary or forearm), 2 canes, or 2 walking poles
  • Right crutch/cane/walking pole moves forwards
• 2 Point


  • WBAT or Full WB
  • 2 crutches (axillary or forearm), 2 canes, or 2 walking poles
  • Right crutch/cane/walking pole moves forwards simultaneously as left limb steps forwards
  • Left crutch/cane/walking pole moves forwards simultaneously as right limb steps forwards
• Modified 2 Point


  • WBAT or Full WB
  • 1 crutch (axillary or forearm), 1 cane, or 1 walking pole
  • Crutch/cane/walking pole moves forwards simultaneously as contralateral affected limb steps forwards
  • Unaffected limb steps forwards
• Mobility Orders


  • Independent
  • Supervision
  • Minimal assist
  • Moderate assist
  • Maximal assist
• Independent


  No help needed in activity