SKILL: USING MECHANICAL AIDS FOR WALKING

LEGEND:
1. Task not accomplished as required 2. Accomplished task adequately 3. Fully accomplished task with art and
dexterity

PREPARATION 1 2 3 COMMENTS
A. CANES
1. Obtain essential equipment before starting
 Three types of canes are commonly used: the standard straight-
legged cane; tripod cane; and the quad cane. Cane tips should
have rubber caps to improve traction and prevent slipping. (the
length should permit the elbow to be slightly flexed)
PROCEDURE
1. Hold the cane with the hand on the stronger side of the body to provide maximum
support and appropriate body alignment when walking
2. Position the tip of a standard cane about 15 cm (6 inches) to the side
and 15 cm (6 inches) in front of the near foot, so that the elbow is
slightly flexed
3. When maximum support is required
 Move the cane forward about 30 cm (1 ft) or a distance that is
comfortable while the body weight is borne by both legs
 Move the affected (weak) leg forward to the cane while the
weight is borne by the cane and stronger leg
 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 two
points of support on the floor at all times
4. As you become stronger and require less support
 Move the cane and weak leg forward at the same time, while
the weight is borne by the stronger leg
 Move the stronger leg forward, while the weight is borne by the
cane and the weak leg
B. WALKERS
PREPARATION
1. Assess:
 Client has partial strength in both hands and wrists, strong elbow extensors, and
strong shoulder depressors
 Client has ability to bear at least partial weight on both legs
2. Adjust the height of a client’s walker so that the hand bar is just below the client’s waist
and the client’s elbows 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 that is too high
makes the client stretch and reach)
PROCEDURE
1. 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
2. If one leg is weaker than 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
C. CRUTCHES
PREPARATION
1. Obtain the correct length for the crutches and the correct placement of
the handpiece.

*There are two methods of measuring crutch length:

 The client lies in a supine position and the nurse measures from
the anterior fold of the axilla to the heel of the foot and adds 2.5
cm (1 in.)
 The client stands erect and positions the crutch. The nurse makes
sure the shoulder rest of the crutch is at least three finger widths,
that is, 2.5 to 5 cm (1 to 2 in) below the axilla.
*To determine the correct placement of the hand bar:
 The client stands upright and supports the body weight by the
hand grips of the crutches
 The nurse measures the angle of elbow flexion. It should be 30
degrees. A goniometer may be used to verify the correct angle.
2. Before crutch walking is attempted, make sure client knows facts about
posture and balance. The proper standing position with crutches is called
the tripod (triangle) position.
 The crutches are placed about 15 cm (6 in) in front of the feet
and out laterally about 15 cm (6 in), creating a wide base of
support. The feet are slightly apart.
3. Four-Point Alternate Gait (client needs to be able to bear weight on
both legs) The nurse asks the client to:
 Move the right crutch ahead a suitable distance, such as 10 to 15
cm (4 to 6 in)
 Move the left front foot forward, preferably to the level of the
left crutch)
 Move the left crutch forward
 Move the right foot forward
4. Three-Point Gait (Client must be able to bear the entire body weight
on the unaffected leg. The two crutches and the unaffected leg bear
weight alternately) The nurse asks the client to:
 Move both crutches and the weaker leg forward
 Move the stronger leg forward
5. Two-Point Alternate Gait. The nurse asks the client to:
 Move the left crutch and the right foot forward together
 Move the right crutch and the left foot ahead together
6. Swing-To Gait. (Used by clients with paralysis of the legs and hips) The
nurse asks the client to:
 Move both crutches ahead together
 Lift body weight by the arms and swing to the crutches
7. Swing-Through Gait. The nurse asks the client to:
 Move both crutches together
 Lift body weight by the arms and swing through and beyond the
crutch
8. Getting into a chair. The nurse asks the client to:
  Stand with the back of the unaffected leg centered against the
chair. The chair helps support the client during the next steps
 Transfer the crutches to the hand on the 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
 Lean forward, flex the knees and hips, and lower into the chair
9. Getting Out of a chair. The nurse instructs the client to:
 Move forward to the edge of the chair and place the unaffected
leg slightly under or at 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.
 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.
 Push down on the crutches and the chair armrest while elevating
the body out of the chair.
 Assume the tripod position before moving
10. Getting Up Stairs. The nurse stands behind the client and slightly to
the affected side if needed. The nurse instructs the client to:
 Assume the tripod position at the bottom of the stairs
 Transfer the body weight to the crutches and move the
unaffected leg onto the step
 Transfer the body weight to the unaffected leg on the step and
move the crutches and affected leg up to the step. The affected
leg is always supported by the crutches
 Repeat steps 2 and 3 until the client reaches the top of the stairs
11. Getting Down Stairs. The nurse stands one step below the client on
the affected side if needed. The nurse instructs the client to:
 Assume the tripod position at the top of the stairs
 Shift the body weight to the unaffected leg, and move the
crutches and affected leg down on to the next step
 Transfer the body weight to the crutches, and move the
unaffected leg to that step. The affected leg is always supported
by the crutches
 Repeat steps 2 and 3 until the client reaches the bottom of the
stairs