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 Used to support and balance a patient with decreased leg strength

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. - provides more stability than the single canes. Ambulating with Cane: Cane-foot sequence

Tripod cane three-footed canes Quadripod cane four-footed 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. Cane tips have rubber caps to improve traction and prevent slipping Standard cane 91cm (36 inches) in length and some aluminum canes can be adjusted from 56-97cm (22-38 inches) 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

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 patient s 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

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: Crutches should have large rubber suction tips. Patients should wear well-fitting shoes that have firm soles. Crutches must be adjusted to the patient.

The nurse continually assesses the patient s 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 patient s body weight should be supported by the hands when advancing the patient s 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

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 patient s 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 patient s 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

can damage the brachial plexus nerves, producing crutch paralysis . The patient assumes a tripod position, for maximum stability. This is done by placing the crutches approximately 20 cm to 25 cm (8 to 10 inches) in front and to the side of the patient s toes. The base of support is adjusted to the height of the patient. Crutch Gaits After learning how to shift weight and maintain balance, the patient can now be selected with a crutch gait. The selection of a crutch gait depends on the following: Patient s physical condition Arm and truck strength Body balance

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 PATIENT S 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. Ambulating with Crutches Instruct the patient to wear sturdy, well-fitting shoes. The nurse or the physical therapist should explain and demonstrate the proper manipulation of the crutch. Before a patient attempts on using a crutch, the patient learns standing balance by standing on the unaffected leg by a chair. To help the patient maintain balance, the nurse should hold the patient near the waist or uses a transfer belt. Weight of the body is supported by the hand and not borne on the axilla. The pressure of the crutch on axilla

Types of Crutch Gaits: All crutch gaits begin in the tripod position. The patient should be taught two gaits in order to change from one to another. Each gait requires the use of a different muscle combination, thus, shifting crutch gaits relieves fatigue. If the patient is in crowded places, a slower gait is used. A faster gait can be used for distances. The nurse should continually assess the stability of the patient and protect him or her from falling. When walking with a patient using crutches, the nurse holds the patient s waist for balance. Four point gait: used for partial weight bearing on both feet. Using this gait, maximal support is provided and constant shift of weight is required. Advance the right crutch. Advance the left foot. Advance the left crutch. Advance the right foot. Two point gait: used for partial weight bearing on both feet. This gait provides less support but is faster than the four point gait. 1. Advance left foot and right crutch.

2. Advance right foot and left crutch. Three point gait: non-weight bearing gait. This crutch gait requires good balance and arm strength. It is a faster gait and can be used with walker. 1. Advance left foot and both crutches. 2. Advance right foot. Swing To Gait: Weight bearing is both feet. This gait provides stability and requires arm strength. It can also be used with walkers. 1. Advance both crutches. 2. Lift both feet and swing forward. Land the feet next to crutches. Swing Through Gait: weight bearing. This gait requires arm strength and coordinated balance. This is the most advanced gait. Advance both crutches. Lift both feet and swing forward. Land the feet in front of crutches.