Used to initiate ambulation in pt. with limited valance.
Provides max security, stability, and safety.
Parallel Bars
Where should you guard the pt. when they are using parallel bars.
Guard the pt. from inside the parallel bars.
Ambulation Aids (4)
- Walkers: Standard adjustable or non-adjustable, w/w. folding, hemi.
- Crutches: Adjustable wood or aluminum
- Bilateral canes
- Single Cane
Used when max stability and support are required.
Walkers
Used for a weakened pt. or one who can not follow the sequencing of the altered gait pattern
Wheeled Walkers
Walker Descriptions (3)
- Difficult to use on stairs
- Difficult to perform normal gait pattern.
- Measure and fit: handgrip at level of wrist crease
Standing up with a walker (3)
- Position stronger leg behind weaker
- Pt. grasps armrests of chair to stand, during partial stand, one hand moves to walker grip.
- Alternate- One hand on armrest, other hand on middle of front cross bar of walker.
Crutch Descriptions (5)
- Less stable than walker
- Require good standing balance
- Good function strength of UE is required
- Elderly pts. may feel insecure with them.
- Loft strand crutches are less stable than axillary: more functional on stair and eliminate potential injury to axilla.
Crutch Descriptions Continued (2)
- May cause injury to axillary nerves and vessels if improperly used.
- Measure and fit 6-8” below axilla.
Standing up w/ crutches (2)
- Position stronger leg behind weaker
2. Both crutches on side of affected limb, pt. pushes up from sitting w/ one hand on armrest, one hand on crutch.
Walker or Crutch Gait Pattern (4)
- Advance device forward.
- Move affected extremity forward w/ or after device.
- Move unaffected extremity forward into walker or between crutches.
- Repeat
Single Cane Descriptions (5)
- Used to compensate for impaired balance
- More functional on stairs
- Easy to transport.
- Small base of support
- Measure and Fit: handgrip at level of wrist crease, cane parallel to femur, tibia
Standing up with a Cane
Cane on side of unaffected limb, pt. pushes w. one hand on armrest and moves one hand onto cane.
Guarding technique on level ambulation (4)
- Stand behind and slightly to one side of pt.
- Grasp gait belt from the bottom w/ one hand w/ palm up and forearm supinated.
- Position your free hand above the pts. shoulder to be ready for loss of balance.
- Outside foot moves w/ the ambulation device other foot follow w/ the pt.
Guarding on Ascending Stairs w/ Cain or Crutch (5)
- Remain behind and slightly to the side of the pt.
- Outside foot is on step which pt. is standing.
- Inside foot on the step below.
- Grasp belt with one hand
- Grasp hand rail w/ opposite hand
Single cane stair pattern (3)
- Hold cane in hand nearest goo leg.
- Ascending stair: Up w/ the good. Use good leg to elevate body as steps up w/ weak leg and cane simultaneously.
- Descending Stair Pattern: Down w/ weakened leg and can simultaneously. Follow w/ the good leg.
Crutch Stair Pattern : Ascending
- Up w/ the good leg
- Use good leg to elevate body as steps up w/ weak leg and crutches simultaneously
- Client extends and ER weakened leg during elevation so toes do not strike front edge of stairs.
Crutch Stair Patterns : Descending
- Good leg and crutches go to the front of the step.
- Weak is held forward of the front of the step.
- Bend good leg as crutches are lowered to next step.
- Support weak leg on the next step w/ the crutches
- Down w/ the good leg
Guarding while Descending Stairs (6)
- Stand in front and to the side.
- Outside foot on the step to which the pt. WILL step.
- Inside foot on the step that is one foot lower.
- Do NOT stand w/ both feet on same step; this will make you unstable if the pt. loses balance.
- Grasp safety belt in front, other hand on anterior sh. gently or hand rail.
- Teach pt. to stop and gain balance.
Action if pt. loses balance or falls : Ground level (2)
- Firmly hold gait belt, push forward at pelvis and pull back on shoulder.
- If continues to fall, squat slightly, pull pt. into your body and slide them down your leg to the floor.
Action if pt. loses balance or falls : Ascending Stair (2)
- Restrain pt. at shoulder and with gait belt, move closer to pt.
- If unable to regain balance, encourage to grab handrail and lower pt. to ground using gait belt as guide.
Action if pt. loses balance of falls : Descending Stairs (3)
- Restrain pt. by firmly pushing on shoulders and pulling on gait belt.
- Or hold onto gait belt and hand rail and pull your body close to pt.
- If continues to fall encourage to grab hand rail, maneuver pt. closer to wall and floor using gait belt.
