Ambulation- act of walking or being

able to walk
Ambulation aid- piece of equipment
used to provide support or stability to a
person while walking
Gait- the manner or style of walking
Unilateral- one sided
Bilateral- two sided or both sides
Extremities- arms (upper) or legs
(lower)

ASSISTING WITH AMBULATION

AND GAIT TRAINING
Assistive devices
are used to make
safe ambulation
possible

1) decreased ability to bear weight

on the lower extremities (legs)
2) muscle weakness or paralysis of
the trunk or lower extremities
3) poor balance in the upright
posture

15 year old boy fractures RLE tibia and

fibula. The boy had surgery to repair
and doctors orders NWB for 2 months.
As the physical therapist, what
assistive device will you instruct him to
use?

6.3 Demonstrate appropriate use of

equipment and devices as directed by rehab
professionals.

What device have we already learned

about?

Crutches

Artificial supports that assist a patient

who needs help walking.
Ordered by a physician
Made of wood or aluminum

How do you fit patient

for crutches?
#1 Measurement
points:
Height of heels on
shoes: low broad
heels, approx. 1 to 1
inches high, non skid
soles
Position crutches: 4-6
inches to the side and
front of the pts foot

Distance b/t axilla

and axillary bar:
2 inches

Degree angle for

elbows: 25 30
degrees

#2
Bear weight on both
legs 4-point gait

Each step is separate:

(crutch- opposite
foot-crutch-opposite
foot)

Used: cannot bear full weight on

either leg

#2 continued
When 4-point is
mastered then the
pt can advance to:
2-point
1) Crutch-opposite foot
(move together)
2) Crutch-opposite foot
(move together)

After the patient gains

strength in the arms
and shoulders, faster
gaits such as the
swing-to or swingthrough are taught
Swing-to:
Move both crutches forward
Move feet up to crutches
Swing-through:
Move both crutches forward
Swing both legs in front of
crutches

#3 If a pt can bear
weight on only 1
leg, the first crutch
gait taught is the 3point
Move both crutches and the weak
foot at the same time (3)
Then advance the good foot
forward.

When the pt gains

strength in the arms
and shoulders, faster
gaits such as the
swing-to or swingthrough are taught.

# 4 Why is it
important to avoid
pressure on the
axillary area when
crutch walking?
Nerve damage can
occur.

*Always instruct patients to look

straight ahead and not down at
his/her feet.

crutch walking

swing to

Using Rubric You will grade each other

on Assisting your partner with the
swing-to of crutch walking Why
swing-to?

1st I will show you what I expect.

Student Demonstrates & I grade

Student demonstrates as we grade together
You demonstrate with each other- and grade
one another other You Do

Since you have practiced with crutches,

what conclusion can you make about
the criteria required to place a patient
on crutches?

Review standard & next lesson

LIA - what you learned, what was
interesting, and how can you apply?

Demonstration is usually the

primary
method of instruction.
Once a patient has become proficient on
level
surfaces, instruction or teaching in the
use
of stairs, curbs, ramps, and doors can be
given.
The patient is taught to climb and
descend stairs on the right-hand side
since this is the usual method used
throughout the US.

Assistive devices also

help
to increase the patients
base of support, allowing
a re-distribution of weight
within the base of support

Made of wood or aluminum

Can be adjusted for maximum fit
Measure pt from the armpit to the
http://www.videomd.com/HowToU
seCrutchesProperly-fv6038.aspxheel

The patient may

need
range of motion or
strengthening
exercises
before beginning an
ambulatory
therapy program

To provide maximum stability, the

patient
may need to practice on the parallel
bar. This will help him become
accustomed to the upright position and
learn the sequence for gait or walking
in relative safety.

Crutches
Walkers
Parallel bars

Bilateral canes
Crab canes
Single canes

It is important to instruct the patient

how to protect himself during a fall and
how to get up after a fall
It is important to teach the patient how
to check his ambulatory aid for its safe
operation and use
The patient should avoid throw rugs

Generally the first step- gives the

most support than any
Height- elbows are bent 25-30
degrees when the patient is
standing and holding on to the
bars with his hands

Used for impaired balance or to

improve stability
The handgrip should be placed so
that it is as tall as a persons wrist
from the floor
Place the cane parallel to the femur
and tibia with the foot of the cane
on the floor or at the bottom of the
heel of the shoe

#5 - Cane should be used on the unaffected

(good) side
#6 Canes should be at the height of the pts
top of the femur at hip joint.
Elbow should be flexed at 25 to 30 degree
angle.
Ambulate cane on good side
Cane moves with opposite leg .(this prevents leaning
toward bad side)
3 point gait/2 point gait

Using a cane
improve your balance as you walk or help you compensate for an
injury or disability. choose a cane?
If you need the cane only for balance - a standard cane with a single
tip.
If you need the cane to bear weight - offset cane with four tips. (quad
cane)

Should be adjusted so that the elbow

can be flexed 25-30 degrees when the
patient is standing with his hands on it
The walker is 1st lifted with both hands
and then placed forward 25-30
centimeters.
It is stepped into, first with the
stronger leg and then the weaker leg
http://www.kaisersantarosa.org/video

# 7 Handles on a walker should be at

the level of the patients femurs. The
elbows should be flexed at 25 to 30
degrees
# 8- Rubber tips prevent slipping.
#9 Caution a patient against sliding a
walker b/c it is so lightweight it may tip
over. They should lift them.

To start the patient s/b standing in the

walker
Lift the walker, so that the back legs
are even with toes
Transfer weight forward slightly to the
walker
Instruct pt to use walker for support
and to walk into the walker.

Always walk with patient on their weak

side, slightly behind them
#10 - If using a transfer belt keep a
firm hold in case the patient falls,
eased to the floor, protecting head and
neck.