AMBULATORY AIDS

Assisting the patient with Transfer

• Transfer – is the movement of patient from one
place to another ( bed to chair,chair to commode,
wheelchair to tub).

• While confined to bed, it is impt. That the pt.

maintain muscle strength and participate in
“push-up” exercises to strengthen the arm and
shoulder extensor muscles.

• It is helpful for the nurse to demonstrate the

technique.
PREPARING FOR AMBULATION
• Exercise is the foundation of
preparation.

• The nurse instructs and supervises

the patient in these exercises.
QUADRICEP SETTING EXERCISES

– The patient contracts the quadriceps

muscle by attempting to push the
popliteal area against the mattress and
at the same time raising the heel.
• The patient maintains the muscle
contraction until a count of five and
relaxes for a count of five.
• The exercise is repeated 10 to 15
times hourly.
• It prevents flexion contractures of
the knee.
Gluteal Setting
• The patient contracts or pinches the
buttocks together until the count of
five,
• Relaxes for the count of five, and
repeats 10 to 15 times hourly.
Push up exercise
• Requires the patient to sit upright in bed, a
book is placed under each of the patient’s
hand to provide a hard surface.

• The patient is instructed to push down on

the book raising the body.
•
• It is desirable that the patient be able to
raise and move the body in different
directions.
Pull-ups
• Pull ups on a trapeze, while lifting the
body.
• The patient is taught to raise the arms
above the head and lower them in a
slow, rhythmic manner while holding
weights.
• The hands are strengthened by
squeezing a rubber ball.
Promoting Independent Mobility
• When the patient’s condition
stabilizes and the physical condition
permits, the patient is assisted to sit
up on the side of the bed and then to
stand. The patient’s tolerance of this
activity is assessed.
Using Ambulatory Aids

• A patient who is ready to begin

ambulation must be fitted with the
appropriate ambulatory aid,
instructed as to the prescribed
weight-bearing limits, and taught
how to use the aid safely.
• The patient should wear sturdy, well-
fitting shoes and be advised of the
dangers of wet and highly polished
floors and throw rugs.
• The nurse continually assesses the
patient for stability and protects the
patient from falling.
AMBULATORY AIDS
• 1. Crutches
– Provide for support and balance and are
convenient method of getting from one place
to another.

– Good balance and erect posture are essential

for crutch walking.

– For safety, crutches should have large rubber

suction tips and the patient should wear well-
fitting shoes that have firm soles.
• Patients who are prescribed partial
weight bearing or non-weight
bearing ambulation may use
crutches.
Measuring for Crutches
• 2 inches from the anterior fold of the axilla.
• The hand piece should be adjusted to
allow 20 to 30 degrees of flexion at the
elbow.
• 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.
Crutch Stance
• For maximum stability, the patient
learns t assume a TRIPOD POSITION.
• The crutches are placed approx. 8 to
10 inches in front and to the side of
the patient’s toes.
• This base of support is adjusted
according to the height of the patient.
• The patient should be taught two
gaits in order to change from one to
another.
• Shifting crutch gaits relieves fatigue,
as each gait requires the use of a
different combination of muscles.
CRUTCH GAITS
• 4 – Point Gait
– Partial weight bearing, both feet.
– Maximal support provided
– Requires constant shift of weight.

• 3 – Point Gait
– Non weight bearing
– Requires a good balance.
– Requires arm strength
– Faster gait.
• 2 – Point Gait
– Partial weight bearing both feet.
– Provides less support than 4 pt gait.
– Faster than the 4 pt gait.

• SWING TO
– Weight bearing both feet
– Provides stability
– Requires arm strength
• SWING THROUGH
– Weight bearing
– Requires arm strength
– Require coordination
– Most advance gait
OTHER CRUTCH-MANEUVERING
TECHNIQUE
• To sit down
– Grasp the crutches at the hand pieces
for control.
– Bend forward slightly while assuming a
sitting position.
– Place the affected leg forward to
prevent weight bearing and flexion.
• To stand up :
– Move forward to the edge of the chair
with strong leg slightly under the seat.
– Place both crutches in the hand on the
side of the affected extremity.
– Push down on the hand piece while
raising the body to a standing position.
• To go up stairs
– Advance the strong leg first up to the
next step.
– Then advance the crutches and the
weaker extremity. Note that the strong
legs goes up first and comes down last.
– A memory device : “UP WITH THE
GOOD, DOWN WITH THE BAD”
WALKER
• Provides more support and stability
than a cane or crutches.
• It is useful for patients who have poor
balance or limited cardiovascular
reserve, or who cannot use crutch.
• The patient’s arms resting on the
walker hand grips should exhibit 20 to
30 degree flexion at the elbows.
The patient is taught to ambulate
with a walker as follows:
• Hold the walker n the hand grips for
stability.
• Lift the walker, placing it in front of you
while leaning your body slightly forward.
• Walk into the walker, supporting your
body weight on your hands when
advancing the weaker leg, permitting
partial weight bearing or non weight
bearing as prescribed.
• Balance yourself on your feet.
• Lift the walker and place it in front of
you again, continue this pattern f
walking.
 CANE
• A cane is used to help the patient walk
with greater balance and support and
to relieve the pressure on weight
bearing joints by redistributing the
weight.

• The cane should be fitted with a gently

flaring tip that has flexible and
concentric rings
• The tip with its concentric rings
provide optimal stability, functions
as shock absorber, and enables the
patient to walk with greater speed
and less fatigue.
• The patient is instructed to flex the
elbow at a 30 degree angle, hold the
angle, hold the handle of the cane
approx level with the great trochanter.

• Place the tip of the cane 6 in lateral to

the base of the 5th toe.
• The cane is held in the hand opposite
to the affected extremity.

• The nurse walks with the patient,

holding at the waist as needed for
balance.
• The patient is taught to ambulate
with a cane as follows:

– Cane- foot sequence

– Hold the cane in the hand opposite the
affected extremity to widen the base of
support and to reduce the stress on the
involved extremity.
– Advance the cane at the same time the
affected leg is moved forward.
– Keep the cane fairly close to the body to
prevent leaning.
• Bear down on the cane when the
unaffected extremity begins the swing
phase.
• To go up and down stairs using the cane:
– Step up on the unaffected extremity.
– Then place the cane and affected extremity
up on the step.
– Reverse this procedure for descending
steps.
Assisting the patient using an
Orthosis/Prosthesis
• Orthoses and Prostheses are
designed to facilitate mobilization
and maximize the patient’s quality of
life.
• The nurse helps the patient develop
an attitude of realistic hopefulness.
• If the patient has had an amputation,
the nurse promotes tissue healing,
uses compression dressings to
promote residual limb shaping, and
minimizes contracture formation.
• The patient is taught to examine the
orthosis periodically to see if it fits
as designed, its shape not distorted,
and the padding distributes pressure
evenly.
Management for Prosthesis :
• The prosthesis socket is cleaned with mild
soap/water and dried.

• Clean inserts and liners regularly.

• Use garters to keep socks in place.

• Grease parts as instructed.

• Alternately, the residual limb may be
elevated on a pillow for 24 hours or less after
amputation.

• The patient should avoid positions of flexion

such as sitting for long periods.

• If the patient is able, lying prone (on

stomach) for 30 minutes four times daily
helps prevent contracture.
• Assess the pulse between the heart
and the amputated leg. Compare the
pulse with the other leg.
• Treat PHANTOM LIMB PAIN
appropriately.
HIP CONTRACTURE