Assistive Devices for Walking
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 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.
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
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.
image courtesy of ehow.com, cracked.com and preciousmobility.com