ASSISTING WITH

WALKING USING WALKER

AND CANE
Mrs. Ruba Yaseen
Outline
 Assessment
 Diagnosis
 Planning
 Walker procedure
 Cane procedure
 Crutches procedure
 Evaluation
 Documentation
 Nursing Tips
 Assessment
 Assess the reason the client requires an
assistive device. Is it long term need or a
short term need?
 Assess the client’s physical limitations.
How much weight is the client able to
be? Can he bear weight on both legs or
just one? Is his upper body strength
good? does he tire easily
 Assessment
 Assess the client’s physical
environment . Is he at home or in a
medical facility? Is his environment
suited to his assistive needs and the
assistive device he will be using
 Asses the client’s ability to understand
and follow directions regarding use of an
assistive device. Can he understand the
instructions?
 Diagnosis
 Impaired physical mobility
 Risk for trauma
 Knowledge deficit regarding assistive
devices
 Planning
 The client will demonstrate safe and
independent ambulation with the
assistance of crutches, cane or walker
 The client will feel confident and safe
while using assistive device
 Walker
 A walker is a light weight metal frame
with four legs
 It provides a sense of security and
support
 Walker is used by patients who are
able to bear partial weight while
walking
Patient’s requirements to use walker

 Partial strength in both hands and wrists

 Strong shoulder depressors
 Strong elbow extensors such as triceps
brachi
 Ability to bear at least partial weight on
both legs
.Inform client that you will be assisting with ambulation using a walker
.Lower the height of the bed
Dangle the client at the side of bed for several minutes. Assess for
.vertigo
.Provide a robe or other covering and shoes with firm, nonslip soles
Assess client for strength, mobility, range of motion, visual acuity,
perceptual difficulties, and balance. Note: The nurse and physical
.therapist often collaborate on this assessment
Apply the gait belt around the client’s waist if balance and stability
.are unreliable
.Place the walker in front of the client
Have the client push himself up from the sitting position while
.pushing down on the bed with his arms
Have the client transfer his hands to the walker handgrips, one at a
.time
Be sure the walker is adjusted so the handgrips are just below waist
.level and the client’s arms are slightly bent at the elbow
Walk to the side and slightly behind the client, holding the gait belt if
.needed for stability
Gait Belt
Walker Gait Move the walker and the weaker leg forward at the
same time. Place as much weight as possible or as allowed on the
weaker leg, using the arms for supporting the rest of the weight. Move
the strong leg forward
and shift the weight to the strong leg
Sitting with a Walker Have the client turn around in front of the
chair and back up until the back of his legs touch the chair. Have him
place his hands on the chair armrests, one hand at a time. He then
.lowers himself into the chair using the armrests for support
Set realistic goals and opportunities for progressive ambulation using
.a walker
Consult with a physical therapist for clients
.learning to walk with a walker
.Wash hands
Document the type of device the client is using, the level of
understanding regarding the use of the device, how far the client is
able to walk using the
.device, and the client’s response to the activity
Cane Walking
 canes are light weight , easily movable
devices that are made of wood or metal
 They provide less support than a walker

and are less stable

 A person’s cane length is equal

to the distance between

the greater trochanter
and the floor (56-97 cm)
Appropriate Length of Cane
Types of Canes
1. Single ended canes with
half circle handles:
recommended for patients
requiring minimal support
and those who will be using
stairs frequently
2. Single ended canes with
straight handles:
recommended for patient
with hand weakness
because the handgrip is
easier to hold but not
recommended for patients
with poor balance
3. Canes with three or four
prongs:
provides a wide base of
.Inform client that you will be assisting with ambulation using a cane

.Lower the height of the bed

.Dangle the client at the side of bed for several minutes. Assess for vertigo
Assess client for strength, mobility, range of motion, visual acuity, perceptual
,difficulties
and balance. Note: The nurse and physical therapist often collaborate on this
.assessment
Apply the gait belt around the client’s waist if balance and stability are
.unreliable
Have the client hold the cane in the hand opposite the affected leg. Explain
.the safety and body mechanics underlying using the cane on the strong side
Have the client push himself up from the sitting position while pushing down
.on the bed with his arms
Have the client stand at the bedside for a few moments
Assess the height of the cane. With the cane placed 6 inches ahead of the
client’s body, the top of the cane should be at wrist level with the arm bent
.25%–30% at the elbow
Walk to the side and slightly behind the client, holding the gait belt if needed
.for stability
The Cane Gait Move the cane and the weaker leg
forward at the same time for the same distance .Place
weight on the weaker leg and the cane. Move the strong
.leg forward. Place weight on the strong leg
Sitting with a Cane Have client turn around and back up
to the chair. Have her grasp the arm of the chair with the
free hand and lower herself into the chair. Be sure to place
.the cane out of the way but within reach
Set realistic goals and opportunities for progressive
.ambulation using a cane
Consult with a physical therapist for clients
.learning to walk with a cane
.Wash hands
 Use of Crutches
Inform client that you will be assisting with ambulation. 1
.using crutches
Assess client for strength, mobility, range of motion,. 2
visual acuity, perceptual difficulties, and balance. Note:
The nurse and physical therapist often collaborate on this
.assessment
Adjust crutches to fit the client. With the client supine,. 3
measure from the heel to the axilla. With the client
standing, set the crutch position at a point 4–5 inches
lateral to the client and 4–6 inches in front of the client.
The crutch pad should fit 1.5–2 inches below the axilla (3-
finger width).The hand grip should be adjusted to allow for
.the client to have elbows bent at 30° flexion
 Use of Crutches(cont)
.Lower the height of the bed. 4
.Dangle the client at the side of bed for several minutes. Assess for vertigo . 5
Instruct client on method to hold the crutches; that is, with elbows bent 30° and pad . 6
1.5–2 inches below the axilla. Instruct client to position crutches lateral to and forward
.of feet
.Demonstrate correct positioning
.Apply the gait belt around the client’s waist if balance and stability are unreliable . 7
Assist the client to a standing position with crutches. Stand close to the client to . 8
.support as needed
Four-Point Gait Position the crutches 4.5–6 inches to the side and in front of each . 9
foot. Move the right crutch forward 4–6 inches and move the left foot forward, even
with the left crutch. Move the left foot forward, even with the left crutch. Move the left
crutch forward 4-6 inches and move the right foot forward , even with the right crutch.
Repeat the four point gait
 Use of Crutch(cont)
Three-Point Gait Advance both crutches and the weaker leg forward together 4–6 . 10
inches.Move the stronger leg forward, even with the crutches. Repeat the three-point
.gait
Two-Point Gait Move the left crutch and right leg forward 4–6 inches.Move the right. 11
.crutch and left leg forward 4–6 inches. Repeat the two-point gait
Swing-Through Gait Move both crutches forward together 4–6 inches. Move both . 12
legs forward together in a swinging motion, even with the crutches. Repeat the swing-
.through gait
Walking Up Stairs . 13
Stand beside and slightly behind client . Instruct client to position crutches as if walking . Place the strong leg
on the fist step. Pull the weal leg up and move the crutches up to the first step. Repeat for all steps
Walking Down Stairs Position the crutches as if walking. Place weight on the . 14
strong leg.Move the crutches down to the next lower step. Place partial weight on hands
and crutches.Move the weak leg down to the step with the crutches. Put total weight on
arms and crutches.Move strong leg to same step as weak leg and crutches. Repeat for
all steps. A second caregiver standing behind the client holding on to the gait belt will
. further decrease the risk of falling
.Set realistic goals and opportunities for progressive ambulation using crutches. 15
Consult with a physical therapist for clients. 16
.learning to walk with crutches
Use of Crutch (cont)
 Evaluation
 Assess if the client is able to
demonstrate safe and independent
ambulation with the assistance of
crutches , cane or walker
 Assess if the client feels confident and
safe while using the assistive device
 Documentation
 Nurses’ Notes
 Document the type of device the client is
using, the level of understanding
regarding the use of the device, how far
the client is able to walk using the
device and client’s response to the
activity
Nursing Tips
 Be sure there is about 2 inches or 3 fingers
width of distance between the client’s axilla
and the top of crutch
 Be sure the client is holding his cane on the
good side for optimal effect
 Be sure that the client’s walker is just
below waist level. This allows the client’s
arms to be slightly bent when standing in
the walker. This is a stronger arm position
than with the arms totally straight
Nursing Tips(cont)
 Check the rubber tips on all assistive devices frequently.
They can become worn quickly. Worn rubber tips can lead
to instability and falls
 When measuring the height of a cane be sure the client
stands erect, not hunched or bent over
 When teaching a client to stand up prior to using a walker
have him use the armrest on the chair not the walker, for
support. The walker is less stable and client could pull it
over
 Provide a robe or other covering and shoes with firm ,
nonslip soles to provide for modesty and safety
 Label the client’s equipment so he will wind up with
equipment measured for another person
References
 Delmer’s fundamental & Advance
Nursing Skills . Altman G B, Buchsel P &
Coxon V, 2000