ASSISTIVE DEVICES

ASSISTIVE DEVICES1. Canes

2. Crutches3. Walker

CANESPURPOSES

1. Improve stability of the client with a lower limb disability 2. Maintain balance 3. Prevent further injury 4. Provide security while developing confidence in ambulating 5. Relieve pressure on weight-bearing joints 6. Assist in increasing speed of ambulation with less fatigue 7. Provide for greater mobility and independence

NURSING CARE

1. Ascertain that the client is able to bear weight on the affected extremity 2. Ensure that the client is able to use upper extremity opposite the affected lower extremity 3. Measure to determine the length of cane required 4. Explain the proper techniques in using cane 5. Observe for incorrect use of the cane 6. Evaluate clients response to procedure

MEASUREMENTS

1. Client should hold cane on unaffected side 4 to 6 inches to side of foot.

2. Cane should extend from greater trochanter to floor while cane is held 6 inches from foot. 3. Allow approximately 15 to 30 degrees of elbow flexion.

CRUTCHES

PURPOSES

1. Support body weight, assist weak muscles and provide joint stability 2. Relieve pain 3. Prevent further injury and provide for improvement of function 4. Allow for greater independence

NURSING CARE1. Ensure proper fit of crutches by measuring the distance frim the anterior fold of the axilla to a point 6 inches out from the heel. - Axillary bars must be 2 inches below the axillae and should be padded - Hand bars should allow almost complete extension of the arm with the elbow flexed about 30 degrees when the client places weight on the hands - Rubber crutch tips should be in good condition, about 2-3 inches in height, with circumference of 1 1/2 -1 3/4 inches

2. Assist in the use of proper technique, depending on ability to bear weight and to take steps with either one or both of the lower extremities.

MEASUREMENTSStanding Position- Position crutches with crutch tips at 6 inches to side and 6 inches in front of clients feet and crutches pads 2 inches below axillla

Supine Position - Crutch pad should approximately 2 inches or 2 to 3 finger widths under axilla with crutch tips positioned 6 inches lateral to clients heel

Four-point gait

Right crutch, left foot, left crutch, right foot

- Equal but partial weight bearing on each limb - Slow but stable gait; there are always three point support on the floor - The client must be able to manipulate both extremities and get one foot ahead of the other.

Two-point gait

Right crutch and left foot simultaneously ( vise versa )

-There are always two point of support on the floor.-This is more rapid version of the four-point gait and requires more balance and strength.

Three-point gait

Advance both crutches and the weaker extremity simultaneously , then the good lower extremity.

- Fairly rapid gait, but requires more balance and strength in the arms and the good lower extremity.

-Used when one leg can support the whole body weight and the ether cannot take full weight bearing ( fractured hip ).

Swing crutch gaits

1. Swing-to gait Place both crutches forward, lift and swing the body up to the crutches, then place crutches in front of the body and continue. - There are always two points of support on the floor. - This technique is indicated for anyone with adequate power in the upper arms.

2. Swing-through gait

Place both crutches forward. Lift and swing the body through the crutches in front of the body and continue- Very difficult gait, because as the client swings through the crutches it necessitates rolling the pelvis forward and arching the back to get the center of gravity in front of the hips. - Indicated for the client who has power in the trunk and upper extremities, excellent balance, self-confidence, an a dash of daring ( bilateral amputee, paraplegic with braces )

Tripod crutch gaits

1. Tripod alternate gait

Right crutch, left crutch, drag the body and legs forward.- The client constantly maintains tripod position: both crutches are held fairly widespread out front while both feet are held together in the back. - Necessary for the individual who cannot place one extremity ahead of the other. ( person with flaccid paralysis from poliomyelitis, one with spinal cord injury )

2. Tripod simultaneous gait

Place both crutches forward, drag the body and legs forward. - Because the tripod must have a large base, the clients body must be inclined forward sufficiently to keep the center of gravity in front of the hips.

When person goes downstairs -the crutches and injured leg first, and the uninjured leg follows.

When person goes upstairs -the uninjured leg first, and crutches and injured leg follow

WALKER

PURPOSES

1. Maintain balance 2. Provide additional support because of wide area of contact with floor 3. Allow for some ambulatory independence

MEASUREMENT- Upper bar of walker should be slightly below clients

waist. Elbow should be flexed at approximately 15 to 30 degreeswhen client is standing inside walker with hands on handgrip.

NURSING CARE

1. Measurements for a walker are the same as for cane 2. Assist in ambulating with the walker A. Lift the device off the floor and place forward a short distance, then advance between the walker. B. Two-wheeled walkers: raise back legs of the device off the floor, roll walker forward, then advance to it. C. Four-wheeled walker : push device forward on floor and then walk it.