Assistive Devices for Mobility

When patients cannot ambulate independently, assistive devices provide support and stability. Each device has specific indications, proper fitting requirements, and safe usage techniques. Improper use can lead to falls, nerve damage, and other injuries.

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Crutches

Crutches provide maximum support for patients who cannot bear weight on one or both legs. They require upper body strength and coordination.

Types of Crutches

Proper Fitting of Axillary Crutches

Correct sizing prevents nerve damage and promotes safe ambulation:

1. Crutch length: 2-3 finger widths (approximately 1-1.5 inches) between axilla and crutch pad
2. Handgrip position: Elbows flexed 20-30 degrees when hands are on grips
3. Crutch tips: 4-6 inches to the side and 4-6 inches in front of feet

CRITICAL SAFETY POINT:

Weight must be borne on the HANDS, not the axillae. Pressure on the axillae can compress the brachial plexus nerves, causing "crutch palsy"—numbness, tingling, and weakness in the arms and hands.

Crutch Gaits

The appropriate gait depends on the patient's weight-bearing status and strength:

Stair Navigation with Crutches

Memory Device: "Up with the Good, Down with the Bad"

This phrase helps patients remember the correct sequence:

Going UP stairs:

1. Strong (unaffected) leg goes up first
2. Weak leg and crutches follow together

Going DOWN stairs:

1. Crutches and weak leg go down first
2. Strong leg follows

Rationale: The strong leg does the work of lifting the body up and controlling the descent down.

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Canes

Canes provide minimal support and are appropriate for patients who need slight assistance with balance or have mild weakness on one side.

Types of Canes

Proper Fitting

• Height: Handle at level of greater trochanter (hip) or wrist crease when arm hangs at side
• Elbow flexion: 15-30 degrees when holding cane

Which Side to Hold the Cane?

Hold the cane on the STRONG (unaffected) side.

This seems counterintuitive, but it provides a wider base of support when the weak leg steps forward.

Walking Pattern with a Cane

1. Move the cane forward simultaneously with the weak leg
2. Then move the strong leg forward
3. The cane and weak leg always move together

Stair Navigation with a Cane

Same principle as crutches: "Up with the Good, Down with the Bad"

Going UP:

1. Strong leg steps up first
2. Weak leg and cane follow

Going DOWN:

1. Cane and weak leg step down first
2. Strong leg follows

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Walkers

Walkers provide the greatest stability of all assistive devices. They are ideal for patients with generalized weakness, poor balance, or those who need to rest during ambulation.

Types of Walkers

Proper Fitting

• Height: Handles at hip level (greater trochanter) or wrist crease
• Elbow flexion: 15-30 degrees when hands on grips
• Width: Patient should fit comfortably inside frame

Walking Pattern with a Standard Walker

1. Lift the walker and move it forward (about arm's length)
2. Step into the walker with the weak leg first
3. Step with the strong leg
4. Repeat

SAFETY POINTS:

Never use the walker to pull up from a seated position. The walker can tip and cause a fall. Instead, push up from the chair armrests.

All four legs must be on the ground before stepping. For pickup walkers, ensure stability before advancing.

Stair Navigation with a Walker

Standard walkers are not safe for stairs. Patients should:

• Use a different device (cane, railing) for stairs
• Have a second walker on each floor
• Or use an elevator/stair lift

Rollators with wheels are also unsafe on stairs due to rolling risk.

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Assistive Device Comparison

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Patient Teaching Points

Regardless of device, teach patients these universal safety principles:

1. Wear non-skid footwear — No slippers, bare feet, or smooth soles
2. Clear pathways — Remove rugs, cords, and clutter
3. Use adequate lighting — Especially at night
4. Take your time — Rushing increases fall risk
5. Rest when tired — Fatigue impairs coordination
6. Check rubber tips regularly — Worn tips reduce traction
7. Lock brakes on wheelchairs before transferring

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On the Exam

NCLEX frequently tests:

• Cane placement: Remember—cane on the STRONG side, moves with the WEAK leg
• Stairs: "Up with the Good, Down with the Bad"
• Crutch safety: Weight on HANDS, not axillae
• Walker safety: Lift and move forward, don't use to pull up from chair
• Proper fitting: Elbow flexion 15-30 degrees, handle at hip level

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Key Takeaways

• Crutches: Weight on hands, 2-3 finger widths between axilla and pad
• Cane: Held on strong side, advances with weak leg
• Walker: Lift, move forward, then step into it
• Stairs: "Up with the Good, Down with the Bad"
• All devices: Proper fit = elbows flexed 15-30 degrees