Nursing Review on 3 Assistive Devices: Canes, Crutches, and Walkers

This article is a review on educating and helping patients who are using assistive devices for walking. A nurse needs to know how to properly use canes, crutches, and walkers to ensure safe usage. 

The nurse is responsible for educating the patient on the proper use of assistive devices to incorporate with their daily living activities. These include the appropriate fit, going up and down the stairs, sitting down, getting up, ambulation, and key points to remember.

NCLEX Review: Canes

1. When is a Cane Used?

A cane is used if one of the lower legs is painful or weak. It can also be used for patients who have pain in the hips, knees, or are worried about falling. The cane is used on the opposite side of the weak leg because it is considered the ‘substitute leg’. 

2. How to Know if a Cane Fits Properly?

A cane must be adjusted according to the patient’s height. When adjusting the cane’s height, the handle must touch the insides of the palm’s wrist. The nurse will know if the cane is properly fit when the patient can bend their elbow at a 15-20 degree angle. If these criteria are not met, it means the cane needs more adjustment. 

3. How to Ambulate Using a Cane?

• During the learning process, the patient should wear a gait belt for additional safety. 
• The nurse must stand on the weak side of the patient.
• When walking using a cane, the tip should be placed approximately four inches away from the foot. 
• Make sure that the arm holding the cane is strong or does not experience any pain. 
• When ambulating, here is the combination: Cane + Weak legs together.

4. How to Go up the Stairs With a Cane?

• If possible, hold the rails with your free hand.
• Take your time and take one step at a time.
• Strong legs go up first.
• Cane plus weak leg together.
• Before stepping up again, make sure the weak leg, strong leg, and cane are positioned well and stable on the step. 

5. How to Go Down the Stairs With a Cane?

• Hold the rails with the freehand (if possible).
• Cane goes down first.
• The body should lean slightly forward before stepping down.
• Weaker leg steps forward.
• The stronger leg goes last.

6. How to Sit Down With a Cane? (Granting the chair has an armrest on both sides)

• The patient must back up to the chair until they feel the back of their legs hitting the chair.
• Place the cane on the side of the chair to rest.
• The patient must place both hands on the armrest.
• Place the whole body’s weight on both hands. 
• Bend the strong leg.
• Keep the weak leg slightly extended.
• Sit down on the chair. 

7. How to Get up From the Chair Using a Cane?

• Hold the cane on the strong side.
• Keep the weak leg slightly extended out.
• Grip the chair’s armrest with the freehand.
• The patient must lean forward, placing weight on both hands.

NCLEX Review: Crutches

1. When are Crutches Used?

Crutches are used if one leg is injured. The patient must have stable upper body strength and no arm injury. 

2. How to Know if the Crutches Fits Properly?

• Crutches should be adjusted to cater to the patient’s height.
• There must be a gap between the armpit and the rest pad of the crutch while the patient is holding the crutches. The gap can be measured with 2-3 fingers (or 1-1.5 inches). 

3. How to Ambulate Using Crutches?

• The patient must place the bodyweight on the handgrips, not the rest pad of the crutch, while ambulating. 
• Elbows should be flexed at 30 degrees while holding the grips.
• Start with the tripod position (both legs and crutches in standing position).
• Choose the type of gait depending on the patient’s condition or extremity weakness.

4. What Are the Types of Gait?

• Two-Point Gait: Injured side’s crutch + strong leg. Followed by the crutch on the uninjured side + injured leg.
• Three-Point Gait: The injured leg will not touch the ground. Both crutches forward then the non-injured leg.
• Four-Point Gait: Sequence is (1) Crutch on the injured side (2) non-injured leg (3) Crutch on the non-injured side (4) Injured leg
• Swing-to-gait: Both crutches forward, then swing both legs forward (at the same point of the crutches)
• Swing-through-gait: Both crutches forward, then both legs swing forward past the crutches. 

5. How to Go up the Stairs With Crutches?

• Hold both crutches with one hand.
• The other hand can hold the rails.
• The good leg should go up first.
• Followed by the injured leg.
• Lastly, both crutches.

6. How to Go Down the Stairs With Crutches?

• Move both crutches down.
• Follow the injured leg down.
• Lastly, the good leg down.

7. How to Sit Down With Crutches?

• Let the patient back up in the chair until it is felt on the back of the non-injured leg.
• Move both crutches on the injured side.
• Grip the crutches for support.
• Keep the injured leg slightly extended out.
• Slightly bend the non-injured leg.
• Slowly sit down using the non-injured side while keeping the non-injured leg extended.

8. How to Get up From the Chair Using Crutches?

• Put both crutches on the injured side.
• Grip the crutches for support.
• With your other arm, hold the chair’s armrest.
• Lean forward and push up with the weight on crutches, on the other hand, and the armrest of the chair on the other.
• Once the patient is in a standing position, switch to the tripod position.

NCLEX Review: Walker

1. When is a Walker Used?

A walker is a four-legged frame used to help patients who are still able to walk. It is used for mobility to lean forward, support, rest, and balance. 

2. How to Know if a Walker Fits Properly?

• The handgrips of the walker should be even with the crease of the wrist.
• While holding the walker’s handgrips, the elbows should be flexed at a 15-30 degree angle.

3. How to Ambulate Using Crutches?

• Look straight up; avoid looking down.
• Lift and move the walker forward.
• The weak side next.
• Strong legs next.

4. Can a Patient Go up and Down the Stairs With a Walker?

A patient cannot use a walker when climbing up and down the stairs using a walker. 

5. How to Sit Down in the Chair Using a Walker?

• Back up to the chair until it hits the back of the leg.
• Slightly extend the weak leg.
• Bend the strong leg while feeling for the armrest of the chair.
• Once the weight on both hands is placed on the armrest, the patient can slowly bend until sitting down position is achieved.

6. How to Get up From the Chair Using a Walker?

• Place the walker in front of the chair.
• Lean forward in the chair.
• Weak legs slightly extended out.
• Place the hands on the chair’s armrest.
• Push up with a strong leg.
• Once the patient is in a standing position, firmly grip the walker and start walking.