ASSISTING WITH AMBULATION AND GAIT
TRAINING
KEY TERMS TO KNOW…
Ambulation- act of walking or being able to
walk
 Ambulation aid- piece of equipment used to
provide support or stability to a person while
walking
 Gait- the manner or style of walking
 Unilateral- one sided
 Bilateral- two sided or both sides
 Extremities- arms (upper) or legs (lower)

ASSISTING WITH AMBULATION
AND GAIT TRAINING
Assistive devices
are used to make
safe ambulation
possible
3 MAIN INDICATIONS
 1)
decreased ability to bear weight on the
lower extremities (legs)
 2) muscle weakness or paralysis of the
trunk or lower extremities
 3) poor balance in the upright posture
THINK
15 year old boy fractures RLE – tibia and fibula.
The boy had surgery to repair and doctors
orders NWB for 2 months. As the physical
therapist, what assistive device will you instruct
him to use?
WE NEVER KNOW WHEN WILL WE NEED - ?
WHAT ASSISTIVE DEVICE WILL YOU CHOOSE?
STATE STANDARDS

6.3 Demonstrate appropriate use of equipment and
devices as directed by rehab professionals.
PREVIOUS LEARNING

What device have we already learned about?
Crutches
Artificial supports that assist a patient who
needs help walking.
 Ordered by a physician
 Made of wood or aluminum

CRUTCHES
How do you fit patient for
crutches?
#1 Measurement points:
Height of heels on shoes: low
broad heels, approx. 1 to 1
½ inches high, non skid
soles
Position crutches: 4-6 inches
to the side and front of the
pt’s foot


Distance b/t axilla and
axillary bar:
2 inches
Degree angle for elbows:
25 – 30 degrees
TYPES OF CRUTCH WALKING


#2
Bear weight on both
legs – 4-point gait
Each step is separate:
 (crutch- opposite footcrutch-opposite foot)

Used: cannot bear full weight on either leg
CRUTCH WALKING, CONTINUED



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#2 continued
When 4-point is
mastered then the pt
can advance to: 2-point
1) Crutch-opposite foot (move
together)
2) Crutch-opposite foot (move
together)
CRUTCH WALKING, CONTINUED
After the patient gains
strength in the arms
and shoulders, faster
gaits such as the
swing-to or swingthrough are taught
Swing-to:
Move both crutches forward
Move feet up to crutches
Swing-through:
Move both crutches forward
Swing both legs in front of crutches
CRUTCH WALKING



#3 – If a pt can bear
weight on only 1 leg, the
first crutch gait taught is
the 3-point
Move both crutches and the weak foot at
the same time (3)
Then advance the good foot forward.

When the pt gains
strength in the arms and
shoulders, faster gaits
such as the swing-to or
swing-through are taught.
CRUTCH SAFETY
# 4 – Why is it
important to avoid
pressure on the axillary
area when crutch
walking?
Nerve damage can occur.

*Always instruct patients to look straight
ahead and not down at his/her feet.
VIDEO

crutch walking
swing to
PRACTICE

Using Rubric You will grade each other on
Assisting your partner with the swing-to of
crutch walking… Why “swing-to?”
 1st
–I will show you what I expect….
 Student
Demonstrates & I grade
 Student demonstrates – as we grade together
You demonstrate with each other- and grade one another
other – You Do
WHAT DO YOU CONCLUDE?
Since you have practiced with crutches, what
conclusion can you make about the criteria
required to place a patient on crutches?
CLOSING
Review standard & next lesson
 LIA - what you learned, what was interesting,
and how can you apply?

Demonstration is usually the primary
method of instruction.
Once a patient has become proficient on level
surfaces, instruction or teaching in the use
of stairs, curbs, ramps, and doors can be given.
The patient is taught to climb and descend
stairs on the right-hand side since this is the
usual method used throughout the US.
Assistive devices also help
to increase the patient’s
base of support, allowing
a re-distribution of weight
within the base of support
CRUTCHES
 Made
of wood or aluminum
 Can be adjusted for maximum fit
 Measure
pt from the armpit to the
http://www.videomd.com/HowToUseCr
utchesProperly-fv-6038.aspxheel
The patient may need
range of motion or
strengthening exercises
before beginning an
ambulatory
therapy program
TIPS ON PRE-AMBULATION TRAINING

To provide maximum stability, the patient
may need to practice on the parallel bar. This
will help him become accustomed to the
upright position and learn the sequence for gait
or walking in relative safety.
TYPES OF AMBULATION AIDS IN ORDER
FROM MOST SUPPORT TO LEAST:
 Crutches
 Walkers
 Parallel
bars
 Bilateral
canes
 Crab canes
 Single canes
IMPORTANT!!
It is important to instruct the patient how to
protect himself during a fall and how to get up
after a fall
 It is important to teach the patient how to
check his ambulatory aid for its safe operation
and use
 The patient should avoid throw rugs

PARALLEL BARS
 Generally
the first step- gives the most
support than any
 Height- elbows are bent 25-30 degrees
when the patient is standing and holding
on to the bars with his hands
CANES
 Used
for impaired balance or to improve
stability
 The handgrip should be placed so that it is
as tall as a person’s wrist from the floor
 Place the cane parallel to the femur and
tibia with the foot of the cane on the floor
or at the bottom of the heel of the shoe
CANE
#5 - Cane should be used on the unaffected
(good) side
#6 Canes should be at the height of the pt’s top
of the femur at hip joint.
Elbow should be flexed at 25 to 30 degree angle.
Ambulate cane on good side
Cane moves with opposite leg.(this prevents leaning toward bad
side)
3 point gait/2 point gait

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Using a cane
improve your balance as you walk or help you compensate for an injury or disability.
choose a cane?
If you need the cane only for balance - a standard cane with a single tip.
If you need the cane to bear weight - offset cane with four tips. (quad cane)
WALKER
 Should
be adjusted so that the elbow
can be flexed 25-30 degrees when the
patient is standing with his hands on it
 The walker is 1st lifted with both hands
and then placed forward 25-30
centimeters.
 It is stepped into, first with the stronger
leg and then the weaker leg
 http://www.kaisersantarosa.org/video
WALKER
# 7 Handles on a walker should be at the level
of the patient’s femurs. The elbows should be
flexed at 25 to 30 degrees
 # 8- Rubber tips prevent slipping.
 #9 Caution a patient against sliding a walker
b/c it is so lightweight it may tip over. They
should lift them.

WALKER
To start – the patient s/b standing in the walker
 Lift the walker, so that the back legs are even
with toes
 Transfer weight forward slightly to the walker
 Instruct pt to use walker for support and to
walk “into” the walker.

AMBULATE THE PATIENT
Always walk with patient on their weak side,
slightly behind them
 #10 - If using a transfer belt keep a firm hold in
case the patient falls, eased to the floor,
protecting head and neck.
