Guidelines for Safe Ambulation p. 290

Patient Mobility Ambulation
Unit 2
Ambulation p. 288
• To ambulate: to walk
• Gait: the way one walks; disorders affecting gait:
Stroke (CVA): hemiplegia – one side of body paralyzed
Multiple sclerosis: one or both legs weakened, balance disturbed
Huntington's disease: involuntary movements disturbing balance
Parkinson’s disease: stiffness, tremors, slow movements, shuffling
Arthritis: pain and stiffness in joints
Amputation: may have a prosthesis (artificial limb)
Orthopedic: injuries or disorders of musculoskeletal system
• Nurse or physical therapist evaluates patient’s abilities and needs for ambulation &
mobility p. 289
• Normal gait pattern has 2 phases, starts with ankle in dorsiflexion and heel touching
floor first
• Gait training:
• Physical therapists work with pt, teaching how to walk, walk on different surfaces, go up and
down stairs, get in and out of chair, use assistive device
• Guidelines for Safe Ambulation p. 290!!!! Part of skill #5
Assistive Devices p. 290
• Include: Crutches, Canes, Walkers
• Crutches:
• Rarely for older adults: need balance and 2 strong arms
• Types: standard, forearm
Assistive Devices - Canes p. 292
• Quad canes (4), tripod canes (3) give wide base of support
• Canes aid balance, don’t give support
• Always use on STRONG side
• Proper fit: when hand is on handgrip, pt elbow is flexed 30 Degrees
Procedure 29 p. 292, Assisting Pt to walk with a cane and 3-point-gait
Assistive Devices - Canes p. 293
• 3-point-gait
1. Cane/Walker on strong side goes out first
2. Weak/affected leg is next, until it is even with cane
3. Strong/unaffected leg last, further than cane
• 2-point-gait
1. Cane/Walker on strong side goes out WITH weak/affected leg
2. Strong/unaffected leg goes next
Assistive Devices - Walker p. 294
• For general weakness in both legs, partial weight-bearing on one leg, mild balance
• Need strength in both arms to pick up walker
• Elbow at 30 degrees when hands on handgrips, top of walker reaches the hip joint
• NOT used for transfers (holding on while getting up or sitting down), only for walking
Procedure 30 p. 294!
Assistive Devices - Walker p. 294
• 3-point-gait
1. Patient lifts walker and puts it 6-8 inches ahead, all 4 legs of walker should come down
2. Brings weak/affected leg into walker
3. Brings strong/unaffected leg even with weak foot
• 2-point-gait
1. Patient lifts and moves walker AND weak leg 6-8 inches ahead
2. Brings strong/unaffected leg even with weak foot
The falling patient p. 295
• If pt starts to fall, assist pt onto floor as in
Procedure 31, p. 296
• Don’t try to hold her/him upright = injury for you and/or patient
• After: call nurse to assess before moving pt
Assistive Devices – Wheelchair p. 295
• Used for mobility if can’t ambulate (yet)
• For correct fit:
• 4 inches between top of back and pt’s axillae
• Armrests support without pushing shoulders up or hanging shoulders
• 2-3 inches between edge of seat and pt’s knees
• Hand-width space between pt’s hips and sides of wheelchair
• 2 inches between bottom of footrests and floor
• 90 degree angle between feet and legs
Assistive Devices – Wheelchair p. 295
• Wheelchair Safety p. 297! Especially: backing through doors/elevators/down ramps, pt
positioning 90-90-90 etc
• Positioning pt in wheelchair correctly: see Guidelines for Chair and wheelchair
positioning p. 300, especially: shoulders not shrugged or down; no bare skin on
wheelchair, pressure relieving devices, hips at 90 degree angle, no pressure to back of
• How to help pt back into right position, if body shifted forward p.298,
• see Figures 17-14 to 17-19!
Assistive Devices – Wheelchair p. 300
• Wheelchair activity: to reduce pressure on buttocks and prevent PUs
• Teach pt to shift weight q 15mins
• Wheelchair push-ups:
• Brakes locked, caster wheels in forward position
• One hand on each armrest, keeping elbows bent
• Lean slightly forward, push up on armrests, straightening elbows, lifting buttocks off seat
• Hold to count of 5 if possible
• Leaning: if pt can’t do push ups
• Brakes locked, caster wheels in forward position, feet on floor
• Place hands on armrests or thighs, lean slightly forward
• Lean to each side, relieving pressure on buttocks
Textbook: Read Unit 17 p. 288-302
Workbook: p. 106: Read Unit Summary, Nursing assistant alert, answer all
Completion questions, True/False, and Identification