Assistive devices: crutches, walkers, canes, and wheelchairs
An assistive device is used to help a person perform a specific task, such as walking. Crutches, walkers, canes, and wheelchairs are considered assistive devices. Many times, these assistive devices can be purchased at pharmacies and medical supply stores. The medical assistant should know how to adjust the device to fit the patient. Medical assistants may also coach patients on the proper use of the assistive device. Improper use of assistive devices can lead to falls and injuries.
Crutches
Crutches are used to help a person walk. Crutches can be made out of aluminum or wood and can be adjusted for the patient. The more common crutches are as follows:
- Axillary crutches: Most common type; used when recovering from a foot, ankle, or leg injury or surgery.
- Forearm crutches: Also called Lofstrand or elbow crutches; require more upper body strength. An open elbow cuff fits around the patient’s forearm. These crutches help with proper posture and body mechanics.
- Extension crutches: Also called Canadian crutches. These combine the underarm crutch with an elbow cuff, which provides extra support for the patient.
- Platform crutches: Also called triceps crutches. They have padded armrests with handgrips. These crutches are used when patients cannot straighten their arms to hold the handgrip of the crutch.
- Hands-free crutch: Straps to the thigh, and a platform supports the lower leg.
- M+D crutches: The hinged arm cradles the strap to the forearms, thus eliminating pressure in the axillae, wrists, and hands.
Fitting axillary crutches
Axillary crutches need to be fitted correctly to allow for good body mechanics and to reduce the risk of injury. Crutch palsy can occur with poorly fitted crutches or if the patient rests on the top of the crutches while walking. The axillary nerves can be temporarily or permanently damaged. This can cause loss of hand strength and weakening of the wrist and forearm muscles.
When you fit axillary crutches, the patient must be wearing shoes. Have the patient stand straight up. Fit the crutches so they are 1 to 1½ inches (about 2 finger widths) below the armpit. The crutch should be about 4 to 6 inches to the side and front of each foot. Handgrips must be near the wrist and even with the top of the hip line. When the hands are on the handgrip, the elbow should be bent 15 to 30 degrees.
Limitations with crutches
Providers will indicate the type of crutch, along with any limitations. Common limitations with crutches include the following:
- Weight bearing as tolerated: Patients can place more than half of their body weight on their “bad,” or affected, extremity if it is not painful.
- Partial weight bearing: The provider will indicate how much weight can be placed on the affected extremity.
- Toe-touch weight bearing: Patients can touch the ground with their toes on the affected side. The toe-touch helps with balance. No weight bearing is allowed on the affected extremity.
- Non–weight bearing: Patients cannot put weight on their affected extremity. This type of limitation would require the three-point crutch gait.
Crutch gaits
There are several crutch gaits that a medical assistant should know. The provider may also specify the gait the patient should use. The gait depends on whether the patient can put weight on the affected extremity. The following are common gaits:
- Two-point crutch gait: Mimics normal walking. The patient must be able to put some weight on both legs. From the tripod position (starting position) use this sequence: Move the right crutch with left foot forward and then move the left crutch with the right foot forward. There are two individual movements with this gait. Repeat this pattern.
- Four-point crutch gait: Must be able to put some weight on both legs. This gait is slower, but safer for those with generalized weakness. From the tripod position, use this sequence: Move the right crutch forward, then move the left foot forward, next move the left crutch forward, and lastly bring the right foot forward. There are four individual movements with this gait. Repeat this pattern.
- Three-point crutch gait: Used when partial weight bearing or non–weight bearing is indicated. From the tripod position, use this sequence: Move both crutches and the affected leg forward, then move the “good,” or unaffected, leg forward. Repeat this pattern.
- Swing to crutch gait: Must be able to put some weight on both legs. From the tripod position, use this sequence: Move both crutches forward, then swing the body so the feet are even with the line of the crutches. Repeat this pattern.
- Swing-through crutch gait: Must be able to put some weight on both legs. From the tripod position, use this sequence: Move both crutches forward, then swing the body so the feet land in front of the line of the crutches. Repeat this pattern.
Walkers
Some patients use walkers after surgery. Many older adults use walkers for help with balance and support. Walkers provide more support than canes. A walker’s wide base helps stabilize the gait of the patient and can support up to 50% of the body weight. Walkers have a metal frame and can easily be adjusted to fit an individual. They are lightweight, and several types can fold flat for storage and travel. Several types of walkers are available:
- Hemi-walker: Also called a one-hand walker. These walkers are used by patients who can only grasp the walker with one hand due to a stroke or arm/hand amputation.
- Standard walker: A very common walker; it has four nonskid, rubber-tipped legs. A person needs to pick up the walker with every completed step. Sometimes tennis balls are inserted over the feet to help to move the walker easily across the floor.
- Two-wheel walker: Resembles the standard walker, but the front two legs have wheels. This type of walker is for those who need some help but not constant weight-bearing help.
- Three-wheel walker and four-wheel walker: Also called a Rollator. Each leg has a wheel, and many Rollators have brakes by the handles. Some models have a seat and a basket. These walkers are for people who do not need to lean on a walker for balance.
- Knee walker: A foot-propelled scooter that has a platform to rest the knee and lower leg. This is commonly used instead of axillary crutches for leg or foot conditions.
When you fit a walker, the patient must be wearing shoes. Have the patient step into the walker and relax the arms at the sides of the body. The top of the walker grip should be near the crease in the wrist and even with the top of the hip line. With the shoulders relaxed and the hands on the grips, the elbows should be bent 15 degrees.
When you measure a cane, the patient must be wearing shoes and have the arms relaxed at the sides of the body. The top of the cane should be near the crease in the wrist. With the shoulders relaxed and the hand on the cane, the elbow should be bent 15 degrees. Tingling, numbness, or pain in the hand and fingers may indicate the handle is not appropriate for the person.
Canes
A cane can provide extra assistance for a person who has a minor balance or stability problem. There are two basic types of canes but several different grips or handles. Here are the basic types of canes:
- Single-tipped cane: Provides minimal assistance with walking.
- Four-tipped cane: Also called a quad cane. It provides greater stability for patients than the single-tipped cane.
When you measure a cane, the patient must be wearing shoes and have the arms relaxed at the sides of the body. The top of the cane should be near the crease in the wrist. With the shoulders relaxed and the hand on the cane, the elbow should be bent 15 degrees. Tingling, numbness, or pain in the hand and fingers may indicate the handle is not appropriate for the person.
Wheelchairs
Wheelchairs provide mobility for patients who cannot walk or who are able to walk only short distances. With a regular wheelchair, the patient uses arm muscles for mobility. Motorized wheelchairs are also available. The patient is referred to a medical equipment store, where the appropriate wheelchair is fitted to the individual. It is important to encourage the patient to always lock the wheels before transferring into and out of a wheelchair.