Fundamentals - Practice & Skills, part 10: Canes, Walkers, and Crutches
by Meris Shuwarger BSN, RN, CEN, TCRN August 02, 2021 Updated: December 07, 2022 4 min read 1 Comment
This article focuses on mobility devices — canes, walkers, and crutches. Many of your patients will require mobility devices, so this is important information to know.
You can follow along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
A patient using a cane should hold it on their strong side, also called the "good" side or the "unaffected" side.
To find the best height for a patient's cane, ensure that the handle of the cane is at the level of the patient's wrist or greater trochanter. The greater trochanter is the big bump on the femur right below the hip. It usually aligns with where the wrist falls when the patient's arm is by their side. Also, the patient's arm should be slightly bent at the elbow. If the patient has to straighten their arm to use the cane, the cane is not the correct size for that patient.
When using a four-pronged cane, make sure that the flatter side is toward the patient's body versus the rounded side, which should face out. This is to keep the patient from tripping and falling over the prongs. Always make sure that two points of support are on the ground at all times when using a four-pronged cane.
When walking with a cane: first place the cane 6 – 10 inches forward; next, move the weak (affected) leg forward to the cane; then advance the stronger (unaffected) leg past the cane.
As with canes, the height of a patient's walker should be at wrist level when the patient's arms are by their sides. And, as with a cane, the patient's arm should be slightly bent at the elbow (approximately 30 degrees) when they use a walker — no straight arms, which could lead to discomfort and possible injury.
If a patient uses a walker and they are sitting in a chair, when they wish to get up, they must learn to use the arms of the chair for assistance. They should never use the walker. This is because the walker is not fixed to the ground, so if the patient tries to pull themselves up using the walker, they may pull the walker over, which could result in their falling down and getting injured.
When using a walker: first, push the walker forward; then, move the weak (affected) leg forward inside the walker; then, step forward with the stronger leg inside the walker.
Crutches are assistive devices used to help a patient ambulate. When the lower extremities are affected (for example, a broken ankle), crutches allow the patient to move independently, transferring their body weight from their legs to their torso and arms.
One of the most important things about crutches is ensuring they are adjusted to the right height. When properly set, the underarm pad should sit 2 inches below the axilla (armpit) when the shoulder is at rest. Many important nerves and blood vessels run through this area, and crutches that are too high — that rest in the axilla — will cut off circulation, which could lead to discomfort and injury. Crutches with properly adjusted hand grips will allow elbow flexion of 30 degrees.
When using crutches, the patient should put their weight on their hands, that is, on the hand grips, and not put their weight on the pad under the axilla.
There are a number of different crutch gaits, or methods of moving when using crutches. A patient should choose the gait that allows them to move independently but that takes into consideration their current injury or deficit as well as their degree of coordination:
- Two-point gait: move the opposite crutch and leg together (e.g., left leg/right crutch), followed by the other crutch and leg (right leg/left crutch)
- Three-point gait: move both crutches forward with the injured leg, allowing the unaffected leg to bear the patient's weight, then advance the uninjured leg
- Four-point gait: this gait provides the most support; move one crutch, then the opposite leg, then move the second crutch, followed last by the other leg (e.g., left crutch, right leg, right crutch, left leg); think of this as "walking on all fours"
- Swing-through gait: first, both crutches are advanced simultaneously, then both legs move forward (swing-through) at the same time; this is the most common image that comes to mind when thinking of somebody using crutches
- One-crutch gait: for this gait, the crutch is used on the strong (uninjured) side; move the crutch forward at the same time as the injured leg, then move the uninjured leg forward while the crutch supports the patient's weight
Using stairs with crutches
When climbing (ascending) stairs, the patient should position their unaffected (strong) leg next to the stair railing, then hold the handrail on that side. Position the crutch under the axilla (armpit) of the other (affected, or weak) side, then step up with the unaffected leg. Next, bring the affected leg and crutch up to the step.
When descending stairs (coming down), position the affected leg next to the stair railing and hold the handrail on that side. Position the crutch under the axilla on the other (unaffected) side. Lower the crutch one step, then move the affected leg down. Last, move the unaffected leg down to the step.
Up with the good, down with the bad!
Hi. I'm Meris, and in this video, we are going to be talking about mobility devices such as canes, walkers, and crutches. I am going to following along using our Fundamentals of Nursing flashcards. These are available on our website, leveluprn.com. If you already have a set, and you want to follow along with me, I'm going to be starting on card number 72. Let us get started. Okay. So starting off, you can see that there is a lot of information here on canes and walkers. So I would very much encourage you to read this for detail and to go through this in your books because you will have a lot of patients who use mobility devices.
So first up, we are talking about canes. I want to give you some very important patient teaching. The cane should be held on the strong side. You may also call the strong side the good side or the unaffected side. So be sure you read any test question very carefully to make sure you understand which word it's using and what it means. So we hold canes on the strong side. The other thing is that the cane should be at the height of the patient's wrist or greater trochanter. The greater trochanter is that big bump on the femur right below the hip. It usually aligns with where the wrist will fall when the patient's arm is by their side, okay? Very important to know. And if I am using a four-pronged cane, I want to make sure that the flatter side is towards my body versus the rounded side which should go out, because I do not want my patient to trip and fall over those prongs.
Okay. So talking about walkers, walkers also should be at the height of the wrist when the patient's arms are by their side, so same generally height. And we are going to make sure that the patient has their elbows flexed when they are using it. We do not want it to be straight arms. That's going to lead to discomfort and injury. Big thing to know about walkers, though, is going to be that if my patient uses them, and they are sitting in a chair, I need my patient to learn to use the arms of the chair to help them get out of the chair, not the walker itself. The walker is not fixed to the ground, so if I try to pull myself up using it, I may end up pulling the walker, pulling myself, falling down, being hurt. So I push up off of the chair using the armrest of the chair. I do not pull myself using the walker.
Okay, so moving onto crutches. Very important patient teaching starting right off the bat is going to be that the pads of the crutches should not be up against the axilla, the armpit. We have very important nerves and blood vessels that run right here, so we don't want our patient to be cutting off the circulation there. That's really going to lead to injury and discomfort. So we want it to be two inches below the axilla, and we need to teach our patients that when they are using crutches, they should be putting their weight on their hands, so on the handgrip, not putting their weight on the actual rest of the axilla. Again, weight on the hands on the handgrip, not in the armpits, okay? Very important patient teaching there.
Now we have a bunch of different crutch gaits, as you can see. We have just a lot, so I would encourage you to know a little bit about each of them, understand each of them. The big one that I want to hit here is going to be the swing-through gait. This is probably what you think of when you think of somebody using crutches. This is the idea that I'm moving both crutches together at once and then I am swinging up with both legs to meet the crutches. So this is probably what you're used to seeing, but keep in mind that based on my patient's deficit, they may have different crutch gaits. For instance, two-point, where they are moving the opposite leg and the crutch together, three-point, where both crutches are moved with the injured leg and then the uninjured leg is advanced, and then we also have four-point, which is moving one crutch and then the opposite leg and then the second crutch and then the last leg, so kind of walking on all fours almost, but I mean, standing upright. But think of it as walking on all fours. And then we have the one-crutch gait also, so be familiar with those so that you understand what the patient teaching of those might be.
Now another thing to know about crutches, very, very important, is how to go up and down stairs with these. So you'll see here that we've got a lot of best practices. I'm going to hit the highlights for you and give you a cool chicken. So when I am climbing the stairs, meaning I'm going up the stairs, I'm going to position my unaffected, my strong leg next to the stair railing and then hold onto the hand rail on that side. I'm going to position the crutch under the armpit of the other side, the affected side, and then I'm going to step up with the unaffected, the good leg, and then bring the affected leg up. So I'm going up, I'm descending the stairs with my-- I'm sorry, ascending. I'm going up. I'm climbing the stairs with my good leg. Up with the good, okay? Then descending the stairs, meaning I'm coming down, I'm going down the stairs, where it's going to be a little bit different. I'm going to position the affected leg near the stair railing, hold the hand rail, put the crutch under the unaffected side. Now I'm going to lower the crutch one step. Then I'm going to move the affected leg, the injured leg, the bad leg down, and then move the unaffected leg. Here's a very simple way to remember it. That's a lot of words. We go up with the good and down with the bad, right? We want more good; we want less bad in our lives, so same thing with the stairs. We go up with the good leg, down with the bad leg. So that's the cool chicken for how to remember that. It's a lot of information for crutches, but it's really important because once your patient goes home on crutches, they need to know how to navigate their home and the outside world.
So okay. That is it for crutches, for canes and walkers. Sorry, my brain malfunctioned. I hope that review was helpful. If it was, please like this video and leave us a comment below. If you have a better way to remember these crutch gaits, because there's a lot of them, please tell me in the comments. I very, very, very much want to know because this is tricky stuff. Be sure you subscribe to the next video so that you are the first to know when it posts. Thanks so much, and happy studying.
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November 23, 2021
The way you present the information to retain for testing is exactly what is needed in any nursing program. Direct and clear. No one does it better than you.