Chapter 26: Ambulatory Aids

Preparing for Ambulation Isometric exercises: Quadriceps setting: client alternately tenses and relaxes the quadriceps muscles Gluteal setting: client contracts and relaxes the gluteal muscles to strengthen and tone them

Preparing for Ambulation Upper arm strengthening: flexion and extension of the arms and wrists; raising and lowering weights with the hands; squeezing a ball or spring grip; modified hand push-ups in bed Dangling: normalizes blood pressure Using a tilt table

Assistive Devices Devices to support and assist walking: Parallel bars (handrails) provide practice in ambulating Walking belt applied around client’s waist provides secure grip to prevent injury while ambulating

Ambulatory Aids Cane: a hand-held ambulation device made of wood or aluminum. Rubber tips reduce possibility of slipping Teach client to: Place cane on strong side of the body Move the cane forward at the same time as the weaker extremity Take the next step with the stronger extremity

Ambulatory Aids Walker: most stable device; has curved aluminum bars and three-sided enclosure with four legs for support Nurse educates client to get up from a chair with a walker 1. Move to the edge of the chair 2. Position the walker 3. Pushup on the armrest with both arms 4.Use one hand to grasp the walker and then the other hand

Ambulatory Aids(Cont’d) Crutches: generally used in pairs and made of wood or aluminum Axillary Forearm Platform

Ambulatory Aids (cont’d) Crutch-walking gaits: pattern of walking when ambulating with crutches Four-point gait-use for bilateral weakness or disability such as arthritis or CP Three-point gait –non weight bearing-one amputated, injured, or disables extremity(fractures leg or severe ankle sprain) Three-point gait -Partial weight bearing-amputee learning to use prothesis, minor injury to one leg, or previous injury showing signs of healing Two-point gait-Same as four point, but clients have more strength, coordination and balance. Swing-through gait-injury or disorder affecting one of both legs, such as a paralysed client with leg braces or anamoutee before being fitted with a prosthesis See table 26-1 page 591

Question Which ambulatory aid is used mostly by clients who are diagnosed with arthritis of the hands or wrists? a. Canes b. Auxiliary crutches c. Walkers d. Forearm crutches

Answer d. Forearm crutches The use of crutches requires a great deal of upper arm strength; hence, forearm crutches are used by clients who have arthritis of the hands or wrists since weight is placed upon forearms.

Prosthetic Limbs Temporary prosthetic limb: immediate postoperative prosthesis (IPOP) Permanent prosthetic components delayed for several weeks or months to be sure: Incision has healed Stump size is relatively stable

Prosthetic Limbs (cont’d) Prosthetic components include: Below the knee: socket, shank, ankle/foot system Above the knee: below-the-knee components plus a knee system Ambulation with a lower limb prosthesis requires strength and endurance Proper application

Question Is the following statement true or false? Amputees should avoid strenuous activities, as these can lead to further complications.

Answer False. Amputees can take up strenuous activities such as snow skiing if they use a sturdier modified prosthesis.

General Gerontologic Considerations Functional ability involves mobility and making adaptations to compensate for changes occurring with aging or disease processes May need encouragement and support integrating adaptations into their activities of daily living and maintaining their self-concept and body image Maintaining independence is important to older adults

General Gerontologic Considerations (cont’d) Mobility facilitates staying active and independent As a person ages, he or she may develop flexion of the spine which alters the center of gravity and may increase falls Ensure adequate lighting without laying electric cords in passageways Elevate toilet seats; install grab bars Rearrange home furnishings