1. Chapter 26:
Ambulatory Aids

2. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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.

11. 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

12. 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

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

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

15. 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

16. 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