Assistive devices for walking:

CANE:

 Standard cane is 91cm (36 in.) lonf

 The length should the elbow to be slightly flexed
 The client must hold cane on the unaffected hand. The cane and affected leg
are advanced together. To shift the weight unto the cane.
 Clients may use either one or two canes, depending on how much support
they require

WALKER:

 Instruct client to use “lift and walk” technique ( lift the walker forward, then
make few small steps toward the walker.
 The height of the walker should be at hip level.
 The client using the walker may go up and down the stairs. When going up,
use the walker in front. The walker is used to protect the client from falls.

CRUTCHES:

 The different crutch-walking gaits are as follows:

o FOUR-POINT GAIT. Advance the right crutch, followed by the left

foot; then the left crutch, followed by the right foot. Weight bearing
is allowed.

Right crutch

Left foot

Left crutch

Right foot

o TWO POINT GAIT. Advance the right crutch and left foot together,
then the left crutch and the right foot together. Weight-bearing is
allowed.

Right crutch and left foot

Left crutch and right foot

 o THREE POINT GAIT. Advance both crutches and affected leg together,
followed by the unaffected leg. LITTLE OR NO WEIGHT-BEARING IS
ALLOWED, e.g after total hip replacement or total knee replacement.

Both crutches and affected leg

Unaffected leg

o SWING-TO GAIT. Advance both crutches, swing the body so that the
feet will be to the level of the crutches

o SWING- THROUGH GAIT. Advance both crutches, swing the body so

that the feet will be past the level of the crutches.

 Going up and down the stairs using crutches.

o “up with the good; down with the bad”
 When going up the stairs, advance the “good leg”
(unaffected leg) first, followed by the “bad leg” and the
crutches.
 When going up the stairs, advance the “bad leg” (affected
leg) and the crutches first, followed by the “good leg”.
 NOTE: the “bad leg” should always be with the crutches to
provide support.

CARE OF THE CLIENT WITH CAST:

 Carry the newly- casted body part with palms of the hand. To prevent
indentation and pressure.
 Elevate the body part with pillow support. To prevent edema.
 Expose the cast to dry. Dry cast appears white, shiny, hard, and
resonant. Sensation of heat as the cast is drying is normal. The cast should
not be covered with a blanket or towel while it is drying because the retained
heat can burn the client.
 Keep the cast clean and dry. Plaster of paris dries within 48 hours or
longer especially larger cast. Fiberglass cast may dry in 10-15 minutes,
and the client is allowed to have weight- bearing in 30 minutes after cast
application
 Observe hot spots and musty odor, or drainage from the cast. These are
signs and symptoms of infection.
 Maintain skin integrity- by “petalling” ( applying adhesive tapes at the
edges of the cast to smoothen the areas)
 Do neurovascular checks. The following findings distal to the cast application
indicate that the cast is too tight.
o Skin color- pallor, cyanosis
o Skin temp.- cold skin
o Sensation – numbness and tingling sensation
o Mobility- inability to move the body part
o Pulse- absence of pulse
o
 Windowing- is done to facilitate observation under the cast. It is also done
to assess pulse or to prevent “cast syndrome”. The procedure involves
removal of a part of the cast.
 Cast syndrome may occur if the client has body cast. It is manifested by
bloated feeling, prolonged nausea, repeated vomiting, abdominal distention,
vague abdominal pain, shortness of breath.
 Bivalving- is done for wound care or x-rays. It is also done when the cast is
too tight or when healing process has occurred. The procedure involves
splitting of the cast.