CANES Should be placed relatively closed to the body and should not be placed ahead of toe.

Gait Pattern: 1. Starting postion. Left LE affected. 2. Cane and unaffected extremity is advanced 3. The uninvolved extremity is advanced 4. Cycle is repeated CRUTCHES MEASUREMENT: In standing: 2 below axilla; distal end: 2 lateral & 6 anterior to the foot. Or subtract 16 from pt.s height. In Supine: Anterior axillary fold to a surface pont (mat or table) 6-8 (57.5cm) from the lateral border of the feet. Forearm Crutches distal end: 2 lateral & 6 anterior to the foot; shoulders relaxed to allow 20-30 elbow flexion; cuff: 1-1.5 below the elbow. Gait Patterns: Three point Gait 1. Starting position, left LE is NWB. 2. Weight shifted onto the involved LE and crutches are advanced. 3. Weight shifted through the UE onto the crutches, uninvolved extremity advances beyond the crutches 4. Both crutches are advanced 5. Cycle is repeated Modified three-point-one/ three-point Gait 1. Starting position, left LE PWB/affected 2. Weight shifted onto the uninvolved limb. Crutches and affected extremity are advanced simultaneously. 3. Weight shifted onto the crutches and partially to the affected extremity and the unaffected limb advances. 4. Cycle is repeated. Four-point Gait 1. Starting position, weight is borne on both LE extremities and both crutches. 2. Left crutch advanced. 3. LE advanced. 4. crutch advanced. 5. Left LE advanced. 6. Cycle is repeated. Modified Four-point Gait 1. crutch and left extremity advanced together. 2. LE advanced. 3. Cycle is repeated. Two-point Gait pattern 1. Starting position, weight is borne on both LE and both crutches. 2. Left crutch and LE are advanced together. 3. crutch and left LE are advance together.

Modified Two-point Gait (use of one crutch only) 4. LE advanced. 5. crutch and left extremity advanced together. 6. Cycle is repeated. WALKERS FWB Gait 1. Walker is picked up and moved forward about an arms length. 2. First LE is advanced. 3. Second LE is advanced past the first. 4. Cycle is repeated. PWB Gait 1. Walker is picked up and moved forward about an arms length. 2. Affected limb is moved forward and body weight is shifted partially onto this limb and partially through the UEs to the walker. 3. Unaffected limb is moved forward past the affected limb. 4. Cycle is repeated. NWB Gait 1. Walker is picked up and moved forward about an arms length. 2. Weight is shifted through the UEs to the walker. Involved limb is held anterior to the pt.s body but does not make contact to the floor. 3. Uninvolved limb is moved forward. 4. Thy cycle is repeated. ASSUMING STANDING AND SEATING POSITIONS CANE A. Coming to Standing 1. Patient scoots forward. 2. Cane positioned on uninvolved side or lean against armrest. 3. Patient leans forward, and pushes down with both hands on armrests, comes to standing position and grasps the cane B. Return to Sitting 1. As pt. approaches the chair, pt. turns in a small circle toward the stronger side. 2. Pt. backs up until the chair can be felt against the pt.s legs. 3. Pt. reaches for armrest with the free hand, releases the cane (broad-based), and reaches for the opposite armrest. CRUTCHES A. Return to Standing 1. Patient scoots forward. 2. Crutches placed together in a vertical position on affected side. 3. One hand is placed on the handpieces of crutches; on the armrest of chair 4. Patient leans forward and pushes to a standing position. 5. Once balanced is gained, one crutch is cautiously placed under the axilla on the unaffected side

B. Return to Sitting 1. As pt. approaches the chair, pt. turns in a small circle toward the stronger side. 2. Pt. backs up until the chair can be felt against the pt.s legs. 3. Both crutches are placed in a vertical postion (out from the axilla) on the affected side. 4. One hand is placed on the handpieces of crutches; on the armrest of chair 5. The patient lowers to the chair controlled. WALKERS A. Coming to Standing 1. Patient scoots forward. 2. Walker positioned directly in front of the chair. 3. Patient leans forward, and pushes down with both hands on armrests, comes to standing position. 4. Once in standing position, the patient reaches for the walker, one hand at a time. B. Return to Sitting 1. As pt. approaches the chair, pt. turns in a small circle toward the stronger side. 2. Pt. backs up until the chair can be felt against the pt.s legs. 3. Patient reaches for one armrest at a time. 4. The patient lowers to the chair controlled. STAIR CLIMBING TECHNIQUES ASCENDING STAIRS 1. PT positioned posterolateral on the affected side behind the patient. 2. Wide BOS with each foot on a different stair. 3. A step should be taken only when the patient is not moving. 4. One hand is placed posteriorly on the guarding belt and one is anterior to, but not touching, the shoulder on the weaker side. DESCENDING STAIRS 1. PT positioned anterolateral on the affected side in front of the patient. 2. Wide BOS with each foot on a different stair. 3. A step should be taken only when the patient is not moving. 4. One hand is placed anteriorly on the guarding belt and one is anterior to, but not touching, the shoulder on the weaker side GOOD LEG GOES TO HEAVEN (ASCEND) | BAD LEG GOES TO HELL (DESCEND) CANES A. Ascending 1. Unaffected LE leads up 2. Cane and affected LE follow. B. Descending 1. Cane and affected LE lead down. 2. Unaffected LE follow.

CRUTCHES Three-point Gait A. ASCENDING 1. Patient close to the foot of the stairs. Involved LE is held back to prevent catching on the lip of the stairs. 2. Push down firmly on both handpieces of the crutches and leads up with the unaffected LE. 3. Crutches are brought up to the stair that the unaffected LE is now on. B. DESCENDING 1. Patient stands close to the edge of the stair so that the toes protrude slightly over the top. The uninvolved LE is held forward over the lower stair. 2. Both crutches are moved down together to the front half of the stair of the next step. 3. Push down firmly on both handpieces of the crutches and lowers the unaffected LE to the step that the crutches are on. PWB Gait A. ASCENDING 1. Patient close to the foot of the stairs. 2. Push down firmly on both handpieces of the crutches and distributes weight partially on the crutches and partially on the affected LE while the unaffected LE leads up. 3. The involved LE and crutches are then brought up together. B. DESCENDING 1. Patient stands close to the edge of the stair so that the toes protrude slightly over the top. 2. Both crutches are moved down together to the front half of the stair of the next step. The affected LE is then lowered. 3. The uninvolved LE is lowered to the step the crutches are on. Two-point Gait A. Ascending 1. Patient close to the foot of the stairs. 2. LE is moved up and then the left LE. 3. crutch is moved up and then the left crutch is moved up B. Descending 1. Patient stands close to the edge of the stair. 2. crutch goes down then the left crutch. (may be combined) 3. LE is moved down and the left LE. PROTECTIVE FALLING FORWARD FALL 1. Pt. release crutches and quickly flips it to side. 2. Pt. reaches forward with both UE and turns head to side. 3. Hands in contact w/ the floor, elbows bent. 4. Body is lowered to the floor. BACKWARD FALL 1. Pt. release crutches and quickly flips it to side. 2. Tuck chin toward the chest and reach forward with both UE. 3. Semiflexed trunk so that the buttocks will contact the floor first.