IT'S NOT UNCOMMON for patients to need a little extra assistance in getting back on their feet after suffering an injury or stroke or undergoing leg, knee, or hip surgery. To help them regain their ability to walk, these patients may have to use an assistive device, such as crutches, a cane, or a walker, to achieve mobility. This is a vital step in the recovery process.
When your patient is ready, you and the physical therapist will help him prepare for ambulation. You'll teach him the appropriate exercises to strengthen his muscles, as we discussed in the September/October issue of LPN2005, and make sure he's using the right assistive device for his mobility issues.
We reviewed the proper use of crutches in the September/October issue. Now, let's discuss the right way to use a cane.
A little support
A patient who has weakness in his leg, a trunk injury, or pain, and who needs minimal assistance may use a cane to help him walk with greater balance and support. A cane also relieves pressure on weight-bearing joints by redistributing the patient's weight. A quad, or four-footed, cane provides more stability than a standard straight cane.
To check for correct fit of the cane, make sure the patient can bend his elbow at a 30-degree angle, hold the cane's handle about level with the greater trochanter, and place the tip of the cane 6 inches lateral to the base of the fifth toe. An adjustable cane makes it easy to customize the device for the patient. The cane should have a slightly flared tip with flexible, concentric rings. These features provide maximum stability, work like a shock absorber, and enable the patient to walk with greater speed and less fatigue.
You or the physical therapist will teach the patient to follow these steps when walking with a cane:
* Hold the cane in the hand opposite the affected extremity (the "good side") to increase support and to lessen the stress on that extremity. The cane may be used on the same side if the patient can't hold the cane in the opposite hand.
* Move the cane forward in unison with the affected leg. This mimics a normal walking motion.
* Keep the cane close to the body to prevent leaning.
* Bear down on the cane when the unaffected extremity moves forward.
Up and down
You or the physical therapist will instruct the patient to follow these guidelines to go up and down stairs using the cane:
* Hold the stair rail, if possible.
* Step up on the unaffected extremity.
* Place the cane and the affected extremity up on the same step.
* Reverse this procedure to go down the stairs.
As with a patient using crutches, be sure to assess his stability and protect him from falls. Walk with the patient, supporting his balance as needed. Check his tolerance of walking and provide rest periods when he's fatigued.LPN
On the Web
American Academy of Orthopaedic Surgeons: http://www.orthoinfo.aaos.org
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