The term ambulates means “to move the body by walking with or without assistance.” Once the patient has tolerated sitting in a chair, the next step is to begin to walk. The physical therapist will instruct the patient and caregiver about any special techniques required and will prepare a schedule for daily ambulation. Your role as the home caregiver is to assist their patient, as needed, making sure that the physical therapist’s directions are followed. Sometimes the patient may want to walk longer than the directions allow. Always follow the physical therapist’s directions.
When assisting your patient to walk, follow these general rules:
- Assist patient in putting on the gait belt, if needed.
- Assist patient to the standing position, then count to 10 before proceeding.
- Stand by the patients’ weaker side and slightly behind.
- Grasp gait belt in back with one hand while placing another hand in front of collarbone on the weaker side.
- Do not rush the patient; be patient—allow plenty of time.
- Practice good body mechanics.
- If the patient becomes tired, wait a few moments before proceeding.
- Calmly encourage and reassure the patient, as needed.
Walking devices, such as walkers, canes, and crutches may be needed to help support patients when walking. The doctor determines the types(s) of assisting devices according to the patients’ needs and abilities. The physical therapist fits the device to the patients’ size. Then the patient is instructed about the proper use and care of the device. It is your responsibility to make sure that the patient follows these directions. Never change the directions given by the physical therapist. If the patient is having difficulty using the device correctly, contact the place where you leased or purchased the equipment.
Walkers are small metal stands that the patient leans on when walking from place to place. They are used for patients who have difficulty with balance or are weak and need additional support. Of all the types of assisting walking devices, walkers offer the greatest amount of stability because they provide four points of support. Some walkers have wheels and are pushed around, some are moved by lifting, and others have seats attached so that the patient may rest when necessary. The type of walker is ordered by the doctor and usually obtained from a medical supply company. The physical therapist will instruct the patient and caregiver about the proper technique when using the walker. Listed below are some basic guidelines that the patient should follow to use the walker correctly and safely.
- Always stand before grasping the walker; walkers are not meant to support the patient’s full weight when rising from sitting position. However, the patient may use it to pull up to the standing position if you hold it steady; remind the patient that, when unattended, the walker must never be grasped to rise from a sitting position or to lower oneself to a sitting position.
- All four legs of the walker are on the floor in a level position before taking a step; this technique will provide a solid base of support.
- The walker without wheels is advanced by picking it up and moving it forward while standing still; this technique will help keep the body in proper position and balance.
- One foot is moved and then the other into the walker after the walker is in the proper position.
- When getting into a chair from the walker, the patient releases the walker, grasps the arms of the chair, and lowers self into the chair.
Canes are sticks that patients lean on for balance while walking. There are two types:
- Regular—has a curved handle and provides one point of
- Broad-based—has three or four prongs (tripod or quad cane) that provide a greater base of support than the regular
Canes provide limited support to the patient’s weak side. A cane should only be used by patients who are able to walk without much assistance. Like all assisting walking devices, canes must be properly fitted to the patient. The physical therapist fits the cane and gives instruction about its proper use and care.
The patient is using a cane properly and safely:
- When it is held in the stronger hand with the elbow slightly bent.
- It is held in the hand opposite the weak leg.
- The rubber cap(s) is in place and replaced when worn.
Walking aids that are held in place by the arms. The patient must have strong shoulders, arms, wrists, and hands. At least one leg must be strong enough to bear weight. Other requirements include the ability to stand erect and have good balance, and the wearing of sturdy walking shoes.
There are three types of crutches:
- Axillary crutches—made of wood or aluminum and fitted under the arm.
- No axillary crutches (Canadian crutches)—fit halfway between the shoulder and elbow. They are held in place by a cuff that goes around the forearm.
- Adjustable or telescopic crutches—can be adjusted to full length, elbow length, or can be used as a cane.
The doctor will prescribe special exercises to strengthen the muscle of the upper body that will be used to bear weight. The physical therapist will instruct the patient about how to do the exercises when to practice and for how long each day. When the patient is strong enough, the therapist selects the type of crutch best suited to the patient’s physical condition. Measuring and fitting the crutch is also the responsibility of the therapist.
The patient is using crutches correctly and safely When:
- Weight is placed on upper arms, wrists, and hands—not under the arms;
- Instructions are given by the therapist are followed accurately.
- Rhe rubber crutch tips are in place and replaced when worn.
A Word of Caution
There may be situations where your patient has developed poor habits of positioning, lifting, moving, or using assisting devices incorrectly. When you observe this, explain, in a tactful manner, the dangers to the patient; why the action is incorrect; and demonstrate the correct method. Assist them to practice the activity until you are certain that they have learned the proper way. If they insist on continuing to perform activities incorrectly, report this to the doctor and physical therapist.
Safety Tips: Using Walkers, Canes, and Crutches
- That all bolts are tightened and tips have rubber safety protectors.
- Place walkers, canes, or crutches, when not in use, near the patient but out of traffic pattern of the room.
- Assist patient in putting on walking shoes—not floppy shoes.
- Remove obstacles from patients’ path.
- Reinforce instructions of the physical therapist.
- Do not rush the patient—allow plenty of time to practice walking.
- Practice using assisting devices when the patient’s energy level is high.