Ambulation

Before beginning ambulation, confirm that the patient does not...

Assisted ambulation with one nurse:
  • Before beginning ambulation, confirm that patient does not feel light-headed.
  • Apply gait belt if unsure of patient's stability, and assist patient to standing position.
  • Have patient take a few steps while nurse is positioned on patient's stronger side. If an assistive device (e.g., cane, walker) is used, then nurse stands on patient's weak side.
  • Grasp walking belt in middle of patients back.
  • Take a few steps forward with patient; assess for strength and balance.
  • If patient becomes weak or dizzy, return patient to bed or chair, whichever is closer.
  • If patient begins to fall, gently ease patient to floor by holding firmly onto gait belt, stand with feet apart to provide broad base of support, extend leg, and let patient gently slide to the floor. As patient slides, nurse bends knees to lower body.
Assisted ambulation with two nurses:
  • Follow steps 1a and 1b.
  • Stand on either side of patient.
  • Both nurses grasp walking belt in middle of back.
  • Step forward in unison with patient, keeping speed and step size same as patients.
  • Gradually increase distance walked.
  • Follow steps 1f and 1g.

Ambulation with assistive devices:
Assist patient in crutch walking by choosing appropriate crutch gait:
Four-point gait:

  • Begin in tripod position. Crutches are placed 6 inches (15 cm) in front and 6 inches to side of each foot. The patients weight should be placed on the handgrips.
  • Move right crutch forward 4 to 6 inches (10 to 15 cm).
  • Move left foot forward to level of left crutch.
  • Move left crutch forward 4 to 6 inches (10 to 15 cm).
  • Move right foot forward to level of right crutch.
  • Repeat above sequence.

Three-point gait:

  • Begin in tripod position.
  • Advance both crutches and affected leg.
  • Move stronger leg forward, stepping on floor.
  • Repeat sequence.

Two-point gait:

  • Begin in tripod position.
  • Move left crutch and right foot forward.
  • Move right crutch and left foot forward. Repeat sequence.

Swing-to gait:

  • Begin in tripod position.
  • Move both crutches forward.
  • Lift and swing legs to crutches, letting crutches support body weight.
  • Repeat two previous steps.

Swing-through gait:

  • Begin in tripod position.
  • Move both crutches forward.
  • Lift and swing legs through and beyond crutches.

Assist patient in climbing stairs with crutches:

  • Begin in tripod position.
  • Patient transfers body weight to crutches.
  • Patient advances unaffected leg to stair.
  • Both crutches are aligned with unaffected leg on stairs.
  • Repeat sequence until patient reaches top of stairs.

Assist patient in descending stairs with crutches:

  • Begin in tripod position.
  • Patient transfers body weight to unaffected leg.
  • Move crutches to stair, and instruct patient to begin to transfer body weight to crutches and move affected leg forward.
  • Patient moves unaffected leg to stair and aligns with crutches.
  • Repeat sequence until patient has descended the stairs.

Assist patient in ambulating with walker:

  • Have patient stand in center of walker and grasp handgrips on upper bars.
  • Lift walker, move it 6 to 8 inches (15 to 20 cm) forward, and then set it down, making sure all four feet of the walker stay on the floor. Take a step forward with either foot. Then follow through with the other leg.
  • If there is unilateral weakness, after the walker is advanced, instruct the patient to step forward with the weaker leg, support self with the arms, and follow through with the uninvolved leg. If patient is unable to bear weight on one leg, after advancing walker, have the patient swing onto it, supporting weight on hands.

Assist patient in ambulating with cane (standard or quad):

  • Begin by placing cane on the side opposite the involved leg.
  • Place cane forward 6 to 10 inches (15 to 25 cm), keeping body weight on both legs.
  • Move involved leg forward, even with the cane.
  • Advance uninvolved leg past cane.
  • Move involved leg forward, even with uninvolved leg.
  • Repeat these steps.