Ambulation Aids: Measuring and Fitting

  Assess the patient's limitations and capabilities to determine which ambulation device is appropriate...

   1. Assessment should include strength, mobility, range of motion, visual acuity, perceptual difficulties, and balance.
   2. Perform hand hygiene.
   3. Verify patient's identity in accordance with institutional policy.

Cane

   1. Determine the length of the cane with the patient standing or supine.
   2. Ensure that the handgrip of the cane is level with the greater trochanter or the ulnar crease of the wrist when the arm is straight down at the side.
   3. With the cane parallel to the femur and tibia, ensure that the foot (tip) of the cane is on the floor or at the bottom of the heel of the shoe.
   4. Confirm fit with the patient standing. There should be approximately 20 to 30 degrees of elbow flexion when the patient grasps the hand piece and positions the aid for ambulation. To position for ambulation, the tip of the cane is placed forward approximately 4 to 5 inches and laterally to the forefoot approximately 2 to 4 inches with the cane of the stronger side of the body.

Crutches

   1. If the patient's height is known, subtract 16 inches from the height; the resulting value approximates the length from the axillary pad to the crutch tip.
   2. If height is uncertain or unknown, measure the supine patient from the anterior axillary fold (crease of armpit) to a point approximately 6 to 8 inches lateral to the patient's heel. This value represents the overall crutch length.
   3. To determine the hand piece height, with the patient's arm held close to his or her side, measure from the anterior axillary fold to the trochanter or ulnar wrist crease. Use this value to position the hand piece by measuring down from the center of the axillary pad 1.5 to 2 inches or three finger widths.
   4. Confirm the fit with the patient standing with head and trunk erect, shoulders relaxed and level, feet flat on the floor, and knees slightly flexed. The crutch tips should be 2 to 4 inches lateral and 4 to 6 inches anterior to the toes of the forefoot. The elbows should be flexed approximately 15 to 25 degrees when the hand piece is grasped with the wrist in a neutral position.

Walker

   1. Accomplish measurement with the patient either standing or supine.
   2. Ensure that the handgrip of the walker is level with the ulnar wrist crease or greater trochanter with the walker in front of and along the patient's sides.
   3. Ensure that the feet of the walker are resting on the floor or are even with the heels of the shoes with the hips and knees straight.
   4. Confirm the fit with the patient standing. There should be approximately 15 to 25 degrees of elbow flexion when the patient grasps the hand piece and positions the aid for ambulation. To position for ambulation, the tips of the walker are placed forward approximately 4 to 5 inches and laterally to the forefoot approximately 2 to 4 inches.

Post Procedure

   1. Instruct the patient in correct use of the device.
   2. Perform hand hygiene.
   3. Document the procedure in the patient's record.
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