🦽 Lecture 4
Crutches, Canes, Walkers
Gait types, cane rules, measuring crutches, stair safety.
Crutch Gaits
📏
Measuring crutches: 2–3 fingers between pad and axilla. Tip = 6" lateral + 6" in front. Elbow = 30°
| Gait | Pattern | Use When |
|---|---|---|
| 2-Point | Crutch + opposite foot together, alternate | Mild bilateral weakness |
| 3-Point | Both crutches + bad leg → then good leg | ONE leg affected |
| 4-Point | Everything separately, 1 at a time | Severe bilateral weakness |
| Swing-Through | Both crutches → swing good foot past tips | Non-weight bearing / amputee |
🎯 Gait Selection
EVEN gaits (2 or 4) for EVEN (bilateral) problems
ODD gait (3) for ODD (one leg) problems
2 = mild | 4 = severe | Can't bear weight = swing-through
ODD gait (3) for ODD (one leg) problems
2 = mild | 4 = severe | Can't bear weight = swing-through
Cane & Walker
🦯
CANE: Hold on UNAFFECTED (strong) side. Advance cane with OPPOSITE (affected) side. Handgrip at wrist level.
🚶
WALKER: Pick it up → Set it down → Walk to it. Don't tie things to FRONT.
⚠️
NCLEX does NOT like tennis balls or wheels on walkers!
Stairs & Teaching
🪜 Stair Rule
"Up with the GOOD, Down with the BAD"
Going UP: good foot first | Going DOWN: bad foot first | Crutches ALWAYS move with the BAD leg!
✅
Early RA (bilateral, mild) → 2-point | AK Amputation → Swing-through | 1st day post-op knee → 3-point | Advanced ALS → 4-point
📖 Notes for Dummies
🧠 Think of it this way…
This is all about helping patients walk safely. Ask two questions: HOW MANY legs are affected? HOW BAD is it? Those two answers tell you which gait to choose every time.
🎯
Two questions = right answer:
BOTH legs affected → even-numbered gait (2 or 4)
ONE leg affected → 3-point (odd)
Can't bear weight at all → swing-through
BOTH legs affected → even-numbered gait (2 or 4)
ONE leg affected → 3-point (odd)
Can't bear weight at all → swing-through
📊
2 vs 4 point:
MILD problem → 2-point (faster, less stable)
SEVERE problem → 4-point (slower, more stable)
MILD problem → 2-point (faster, less stable)
SEVERE problem → 4-point (slower, more stable)
🦯
Cane rule — protect the weak side:
Hold cane on STRONG side. When your bad leg steps forward, the cane on the opposite side takes the weight. Cane and bad leg work as partners on opposite sides.
Hold cane on STRONG side. When your bad leg steps forward, the cane on the opposite side takes the weight. Cane and bad leg work as partners on opposite sides.
🪜
Stairs — "Good to Heaven, Bad to Hell":
Going UP → lead with GOOD foot (good things = going up!)
Going DOWN → lead with BAD foot (bad things = going down!)
Going UP → lead with GOOD foot (good things = going up!)
Going DOWN → lead with BAD foot (bad things = going down!)
📝 Quick chart:
👣 Both legs, mild (early arthritis) → 2-point
🦵 One leg (right knee surgery) → 3-point
😰 Both legs, severe (late MS) → 4-point
🚫 No weight at all (amputation) → swing-through
👣 Both legs, mild (early arthritis) → 2-point
🦵 One leg (right knee surgery) → 3-point
😰 Both legs, severe (late MS) → 4-point
🚫 No weight at all (amputation) → swing-through