1. Ambulatory Aids PNU 145 Chapter 26 Ambulatory Aids Cheryl Proffitt, RN,MSN September, 2015

2. Objectives  Name four activities that prepares clients for ambulation  Give two examples of isometric exercises that tone and strengthen lower extremities  Identify one technique for building upper arm strength  Explain the reason for dangling clients or using tilt table  Name two devices used to assist clients with ambulation  Give three examples of ambulatory aids  Identify the most stable type of ambulatory aids

3. Learning Objectives  Describe three characteristics of appropriately fitted crutches  Name four types of crutch-walking gaits  Explain the purpose of a temporary prosthetic limb  Discuss two criteria that must be met before constructing a permanent prosthetic limb  Name four components of above-the-knee and below-the- knee prosthetic limbs  Describe how a prosthetic limb is applied  Discuss age-related changes that affect the gait and ambulation of older adults.

4. Ambulatory Aids Introduction  Used for clients with disorders or injuries to the musculoskeletal system  Clients who are weak or unsteady because of age related problems and have difficulty walking  Clients with neurological problems and have difficulty walking

5. Preparing for Ambulation  Patient’s who are debilitated ( those who are frail or weak from prolonged inactivity) require physical conditioning before they can ambulate  Some techniques that can help to increase muscle strength and the ability to bear weight includes performing isometric exercises with the lower limbs and isotonic exercises with the upper limb, dangling at the bedside and using the tilt table.

6. Preparing for Ambulation Isometric exercises: Used to promote muscle strength and tone. Types –Quadriceps setting: client alternately tenses and relaxes the quadriceps muscles. Enables client to stand and support the body –Gluteal setting: client contracts and relaxes the gluteal muscles to strengthen and tone them. Assist with walking

7. Quadriceps and Gluteal Setting Exercises

8. Upper arm strengthening: flexion and extension of the arms and wrists; raising and lowering weights with the hands; squeezing a ball or spring grip; modified hand push-ups in bed. Dangling: normalizes blood pressure. Sitting at the edge of the bed, helps to normalize blood pressure Using a tilt table- a device that raises the client from a supine to a standing position. Preparing for Ambulation

9. Ambulation Aids Cont’d

10. Assistive Devices Devices to support and assist walking: –Parallel bars (handrails) provide practice in ambulating –Walking belt applied around client’s waist provides secure grip to prevent injury while ambulating

11. Ambulatory Aids Three aids are used to help with ambulation, crutches, walker, canes Crutches: generally used in pairs and made of wood or aluminum –Axillary –Forearm –Platform

12. Types of crutches

13. Ambulatory Aids (Cont’d) Cane: a hand-held ambulation device made of wood or aluminum- clients with weakness –Rubber tips reduce possibility of slipping Walker: most stable device; has curved aluminum bars and three-sided enclosure with four legs for support. Used for clients needing support and assistance with balance Clients holds and stands within walker, takes step forward

15. Ambulatory Aids (cont’d) Crutch-walking gaits- pattern of walking when ambulating with crutches. Types ( point refers to the sum of the crutches and legs used) –Four-point gait –Three-point gait – non/partial weight bearing –Two-point gait –Swing-through gait

16. Using a Cane

17. Crutch-Walking Gaits

18. Prosthetic Limbs Is used for clients with arm/leg amputation Types: Amputation at the foot-(Syme’s amputation) Below the knee- (BK amputation) Above the knee- (AK amputation) Entire leg and a portion of the hip (hemi- pelvectomy)

19. Temporary Prosthetic limb Temporary prosthetic limb: immediate postoperative prosthesis (IPOP) Permanent prosthetic components delayed for several weeks or months to be sure that :  Incision has healed  Stump size is relatively stable

20. Prosthetic Limbs (cont’d) Prosthetic components include: Below the knee: socket, shank, ankle/foot system. Above the knee: below-the-knee components plus a knee system

21. Applying a Leg Prosthesis Nurses are responsible for managing the care of the stump. (Refer to Skill 26-3 in the textbook.) Ambulating with a lower extremity limb prosthesis requires strength and endurance.

22. Nursing Implications Nursing diagnoses include: –Impaired physical mobility –Risk for disuse syndrome, trauma –Unilateral neglect –Risk for activity intolerance –Risk for peripheral neurovascular dysfunction –Look at care plan 26-1

23. General Gerontologic Considerations Functional ability involves mobility and making adaptations to compensate for changes occurring with aging or disease processes May need encouragement and support integrating adaptations into their activities of daily living and maintaining their self-concept and body image Maintaining independence is important to older adults

24. General Gerontologic Considerations (cont’d) Mobility facilitates staying active and independent As a person ages, he or she may develop flexion of the spine which alters the center of gravity and may increase falls Ensure adequate lighting without laying electric cords in passageways Elevate toilet seats; install grab bars Rearrange home furnishings

25. References Timby, B. (2009). Fundamental nursing skills and concepts (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Google pictures. (2015, August 10). Retrieved from http://www.google.com