1. Patient Mobility - Ambulation
Unit 2

2. Ambulation p. 288 To ambulate: to walk
Gait: the way one walks; disorders affecting gait:
Stroke (CVA): hemiplegia – one side of body paralyzed
Multiple sclerosis: one or both legs weakened, balance disturbed
Huntington's disease: involuntary movements disturbing balance
Parkinson’s disease: stiffness, tremors, slow movements, shuffling
Arthritis: pain and stiffness in joints
Amputation: may have a prosthesis (artificial limb)
Orthopedic: injuries or disorders of musculoskeletal system

3. Ambulation
Nurse or physical therapist evaluates patient’s abilities and needs for ambulation & mobility p. 289
Normal gait pattern has 2 phases, starts with ankle in dorsiflexion and heel touching floor first
Gait training:
Physical therapists work with pt, teaching how to walk, walk on different surfaces, go up and down stairs, get in and out of chair, use assistive device
Guidelines for Safe Ambulation p. 290!!!! Part of skill #5

4. Assistive Devices p. 290 Include: Crutches, Canes, Walkers Crutches:
Rarely for older adults: need balance and 2 strong arms
Types: standard, forearm

5. Assistive Devices - Canes p. 292
Quad canes (4), tripod canes (3) give wide base of support
Canes aid balance, don’t give support
Always use on STRONG side
Proper fit: when hand is on handgrip, pt elbow is flexed 30 Degrees
Procedure 29 p. 292, Assisting Pt to walk with a cane and 3-point-gait

6. Assistive Devices - Canes p. 293
3-point-gait
Cane/Walker on strong side goes out first
Weak/affected leg is next, until it is even with cane
Strong/unaffected leg last, further than cane
2-point-gait
Cane/Walker on strong side goes out WITH weak/affected leg
Strong/unaffected leg goes next

7. Assistive Devices - Walker p. 294
For general weakness in both legs, partial weight-bearing on one leg, mild balance problems
Need strength in both arms to pick up walker
Elbow at 30 degrees when hands on handgrips, top of walker reaches the hip joint
NOT used for transfers (holding on while getting up or sitting down), only for walking
Procedure 30 p. 294!

8. Assistive Devices - Walker p. 294
3-point-gait
Patient lifts walker and puts it 6-8 inches ahead, all 4 legs of walker should come down together
Brings weak/affected leg into walker
Brings strong/unaffected leg even with weak foot
2-point-gait
Patient lifts and moves walker AND weak leg 6-8 inches ahead

9. The falling patient p. 295
If pt starts to fall, assist pt onto floor as in
Procedure 31, p. 296
Don’t try to hold her/him upright = injury for you and/or patient
After: call nurse to assess before moving pt

10. Assistive Devices – Wheelchair p. 295
Used for mobility if can’t ambulate (yet)
For correct fit:
4 inches between top of back and pt’s axillae
Armrests support without pushing shoulders up or hanging shoulders
2-3 inches between edge of seat and pt’s knees
Hand-width space between pt’s hips and sides of wheelchair
2 inches between bottom of footrests and floor
90 degree angle between feet and legs

11. Assistive Devices – Wheelchair p. 295
Wheelchair Safety p. 297! Especially: backing through doors/elevators/down ramps, pt positioning etc
Positioning pt in wheelchair correctly: see Guidelines for Chair and wheelchair positioning p. 300, especially: shoulders not shrugged or down; no bare skin on wheelchair, pressure relieving devices, hips at 90 degree angle, no pressure to back of knees
How to help pt back into right position, if body shifted forward p.298,
see Figures to 17-19!

12. Assistive Devices – Wheelchair p. 300
Wheelchair activity: to reduce pressure on buttocks and prevent PUs
Teach pt to shift weight q 15mins
Wheelchair push-ups:
Brakes locked, caster wheels in forward position
One hand on each armrest, keeping elbows bent
Lean slightly forward, push up on armrests, straightening elbows, lifting buttocks off seat
Hold to count of 5 if possible
Leaning: if pt can’t do push ups
Brakes locked, caster wheels in forward position, feet on floor
Place hands on armrests or thighs, lean slightly forward
Lean to each side, relieving pressure on buttocks

13. Homework
Textbook: Read Unit 17 p Workbook: p. 106: Read Unit Summary, Nursing assistant alert, answer all Completion questions, True/False, and Identification