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Assistive Devices

Oct 03, 20245 min read

Rehabilitation is a health-oriented process that assists an ill person or a person with disability. It is used to achieve the greatest possible level of holistic functioning.

Nursing Considerations

  1. Physical
  2. Psychological: antihistamine (glaucoma), antipsychotics (retinal dysfunction), corticosteroids (swelling, cataracts)
  3. Coordination: balance, gait
  4. Safety
  5. Resources

Assistive Devices

These are known as “mechanical aids” that are used to improve the functional capabilities of an individual.

  1. Wheelchair
    • Parts of the Wheelchair:
      • Push handle: for caregivers to push the wheelchair.
      • Backrest: rest for the back
      • Armrest: on the side, may be detachable
      • Cushion: on top of the seat for comfort
      • Seat: seat
      • Frame: the body of the wheelchair
      • Push Ring: for independent movement of the patient
      • Calf Strap: straps the calves
      • Footplate: where the feet rests
      • Brake: always loosens over time.
      • Rear Wheel: large wheel
      • Anti-tip Bar: a bar under the seat the caretaker can leverage to raise the front of the wheelchair.
      • Castor: smaller wheels
      • Straps: applied when necessary.
    • Considerations:
      • Assistance: always look for assistance when traversing less-than-ideal areas.
      • Power Chairs
  2. Crutches: supports body weight, assisting weak muscles, and provides joint stability.
    • Variations of Gait
      • Four-Point Gait: left crutch, right leg, right crutch, left leg (right affected side), mirror if left side is affected.
        • Used for weakness in both legs or poor coordination (Polio, Arthritis, Cerebral Palsy). This provides excellent stability as it maintains at least three points of contact with the floor. However, it is the slowest but most stable gait pattern.
        • Used for patients that require two assistive devices or a walker.
      • Three-Point Gait: starting in the tripod position, advance both crutches at once, advance the affected leg, then the unaffected leg.
        • Used for weakness in one leg. The unaffected leg should be able to take all the load.
        • Used for patients that require two assistive devices or a walker.
      • Tripod Gait: either side of the crutch may advance, followed by the other crutch, then simultaneously drag both feet.
        • Taught to patients who will use swing patterns, indicated for affectation of both legs and paraplegia.
      • Two-Point Gait: starting with the bad leg and the contralateral crutch, then alternate.
        • Requires more balance, and is the most difficult form. A progression of a four-point gait.
        • Used for patients that require two assistive devices.
      • Swing-to-Gait: similar to tripod, but both crutches advance simultaneously. Feet are dragged simultaneously, as with the tripod, to the crutch tips.
        • Used for affectation of both legs, and additional truncal instability.
      • Swing-through-Gait: similar to swing-to-gait, but the ending position of the legs are past the crutches.
        • Used for bilateral lower extremity affectation, paraplegia, and patients with spina bifida (causes lower extremity paralysis).
        • It is the fastest gait, but also the most instable.
    • Variations of Use
      • Non-weight Bearing
      • Touch-down Weight Bearing/Toe-touch Weight Bearing
      • Partial Weight bearing
      • Weight Bearing to Tolerance
      • Full Weight Bearing
    • Variations of Crutches
      • Underarm Crutch/Axillary Crutch: is settled under the axillary.
      • Loftstrand Crutch: has arm straps for support, but is in line with the arm.
      • Platform: arm straps for support, but arms are perpendicular to the crutch.
    • Parts of the Crutch:
      • Crutch Pad/Axillary Bar: the area in contact with the axillary region
        • The crutch pad should be two to three finger breadths (1.0” - 1.5”) under the axillary region at rest
      • Hand Grip: the bar being held by the user. When held, there should only be a slight bend (15 degree) of the elbow.
      • Crutch Tip/Rubber Tip: the foot of the crutch in contact with the floor. Contact points of the crutches should follow a tripod position, extended 4 inches in front and 6 inches laterally.
    • Use:
      • Safety Considerations
        • Padding should be present and stable at the crutch pad, hand grip, and crutch tip.
        • Inform the client on the amount of load their affected leg can take.
        • All nuts (for adjustment) should be checked as in-place before use, especially after adjusting the crutch.
        • Always wear good, supportive shoes or use bare feet rather than loose (potentially slippery) footwear.
        • Avoid wet surfaces, remove rugs, and other.
  3. Walker: used to maintain balance and provide (the best) support because of wide area of contact (four-legged) with the floor. It allows for some ambulatory independence.
    • Cons: bulky; cannot be used in small areas.
    • Variations: pick-up walker (no wheels), rolling walker (four wheels), and two-wheeled walkers.
    • Use:
      • When unfolding, make sure the walker is locked (marked by a click) and rubber foot pads are present.
      • The height of the patient arm on the walker hand grip should be 20 to 30 degrees of flexion of the elbows.
      • When arms are relaxed, the wrists should be on the level of the handgrips.
      • When walking, the affected side should be used first.
      • When seated, grip both armrests of the chair and push yourself to stand before grabbing the walker.
      • When sitting, advance the affected leg, grab the armrests, and support yourself for sitting.
      • When climbing stairs, lead with the unaffected leg. Fold the walker in half, then hold it to support the affected side. Grab the railings and support the unaffected side with it. Step with the unaffected leg, then the walker, then the bad leg.
      • When descending stairs, lead with the affected leg. Holding the walker as stated earlier, step with the walker first, then the affected leg then the unaffected leg.
  4. Cane: when the legs are able to bear load, and only mild imbalance is of concern.
    • Variations:
      • One-tip Cane/Standard Straight-legged Cane
      • Quad Cane (four legs)
    • Use:
      • Height adjustment: the handle of the cane should be at the level of the greater trochanter with 30 degrees of elbow or wrist flexion.
      • Hold the cane on the unaffected side unless contraindicated.
      • When walking, advance the cane, followed by the affected leg, then the unaffected leg.
      • When climbing stairs, lead with the cane, then the unaffected leg, then the other.
      • When descending stairs, lead with the cane, then the affected leg, then the other.

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