7.3 Ambulation and Assistive Devices
Key Takeaways
- Ambulation prevents complications of immobility including pressure injuries, pneumonia, and blood clots
- Position yourself on the resident's weak side during ambulation
- Cane walking pattern: "Cane, bad leg, good leg" — the cane moves with the weak leg
- For stairs: "up with the good, down with the bad" — strong leg leads going up, weak leg leads going down
- ROM exercises: support above and below the joint, move gently, stop if pain occurs
- If a resident begins to fall during ambulation, ease them slowly to the floor — do not try to hold them up
Ambulation and Assistive Devices
Ambulation (walking) is a critical component of restorative care (INACE Duty Area 4 — Performing Basic Restorative Skills). Maintaining mobility helps prevent complications of immobility including pressure injuries, contractures, pneumonia, blood clots, and depression. Assisting with ambulation using assistive devices is one of the 21 mandated INACE performance skills.
Benefits of Ambulation
| System | Benefit |
|---|---|
| Musculoskeletal | Maintains strength, flexibility, and bone density |
| Cardiovascular | Improves circulation, reduces blood clot risk |
| Respiratory | Promotes deep breathing, prevents pneumonia |
| Gastrointestinal | Promotes appetite and regular bowel function |
| Urinary | Improves bladder emptying |
| Integumentary (Skin) | Reduces pressure injury risk |
| Psychological | Reduces depression, improves self-esteem and independence |
| Neurological | Maintains balance and coordination |
Types of Assistive Devices
| Device | Description | When Used |
|---|---|---|
| Standard walker | Four-legged frame; lifted with each step | Maximum stability; bilateral weakness |
| Wheeled walker (rollator) | Walker with wheels; push forward | Moderate stability; better coordination |
| Single-point cane | One tip, C-shaped handle | Mild balance difficulty; one-sided weakness |
| Quad cane | Four-point base, increased stability | Moderate balance difficulty; one-sided weakness |
| Forearm crutches | Cuff around forearm, hand grip | Long-term mobility needs |
| Axillary crutches | Under-arm, with hand grip | Temporary non-weight-bearing (e.g., broken leg) |
| Wheelchair | Seated mobility device | Non-ambulatory or limited endurance |
Assisting with Ambulation (INACE Skill)
Before Ambulation:
- Check the care plan for the level of assistance and any restrictions
- Ensure the resident is wearing proper non-slip footwear
- Apply a gait belt per facility policy
- Check the assistive device — ensure rubber tips are intact, wheels roll properly
- Clear the pathway of obstacles
- Position yourself on the resident's weak side (or slightly behind)
During Ambulation:
- Support the resident by grasping the gait belt from behind with an underhand grip
- Walk at the resident's pace — never rush
- Encourage the resident to look ahead, not down at their feet
- For walkers: the resident moves the walker forward first, then steps into it
- For canes: the cane moves forward with the weak leg ("up with the good, down with the bad")
- Monitor for signs of fatigue: shortness of breath, dizziness, sweating, pallor
- Ensure rest stops are available (chairs placed along the route)
If the Resident Begins to Fall:
- Do NOT try to hold them up — this risks injury to both of you
- Ease the resident slowly to the floor using the gait belt
- Protect the resident's head
- Call for help
- Do not attempt to get the resident up — wait for nurse assessment
- Complete an incident report
Cane Walking Pattern
The correct pattern for walking with a cane when there is weakness on one side:
- Move the cane forward first
- Move the weak/affected leg forward (to the cane)
- Move the strong/unaffected leg forward (past the cane)
Memory aid: "Cane, bad leg, good leg" or "Up with the good, down with the bad" (for stairs — good leg goes up first, bad leg goes down first)
Range of Motion (ROM) Exercises
Range of motion exercises help maintain joint flexibility and prevent contractures:
| Type | Description | Who Performs |
|---|---|---|
| Active ROM (AROM) | Resident performs movements independently | Resident with CNA encouragement |
| Active-Assistive ROM (AAROM) | Resident performs with CNA help | CNA assists through full range |
| Passive ROM (PROM) | CNA moves the resident's joints | CNA performs on immobile residents |
ROM Exercise Rules:
- Support the limb above and below the joint being exercised
- Move the joint gently through its full range of motion
- Stop if the resident reports pain — never force a joint
- Perform 3-5 repetitions per joint (or as ordered)
- Exercise each joint in the order listed in the care plan
- Report any new limitations, pain, or swelling to the nurse
When assisting a resident who has left-sided weakness to walk with a cane, the correct walking pattern is:
When performing passive range of motion (PROM) exercises, you should:
Where should you position yourself when assisting a resident with ambulation?