7.3 Ambulation and Assistive Devices

Ambulation as Restorative Care

Ambulation (walking) falls under INACE Duty Area 4, Basic Restorative Skills, and assisting a resident to walk with an assistive device is one of the 21 mandated manual performance skills. The clinical purpose is to fight the complications of immobility — the cascade that begins when a resident stays in bed too long.

Complications of Immobility (and What Walking Prevents)

Matching the Assistive Device

Before use, inspect the device: rubber tips intact and not worn smooth, walker height at the resident's wrist crease with elbows slightly bent, wheels rolling freely, and brakes (on a rollator) working. A cane should be held in the hand opposite the weak leg.

Assisting with Ambulation (INACE Skill)

Before: check the care plan for the assist level and any weight-bearing restriction; apply non-slip footwear; apply the gait belt; inspect the device; clear the path of cords, rugs, and clutter; place a chair along the route for rest.

During: stand on the resident's weak (affected) side, slightly behind, holding the belt underhand; for a walker, the resident moves the walker forward first, then steps into it — they should not get ahead of it; encourage looking ahead, not at the feet; walk at the resident's pace; watch for fatigue cues — shortness of breath, dizziness, sweating, pallor, or chest pain — and stop and seat the resident if they appear.

Cane and Stair Patterns

When one side is weak, the cane and the weak leg work as a pair:

1. Move the cane forward.
2. Move the weak (affected) leg to the cane.
3. Move the strong (unaffected) leg past the cane.

Memory aids: "Cane, bad leg, good leg" on level ground, and on stairs "up with the good, down with the bad" — the strong leg leads going up, the weak leg leads going down, with the cane on the step with the weak leg.

If the Resident Starts to Fall

This is a heavily tested scenario. Do not try to hold the resident upright — a sudden dynamic load injures you and them.

1. Widen your stance and keep your back straight.
2. Pull the resident toward your body using the gait belt.
3. Ease them down along your bent leg to the floor.
4. Protect the head from striking anything.
5. Call for the nurse and stay with the resident; do not get them up.
6. After a nurse assesses for injury, complete an incident report documenting facts only.

Range of Motion (ROM) Exercises

Range of motion exercises maintain joint flexibility and prevent contractures (permanent shortening/stiffening of a joint).

ROM rules: support the limb above and below the joint; move slowly and smoothly through the available range only; perform 3-5 repetitions (or per care plan); work in a head-to-toe order; never force a joint or push past resistance; and stop immediately if the resident reports pain, reporting any new stiffness, swelling, or limitation to the nurse. Performing ROM during a bath, when joints are warm and clothing is already off, is an efficient, common practice.

ROM Movement Vocabulary

The written INACE knowledge test expects you to recognize the standard movement terms used in the care plan and reported to the nurse.

Worked Example: A Safe Walk That Fails Halfway

A resident with right-sided weakness is cleared for ambulation with a quad cane and a one-person assist. The CNA checks the care plan, applies non-slip socks and a gait belt, inspects the cane's rubber tip, and clears the hallway. The cane is placed in the resident's left hand; the CNA stands on the right (weak) side, slightly behind, holding the belt underhand. Pattern: cane, right leg, left leg.

Forty feet in, the resident becomes pale, short of breath, and says, "I'm dizzy." The correct response is not to push on — it is to stop, turn the resident toward the chair the CNA had pre-positioned, lower them into it, stay with them, and report the fatigue signs to the nurse. Recognizing the stop point is exactly what evaluators look for.