3.7 Assistive, Prosthetic, and Orthotic Devices
Key Takeaways
- 172 NAC 108 restorative skills include use of assistive devices in transferring, ambulation, eating, and dressing, plus care and use of prosthetic and orthotic devices.
- Check skin under braces, splints, and prostheses for redness or breakdown and report problems to the nurse before forcing reapplication.
- Apply and store devices only as directed by the care plan and nurse; never improvise fit.
- Encourage resident participation in device use to promote independence and dignity.
Assistive, Prosthetic, and Orthotic Devices
Restorative nursing helps residents regain or maintain the highest possible function. 172 NAC 108 specifically requires training in use of assistive devices for transferring, ambulation, eating, and dressing, and in care and use of prosthetic and orthotic devices.
Restorative Philosophy for Device Use
Devices are tools for independence, not shortcuts for staff speed. Encourage the resident to do as much as is safe. Explain each step, protect dignity, and match the care plan. If a device is missing, damaged, or unused because it hurts, report that barrier—do not silently abandon the restorative goal.
Assistive Devices for Mobility and ADLs
| Device | CNA Focus | Common traps |
|---|---|---|
| Gait belt | Apply snugly over clothing; use for stand-pivot and ambulation unless contraindicated | Placing on bare skin; forgetting to remove after transfer when policy requires |
| Walker/cane | Correct height; advance device then weak then strong leg as taught | Letting resident "carry" a walker without weight-bearing through handles |
| Wheelchair | Lock brakes for transfers; position footrests; protect elbows/heels | Transferring with unlocked brakes |
| Reachers/plate guards/built-up utensils | Support self-feeding and dressing independence | Doing the task for the resident when they can participate |
Transfer and Ambulation Tips
- Place the device on the resident's strong side when that is the care-plan method for canes.
- Clear pathways of chairs, O2 tubing, and scatter rugs.
- Stay slightly behind and to the side during ambulation as trained.
- Never let a resident pull on your neck; use a gait belt and proper body mechanics.
Prosthetic Devices
A prosthesis replaces a missing body part (for example, a lower-limb prosthesis). CNA responsibilities typically include:
- Assisting with application/removal only as trained and assigned
- Inspecting the residual limb and skin contact areas for redness, blisters, or drainage
- Keeping the prosthesis clean and stored safely when not in use
- Reporting pain, poor fit, or skin breakdown to the nurse immediately
- Allowing residual limb sock/liner care exactly as directed—do not invent padding
Residual Limb Skin Checks
Look for warmth, openness, odor, or pressure rings. Compare to the usual baseline. Even a small blister can become a serious wound in a person with diabetes or vascular disease.
Orthotic Devices
An orthosis (brace/splint) supports or aligns a body part. After removal, check skin over bony areas. Do not pad a brace in a way that changes prescribed alignment unless the nurse directs you. If the resident cannot tolerate the device, stop and notify the nurse.
Common orthoses in long-term care include ankle-foot orthoses (AFOs), wrist splints, abdominal binders, and knee immobilizers. Schedule on/off times may be ordered to prevent skin breakdown while maintaining alignment.
Safety Rules Checklist
- Follow the care plan—device schedules are clinical orders.
- Never force a device that no longer fits.
- Keep pathways clear so device users can move safely.
- Promote independence: let the resident do what they can safely do.
- Report pain, numbness, coolness, or color change distal to a brace.
- Know facility policy for cleaning and labeling devices.
Exam and Skills Links
Knowledge items may ask what to do when skin under a brace is red. Skills scenarios involving dressing, transfers, or feeding may include adaptive equipment. Verbalize skin checks and brake locking—evaluators listen for those safety steps.
Eating and Dressing Devices in Detail
Adaptive eating equipment may include nosey cups, weighted utensils, sip lids, and non-slip mats. Place items within the resident's visual field and strong-side reach. For dressing sticks, button hooks, and sock aids, break the task into steps and celebrate partial success. Rushing adaptive care defeats the restorative purpose and can cause shoulder injury if you pull clothing against contractures.
Storage, Labeling, and Infection Control
Label devices with the resident's name. Clean reusable ADL equipment according to facility infection-control policy between uses if shared and after contamination. Do not place prostheses on the floor. Keep orthoses dry unless the manufacturer and nurse instruct otherwise. Moist braces against skin raise fungal and bacterial risk.
Falls Prevention Link
Improperly fitted walkers, unlocked wheelchair brakes, and missing footwear turn assistive devices into fall hazards. Before ambulation, check non-skid footwear, device tips/wheels, and adequate lighting. After surgery or a new prosthesis, expect a therapy plan; do not advance the resident beyond ordered weight-bearing status.
Collaboration with Therapy
Occupational and physical therapists often set device goals. CNAs carry those goals into evenings, nights, and weekends when therapy is absent. If the resident refuses a device, document the refusal, notify the nurse, and explore reasons (pain, fear, skin issue) rather than forcing compliance.
While removing a resident's ankle-foot orthosis, the CNA finds a new blister over the heel. What is the correct action?
Which restorative skill is specifically listed in Nebraska 172 NAC 108?