6.3 Ambulation, Assistive Devices, and Fall Risk

Ambulation Is a Safety Skill

Ambulation means walking. For many residents, walking maintains function -- it improves circulation, reduces stiffness, supports bowel activity, helps breathing, lifts mood, and preserves confidence. For others, ambulation is part of recovery after illness, surgery, or bed rest, where it helps prevent complications of immobility such as pressure injuries, blood clots, pneumonia, and muscle wasting. The aide encourages walking as assigned but never pushes beyond the care plan or the resident's current condition.

On the clinical skills test, Ambulate a Resident Using a Gait Belt is a randomly assigned skill; applying the belt and providing standby support are critical element steps.

Before ambulation, check the care plan for assistance level, distance, device, gait belt use, weight-bearing limits, special shoes or braces, oxygen needs, and whether a second staff member is required. If the plan says two-person assist, the aide does not walk the resident alone because the hallway looks clear. If the resident refuses, the aide reports the refusal and tries supportive communication but does not force the resident.

Ambulation Readiness Check

A gait belt is usually used during ambulation so the aide can steady the resident. Walk slightly behind and to the weaker side unless the care plan directs otherwise, holding the belt at the back or side with an underhand grasp. Keep your own base wide and your steps controlled. Do not let the resident hold your neck, and do not pull the resident forward by the arms.

Assistive devices help only when used correctly. A walker is advanced first, then the weak leg steps into it, then the strong leg follows; the resident stands inside the walker -- not behind it -- and should not lift it too high or push it too far ahead. A standard walker has four legs and must be lifted; a rolling (wheeled) walker is pushed. A cane is held on the strong, unaffected side and moves at the same time as the weak leg -- a useful memory aid is COAL: Cane Opposite Affected Leg. To climb stairs, the strong leg leads going up and the weak leg leads coming down ("up with the good, down with the bad").

Crutches and specialized devices require specific training and should not be guessed at.

Device height matters. A cane or walker that is too low makes the resident bend forward; one that is too high raises the shoulders and reduces control. Properly fitted, the hand grip should reach the wrist crease with the arm relaxed, giving a slight elbow bend (about 15-30 degrees). Aides usually do not adjust device height independently; report devices that look damaged, have missing rubber tips, are uneven, loose, or wrong for the resident.

Fall risk changes throughout the day. A resident may walk well after breakfast but poorly after pain medication, dialysis, poor sleep, infection, dehydration, or a long therapy session. Watch for a slower pace, dragging a foot, shuffling, leaning, grabbing furniture, new tremor, shortness of breath, sweating, pale color, confusion, or fear. Statements such as "My legs feel like rubber," "I need to sit," "I feel funny," or "I can't catch my breath" require an immediate stop, rest, and report. Chest tightness or chest pain during a walk is an emergency-level finding to report at once.

Manage tubes and equipment before walking. Oxygen tubing, urinary drainage tubing, intravenous lines, and chair alarms can become trip hazards or pull loose. The aide does not disconnect equipment; instead, ask the nurse for help, keep a urinary drainage bag below bladder level and off the floor, and ensure tubing is not wrapped around feet or walker legs. Rest breaks are part of safe ambulation -- know where the resident can sit if tired. When trailing a wheelchair, keep it close enough to be useful but not so close it clips the heels, and lock the brakes before the resident sits.

Ambulation also requires dignity. Encourage the resident to do what they can: stand from the chair, hold the device, set the pace, choose a safe destination, or decide whether to rest. Avoid rushing, scolding, or talking over the resident. A resident who is fearful after a fall may need calm cues and small goals.

What to Report After Walking

Report new pain, dizziness, shortness of breath, chest discomfort, weakness, knee buckling, a near fall, an actual fall, refusal, unsafe device condition, a change in gait, or inability to complete the usual distance. Also report when the resident can safely do more than the care plan reflects, because restorative and nursing staff may reassess the goals.