Ambulating with an assistive device can be a little intimidating and often tricky for individuals using them for the first time. It is astounding how many patients tell me after their injury or surgery that they are given crutches or a cane without formal instruction on how to use them. However, if you take your time and think about each movement carefully, using an assistive device is easier than you think.

First, let’s discuss what an assistive device is. An assistive device is any device that will help and allow an individual to be more mobile with standing and weight bearing activities (walking, stair negotiation, etc). Assistive devices are often used to help individuals with decreased balance, pain, weakness, fatigue, and joint instability. They are also used to off load full or partial weight of a lower extremity that has undergone a surgical procedure. There are many different types of assistive devices with the most common being walkers, canes, and crutches.

Fitting the Device for Your Needs

Before using an assistive device you must set up the device for your specific body and overall mobility needs. Regardless of which type of assistive device you use (walker, cane, or crutches), you need to have the device fit you properly. If the device is placed too low for your body height, you will end up putting excessive weight on your upper extremities. If the device is too high, it often results in excessive shoulder shrugging and discomfort. Measuring and adjusting a device in standing is the most accurate, but it can also be done with the individual lying down. If you are using a walker, start by standing in the opening of the walker with the walker directly in front of you. If you are using a cane or crutch/crutches, you will place the device at your side. With the shoulders relaxed and your arms resting at your sides, the hand piece or handle of the device should land at the crease of your wrist. For crutches, make sure the top of the crutch is about two inches or two fingers width below the arm pit.

Proper placement of the device is also quite important for optimal use and function. When using a walker it is placed right in front of you, when using two crutches one is placed on either side, but when using a cane it is held in the opposite hand of the affected side or leg. For example, if surgery was done on a right knee the cane would be held in the left hand or if someone is experiencing right sided weakness the cane would again be held on the opposite side, the left. For those new to assistive devices, this may seem counter- intuitive. However, placing the cane on the opposite side ensures a natural gait pattern, promotes optimal posture and widens the base of support. For those looking to offload pressure or weight on their affected side, placing the cane to the opposite side allows you to shift weight away from your injured or weaker side.

Time to Get Moving

Once the device is all set up and adjusted appropriately, it is time to get moving. Proper ambulation and walking pattern will vary greatly depending on the assistive device being used and on the amount of weight that is placed on the affected limb. Regardless of the device you are using, you will start by advancing the device first, followed by the affected or surgical side, and lastly the non-affected/stronger side. Once this walking pattern becomes easier, you can progress to a more natural gait pattern by advancing the device and the affected side together.

Now that you have mastered walking with your assistive device it is time to tackle the stairs. You should always use a railing if it is available to you. A railing is sturdier and more supportive than your device, leading to improved balance and stability with stairs.

• Ascending Stairs: When going up stairs you want to lead with your “good” or non-injured leg first. Leading with your nonaffected side will allow your stronger side do most of the work to advance you up a step. At first, you will be going up the stairs one step at a time until your leg is strong and flexible enough to allow for a reciprocal pattern.

• Descending Stairs: When going down stairs you want your “bad” leg to lead first while your stronger leg stays on the step above. Lowering yourself down in a controlled manner requires a great deal of strength, your stronger leg should do all of the work.

Learning proper ambulation and stair negotiation with an assistive device can take some time. Practice and repetition will build your confidence and your walking will become more natural. Following an injury or surgery, your physical therapist will work with you to ensure proper fit, use, and safety.

References
1. O’Sullivan, Susan B. and Thomas J. Schmitz. Physical Rehabilitation. 4th Ed. Philadelphia: F.A. David, 2006.