Assistive Devices

Mobility Aids in Restorative Nursing Practice

Restorative care focuses on helping patients regain or maintain the highest possible level of function and independence. Within this framework, assistive devices (e.g., canes, walkers, crutches, wheelchairs) are essential tools that support mobility, reduce fall risk, and promote engagement in daily activities. For the Certified Nursing Assistant (CNA), understanding the correct use, safety checks, and patient assistance techniques for these devices is both a clinical responsibility and a high-yield exam topic.[1]

Standard Terminology for Mobility and Support Devices

  • Assistive device – any tool, equipment, or system that helps a person perform tasks they might otherwise be unable to do safely.
  • Mobility aid – a subset of assistive devices specifically used to improve walking or transferring (canes, walkers, crutches, wheelchairs).
  • Gait belt (transfer belt) – a safety device placed around the patient’s waist to assist with transfers and ambulation; not an assistive device itself but often used together.
  • Weight-bearing status – clinical prescription (e.g., non-weight-bearing, partial weight-bearing, full weight-bearing) that determines how much weight a patient can put on a limb.
  • Proper fit – device must be adjusted to the patient’s height, arm length, and weight to ensure safety and efficiency.[2]

Procedural Protocols for Cane, Walker, Crutch, and Wheelchair

Assisting a Patient with a Cane

  1. Ensure correct height – The top of the cane should align with the patient’s wrist crease when the arm is relaxed at the side.
  2. Instruct to hold the cane in the hand opposite the weak side (e.g., right leg weak → left hand holds cane).
  3. Gait pattern – Cane moves forward simultaneously with the weak leg.
  4. Maintain a wide base of support – The cane should be placed about 6 inches (15 cm) to the side of the foot.
  5. Observe for shoulder hiking or leaning – These indicate improper height or technique.[3]

Assisting with a Walker

  1. Adjust height – Handgrips should be at wrist level when the patient stands upright.
  2. Instruct the patient to lift the walker and place it forward a short step length (do not slide standard walkers – risk of tipping).
  3. Step forward with the weaker leg first (if partial weight-bearing), then bring the strong leg up.
  4. Keep elbows slightly bent (about 15–20 degrees) while gripping to prevent excessive strain.
  5. Check rubber tips – Replace if worn or missing to prevent slipping.[4]

Crutch Walking (Cruising vs. Swing-Through Gait)

  1. Align axillary pads 1–2 inches below the armpit (do not bear weight on the armpit – risk of nerve damage).
  2. Use three-point gait (if one leg is non-weight-bearing) – both crutches and the weak leg move forward together, then the strong leg.
  3. Always place crutches at a 30-degree angle away from the body to maintain stability.
  4. For stairs – “up with the good, down with the bad” – ascend with strong leg first; descend with weak leg and crutches first.[5]

Wheelchair Use and Transfers

  1. Lock brakes before any transfer or when the patient is seated.
  2. Position footrests out of the way to prevent tripping or pinching.
  3. Transfer towards the patient’s stronger side using a gait belt and proper body mechanics (bend at hips/knees, keep back straight).
  4. Inflate tires to manufacturer specification – soft tires cause instability during propulsion.
  5. Encourage self‑propulsion when the patient is capable, as it promotes upper‑body strength and independence.[6]

Clinical Indicators of Mobility Impairment

  • Unsteady gait or swaying during ambulation.
  • History of recent falls (especially in older adults).
  • Pain, weakness, or limited range of motion in a lower extremity.
  • Inability to bear weight fully on one leg (post‑surgery or fracture).
  • Fatigue during short walks (e.g., less than 50 feet).[7]

Observational Parameters for Device Fit and Gait

  • Observe gait – note symmetry, base of support, arm swing, and any stumbling.
  • Evaluate device fit – height alignment, handgrip comfort, and condition of tips/brakes.
  • Assess patient’s ability to follow instructions – cognitive understanding reduces fall risk.
  • Document any changes in mobility – increased pain, decreased confidence, or new unsteadiness – and report to the nurse.[8]

Interventions to Support Safe Assistive Device Use

  • Remind the patient to wear non‑slip, closed‑toe footwear.
  • Ensure the environment is clutter‑free – remove loose rugs, cords, and objects on the floor.
  • Stand by (close enough to catch if needed) without restricting the patient’s movement.
  • Provide verbal cues – “Place your cane here… now step with your right foot.”
  • Reinforce proper technique – “Keep the walker close to you; don’t reach too far forward.”
  • Encourage rest breaks to avoid fatigue‑induced falls.[9]

Risk Mitigation in Assistive Device Utilization

  • Fall prevention is the top priority – approximately 30% of community‑dwelling older adults who use assistive devices report at least one fall per year.[10]
  • Never allow a patient to use a borrowed or unadjusted device – incorrect height leads to poor posture and falls.
  • Inspect rubber tips and wheelchair brakes daily – worn parts increase slip risk.
  • Avoid pulling the patient by the arm – use a gait belt and steady them by the waist or hips.
  • Watch for signs of over‑exertion – shortness of breath, pallor, dizziness – and stop activity immediately.
  • Report any device damage or malfunction before the next use.[11]

Test-Ready Strategies for Device-Related Questions

  • Remember the “opposite hand” rule for canes – cane in the right hand when the left leg is weak. This is a frequent multiple‑choice question.
  • “Up with the good, down with the bad” applies to crutches and stairs.
  • Know the three weight‑bearing categories: non‑weight‑bearing, toe‑touch/partial, and full.
  • Lock wheelchair brakes before any transfer – test question trap: “You assist a patient into the wheelchair. What should you do first?” → Lock the brakes.
  • Gait belts are not for lifting; they are for guiding and steadying.
  • Memory aid: “C – Check fit; A – Adjust height; N – No axillary pressure; E – Elbows slightly bent.”
  • Cotton or rubber‑tipped canes are for indoor use; metal or ice tips for outdoor/ice.[12]

References & Sources

  1. American Academy of Orthopaedic Surgeons (AAOS). How to Use Crutches, Canes, and Walkers. OrthoInfo. https://orthoinfo.aaos.org/en/recovery/how-to-use-crutches-canes-and-walkers
  2. National Association of Health Care Assistants (NAHCA). Restorative Care and Assistive Devices. https://www.nahcacna.org/
  3. Perry, A.G., & Potter, P.A. (2022). Fundamentals of Nursing (9th ed.). Elsevier. https://shop.elsevier.com/books/fundamentals-of-nursing/potter/978-0-323-32740-4
  4. Centers for Disease Control and Prevention (CDC). STEADI – Check for Safety: A Home Fall Prevention Checklist for Older Adults. https://www.cdc.gov/steadi/pdf/steadi-brochure-checkforsafety-508.pdf
  5. Sorrentino, S.A., & Remmert, L. (2020). Mosby’s Essentials for Nursing Assistants (6th ed.). Elsevier. https://shop.elsevier.com/books/mosbys-essentials-for-nursing-assistants/remmert/978-0-323-52392-9
  6. Occupational Safety and Health Administration (OSHA). Workplace Safety and Health Topics: Preventing Back Injuries in Healthcare – Safe Patient Handling. http://www.osha.gov/healthcare/safe-patient-handling
  7. The Joint Commission. National Patient Safety Goals – Hospital: Fall Reduction. https://www.jointcommission.org/standards/national-patient-safety-goals/
  8. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. State Operations Manual: Appendix PP – Guidance to Surveyors for Long Term Care Facilities (Tag F323). 42 CFR Part 483. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483
  9. American Nurses Association (ANA). Principles for Safe Patient Handling and Mobility. https://www.nursingworld.org/practice-policy/work-environment/health-safety/safe-patient-handling/
  10. CDC. STEADI – Facts About Falls. https://www.cdc.gov/falls/data-research/facts-stats/index.html
  11. National Institute on Aging (NIA). Fall Prevention: Tips to Prevent Falls. https://www.nia.nih.gov/health/falls-and-falls-prevention
  12. Saunders Comprehensive Review for NCLEX-PN® & NCLEX-RN®. (2021). Restorative Care and Assistive Devices. Elsevier. https://evolve.elsevier.com/cs/product/9780443112874?role=student

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