Ambulatory Training

1. Ambulatory Training By Molly Williams Student Physical Therapist

2. Definitions to Know • Non-weight bearing (NWB): the involved lower extremity is not to be weight bearing and is usually not permitted to touch the ground. • Toe-touch weight bearing (TTWB): the patient can rest the foot of the involved lower extremity on the ground for balance but not for weight bearing. • Partial weight bearing (PWB): a limited amount of weight bearing, such as five pounds, is permitted for the involved lower extremity. When partial weight bearing is required, but a specific amount of weight is not specified, minimal weight bearing should be permitted on the involved lower extremity until a specific amount is confirmed by the referring physician. • Weight bearing as tolerated (WBAT): the patient determines the amount of weight bearing that will occur on the involved lower extremity. The amount of weight bearing permitted may vary from minimal to full, depending upon the tolerance of the patient. • Full weight bearing (FWB): the patent is permitted full weight bearing on the involved lower extremity. Ambulatory assistive devices are not used to decrease weight bearing but may be used for assistance with balance.

3. Why is Proper Fitting Important? When crutches are too long or when a patient rests on the tops of the crutches, injury to nerves and blockage of blood vessels in the axilla can occur. • Results: • Pain or tingling in the upper extremities • Muscle weakness • Potential paralysis

4. Sit to Stand with Crutches • 1. Hold both crutches with hand on uninvolved side (or whatever side is comfortable for patient) • 2. Push up from the chair with opposite hand • 3. Once standing, gain balance and transfer one crutch into the other hand. • 4. The patient then places the crutches slightly in front and lateral to the toes • 5. Adjust crutch height appropriately prior to ambulation *If it is difficult for the patient to stand, have him/her bring noninvolved (good) foot back behind the knees and lean upper body forward (nose over toes).

5. Proper fitting of Crutches • Position crutch tips on floor, slightly in front and lateral to patient’s feet • Place two or three fingers between the patients axilla and the top of the crutch on each side • The handgrips should be approximately at the level of the patient’s wrist crease. Elbows are flexed approximately 20-30 degrees. • *Crutches come in different sizes: • 4’6” – 5’2” • 5’2” – 5’10” • 5’10” – 6’6”

6. Sit to Stand with Walker • 1. Patient sitting edge of bed • 2. One hand on bed • 3. Other hand on hand grip of walker • 4. Once standing in upright position, place hand from bed on other hand grip of walker • 5. Adjust walker height appropriately prior to ambulation *If it is difficult for the patient to stand, have him/her bring noninvolved (good) foot back behind the knees and lean upper body forward (nose over toes).

7. Fitting Walker • The patient stands up right with shoulder girdle relaxed in the walker • The handgrips should be at the level of the patient’s wrist crease when the upper extremities are relaxed • When the patient grasp the handgrips with the shoulder girdles level and relaxed, the elbows are flexed approximately 20-30 degrees

8. Ambulating with Assistive Device • Crutches/Walker: Advance Device ⇨ involved LE ⇨ non involved LE

9. Ascending and Descending Stairs • “Good go to heaven, Bad go to……” • Ascending: • Up with the uninvolved LE (good) first • Descending: • Down with involved LE (bad) first *When using crutches with stairs, move crutches with the involved extremity when ascending and descending stairs

10. Questions? References: • Duesterhaus M, Duesterhaus S. Patient Care Skills. New Jersey: Pearson; 2010.