Chapter 13 Assisting with Mobility 385 Copyright Goodheart-Willcox Co., Inc. In addition to these, there are newer, hands-free crutches. A knee walker or knee scooter is a wheeled device that sup- ports the injured leg. The knee of the injured leg is placed in a padded seat while the good leg pushes the scooter. The patient uses the scooter handles to maneuver and make turns. Guidelines for Using Crutches. Some healthcare facilities may have special procedures or training for healthcare workers who will be assisting patients to ambulate with crutches. The fi t and size of standard crutches is important. Before allowing a patient to ambulate with crutches, the fi t and size of the crutches must be deemed appropriate for that patient (Figure 13.15). The tops of the crutches (crutch pad) should be about one and a half inches below the axilla, while the patient is standing up straight and shoulders are relaxed. The hand- grips of the crutches should be even with the hips. The elbows should be able to bend slightly when the handgrips are used. The crutch length should equal the distance between the axilla and about six inches in front of the patient’s shoe. The tops of the crutches should be held tightly to one’s sides, but never pressing into the axilla, which can damage the nerves. The bottoms of the crutches should always have rubber tips. Before helping the patient to ambulate with crutches, check for fl aws (cracks in wooden crutches and bends in metal crutches) and tighten all the bolts on the crutches, if appropriate. Using the Appropriate Gait. Equally important to properly siz- ing crutches is knowing which crutch walking gait is ordered by the doctor so proper instructions can be given. Each gait starts in a tripod position (Figure 13.16). The crutch tips are placed about four to six inches to the side and slightly in front of each foot. The strong foot bears the weight of the body. A four-point gait is used when there is some weight-bearing ability on both legs. Start with the tripod position. Then follow the sequence for the four-point gait (Figure 13.17 on the next page). A three-point gait is used when there should be no weight bearing on the affected, or injured leg. Start with the tripod posi- tion and follow the sequence for the three-point gait (Figure 13.18 on the next page). When using the three-point gait, the non- weight-bearing leg should move forward along with the crutches. A two-point gait is used when both legs can bear some weight. This is an alternative to the four-point gait, which also allows for some weight to be placed on each foot. Start with the tripod position and follow the sequence for the two-point gait (Figure 13.19 on the next page). A swing-through gait is used when the legs are para- lyzed and in braces. Start with the tripod position and follow the sequence for the swing-through gait (Figure 13.20 on the next page). Wards Forest Media, LLC Figure 13.15 Before a patient uses crutches to ambulate, check that they properly fit the patient and are in good condition. Wards Forest Media, LLC Figure 13.16 The tripod position is the neutral starting position for ambulating with crutches.