>> Hi, I'm Kathie Kushto-Reese and I'm Shari Lynn. And today we're going to teach you about ambulatory assisted devices.

>> And so we're going to begin with a cane. So let's start with a cane. This is a straight wooden cane. It has to be ordered at the proper height. It's obviously not adjustable. It's not really supportive. If you have a patient that really needs a lot of support and if they lean on this cane, they're going to go down. It won't hold them up. Sometimes you'll have people who say, I have pain in my knee, so if I use this cane it just takes the pressure off a little bit. And that's ok, but at least they have their balance. So this would be the wooden cane. Ok? And this is a metal cane and this is adjustable. You can see you can just push the button in and then you can adjust it for different heights. It doesn't matter which cane the patient has, the measurement is always the same. The cane should always be at a hundred sixty degree angle of the arm; which brings it to about the hip. And so here is our patient.

>> And I do have knee problems.

>> Well then it's good that you have that.

>> Ok.

>> So here we can see that that's at the proper height because that would be her hip, angle of a hundred sixty degrees, the bend of the arm.

>> Ok, so I walk like this. This is my bad knee. So it's cane, bad knee, good leg, cane, bad knee, good leg.

>> Right.

>> And if I do it like this.

>> That's too fast.

>> Ok.

>> You don't want to go too fast because you don't want to lose your balance.

>> Ok.

>> It's cane, weak, strong. That's how you remember it, cane, weak, strong. Now this is another cane. This is a quad cane. Just because it's a quad cane, it's no different in how it's used then the other canes. It's still cane, weak, strong; quad four legs and if you'll notice two of the legs stick out a little further and these are a little flatter. These, this is the side that's against the body so it's not to have the patient's foot get caught and trip. So these are flatter. But it's a quad cane. It's a little more support than the others and would you like to try this one?

>> I'll try that.

>> Ok.

>> This feels more like, oh, that's nice, very supportive.

>> That's good support.

>> Ok.

>> So it's cane, weak, strong, cane, weak, strong and you're just going to step to the center of cane and you only put in front of you just a little bit. You don't want big steps. You don't want to throw the patient's center of gravity off. And so that would be the quad cane. So you've seen the wooden cane, the straight cane and the quad cane. Even though this is a little more support it's not support for someone who really does, can't keep their own balance. For a patient who can't keep their own balance they might have a walker. A walker is also adjustable four sides, and it's a lot stronger. So you can see it doesn't fall over so much. And, once again the same kind of bend 160 degrees of the angle of the arm and there's really no stepping rule with this because it depends on what's wrong with the patient. But would you like to try with our walker?

>> Sure I'll try the walker.

>> So you put the walker forward and step to the center. It's tiny little steps once again and that's how it goes. And so that's the walker that has greater support for the patient that may be a little wobbly with the cane. Now a lot times your patients are evaluated in the hospital by physical therapy and they decide what apparat ice the patient should have but when physical therapy leaves, you as the nurse has to reinforce that learning. So you have to know the rules. So that's the walker. Ok, so you have your crutches and you want to make sure the crutches are at the right height. So the measurement under the arm would be two finger widths from the axial to the top of the crutch, like this. And so you would know that that's the correct height. And that would be the correct height like this for me. The once again the arms are at a 160 degree bend and that brings the handles just about the hip. And that would be the proper me3asurement for crutches. And with the crutches you're going to have the patient put them forward and out a little bit and then swing through. It takes a lot of balance. So of course, you wouldn't recommend crutches for an elderly patient that doesn't have a good sense of balance or doesn't have good upper body strength. So you really want to access that. But it's just forward, out and swing through. You want to teach the patient that the pressure is on the hands not under the arms, that's incorrect. It's on the hands right here and at the proper height it will be that 160 degree angle. An important thing to be teaching your patients is how to go up and down the stairs with crutches. So if the patient is going up the stairs, they would put their, they would hop up first on the foot and then bring the crutches up. If they're going down, they put the crutches down on the step and then they hop down to that step. And it's important that they do it that way. If someone is just learning how to do the crutches on the stairs you want to make sure you really nearby because they will lose their balance because if they're going up the stairs and they hop up they are at one point with crutches behind them and that's a really weird feeling on the stairs. So it feels like you're falling backwards. Same with going down. So you want to make sure you're nearby. You can hold on to them. You can use a transfer belt which you'll learn about in lab to hold on to them until you're sure they have their balance. If they're at home and they say I'd rather just slide down the stairs on my rear that's perfectly safe, that's time, that's a good idea. And if they're going up and down stairs where there's a railing, if they just want to have the crutches under one arm and hold on to that railing that's pretty safe too because the railing shouldn't be going anywhere. And here we have a wheel chair. And there's really some important things that you need to know about the wheelchair. The most basic thing is always lock the wheels when your patient is getting in or out of the wheelchair. So here comes our patient. And they're going to step in front of our wheel chair. And we're going to say do not sit yet because we want to lock the wheels. There's one locked on this side and the other locked on this side. And then we're going to say to the patient, reach back and feel the arms of the wheelchair before sitting and then sit. There we go. So that way if they bump the wheelchair it doesn't go out from under them. Ok, and then you unlock the wheels and off you go. When you get the patient out of the wheelchair, it's just the reverse. Once again you're locking your wheels. You see the wheelchair won't go and then the patient will attempt to go, oh see that's wrong. See what happens, she pulled the walker right down on her. You don't want that to happen. So you want to make sure your patients are always safe and you want to say to your patient before getting up, push off on the handles of the wheelchair and make sure you're standing and then reach for your walker. And then you know that your patient is not going to pull the walker down on them and topple over. And so that is the proper way to use the wheelchair. So you've seen the canes, the walker, the crutches and the wheelchair, remembering that with the cane the walker and the crutches that there's always a 160 degrees bend in the arm and you always want to watch for safety and stay nearby while your patient learns how to use the apperatice that they'll be using. And that's it for ambulatory assisted devices.