BODY MECHANICS AND MOVING

Objectives
At the end of this chapter the learner will be able to:
• State the principle underlying proper body mechanics
and relate a nursing consideration.
• Mention different positions used for various examination
and treatment.
• Identify principles related to safe movement of clients in
and out of bed.
• Demonstrate the ability to move a partially mobile client
safely from bed to chair and back.
• Demonstrate the ability to teach each of the crutch
walking gaits to a client.
• State the purposes of range of motion exercise.
 BODY MECHANICS

Definition
• Body mechanics is the coordinated use of the body parts to
produce motion and to maintain balance
• It is movement of the body in a coordinated and efficient way
so that proper balance, alignment, and conservation of energy
is maintained.
• It is the use of safest and most efficient method of moving and
lifting
• Body mechanics is a critical aspect of nursing that
focuses on the efficient and safe use of the body
during daily activities, particularly when lifting,
moving, or repositioning patients.
• It encompasses principles of posture, balance, and
coordinated movement, which are essential for both
nurse safety and effective patient care.
 Importance of body mechanics

• For nurses, practicing proper body mechanics is not

merely beneficial; it is essential.
• The physical demands of nursing often involve
repetitive lifting and transferring of patients, which
can lead to musculoskeletal injuries if proper
techniques are not employed.
 Injury Prevention

• Proper body mechanics help reduce the risk of back

injuries and other musculoskeletal disorders among
healthcare workers.
• Poor lifting techniques can lead to strains and sprains,
which are common occupational hazards in nursing
 Patient Safety

• Utilizing correct body mechanics during patient

handling minimizes the risk of falls and injuries to
patients.
• Safe lifting and transferring techniques ensure that
patients are moved without undue stress or
discomfort
 Efficiency

• Good body mechanics enhance the efficiency of

movement, allowing nurses to perform tasks with less
effort and fatigue.
• This efficiency can lead to improved overall job
performance and job satisfaction.
 Understanding and practicing good body mechanics
is vital for nurses to protect themselves from injury
while providing safe and effective care to patients.
 Principles of good body mechanics:

 Face your work area.

 Bend your knees and squat to lift a heavy object.

 Hold items close to your body and base of support.

 Have a wide base of support.

 Use your larger and stronger muscles.

 Avoid unnecessary bending and reaching.

 Push, slide, or pull heavy objects when you can.

 Turn your whole body when changing direction of

movement.
 Work with smooth and even movements.

 Bend your hips and knees to lift heavy objects from

the floor.
Do not lift objects higher than chest level.
Get help from a co-worker if the person cannot
assist with turning or moving.
Use assist equipment and devices when possible.
 BASE OF SUPPORT
THE AREA ON WHICH AN OBJECT RESTS
A GOOD BASE OF SUPPORT IS NEEDED
FOR BALANCE WHEN LIFTING
YOUR FEET ARE YOUR BASE OF SUPPORT
STAND WITH YOUR FEET APART FOR A
WIDER BASE OF SUPPORT AND MORE
BALANCE
BEND YOUR KNEES AND SQUAT TO LIFT A HEAVY OBJECT

DO NOT BEND FROM YOUR WAIST

WEARING A BACK
SUPPORT WILL HELP
YOU TO USE GOOD
BODY MECHANICS
WHEN LIFTING HEAVY
PATIENTS.
 BODY ALIGNMENT

 Defined as positioning body parts in relation to each

other to maintain correct body posture
 Refers to the relative position of body parts in
relation to each other
 Focuses on positioning of body parts for optimal
function
• focuses on maintaining an optimal posture
that supports overall function and reduces
stress on the musculoskeletal system
• Reduces strain on joints and muscles
• Body alignment plays a crucial role in
preventing injuries by maintaining the body's
musculoskeletal system in an optimal position,
which directly impacts movement efficiency
and reduces strain on muscles and joints.
• Importance of Body Alignment in Injury
Prevention
• Stress Distribution: Proper body alignment
ensures that weight and forces are evenly
distributed across the body. This minimizes
excessive strain on specific muscles and joints,
reducing the risk of overuse injuries
• Enhanced Performance: Good alignment not
only prevents injuries but also enhances
physical performance.
• Avoiding Compensatory Movements:
Misalignments can lead to compensatory
movements where other body parts take on
excessive loads to compensate for the
misaligned areas.
THE TRUNK OF THE PERSON SHOULD BE IN A STRAIGHT LINE WHEN THE PATIENT IS LYING
DOWN
 PROPER POSITIONING IN A CHAIR
THE PATIENT IN A CHAIR SHOULD SIT UP STRAIGHT

THE BACKS OF HIS KNEES

SHOULD BE SLIGHTLY AWAY
HIS LOWER BACK SHOULD
FROM THE SEAT OF
REST AGAINST THE BACK OF
THE CHAIR
THE CHAIR

HIS FEET SHOULD REST

ON THE FLOOR
Equipment
Pen
Documentation/charting format
Bed or examination couch
 Positioning the patient
 Positioning the patient is a critical aspect of healthcare
that involves placing patients in specific postures to
ensure their safety, comfort, and the effectiveness of
medical procedures.

 Is turning or putting patients in a proper body alignment

for diagnostic or therapeutic purpose
 It is a technique used by nurses to help keep patients
safe and comfortable, and to promote their overall
health.
 Refers to the strategic placement of a patient during a
medical procedure to provide optimal access and
visibility for the healthcare team.
 It involves strategically placing patients in various
positions to enhance physiological functions, prevent
complications, and facilitate rehabilitation.
 Benefits of patient positioning

 Reduce Risk of Pressure Sores

 Preserve muscle function
 Prevent deformities
 Improve circulation
 Provide comfort, support, and good body alignment
 Make the patient ready for different procedures
 Pain Relief
 Better respiratory function
General principles for positioning :
 Change the inactive client's position at least every 2
hours.
 Enlist the assistance of at least one other caregiver.

 Raise the bed to the height of the caregiver's elbow.

 Remove pillows and positioning devices.

 Unfasten drainage tubes from the bed linen.

 Turn the client as a complete unit to avoid twisting

the spine.
General principles…
Place the client in good alignment with joints
slightly flexed.
Replace pillows and positioning devices.

Support limbs in a functional position

Use elevation to relieve swelling or promote

comfort.
Provide skin care after repositioning.
 Types of positioning
Common positioning methods of pt includes

1. Prone position

2. Semi-prone position/Sims’ position

3. Lateral recumbent/side lying position

4. Supine (back lying)

5. Dorsal recumbent position

6. Lithotomy position

7. Knee chest

8. Fowler’s position

9. Trendelenburg position
Figure: Proper prone position
 Prone position
Definition
• Prone position is putting the patient in a flat on the
abdomen, legs extended, feet over the edge of the
mattress, and toes pointing to the floor

Purpose
• To Promote drainage from mouth

• To prevent contractures of hips and knee

• To examine the spine and the back

 Prone position…
Indication
 Patient with excessive secretion from mouth

 Patient with potential risk of knee and hip contracture

Contraindication
 Respiratory impairment/breathing difficulties

 Foot drop

 Pregnant women

 Clients with abdominal incisions

 Prone position…

Equipment

1. Small pillow (3)

2. Bed with side rails

3. Draw sheet or turn sheet

4. Documentation format

5. Receiver for drainage( if any)

 Procedure…
1. Great the patient and explain the procedure

2. Perform hand washing

3. Collect all necessary equipments

4. Provide privacy

5. Elevate bed to highest position.

6. Place turn or draw sheet under client’s back and head

7. Assist the client to lie

 Prone position…
8. Place a small pillow under client’s head; turn head to
side.

9. Extend the client’s arms near side or flexed toward head.

10. Place a small pillow under chest for female clients and
for clients with barrel chest.

11. Place a small pillow under ankles or mattress.

12. Assess client for comfort.

13. Lower the bed and elevate the side rails

Figure.--- Proper Semi prone position
 Sim’s position/semi-prone
Definition

• Semi-prone position is putting or assisting patients

with:
 Upper arm flexed at shoulder and elbow;

 Lower arm positioned behind client and

 Both(optional) legs flexed in front of client with more

flexion in upper leg
 Sim’s position…
Purpose
 To promotes drainage from mouth

 To prevents aspiration

 Comfortable for sleeping.

Indication
 For rectal examination

 Pressure sore on the buttocks/sacrum and hips

 Sim’s position…
Contraindication
Lumbar lordosis
Foot drop
Client with leg injuries
 Sim’s position…
Equipment

1. Small pillow (3)

2. Bed with side rails

3. Draw sheet or turn sheet

4. Sand bag

5. Documentation format

6. Receiver for drainage( if any)

 Cont…semi prone position

Procedure
1. Great the patient ( if conscious ) and explain the
procedure
2. Perform hand washing
3. Collect all necessary equipments
4. Provide privacy
5. Elevate bed to highest position.
6. Place turn or draw sheet under client’s back and head
7. Flexed at shoulder and elbow
8. Position lower arm behind and away from the back
 Cont…semi prone position

9. Put pillow between chest and upper arm;

10. Flex both legs in front with more flexion in upper
leg.
11. Put pillow between legs
12. Support ankle with sand bag (if necessary )
13. Lower the bed and elevate the side rails
14.Wash your hand
15. Note the patient reaction
16. Document the procedure
Figure: Lateral position
 Lateral/side lying position

• Is putting patient on either side with legs flexed at knee( the upper
leg is more flexed than the lower leg)

Purpose

 To Promote drainage from mouth

 To perform back care

 To relieves pressure on sacrum and heels

 To perform enema

 To take rectal body temperature

 To insert suppositories
 Lateral/side lying position…
Indication
• Enema and colonic irrigation

• Pressure sore on heel and sacrum

• Rectal examination

• To measure rectal temperature

Contraindication
 Arm and rib fracture

 Spinal injury

 Flank injury
 Lateral/side lying position…
Equipments
 Pillow of different size (4)
 Bed with side rails
 Draw sheet or turn sheet
 Documentation format
 Procedure
1. Great the patient ( if conscious ) and explain the
procedure

2. Perform hand washing

3. Collect all necessary equipments

4. Provide privacy

5. Place turn or draw sheet under client’s back and head

6. Elevate bed to highest position

7. Logroll client to side

 Procedure…
8. Place a small pillow under client’s head.
9. Place pillow behind client’s back.
10. Put a pillow tucked by the client’s abdomen.
11. Place a pillow between client’s legs.
12. Run your hand under the client’s dependent shoulder and
move the shoulder slightly forward
13.Lower the bed and elevate the side rails
14.Wash your hand
15. Note the patient reaction
Figure: Proper supine position
 Supine (back lying)
 Is putting patient in back lying with a small pillow to support
the head and shoulder
Purpose
• Promote comfort

• To help healing after certain abdominal operations

Indication
 After abdominal, chest and neck surgery

 For physical examination of anterior part of the body

 Usual position for the patient

 Supine (back lying)…
Contraindication
 Spinal injury

 Cardiac patient (CHF)

 Breathing impairments

 Pressure sore (buttock, sacrum, heal and

shoulder )
 Supine (back lying)…
Equipments
1. Pillow of different size (3)
2. Bed with side rails
3. Draw sheet or turn sheet
4. Air rings
5. Cotton rings
6. Footboard or high-top tennis shoes
7. Documentation format
Figure ….. Proper dorsal recumbent position
 Dorsal recumbent position
Definition: Dorsal recumbent position is putting patient
in back lying position with knees flexed and the soles
of the feet flat on the bed

Purpose
 Promote comfort

 For visualizing the perineum

 To insert urinary catheter

 To relief pressure on knee and ankle

 Dorsal recumbent position…
Indication
 Rectal , vulval and vaginal examination
 Pelvic surgical procedures
 Vaginal douche/irrigate/
 Perineal care
 Catheterization
 Supra-pubic puncture
 Dorsal recumbent position…
Contraindication

• Spinal injury

• Cardiac patient (CHF)

• Breathing impairments

• Pressure sore (buttock, sacrum, heal and

shoulder )
 Dorsal recumbent position…
Equipments

1. Pillows

2. Bed with side rails

3. Draw sheet or turn sheet

4. Bath Blanket or sheet

5. Air rings

6. Cotton ring

7. Documentation format
 Procedure

1. Great the patient ( if conscious ) and explain the

procedure
2. Perform hand washing
3. Collect all necessary equipments
4. Provide privacy
5. Elevate bed to highest position.
6. Place bed in a flat position.
7. Cover the client with a sheet or a bath blanket
8. Place the patient’s head in a straight line with his or
her back, shoulders, hips and knees
 Cont…

9. Place small pillows under head and shoulder or

elevate the top of the bed.
10. Place air ring under the hips/buttock
11. Flex the leg and wide apart
12. Place cotton ring under the heels
13. Lower the bed and elevate the side rails
14.Wash your hand
15. Note the patient reaction
16. Document the procedure
Figure: Lithotomy position
 Lithotomy position
 It is similar to dorsal recumbent position, except that the
client’s legs are well separated and the knees are a slightly
flexed. The nurse will usually place the client’s feet in stirrups.

 Keep the client covered as much as possible for privacy

Purpose

• To provide good visual and physical access to perineum

• To perform simple pelvic procedures to major surgeries

• To conduct delivery
 Lithotomy position…
Indication
• Pelvic medical examination and surgeries

• Delivery

Contraindication
• Spinal injury

• Breathing impairments
 Lithotomy position…
Equipment
 Pillow (1)

 Bed with side rails/examination table/delivery

couch
 Draw sheet /drape

 Screen(physical barrier for privacy)

 Documentation format
 Lithotomy position…
Procedure
1. Great the patient and explain the procedure
2. Perform hand washing
3. Collect all necessary equipments
4. Provide privacy
5. Elevate bed to highest position.
6. Place bed in a flat position.
 Lithotomy position…
7. Cover the client with a sheet or a bath blanket

8. Lie the patient flat with pillow under the head

9. Flex the hips and support with knee rest over a couch

( if available)

10. Wash your hand

11. Note the patient reaction

12. Document the procedure

Figure: knee chest position
 Knee chest
• Is putting a patient on the Knee and the chest with the
head turned one side, arms above the head, client’s head is
turned to the side and one cheek on a pillow

Purpose of knee chest position

1. Used for vaginal and rectal examination

2. Used as referral position in cord prolapse or retroverted

uterus

3. Assumed for postpartum and gynecologic exercises

 Knee chest…
Indication

 Sigmoidoscopic examination

 Vaginal and rectal examination

 Cord Prolapse

 Retoverted uterus

Contraindication

 Cardio-pulmonary problem

 Upper arm, spine and ribs fracture

 Increased intra-cranial pressure (IICP)

 Knee chest…
Equipments
1. Pillow (1)
2. Drape/ Bath Blanket or sheet
3. Screen
4. Documentation format
Figure fowler’s position
 Fowler's position (semi-sitting)
• Fowler's position is sitting position in which
the head is elevated at different angle (15-90) 0
angle and may have knees either bent or
straight
 Fowler's position…
Types

1. High Fowler's position is when the patient's head is

raised 60-90 degrees,

2. Fowler's which is 45-60 degrees

3. Semi-Fowler's position is when the patient's head is

elevated 30-45 degrees.

4. Low Fowler's position is when the head of bed is

elevated 15-30 degrees

– Low Fowler's Position (15-30 degrees):
Benefits:
• Helps prevent acid reflux, making it beneficial for patients with gastroesophageal reflux disease (GERD).
• Aids in digestion by allowing gravity to assist in the downward flow of food.
– Semi Fowler's Position (30-45 degrees):
• Benefits:
• Enhances respiratory function by allowing better lung expansion.
• Provides comfort for patients experiencing mild respiratory distress

 Fowler's Position (45-60 degrees):

• Benefits:
• Further improves lung expansion and gas exchange, beneficial for patients with significant respiratory issues.

• .
Facilitates activities like eating and reading, enhancing overall patient comfort
– Semi Fowler's Position (30-45 degrees):
• Benefits:
• Enhances respiratory function by allowing better lung expansion.
• Provides comfort for patients experiencing mild respiratory distress
Purpose

To relive dyspnea

To improve circulation

To prevent aspiration during the introduction of

feeding tubes

To facilitate drainage from abdomen and pelvic

cavity post operatively
 Purpose…
To relax the muscle of the abdomen, back and thighs

To relive tension on abdominal suture

To promote comfort

Increase comfort during eating

To relieve edema of the chest and abdomen

 Fowler position…
Indication

 Cardio-pulmonary problem (Respiratory distress,

CHF, pulmonary edema..)

 Increased intra abdominal pressure

 Abdominal, back and thigh muscle strain

 Nasal or oral passageway procedures (e.g. NGT…)

 Fowler position…

Contraindication
 Comatose/unconscious patients

 Spinal injury

 Foot drop

 Head injury

 Shoulder dislocation
 Fowler position…
Equipment
1. Small pillows
2. Foot rest/foot board
3. Back support
4. Hand wrist support
5. Screen if necessary
Procedure

Greet the patient ( if conscious ) and explain the

procedure

Perform hand washing

Collect all necessary equipments

Provide privacy

Place the patient in sitting position with arms at sides,

knees raised with pillow
 Procedure…

Place bed in a 15° to 30° angle for low-Fowler’s position,

30-45 degree for semi fowler position, 45° to 60° angle for
Fowler’s position, or 60° to 90° angle for high-Fowler’s
position.

Turn patients head to one side and align the patient in good
position

Place a small pillow under client’s head.

Support the backs and arms with pillows.

 Procedure…
Place a pillow between client’s legs.

Lower the bed and elevate the side rails

Wash your hand

Note the patient reaction

Document the procedure

 Trendelenburg position
Defn: is putting the patient in a flat on the back with
the feet higher than the head by 15-30 degree

Purpose

• To allow better access to pelvic organ during pelvic

surgery

• To enhance access to central venous line

 Trendelenburg position…
Indication

 Hypotension/shock

 Abdominal and gynecologic surgery

 Placing central venous line

Contraindication

 Cervical –spine fracture

 Respiratory impairment/breathing difficulties

 Brain injury
 Trendelenburg…

Equipments

Drape(to cover specific area of the body during examinations )

Screen

Documentation format
Procedure

1. Great the patient ( if conscious ) and explain the procedure

2. Perform hand washing

3. Collect all necessary equipments

4. Provide privacy

5. Place the patient’s head lower than the feet with arms at the side

6. Place bed blocks at the foot end of the bed.

7. Lower the bed and elevate the side rails

8. Wash your hand

9. Note the patient reaction

10. Document the procedure

Positioning Devices
 Devices…
 Adjustable Bed
 The adjustable bed can be raised or lowered and allows
the position of the head and knees to be changed.
 Mattress
 A comfortable, supportive mattress is firm but flexible
enough to permit good body alignment.
 Bed Board
 A bed board (rigid structure placed under a mattress)
provides additional skeletal support
 Pillows
 Pillows are used to support and elevate a body part.
 Trochanter Rolls

• Trochanter rolls prevent the legs from turning

outward.
 Hand Rolls

 Hand rolls are devices that

preserve the client's functional
ability to grasp and pick up
objects.
 Hand rolls prevent contractures
(permanently shortened muscles
that resist stretching) of the

fingers.
 Foot Boards, Boots, and Foot Splints
• Foot boards, boots, and splints are devices that
prevent foot drop by keeping the feet in a
functional position.
 Trapeze

 A trapeze is a triangular piece

of metal hung by a chain over
the head of the bed.

 Facilitates movement in bed

without putting pressure on a
leg or hip joint
Protective Devices
 Side Rails
 Side rails are a valuable device to aid clients in
changing their position and moving about while in
bed.
 With side rails in place, the client can safely turn
from side to side and sit up in bed.
Moving and transferring a patient
1. Dangling

Defn: Dangling is sitting on the side of the bed with the feet hanging
down

Purpose

• To prepare patient before walking ,moving to chair or wheelchair

or performing others

• To relive pressure in case of pulmonary edema

Indication(intended for)

 Moving patient out of bed

Contraindication

 Unconscious patient

 Spinal injury

Precaution

 Do not leave the patient alone when dangling

 If the patient becomes dizzy lie him down.

 Have the patient cough, deep breath, and exercise their leg
muscles when dangling

 Check the person’s pulse and respirations

2. Log rolling

Defn: Logrolling is a technique used to turn a patient whose

body must at all times be kept in a straight alignment.

Purpose

• To turn a patient to the side of bed

Indication

 Spinal injury

Note: logrolling is accomplished by two or three nurses

working in a coordinated fashion
 Cont…

Figure … Log rolling

3. Moving patient up in bed

Definition
 Moving patients up in bed refers to returning the patient to
previous correct position in bed if he/she slides to the foot
side of the bed.

Purpose
• To make patients in comfortable position in bed

• To maintain good body alignment

Indication
 Patient slides to the foot of the bed
Procedures

• Inform client of reason for the move and how

to assist (if able)

• Elevate bed to high position and lower head of bed

• With two nurses, place draw sheet under client’s

back and head

• Nurses stand on each side of client. Position

client with knees flexed to push with feet if able
to assist with move

• Have client use a bed trapeze, if available

Procedure…

• Nurses lift up on the draw sheet & move the

client up toward the head of the bed. With the
signal from the lead nurse

• Elevate head of bed, if tolerated by client.

• Assess client for comfort.

• Lower bed and elevate side rails

Fig… two nurses moving a patient up in bed
Transferring a p/t form bed to stretcher

• Stretcher is used to facilitate client transfer for a patient

who must lay during transfer

• Stretchers have several safety features, including side

rails, safety belts/straps, and locking wheels.

• As it is more narrow than the bed cautiousness is

necessary when using stretchers

• Ideally the stretcher should be the same height as the bed

so that the patient can be easily slipped from one to the
 Transferring patients…
• Place the stretcher parallel to and close against the bed,
with the head of the stretcher at the patient’s head, and
secure it with the brakes.

• If the patient is mobile, put a clean sheet on the stretcher

and assist the patient as he transfers himself on to the
trolley.

• Always allow the patient to help as much as he can

• Up to four people may be required to lift a week patient

from bed to stretcher, or five people if there is a fracture
Transferring from Trolley to Bed, with FOUR lifters

• Have the bed ready to receive the patient

• Wheel the trolley close against the bed, with

the head of the stretcher beside the head of the
bed, and put on the brakes of the trolley.
• Two persons stand at the side of the trolley and
facing the bed, and they steady the stretcher
against the bed with the weight of their bodies.
• One person stands on the opposite side of the bed
putting his or her weight against the bed . The person at
the head end of the trolley places one arm under
patient’s head and shoulders to give support while
moving him.
• At the signal, all three persons lift the patient on this
draw sheet, and at the same time they move the patient
on to the bed. Cover the patient, arrange the pillows,
and tidy the bed.
Transferring a patient from bed to a
wheelchair

• A wheelchair is a means of transportation for

clients
unable to support their weight while standing

• Safety instructions for use of a wheelchair

include:

Keep the wheels locked when not deliberately

 Patient ambulation
• Is assisted or unassisted walking
• It is encouraged soon after the onset of illness
or surgery to prevent the complications of
immobility
Purpose

• To Keep clients more active

• To prevent the complications of immobility

• To improve muscle tone and strength

• To slow down loss of bone mass and density related to

osteoporosis

• To improves appetite , peristalsis and circulation

• To give a sense of accomplishment

• maintains greater independence for clients(psychological

wellbeing)
 Patient ambulation…

Indication
 Immobile patients

 Postoperative patient

Contraindication
 Unstable vital sign

 Spinal fracture

 Patient with traction

Equipment
• Assistive devices (Gait belt, Cane, Walker and Crutch
 Preparing Client to Walk/ambulate

Precaution for ambulation

• Determine the client’s activity level and tolerance

for physical exertion

• Assess for factors that may negatively affect

ambulation (e.g., mental status, fatigue, pain,
medications).
 Precaution for ambulation…

• Evaluate the environment for safety (e.g.,

presence of obstacles in walkway, adequate
lighting, nonslip floor, handrails).

• Check assistive devices for safety hazards

• Check client’s clothing (e.g., nonslip shoes,

adequate covering for privacy and warmth).
Progressive exercises and activities that
promote independent mobility include:

1. Turning. The client can turn in bed using side rails

for stabilization

2. Sitting. The client can raise the head of the bed and
lower the height of the bed. Then the client turns to
the side of the bed and swings legs over the side of
the bed to assume the dangling position. Arms held in
the tripod position give balance to the sitting position.
3. Standing. The client dangles for a few minutes to
assure balance and then bears weight with both feet at
the side of the bed. For additional stability and balance,
the client can perch on the edge of the bed for several
minutes.

4. Walking. The client assesses strength and balance

while walking, thus allowing a gradual progression of
the duration of walking. Instruct clients to rest by
sitting or standing still stabilized with a guide rail if
fatigued.
Procedure for assistive mobility

• Inform client about the purposes and distance exercise

• Elevate the head of the bed and wait several minutes to

prevents orthostatic hypotension
• Lower the bed height

• With one arm under the client’s back and one arm under the
client’s upper legs, move the client into the dangling
position
• Encourage client to dangle at side of bed for several
 Procedure for assistive mobility…

• Stand in front of client with your knees touching

client’s knees

• Place arms under client’s axilla

• Assist client to a standing position, allowing client

time to balance

• Help client ambulate desired distance or distance of

tolerance by placing your hand under the client’s
forearm and ambulating close to the client
 Assisting patient with assistive devices

• Assistive device is a material used to support client/pt

who unable to walk independently

Common types

 Gait belt

 Cane

 Walker

 Crutch
 Assisting patient with assistive devices…

• Determination of which device to use is based

on the following:

Upper arm strength

Endurance (stamina)

Presence or absence of one-sided weakness

Weight-bearing ability
 Gait belt
• Is an assistive used during simple assisted ambulation

Purpose

• To aid patient/client in ambulation

Indication

• One body part weakness

Equipment

• Gait belt
Figure …..Gait belt
 Cane
• Is assistive devices used by clients who can bear weight
on both legs but have some weakness in one leg or hip

Type

• Standard Cane

• T-handle Cane

• Tripod Cane

• Quad (Quadruped) Cane

 Cane…
Indication
• Some weakness in one leg or hip

Purpose
• To support the patient during walking

Equipment
• Appropriate type of cane

• Gait belt

• Documentation format
 A B C D

A. Standard Cane Figure ….. Canes

B. T-handle Cane
C. Tripod Cane
D. Quad (Quadruped) Cane
 Cane…
Direction of use

1. Use on unaffected side

2. Advance cane simultaneously with affected limb

3. Hold close to body; do not move cane forward

beyond toes of affected foot
Fig. Nurse assisting a patient with quad-cane
 Walker
• Is a waist-high metal tubular device with a handgrip and four
legs

• characterized by the presence of rubber tips on all four legs or

have wheels on the two front legs

Purpose
 To provide extra support, sense of security, and independence

Indication

• Weakness in lower Limbs

• Disability

• Postoperative ( as needed)
 Walker…
The client first moves the walker forward and
then takes a step while balancing his or her
weight on the walker

Styles :

1. Pickup—assists with weight bearing; lifting

may cause some strain for client

2. Rolling—pushed on wheels thus reduces

Fig. walker
Fig. Client using walker
 Crutch

• Is walking aids made of wood or metal in the form of a

shaft which is used to increase client mobility
• It helps the client to stand and walk with the help of
crutch

Purpose
• Reduces anxiety and promotes client’s autonomy

• To improve client’s ability to ambulate

• To improve muscle strength (arms and legs)

• To promote joint mobility

Types of Crutch
Axillary:
 Fits under the axilla with the weight being placed
on the handgrips

Figure. Axillary crutch

Forearm:
• It has a handgrip and a metal cuff that fits
around the arm
• More convenient but provides less stability
than the axillary crutch

Fig. forearm crutch

 Initial assessment for crutch
• Assess physical ability to use crutches and strength of
the client’s arm, back, and leg muscle.

• Observe client’s ability to balance self.

• Note any unilateral or unusual weakness or dizziness.

• Assess which gait is appropriate for client.

• Assess client’s understanding of crutch-waking

technique.
 Types of Crutch walking gaits
1. Two-point gait
2. Three point gait
3. Four point gait
4. Swing to gait
5. Swing through gait
6. Up and down stair gait
 Four point gait
• A gait used for weight bearing with both legs

• Follows the pattern of right crutch forward, left foot

forward, left crutch forward, then right foot forward.

• The four-point gait with crutches is very stable but

slow.
 Four point gait…
Indication

• The gait can be performed when the client can

move and bear weight(partial/full) on each leg.

Contraindication

• Patients unable to bear weight fully on each

leg
Fig. Steps of four point gait
 Two-point gait
Defnition:

• Is an assisted gait used for partial weight bearing on

each leg which provides a strong base of support

Pattern:

• Right crutch and left foot forward together, then

left crutch and right foot forward together.

• It gait requires more balance but is a faster gait.

 Two-point gait…
Indication

• Weakness of the leg with partial ability to bear

weight

Contraindication

• Patients unable to bear weight fully on each

leg
 Three point gait
• Assisted gait with weak/non weight bearing one leg

supported with two Crutches provides stronger base of

support

Pattern

• Advance both crutches and the weaker leg forward

together.

• Move the stronger leg forward, even with the

crutches.
 Three point gait…
Indication

 patients having weakness in one leg or amputated one leg

Contraindication

 Patients having weakness in both legs

Equipment
1. Properly fitted crutches

2. Regular, hard soled street shoes

3. Safety belt, if needed

4. Documentation chart/format
Fig. Three gait point
 Swing to gait
 Crutch walking gait in which both crutches move
together then lift body weight by the arms and
swing to the crutches

Indication

• Weakness of both legs

Contraindication

• Improper body balance

 Swing through gait
• Pattern of crutches forward, then legs swing
forward together through the crutch

Indication

• Weakness of both legs

Contraindication

• Improper body balance

 Down stair gait
• Crutch walking gait helps to move down stair.

• Start with weight on uninjured leg and crutches on the

same level.

• Put crutches on the first step

• Put weight on the crutch handles and transfers

unaffected extremity to the step where crutches are
placed.
 Up stair gait
• It is a crutch gait used to climb up stairs

Procedure

• Start with the crutches and unaffected extremity on the same

level

• Put weight on the crutch handles and lift the unaffected

extremity on the first step of the stairs.

• Put weight on the unaffected extremity and lift other

extremity and the crutches to the step.

• Repeat until client understands the procedure.

 Range of motion exercise/ROM
• It refers to activities aimed at improving
movement of specific or group of joints
• The purposes of ROM exercises are to
maintain
full flexibility,
 ROM…
Purpose

• To maintain the current joint function and flexibility

• To restore joint function that has been lost through

disease or injury, or lack of use

• To maintain muscle tone and strength

• To prevent contractures

• To improve circulation
 ROM…
Types

1. Active- movements of the joints independently by

the client/patient on a nonfunctioning joints

2. Active-passive:-movement of nonfunctioning joint

from partial assistant from others

3. Passive:-movement applied by a nurse or other

person or passive motion machine on a pt’s
immobilized joint.
 ROM…
Indication
 Unable to move joints

 Part of daily living activities

Contraindication

 Dislocation in specific joints

 Heart & respiratory disease and

 Swollen or inflamed joints or musculoskeletal injury

Procedure passive range of motion exercise
(PROM)
1. Wash hands
2. Explain the procedure to the client
3. Adjust the bed to a comfortable height.
4. Select one side of the bed to begin PROM
exercises.
5. Uncover only the limb to be exercised
 Procedure…
6. Support all joints during exercise activity.
7. Use slow, gentle movements when performing
exercises.
8. Repeat each exercise three times.
9. Stop if the client complains of pain or discomfort.
10. Begin exercise with the client’s neck and work
down ward.
 Procedure…

11. Exercise the neck

12. Exercise the client’s shoulder and elbow

13. Perform all exercises on the client’s wrist

and fingers

14. Exercise the client’s hip and leg.

15. Perform exercises on ankle and foot

 Procedure…

16. Move to the other side of the bed and repeat

exercise.
17. Position and cover the client. Return the bed
to low position.
18. Wash your hands.
19. Document completion of PROM exercise
THANK YOU