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Assistive Devices
Fit and Safe Use

Master how to size, fit, and teach canes, walkers, and crutches so patients move with safety and confidence.

NCLEX-RN

What Are Assistive Devices?

An assistive device is any equipment that improves a patient's mobility, balance, and weight-bearing while reducing fall risk. Proper fit is what makes a device helpful rather than hazardous.

Why Correct Fit Matters

Too Tall
Forces shoulders up, strains arms, and tips balance backward.
Too Short
Causes stooping, back strain, and unstable forward leaning.
Just Right
Allows safe weight transfer with about \( 20^\circ\text{ to }30^\circ \) elbow flexion.

The Elbow Flexion Rule

\( 20^\circ\text{–}30^\circ \)
 handgrip device Slight elbow bend

Sizing the Cane

1
Hold the cane in the strong hand — the side opposite the affected leg.
2
Top of cane at wrist crease with the arm relaxed at the side.
3
Advance cane and weak leg together, then step with the strong leg.

Sizing the Walker

wrist line grip height all 4 legs on floor

Sizing Crutches

1
\( 2\text{–}3 \) finger-widths between the axilla (armpit) and the underarm pad.
2
Handgrips at wrist crease, giving \( 20^\circ \) to \( 30^\circ \) elbow flexion.
3
Bear weight on hands, not armpits — never rest body weight on the pads.

Which Device for Which Patient?

Cane
Minimal support; mild balance or one-sided weakness. Bears about \( 25\% \) of body weight.
Walker
Maximum stability; weak legs, poor balance, or high fall risk.
Crutches
Non- or partial weight-bearing on one leg; usually short-term injury.

The Stairs Rule

UP: strong leg first DOWN: weak leg first

How to Fit a Device

1
Apply non-skid shoes and have the patient stand erect.
2
Check handgrip at the wrist crease with the arm relaxed.
3
Verify \( 20^\circ \) to \( 30^\circ \) elbow flexion on grip.
4
Inspect rubber tips and stability, then teach the correct gait.

Example 1: Cane Side

A patient had a left total knee replacement. In which hand should the cane be held?

Example 2: Crutch Fit Check

During crutch fitting, the underarm pads press firmly into the patient's armpits. What is the priority action?

Example 3: Stair Sequence

A patient with a weak right leg is descending stairs with a cane. Which leg moves down first?

Common Mistakes

✕ Cane on Weak Side
Holding it on the affected side narrows support and increases fall risk.
✕ Weight on Armpits
Resting on crutch pads can cause crutch palsy and nerve damage.
✕ Wrong Stair Order
Reversing "up good, down bad" leads to loss of balance.
✕ Skipping Tip Check
Worn rubber tips lose traction and cause slips on smooth floors.

Device Summary

Cane Walker Crutches
SupportMinimalMaximumHigh
Hand/SideStrong handBoth handsBoth arms
Grip heightWrist creaseWrist creaseWrist crease
Elbow bend\(20\text{–}30^\circ\)\(20\text{–}30^\circ\)\(20\text{–}30^\circ\)
Key cautionOpposite leg4 legs down\( 2\text{–}3 \) fingers

Question 1 of 5

A patient with a right hip fracture is learning to use a cane. In which hand should the nurse instruct them to hold it?

Question 2 of 5

When properly fitting any assistive device, the handgrip should align with which landmark?

Question 3 of 5

How much space should there be between the axilla and the underarm crutch pad?

Question 4 of 5

A patient with a weak left leg is climbing up stairs. Which leg should lead?

Question 5 of 5

Which patient is the best candidate for a standard walker?