🧠 Overview
This chapter explains how the body moves, what happens when patients are immobile, and
how nurses safely assist with mobility using crutches, walkers, and canes. It connects anatomy,
safety, and nursing care into one concept: helping patients move safely and regain independence.
🩻 1. Normal Structure and Function of Movement
Movement involves three systems working together:
Musculoskeletal System
• Provides structure, protection, and movement.
• Bones (long, short, flat, irregular, sesamoid) form the framework.
• Muscles attach to bones via tendons, while ligaments connect bone to bone.
• Joints allow movement:
• Fibrous – immovable (e.g., skull)
• Cartilaginous – slightly movable (e.g., spine)
• Synovial – freely movable (e.g., hip, knee)
Nervous System
• Controls voluntary movement and balance.
• The cerebral cortex controls motor activity, and the cerebellum coordinates
movement and posture.
• Nerves send signals to muscles via neurotransmitters to initiate movement .
Cardiopulmonary System
• Provides oxygen and nutrients for muscle contraction and removes waste.
• Healthy heart and lungs are essential for endurance and mobility.
🛌 2. Altered Function and Immobility
When movement is restricted (bedrest, illness, injury), multiple body systems are affected:
System Effect of Immobility
Musculoskeletal Weakness, muscle atrophy, bone loss, contractures
Cardiovascular Increased workload, risk for DVT (clots)
Respiratory Decreased lung expansion, risk for pneumonia
Skin Pressure injuries
Urinary Stasis → infections, stones
GI Constipation
Psychological Depression, anxiety, isolation
Nurses assess all of these systems and encourage early, safe mobility .
🩺 3. Assessment and Nursing Process
• Observe gait, posture, and coordination
• Assess strength, ROM (range of motion), and balance
• Use fall-risk tools for safety
• Common nursing diagnoses:
• Impaired Mobility
• Risk for Falls
• Activity Intolerance .
🪑 4. Assistive Devices: Crutches, Walkers, and Canes
Transfer Belts (Gait Belts)
• Used for unsteady or weak patients.
• Belt fits snugly around the waist (two fingers between belt and body).
• Nurse stands on the weaker side, holding the belt from behind .
Canes
• For patients needing slight support or balance help.
• Types:
• Single-point cane
• Quad cane (4-prong for more stability)
• How to use:
1. Cane height should reach the hip joint.
2. Hold the cane on the stronger side.
3. Move cane → weak leg → strong leg.
4. Always keep at least one point of support on the ground .
Crutches
• For leg injuries or when one leg can’t bear weight.
• Fit: 2–3 finger widths between axilla and crutch top; elbows slightly bent.
• Types:
• Underarm crutches
• Forearm (Lofstrand) crutches
• Platform crutches (for patients who can’t grip normally) .
Crutch Gait Patterns:
1. Two-point gait – one crutch + opposite leg move together (partial weight-
bearing both legs).
2. Three-point gait – both crutches + injured leg move together, then swing
the good leg through.
3. Four-point gait – move one crutch, then opposite leg, then the other
crutch, then other leg (most stable).
4. Swing-to gait – used by paraplegics; both crutches move forward, then
both legs swing to meet them .
Stairs:
• Upstairs: “Good leg goes up first” → strong leg, then crutches.
• Downstairs: “Bad leg goes down first” → crutches and weak leg, then strong
leg .
Walkers
• Best for patients needing more support than a cane.
• Should reach the patient’s waist.
• No-wheel walker: Lift → step forward into it.
• Front-wheel walker: Push forward → walk in.
• 3- or 4-wheel walkers include seats for resting .
🏋🏾♀️5. Nursing Interventions to Promote Mobility
• Encourage active ROM exercises.
• Reposition at least every 2 hours.
• Use mechanical lifts or lift teams for heavy transfers to prevent nurse injury .
• Educate patients on proper use of assistive devices.
• Monitor for fatigue, dizziness, or shortness of breath during ambulation.
🧩 6. Key Takeaways (Learning Outcomes)
• Musculoskeletal, nervous, and cardiopulmonary systems all coordinate to create
movement.
• Immobility affects every major body system.
• Nurses assess and plan interventions to maintain or restore mobility and prevent
complications.
• Safe use of crutches, walkers, and canes is essential for patient independence
and safety .