One-Pager
Mobility, Assistive Devices and Immobility
Canes, walkers and crutches, transfers and safe handling, casts, traction, halo, amputation care and the hazards of bed rest for the NCLEX
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Walking aids at a glance
| Aid | Fit | Sequence | Stairs |
|---|---|---|---|
| Cane | Held on the strong side (opposite the weak leg); handle at the wrist or greater trochanter; elbow bent about 20–30° | Cane and weak leg forward together, then the strong leg steps past | Up: strong leg first. Down: cane and weak leg first |
| Walker | Handles at hip level (about the wrist crease with the arm hanging); elbows slightly bent | Move the walker, all tips down; step with the weak leg, then the strong leg; stay inside the frame | Not on stairs unless a therapist has trained the client |
| Axillary crutches | Pad about 2–3 finger widths (1–2 in) below the armpit; handgrip so the elbow bends 15–30° | Crutches ahead, weight on the hands, then the strong leg swings through | Up: strong leg, then crutches and weak leg. Down: crutches and weak leg, then strong leg |
Crutch gaits and weight-bearing orders
| Order or gait | What it means |
|---|---|
| Non-weight-bearing | The injured leg stays off the floor |
| Toe-touch (touch-down) | Toes rest on the floor for balance only; no weight goes through the leg |
| Partial weight-bearing | A set amount of weight, as ordered |
| Weight-bearing as tolerated | As much as is comfortable; a flat foot taking full weight under a lesser order needs correcting |
| Three-point gait | One leg cannot bear weight: both crutches and the injured leg move together, then the strong leg |
| Two-point and four-point gaits | Both legs bear some weight: each crutch moves with the opposite leg (two-point together, four-point one at a time) |
| Swing-to and swing-through | Both crutches forward, then both legs swing to or past them; needs strong arms |
Transfers and safe patient handling
- Bed at its lowest height, brakes locked, footrests out of the way, nonskid shoes, gait belt over clothing
- Wheelchair on the client’s strong side, angled to the bed; the client pivots toward the strong side
- Never let the client put their arms around the nurse’s neck; never lift a client manually
- Can bear weight on at least one leg and follow directions: stand-pivot with a gait belt
- Strong arms and sitting balance but cannot stand (paraplegia, leg amputation, weak legs): sliding transfer board with brakes locked and the armrest removed
- Cannot bear weight, cannot follow directions, or very heavy: mechanical lift, slide sheets and enough staff
Hazards of immobility
| System | What bed rest causes | What the nurse does |
|---|---|---|
| Cardiovascular | Venous pooling, clots, orthostatic hypotension | Leg exercises, early walking, prophylaxis as ordered; sit, then dangle, then stand |
| Respiratory | Weak breathing muscles, poor cough, atelectasis, pneumonia | Turn, cough and deep breathe; incentive spirometer; get up |
| Skin | Pressure injury | Reposition, pad bony areas, inspect skin at each turn |
| Musculoskeletal | Strength loss about 20% a week; contractures after a few days; foot drop; bone loss | Range of motion from the start, positioning, early mobility |
| Gastrointestinal | Slow peristalsis, constipation, impaction | Fluids, fiber, activity; fracture pan for hip or spine injuries |
| Urinary | Stasis, retention, infection, stones | Fluids, regular voiding, bladder scan if retention suspected |
| Mind | Depression, anxiety, isolation | Routine, contact, involvement in care |
Orthostatic hypotension and range of motion
- Orthostatic hypotension: systolic drop of 20 mm Hg or more, or diastolic 10 or more, within 3 minutes of sitting or standing
- First time up after bed rest: raise the head of the bed slowly, dangle the legs for a few minutes, then stand with help
- After a cervical cord injury: abdominal binder and compression stockings, raise in stages
- Range of motion: passive when the client cannot move, active-assisted or active when they can
- Move slowly and gently, hold each stretch and repeat as ordered; never force a joint past pain; both sides of the body
Casts, slings and compartment syndrome
| Situation | Action |
|---|---|
| New cast, swelling | Elevate above the heart for the first 24–72 h; ice in a bag wrapped around the cast; move the fingers or toes |
| Wet plaster cast | Handle with the palms; rest on pillows, not a hard edge; plaster takes 2–3 days and fiberglass about 1 h before weight-bearing |
| Itching | Cool air from a hair dryer; nothing inside the cast; no powder, lotion or deodorant |
| Keeping it dry | Two layers of plastic or a waterproof shield; never submerge |
| Report | Too tight, numbness or tingling, burning, pale or blue digits, foul odor, drainage, a hot spot, cracks or soft spots |
| Arm sling | Elbow about 90°, hand and wrist slightly above the elbow, fingers visible, knot at the side of the neck |
Traction, halo and hip precautions
- Traction: weights hang freely, off the floor and bed; ropes in the pulley tracks; skeletal traction weights are never removed by the nurse
- Skin traction for a hip fracture: check the skin and neurovascular status under the straps; fracture pan; fluids and fiber
- Halo: keep the wrench taped to the vest; never lift, turn or pull by the frame or rods; clean pin sites as ordered; never adjust pins
- Halo: report a loose pin, pin pain or redness, fever, rash under the vest, or any new weakness or numbness
- After a posterior-approach hip replacement: no flexion past 90°, no crossing the legs, toes straight ahead; raised seat and toilet, reacher, pillow between the thighs
- After an anterior approach the surgeon’s protocol differs: avoid stepping back with the leg turned out
Amputation and the residual limb
- Wash daily with mild soap and water, dry well, never soak; inspect every day, with a mirror for the back
- No lotion or powder under the socket; a clean prosthetic sock every day
- Elastic wrap rewrapped every 2–4 h with no creases, and the limb protector on whenever out of bed; no pillow under the residual limb
- Lie prone 3 or 4 times a day, about 20 min each, to stretch the hip muscles and prevent hip flexion contracture
- Phantom sensation and pain are real: assess and treat them like any other pain
- Report redness or streaks, warmth, new drainage, opening of the wound, dark skin, fever or pain not controlled
Conditions that change mobility
| Condition | Mobility point |
|---|---|
| Stroke with hemiparesis | Cane on the strong side; wheelchair on the strong side; guard the weak side |
| Parkinson disease | Freezing and shuffling: step over a real or imagined line, walk to a count or music, lift the feet, turn in a wide arc |
| Rheumatoid arthritis | Warmth (shower, warm soak) on waking, then activity later; built-up handles, easy-open caps, reachers; protect small joints |
| Multiple sclerosis | Heat worsens weakness: plan activity for cool parts of the day; balance rest and activity |
| Hip fracture going home | Remove throw rugs and clutter, add grab bars and nonskid footwear, raised toilet seat |
| Thin or cachectic client lying on one side | Pad the outside of the knee: pressure on the peroneal nerve at the fibular head causes foot drop |
Occupied bed and bariatric care
- Raise the bed to working height; keep the far side rail up and roll the client toward it
- Hold linens away from the uniform; never shake them; soiled linen never on the floor
- Bottom sheet tight and wrinkle-free; top covers loose over the feet; inspect the skin while turning
- Finish with the bed low, brakes on and the call light in reach
- A heavy client: mechanical lift, friction-reducing slide sheets, bariatric equipment and enough staff, never a manual lift or delayed turning
In depth
The one-page summary above is what the PDF prints. These sections go further.
Choosing and fitting the aid
Walkers are the most stable aid; they need both hands and are not used on steps. Crutches are fairly stable and need strong arms. Canes are the least stable and suit one weak leg or a painful hip, held in the hand opposite the affected hip. Physical therapy chooses and fits the aid; the nurse checks fit, reinforces the sequence and guards the client.
Crutch tips sit a little to the side and about 15 cm in front of the shoe. The pad is braced against the chest wall below the armpit; leaning on it presses the radial nerve and the axillary nerve and artery, giving tingling of the hand and weak wrist and finger extension (crutch palsy). Rubber tips are checked daily and replaced when worn.
Sitting down with crutches: back up until the seat touches the legs, put both crutches in the hand on the weak side, reach back for the armrest with the free hand, extend the weak leg and lower slowly. Standing reverses the steps. With a cane on stairs, the MedlinePlus order is strong leg, weak leg, then cane going up, and cane, weak leg, then strong leg going down; either way the strong leg leads up and the weak side leads down.
Safe handling: why manual lifting fails
Good body mechanics alone do not prevent lifting injuries when the load is a person: the weight is uneven, it may move or resist, and it is lifted often and in awkward postures. Safe handling programs replace lifting with equipment: gait belts for clients who bear weight, sit-to-stand lifts for those who bear some, full mechanical lifts for those who bear none, and slide sheets or lateral transfer boards for moving a supine client between surfaces.
A sitting transfer board is different from a lateral slide board: the client sits, leans, and moves across in short shifts using the arms. It fits paraplegia with good arm strength, leg amputation before prosthetic fitting, or weak legs with fair sitting balance. It does not fit tetraplegia without arm strength or a client who cannot follow instructions.
Bed rest, system by system
Venous stasis and reduced cardiac output lead to clots and to orthostatic hypotension on first rising. Weak respiratory muscles and a poor cough lead to atelectasis, hypoxia and pneumonia. Reduced tissue perfusion leads to pressure injury. Muscles lose strength quickly, joints stiffen within days, and bone loss raises fall and fracture risk. Slowed peristalsis and low intake lead to constipation and impaction; urinary stasis leads to retention and infection. Depression and anxiety follow isolation. Early mobility protocols screen neurologic, respiratory and circulatory stability before mobilizing.
Range-of-motion exercise starts as soon as possible. Each stretch is held briefly and repeated as prescribed; movements are slow and gentle, because a forced stretch causes pain and loses the client’s cooperation.
Casts and compartment syndrome in more detail
Swelling is greatest early, so elevation above the heart and ice around the cast are the first answers to a cast that feels snug, with checks of color, warmth, movement, sensation and capillary refill. Swelling that persists after elevation, or any numbness, is reported so the cast can be split (bivalved) or changed.
Compartment syndrome is different: pressure in a closed fascial space rises until capillary flow stops, while the artery may still carry a pulse. The first signs are pain out of proportion and pain on passive stretch, then paresthesia; paralysis, pallor and pulselessness mean muscle is dying. Constricting casts, splints and dressings come off, the limb stays at heart level rather than raised, and the provider is called for compartment pressure measurement and fasciotomy.
Exam pearls
- Cane: strong side, moves with the weak leg
- Walker: walker first, then weak leg, then strong leg; not a stair tool
- Crutches: hands carry the weight; up with the good, down with the bad
- Transfers: chair on the strong side; the nurse guards the weak side; no lifting by hand
- Dizzy on first standing: sit, dangle, then stand slowly
- Cast itch: cool air, nothing inside; pain with passive stretch: call now, heart level
- Halo: wrench on the vest, never lift by the frame
- Residual limb: no pillow under it, lie prone, no lotion, inspect daily
Related one-pagers
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- Elimination, Ostomy and Catheter CareStomas and pouching, high-output ileostomy, ileal conduit, irrigation, bowel programs, impaction, bladder training, catheters, CAUTI, specimens, sitz baths and PD sites for the NCLEX
- Hygiene, Sensory Deficits and Comfort MeasuresHearing aids, Deaf clients and interpreters, vision loss and eye devices, ear and oral care, bathing and diabetic feet, heat and cold, and communicating after a stroke for the NCLEX
- Nutrition, Tube Feeding and Medications by TubeTube placement checks, residuals, aspiration precautions, flushing, drugs through tubes, NG suction, PEG care, TPN basics and diets for GI symptoms for the NCLEX-RN and PN
- End of Life, Hospice, Pain and SleepSigns that death is near, comfort in the last days, around-the-clock opioids, fentanyl patches and PCA, pain without self-report, sleep, fatigue and postmortem care for the NCLEX
Sources
- Open Resources for Nursing (Open RN). Nursing Fundamentals 2e, 13.2 Mobility: Basic Concepts. Chippewa Valley Technical College; LibreTexts copy. CC BY 4.0. Link
- MedlinePlus. Using crutches. US National Library of Medicine. Reviewed April 1, 2025. Link
- MedlinePlus. Using a cane. US National Library of Medicine. Reviewed April 1, 2025. Link
- MedlinePlus. Using a walker. US National Library of Medicine. Reviewed April 1, 2025. Link
- McCue JY. How To Fit and Walk With Underarm Crutches. Merck Manual Professional Edition. Reviewed March 2026. Link
- Isaac Z. Therapeutic and Assistive Devices. Merck Manual Professional Edition. Reviewed December 2025. Link
- American Academy of Orthopaedic Surgeons. Care of Casts and Splints. OrthoInfo. Link
- MedlinePlus. Closed reduction of a fractured bone: aftercare. US National Library of Medicine. Reviewed June 27, 2026. Link
- Merck Manual Professional Edition. Compartment Syndrome. Reviewed March 2025. Link
- MedlinePlus. Leg amputation: discharge. US National Library of Medicine. Reviewed June 27, 2026. Link
- MedlinePlus. Taking care of your new hip joint. US National Library of Medicine. Reviewed November 7, 2024. Link
- Nemours KidsHealth. Halo Brace: How to Care for Your Child. Link