POSTURE

GAITS
USE OF CRUTCH,
WALKER, AND
CANE
TRANSFER TO AND
FROM A
WHEELCHAIR

POSTURES
I.

II.

CORRECT/GOO
D POSTURE

Alignment of the ear, shoulder,

hip, knee and ankle, as seen from
the side.
When sitting, head should be
erect, and back posture should
maintain the three natural spinal
curves.
In sleep, pillows and mattresses
are used to maintain spinal curves
and support the head and neck so
they are level with the upper
back.
--American
Physical
Therapy Association (APTA)

KYPHOSIS

Also called hunchback.

Outward curvature of the thoracic spine characterized by an abnormally rounded upper back
(more than 50 degrees of curvature).
The head is pushed forward, in front of gravitational center. The upper back is rounded,
accentuating the thoracic curve.
According to the Maryland Spine Center (MSC), this condition can develop from unhealthy
posture habits, bone and joint degeneration and spinal deformity. Severe cases diagnosed as
Scheuermann's kyphosis create a noticeable hump in the upper back.

CAUSES:
Degenerative diseases of the spine (such as arthritis or disk degeneration)
Fractures caused by osteoporosis (osteoporotic compression fractures)
Injury (trauma)
Slipping of one vertebra forward on another (spondylolisthesis)

III. LORDOSIS

Inward curve of the lumbar spine (just above the buttocks)

Standing with locked knees contributes to this unhealthy posture that aligns the head behind your
center of gravity. Shoulders may also be pulled back too tightly.
The MSC reports behavioral and developmental causes for this condition that may create neck or
back pain.

CAUSES:
Poor posture.
Pregnancy
Obesity
Spondylolisthesis
Osteoporosis (weakening of the bones with age)
Discitis (a disorder of the disks between the spinal vertebrae)

IV.

SCOLIOTIC

Lateral curvature of the thoracic spine.

The curve is often S-shaped or C-shaped.
Abnormal sideways curve of the spine that results in improper alignment of the spine, shoulders
and neck.
Visible symptoms may include uneven shoulder height or a nonvertical neck angle.
The American Chiropractic Association notes that scoliosis may cause back pain or progressively
impinge on internal organ function. The majority of scoliosis cases are mild (less than 20-degree
curve), however, and don't pose serious threats to healthy posture.

CAUSES:

Congenital scoliosis ( abnormality present at birth)

Neuromuscular scoliosis (spina bifida or cerebral palsy or conditions that are
accompanied by, or result in, paralysis)
Degenerative scoliosis. Traumatic (from an injury or illness) bone collapse, previous
major back surgery, or osteoporosis (thinning of the bones)
Idiopathic scoliosis (most common type)

V.

OTHERS:
A. SWAYBACK

Swayback and lordosis appear similar, owing to the concave curve in the back area however,
upon closer look, it is apparent in the lordotic posture that the lumbar spine is concave, while in
the swayback posture the low lumbar area is actually flattened.
In the swayback posture the concave curve of the spine is much higher, in the lower thoracic
spine.

SEEN IN:
Runners
Ballerinas
Sedentary individuals
Older adults (weakening of the aging gluteals)
Person with chronic pain
Common overuse injuries (labral tears at the hip, low-back pain, plantar fasciitis, iliopsoas
bursitis and tendinopathy, recurrent hamstring strain and shoulder impingement)

B. FORWARD HEAD POSTURE

 Anterior positioning of the cervical spine.

This posture is sometimes called "Scholar's Neck", "Wearsie Neck", or "Reading Neck."
CAUSES:
Sleeping with the head elevated too high,
Extended use of computers and electronic gadgets
Lack of developed back muscle strength
Lack of nutrients such as calcium

GAITS
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Gait disorders

I.

SPASTIC GAIT

Also called scissors gait due to the type of walk.

The hips and knees are slightly flexed and the knees and thighs hit each other while walking in a
criss-cross manner giving it the name scissors gait.
CAUSES:
Brain abscess
Brain tumour
Cerebrovascular accident for e.g. Stroke cerebral palsy
Multiple sclerosis
Spinal cord tumour
Liver failure
Pernicious anaemia
TREATMENT:
Treatment includes checking for skin soreness due to loss of sensation and using braces or splints
in the shoes while walking.
Physiotherapy will in time improve gait significantly.

II.

PROPULSIVE GAIT
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Here, the posture is stooping with the head and neck bent forward in an attempt to move the body
forward.
CAUSES:
Parkinsons disease
Carbon monoxide poisoning
Manganese poisoning
Temporary propulsive gait is seen due to drugs like haloperidol and phenothiazines used in
psychiatric conditions
TREATMENT
Give plenty of time for walking to avoid falls.
When walking on uneven terrain, help of another person or a walking stick should be used.
Physiotherapy will help in regaining balance

III. STEPPAGE GAIT

As the name suggests, the person has to lift the affected leg higher than normal while walking due
to a foot drop. A foot drop causes the toes to point towards the ground and leads to the toes
scraping the ground while walking.
CAUSES:
Multiple sclerosis
Guillian barre syndrome
Peroneal neuropathy
Lumbar slipped disc
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Spinal cord injury

TREATMENT:
Use of leg braces and splints in shoes (to help keep foot in a proper position while walking)
Physiotherapy

Enough rest as fatigue may cause the him/her to fall and injure the toes.

IV. WADDLING GAIT

This resembles a duck walk hence it is called waddling gait. It could occur due to a congenital hip
disorder, spinal muscle atrophy, muscular dystrophy or myopathy (muscle disease).

V.

ATAXIC GAIT

This is also known as broad based gait.

Due to unsteadiness, the person keeps the legs wide apart while walking for fear of falling.
CAUSES:
Alcohol intoxication
Cerebellar ataxia
Stroke
Polyneuropathy seen in diabetes mellitus
TREATMENT
Treatment of the cause is important
Alcohol should be strictly discontinued and sugars and diet should be strictly monitored in case of
diabetes

CRUTCH WALKING GAITS

I.

4-POINT GAIT

The 4-point gait is used when the patient can bear some weight on both lower extremities. Place the
patient in the tripod position and instruct him to do the following.
(1) Move the right crutch forward.
(2) Move the left foot forward.
(3) Move the left crutch forward.
(4) Move the right foot forward.
(5) Repeat this sequence of crutch-foot-crutch-foot for desired ambulation.

II.

3-POINT GAIT

The 3-point gait is used when the patient should not bear any weight on the affected leg. Place the patient
in the tripod position and instruct him to do the following.
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(1) Move the affected (non-weight bearing) leg and both crutches forward together.
(2) Move the unaffected (weight bearing) leg forward.
(3) Repeat this sequence for desired ambulation.

III.

2-POINT GAIT

The 2-point gait is used when the patient can bear some weight on both lower extremities. Place the
patient in the tripod position and instruct him to do the following.
(1) Move the right leg and left crutch forward together.
(2) Move the left leg and the right crutch forward together.
(3) Repeat this sequence for desired ambulation.

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WALKING UP AND DOWN THE STAIRS

I. CRUTCH
Walking Up Stairs:
1. Hold on to rail with on hand and crutches with the other hand
2. Push down on the stair rail and the crutches and step up with the unaffected leg
3. If not allowed to place weight on the affected leg, hop up with the unaffected leg
4. Bring the affected leg and the crutches up beside the unaffected leg
5. Remember, the unaffected leg goes up first and the crutches move with the affected
leg [memory tip: good goes to heaven, bad goes to hell good leg first when going UP stairs;
bad leg first when going DOWN stairs]

Walking Down Stairs:

1. Place the affected leg and the crutches down on the step below; support weight by leaning on
the crutches and the stair rail
2. Bring the unaffected leg down
3. Remember the affected leg goes down first and the crutches move with the affected
leg [memory tip: good goes to heaven, bad goes to hell good leg first when going UP stairs;
bad leg first when going DOWN stairs]

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II.

CANE

1. For correct size, have the client wear shoes. The correct length is measured from the wrist to the
floor
2. Cane is used on the unaffected side to provide support to the opposite lower limb
3. Advance cane simultaneously with the opposite affected lower limb
4. The unaffected lower limb should assume the first full weight-bearing step on level surfaces

III.

WALKER

1. For correct size, have the client wear shoes. The clients wrists are even with the handgrips on the
walker when arms are dangling downward
2. Advance walker approximately 12 inches
3. Advance the affected lower limb [white foot]
4. Move unaffected limb forward [gray foot]

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MOVING FROM WHEELCHAIR TO BED

Description
Using this technique you will find it safer and easier to transfer a person from the wheelchair to the bed
but not at the expense of your back. There is always a risk for falls, and no transfer technique is without
risk.
What you'll need
Wheelchair/bedside commode/bed
Caregiver Must be Physically Capable of performing transfers (lifting and rotating movements)
Nonskid slippers, shoes or socks
Adequate room to maneuver
Task time
5-10 minutes
Steps for transferring from Wheelchair to Bed
1. Have the bed at the lowest level.
2. Park the wheelchair with the persons strongest side next to the bed.
3. Lock the wheelchair brakes and remove feet from foot rests.
4. Swing or remove foot rests from wheelchair.
5. Explain the sequence of lifting and pivoting into the wheelchair (example: on the count of 3, I am
going to help you stand up and turn to your strong side; eg right side as in above example; and sit
in the wheelchair).
6. Using the bear hug technique, ask the people to place his/her arms on your shoulders as you place
your arms around his/her trunk.
7. Bracket their feet with your feet to prevent slipping.
8. Using your leg muscles, stand up and bring the person upward in a slow steady rising motion.
9. Seat the person on the bed
10. Assist in bring the persons legs up onto the bed.
11. Position for comfort.

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If patient is unable to bear own weight or is unpredictable, this lift will require two nurses: nurse #1 and
nurse #1.
Place wheelchair parallel to the bed with back of chair facing the head of the bed.
Nurse #1 stands behind chair with their bedside knee on the bed and the other leg slightly bent.
Nurse #1 then wraps arms around patient in an arm-wrist crossed over grip.
Nurse #2 is positioned facing the bed, with the legs of the patient in between them and the bed.
They then squat, sliding one hand under patients thighs and the other hand under heels.
Nurse #1 says the command 1-2-3-lift and straightens their supporting leg and shifts weight over
to bent knee.
At the same time, nurse #2 stands up from the squat position while keeping their back straight.
Together they lift the patient into bed.

MOVING FROM BED TO WHEELCHAIR

Description
Using this technique you will find it safer and easier to transfer a person from their bed to the wheelchair
(or bedside commode). There is always a risk for falls, and no transfer technique is without risk.
What you'll need
Wheelchair/bedside commode/bed
Caregiver Must be Physically Capable of performing transfers (lifting and rotating movements)
Nonskid slippers, shoes or socks
Adequate room to maneuver
Task time
5-10 minutes
Steps for transferring from Bed to Wheelchair
1. Remove clutter from area, including all scatter rugs
2. Discuss with the transferee, the process before and during the transfer
3. The amount of room available for transfer will dictate which side of the bed you will be
transferring from.
4. Determine if the transferee has a stronger side, as he/she will be better able to scoot to the edge of
the bed on that side prior to transfer.
5. Position wheelchair on the transferees strongest side (for example if the right side is strongest,
you will be transferring from the right side of the bed.)
6. Assist person to be transferred to edge of bed and to sitting position first with feet dangling and
then with feet on floor
7. For ease of transfer, position the wheelchair next to the knee on his/her strongest side
8. Pull wheelchair within a foot of the persons knee and lock the wheelchair brakes
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9. Explain the sequence of lifting and pivoting into the wheelchair (example: on the count of 3, I am
going to help you stand up and turn to your strong side; eg right side as in above example; and sit
in the wheelchair)
10. Using the bear hug technique, ask the person to place his/her arms on your shoulders as you place
your arms around his/her trunk
11. Bracket their feet with your feet to prevent slipping
12. Using your leg muscles, stand up and bring the person upward in a slow steady rising motion
13. If transferee is capable, have him/her reach for the furthest wheelchair armrest
14. Pivot towards wheelchair seat, and lower slowly
15. Attach or swing foot rests of wheelchair into place
16. Place persons feet onto foot rests of wheelchair

Helpful Hints

Never leave a person unattended on a bedside commode

To protect the caregivers back, always use your legs to liftnot your back
Move your feet during the pivoting process to maintain proper back alignment
For people with fragile skin, remember to use your hands and not your fingers during transfer
Learn how to attach and detach wheelchair foot rests prior to actual transfer
If you are uncertain about the person's ability to assist with transfers, have a second caregiver
stand by to assist.
You may want to consider that it would be safer to care for an extremely weak person in bed. Do
not attempt to transfer anyone if you feel unable to lift their full weight. Despite your best efforts,
you must realize that during any transfer, there is a potential for falling and or significant injury to
both you and the person.

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