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Hey, what's up everyone, Doctor 
Zeshan here. 

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I really want to take a moment 
to thank everyone that listens 

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to our podcast, that subscribes 
to the podcast, that even shares

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it amongst other people and your
peers. 

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Thank you so much from myself 
and the team at NCLEX High 

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Yield. 
It's because of the audience 

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that we have, the people that 
follow us on here on Instagram, 

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on Facebook, on YouTube and on 
TikTok that really keeps us 

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going and motivated to keep 
bringing you some new content as

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often as we can remember. 
We do have our free weekly Zoom 

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every single Wednesday that we 
do a new topic, practice 

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questions as well to try to come
to that free weekly Zoom, free 

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education. 
Why not? 

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And then also right after that, 
we start doing trivia. 

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It helps the neurons fire. 
So I'm on test day. 

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You get that association real 
quick. 

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You're not wasting a lot of that
brain power. 

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And lastly, remember we always 
have on demand going, if you 

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like the podcast, if you like 
our YouTube channel, imagine 

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having 70 hours of content with 
the notes with myself lecturing 

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on pretty much every topic and 
seeing all these people get 85 

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and out. 
So again, thank you all so much 

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and good luck. 
So let's talk about Keynes. 

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The different topics that we're 
going to cover with Keynes are 

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the different types of Keynes. 
They're indications for use, 

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proper use of the cane and then 
safety and patient education. 

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So there's different levels of 
exactly what we can ask on the 

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boards regarding canes. 
The first one is identifying 

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what type of a cane it is. 
So we've got what's called a 

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single point cane and we've got 
a quad cane. 

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And if you just look at exactly 
what they're saying when they 

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define the type of cane it is, 
single point is one of those 

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ones that's just a stick. 
It's only got the one end to it,

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whereas the quad cane, it has 
four little legs, quad being 

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four and then the cane being the
portion of it that holds. 

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So this one offers more 
stability. 

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So the single point cane has 
minimal stability and it's good 

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for balance and support. 
But if you think about just the 

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actual structure of that cane, a
single point is one leg that 

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you're holding on, whereas the 
quad cane has much more 

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stability than the single point 
because it's got 4 legs at the 

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base. 
When do we use it? 

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Well, we need it for patients 
that have balance issues. 

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And when we talk about balance 
issues or need balance 

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assistance, we're looking at 
unilateral weakness. 

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Unilateral weakness. 
So in what patients are Keynes 

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indicated, think of patients 
that develop a unilateral 

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weakness. 
So patients such as strokes is a

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big one. 
What other balance issues or 

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not? 
Not just balance, how about just

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unilateral weakness and what 
other situations do you see? 

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And so when we think about 
unilateral weakness, we think of

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different types of populations, 
populations like stroke 

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patients, patients that have 
balance issues like Vertigo. 

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How about people that have that 
unilateral weakness with age and

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degeneration? 
How about arthritis? 

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We don't want to mix up crutch 
with cane. 

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Now let me explain the 
difference real quick. 

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So that way we understand when 
we use one over the other in a 

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cane, we have weakness or 
balance issues. 

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Whereas a crutch is going to be 
for more severe injuries, 

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surgery on the leg or a fracture
of the leg. 

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So 1 is going to be for a more 
severe injury. 

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The other one is a little bit 
more milder, mild weakness or 

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balance issues, crutch. 
We need to be able to have that 

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support because we have a broken
leg, we've been we are unable to

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use that leg, whereas the cane 
offers more stability, whether 

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it be single point or quad cane.
It's therefore stability in mild

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balance issues, mild weakness as
well too, such as stroke 

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victims, people that are 
recovering from strokes and or 

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people that have arthritis. 
So things of that nature. 

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So that's between crutch and 
cane. 

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So moving on with cane, we must 
look at educating on the proper 

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use of a cane. 
So the proper use of cane starts

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with fitting. 
What are we looking at? 

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What parameters are we looking 
at when we're dealing with a 

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patient that needs to be fitted 
for a cane? 

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Well, first and foremost, we've 
got to look at their height 

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because the length of the cane 
is going to be dependent on 

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their height because ultimately 
the cane should align with the 

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wrist when the patient is 
standing with their arms down, 

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standing with arms down. 
So if I'm fitting a cane, what 

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I'm looking at is the height. 
So ultimately, how am I going to

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determine the length of the 
cane? 

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Well, I want them to stand up 
and I want them to put their 

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hands by their side. 
And where the wrist falls next 

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to the side of the body is where
I want the height of the cane to

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be. 
When we talk about technique of 

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canes, we're going to be talking
about what hand to hold it in, 

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how we're going to walk with it,
and how we're going to take 

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steps moving forward. 
And then the use of a cane going

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up the stairs and also going 
down South. 

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With technique, we want to start
with what hand do we want to 

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hold it in? 
And the hand that we're going to

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hold it in is the hand opposite 
of the affected leg. 

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So with the cane, we hold it on 
the hand opposite of the 

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affected side or we hold it on 
the side of the good leg. 

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Well, we know what hand to hold 
it in, but how do we walk with 

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it? 
So let's talk about walking with

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a cane. 
First we want to move the cane 

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forward. 
We then take the weaker leg and 

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we align it forward with the 
cane and then we bring that 

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stronger leg up or forward. 
So technique, we start with what

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hand we hold the cane in and it 
is in fact the hand opposite of 

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the affected leg or the hand 
that is in fact the stronger leg

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or the hand that is the same as 
the stronger leg. 

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Then we have to learn how to 
walk with the cane. 

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So when we educate our patients,
select all that apply, we're 

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going to move the cane forward, 
step one, Step 2, bring the 

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weaker leg aligned to that cane 
and then Step 3, bring the 

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strong leg forward. 
So in order move the cane 

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forward first, then the weaker 
leg, we align to the cane and 

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then we bring the stronger leg 
forward. 

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Now we're going to talk about 
using a cane going up and down 

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stairs with stairs. 
Remember the quick tip, we go up

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with the strong, down with the 
weak. 

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So what does that mean? 
When we go up the stairs, we 

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start with the strong leg and 
then we bring up the cane and 

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then we bring up the weak leg. 
Whereas when we go down, we go 

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down with the weak. 
But when we go down with the 

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weak, we start with the cane 
first, then the weaker leg, then

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the strong leg. 
So recap with stairs. 

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When we go up the stairs, we go 
up with the strong, down with 

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the weak, up with the strong, 
down with the weak, go up the 

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stairs with the strong leg 
first, cane second, weak leg 

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last. 
I'm going to go down the stairs.

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We go down with the weaker leg. 
We start with the cane, then the

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weaker leg, then the stronger 
leg. 

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So there's in each one of these,
it's a three-step process. 

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So just remember up with the 
stairs or I'm sorry, up with the

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strong, down with the weak. 
Each one is going to have three 

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steps. 
So when you go up strong leg, 

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cane, weak leg. 
When we go down cane, weak leg, 

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strong leg. 
Another part of Canes that gets 

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overlooked that I think is 
important, that we should know 

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that's very, very fair game for 
the boards is safety 

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considerations regarding canes. 
Because ultimately the problem 

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with patients that have the 
necessity for Canes is that they

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are a fall risk. 
That's the biggest thing. 

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A lot of these people, they will
end up hurting themselves 

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severely because of a fall in 
elderly patients. 

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What are we concerned about fall
in patients that have arthritis,

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in elderly patients, stroke. 
We're worried about falls 

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because recovering from a fall, 
especially as we age, is one of 

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the biggest risk factors for not
recovering and actually becoming

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debilitated is false. 
So we must consider the safety 

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precautions when we're dealing 
with canes. 

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So what is the first thing we're
going to look at? 

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What's simple? 
Inspect the device. 

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So inspect the device. 
What does that mean? 

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Well, we want to regularly check
the cane and look for wear and 

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tear, right? 
We want to make sure that the 

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rubber tips, because on the 
bottom is a rubber tip in order 

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to prevent slipping, so we get 
good traction, make sure that is

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intact so that we we're not 
overlooking something that can 

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be detrimental to their safety. 
The second is called 

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environment. 
So safety with a cane, we must 

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look at environment. 
So again, loose rugs, cords, 

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clutter, clear pathways, Night 
Lights, fall risks, make sure 

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there's no leaks or any wet damp
areas, no dusty areas. 

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Anything that can cause slipping
or getting in the way or 

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tripping is considered 
environmental safety. 

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The next two for safety 
precautions are going to be are 

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they able to wear bear the 
weight on that cane? 

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Is it sturdy enough or is it a 
little flimsy? 

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Are there any cracks in it? 
Are they able to balance on it? 

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So again, we want to just do a 
little bit more safety 

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precautions when it comes to 
cane use and cane safety. 

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So for crutches, which obviously
can be compared to canes, but 

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the difference being that one is
going to be for something more 

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severe like we talked about as 
far as fractures, as far as post

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surgery things where we need to 
be able to to recover. 

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And these patients, they require
non weight bearing or partial 

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weight bearing on one or both 
legs. 

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So we really can't use the legs 
in this situation. 

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And the other situation with 
canes, we had weaker legs or we 

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had weakness or we had balance 
issues. 

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In this situation we have non 
weight bearing leg or a partial 

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weight bearing leg or legs. 
That's when we need crutches. 

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That is going to take the weight
off of that leg completely. 

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So what are some parameters that
we're going to look at? 

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What are some sections that the 
boards like to talk about when 

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it comes to crutches? 
Well, we just talked about the 

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purpose of it where we have a 
non weight bearing or a partial 

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weight bearing leg or legs. 
Then we're going to talk about 

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the types of crutches. 
We're going to talk about weight

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distribution. 
We'll talk about positioning. 

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We'll talk about gait patterns, 
which is that 2.3 point, 4 point

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gait. 
We'll talk about stability and 

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patient population. 
So let's talk about the 

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different types of crutches. 
When we talk about the different

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types of crutches, the two that 
we're going to see for the sake 

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of the boards that I want you to
know, is an axillary crutch. 

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And where's our axilla? 
It is our armpit, right? 

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So an axillary crutch and a 
forearm crutch. 

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When do we use which and how do 
we use them? 

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Well, the axillary crutch is the
standard crutch that you think 

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about that has the handle and 
then there's a pad right 

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underneath the arm, right 
underneath the armpit and we're 

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able to put pressure on it. 
Now the thing about axillary 

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crutches is that it can compress
the axillary nerve. 

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So educating them on proper use 
of a crutch is very important. 

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Then our forearm crutch is going
to be used for long term 

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disabilities, people that have 
chronic conditions. 

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And these are the ones that you 
would see that potentially both 

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legs are not able to be used and
they're placing their forearms 

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into that crutch. 
And now they're using that 

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crutch as a means of replacing 
or stabilizing their leg. 

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And that's what a forearm crutch
is. 

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So with crutches, again, we 
talked about the the indications

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for the uses, whether it be non 
weight bearing or partial weight

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bearing situations where you 
cannot put any type of weight or

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a little bit of weight on either
one or both legs. 

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So a situation that we'll see 
that in things like fractures, 

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sprains, dislocations, surgical 
recovery, hip or knee surgeries 

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or severe severe joint pain, 
severe joint pain. 

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Then we went into the types of 
crutches. 

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The two different types of 
crutches that we're going to see

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are the axillary crutches, which
are again underneath the arm in 

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the axillary area or the armpit 
area. 

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This is good for short term 
mobility. 

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Then we've got our forearm 
crutches or loft strand 

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crutches. 
These are used for long term 

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mobility in patients with 
chronic conditions because the 

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cuff fits around the forearm and
it gives more freedom of the 

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hands, whereas under the 
axillary we're kind of bound to 

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our hands not being as free. 
So these are grade 4 things like

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or these are great for patients 
that have potentially cerebral 

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palsy or other neurological 
conditions where they're unable 

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to utilize both legs. 
So now we're going to talk about

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proper fitting of crutches. 
So education, education. 

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The reason why we're going to 
properly fit these is 1, So we 

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utilize them properly, second, 
so they're comfortable, and 3rd,

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so we don't obtain any injuries.
So with axillary crutches, we're

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going to adjust the height so 
that there's two to three finger

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widths of space between the top 
of the crutch and the armpit. 

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So one to two inches or two to 
three finger widths between the 

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top of the crutch and the actual
armpit or the axillary area. 

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So you don't want them resting 
on it. 

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You want space so that you have 
that two to three finger width 

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or one to two inches in between 
that top and the armpit. 

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Because again, what are we 
trying to prevent? 

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Axillary nerve damage? 
The hand grips should be at the 

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wrist level. 
The hand grips should be at the 

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wrist level. 
When the patient's arms are 

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hanging naturally, so as they 
stand, let their hands dangle. 

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The wrist is where the hand 
grips should be at. 

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The wrist is where the hand 
grips should be at. 

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This allows for our elbow to 
bend, as most literature would 

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say, in that 30° angle. 
So again, hand grips should be 

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positioned where the wrist is 
hanging naturally gangly at the 

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side of the body. 
This allows for the elbow to 

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bend at that 30° angle, which is
going to provide control and 

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comfort, control and comfort 
with the forearm crutch. 

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The cuff should fit snugly 
around the forearm, so about one

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to two inches below the elbow. 
And again, the hand grip should 

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be at the wrist level when the 
arms are hanging naturally. 

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So again, just a little quick, 
quick point. 

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When we're dealing with where we
should have the grips at, it 

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should always be for crutches in
this situation, accelerator, 

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forearm, it should always be 
when you dangle your hands to 

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the side at the level of the 
wrist. 

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Now we get into arguably the the
topic with crutches that gets 

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tested the most in this 
situation. 

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We're going to talk about 
walking with crutches. 

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Walking with crutches, which is 
in fact A2 point gate, a 

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three-point gate, and a four 
point gate. 

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We'll start with the non weight 
bearing and then we'll get into 

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partial weight bearing. 
You've got the option of partial

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weight bearing and non weight 
bearing. 

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With partial weight bearing you 
can use A2 point or a four 

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point. 
With partial weight bearing you 

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can use A2 point or a four 
point, whereas with non weight 

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bearing we're going to use that 
3 point gate. 

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So what is a three-point gate? 
First and foremost, we must 

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understand that we're going to 
use this with non weight bearing

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crutches. 
So 3 point gate is non weight 

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bearing. 
With this, the patient cannot 

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bear weight with one leg. 
So what are the steps? 

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Step one, move both crutches 
forward together. 

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So let's just think about this. 
If I've got one leg that cannot 

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bear weight, I've got 2 crutches
and one leg. 

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How many points is that with non
weight bearing? 

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3 point gait is we've got two 
crutch legs and one good leg 

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that is your three points. 
So now step by step, what are we

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going to do? 
Move both crutches forward 

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together, then move the injured 
non weight bearing leg forward. 

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Without placing any weight on it
and then step forward with the 

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unaffected leg one more time. 3 
point gait. 

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00:20:27,560 --> 00:20:29,600
We have a non weight bearing 
leg. 

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So the three points are in fact 
the crutches and the weight 

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bearing leg. 
The steps of moving forward in 

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the three-point gait is move the
crutches forward followed by the

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non weight bearing leg without 
placing weight on it and then 

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step forward with the unaffected
leg. 

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That is your 3 point gate. 
Our four point gate and our two 

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point gate again are going to be
with partial weight bearing. 

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Partial weight bearing, which 
means that we can put a little 

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bit of weight on that fourth 
point or that second point 

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depending on what the situation 
is. 

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So the four point gate is with 
partial weight bearing on both 

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legs. 
In this situation we have 4 

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steps, 4 point gate, 4 steps. 
If we're able to put partial 

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weight on both the legs, then 
we're going to move the right 

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crutch forward, then the left 
leg forward, left crutch 

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forward, right leg forward. 
Again, 4 point gate with partial

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00:21:50,160 --> 00:21:55,640
weight bearing, we're going to 
move the right crutch forward, 

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left leg forward, left crutch 
forward, right leg forward. 

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00:22:01,720 --> 00:22:06,120
So we alternate. 
It's a slow gate, but it's 

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steady and it's stable. 
So this is great for people that

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have bilateral weakness. 
Then the last one is our two 

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00:22:20,240 --> 00:22:22,720
point gate, again using 
impartial weight bearing. 

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And in this situation we have 
two steps. 

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00:22:27,600 --> 00:22:32,000
Move the left crutch and right 
leg forward together. 

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00:22:35,720 --> 00:22:41,840
Step 2 Move the right crutch and
left leg forward together. 2 

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00:22:41,840 --> 00:22:48,400
steps 2 point gate again move 
the left crutch and right leg 

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00:22:48,400 --> 00:22:51,240
forward together. 
Step 2. 

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00:22:51,360 --> 00:22:59,160
Move the right crutch and the 
left leg forward together and 

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that is crutches.