Ask a PT Response: "When I instruct my patients and/or their family members for proper stair negotiation with hand rail assist the following is recommended:

Negotiating Up Steps
1) Have patient get as close to the stairs as possible
2) Patient will hold onto hand rail(s) and family member will provide assist as necessary throughout entire task. Patient should utilize both hand rails initially if available and the rails are not too far apart. Once the patient's functional status improves paitent can progress to single railing. For single railing the following is recommended: Patient will hold on to hand rail on right side if left leg is involved or weaker. Patient will hold on to hand rail on left side if right leg is involved or weaker.
If there is only a railing on one side, the patient should utilize the available railing and an assistive device such as a cane or crutch on the other side to assist with stair negotiation.
3) Patient will negotiate up the step first with the uninvolved or stronger leg and will than follow with the involved or weaker leg onto the same step. When utilizing an assistive device, the assistive device will follow with the involved or weaker leg.
4) patient will repeat this pattern until patient reaches the top of the stairs.

 

Negotiating Down Steps
1) Have patient get as close to the stairs as possible
2) Patient will hold onto hand rail(s) and family member will provide assist as necessary throughout entire task. Patient should utilize both hand rails initially if available and the rails are not too far apart. Once the patient's functional status improves paitent can progress to single railing. For single railing the following is recommended: Patient will hold on to hand rail on right side if left leg is involved or weaker. Patient will hold on to hand rail on left side if right leg is involved or weaker.
If there is only a railing on one side, the patient should utilize the available railing and an assistive device such as a cane or crutch on the other side to assist with stair negotiation.
3) Patient will negotiate down the step first with the involved or weaker leg and will than follow with the uninvolved or stronger leg onto the same step. When utilizing an assistive device, the assistive device should be placed on the down step first followed by the involved or weaker leg.
4) patient will repeat this pattern until patient reaches the bottom of the stairs.

A good way to ensure the patient performs the proper sequencing for stair negotiation is to have them remember the phrases "up with the good and down with the bad" or "the good go to heaven and the bad go to hell" (when going up the stairs the good leg will lead first and when coming down the stairs the bad leg will lead first).

 

If a patient is unsafe or unable to negotiate stairs on her feet, than it is recommended that they negotiate up and down the steps on their posterior. I hope this helps."