Mobility Aids: Crutches and Walkers

Walking Aids

• Walking aids significantly modify gait patterns.
• Some users utilize them to reduce pain in affected joints.
• Others are unable to walk without assistive devices.

Indications for Assistive Devices

• Poor balance
• Inability to bear weight on a lower extremity (due to fracture or injury).
• Paralysis affecting one or both lower extremities, or amputation of a lower extremity.
• Structural deformities or diseases leading to decreased lower extremity function.
• Muscle weakness or paralysis of the trunk.

Benefits of Early Ambulation

• Aids circulation
• Prevents calcium loss in bones
• Aids pulmonary and renal systems

General Principles

• Patients must undergo thorough evaluation to select appropriate assistive devices.
• Therapists should consider the patient's overall medical condition and weight-bearing status of the affected extremity.
• Therapists should determine the range of motion and strength of the primary muscles needed for ambulation.
• Patients should press downward on the assistive device to move forward.
• The unaffected lower extremity, scapula, shoulder, and elbow musculature assists body support, moving the non-affected leg forward.
• The finger flexors help maneuver the device.

Muscles Used with Assistive Devices (e.g., Crutches)

• Upper extremity: scapula stabilizers, shoulder depressors, shoulder extensors, elbow extensors, finger flexors.
• Lower extremity: hip extensors, hip abductors, knee extensors, knee flexors, ankle dorsi-flexors.

Factors to Consider When Choosing an Aid

• Amount of support needed
• Ability to use the device
• Level of disability
• Coordination
• Stability

Example of Individual Needs

• Patients with similar fractures may have differing needs.
• One patient might use crutches if properly coordinated, while another may require a walker.
• As improvements occur, patients may advance to less supportive devices for greater maneuverability.

Poor Aid Fit

• Devices fitted incorrectly or poorly trained usage may cause several problems:
• Inefficient gait patterns
• Injury to parts of the body
• Increased fall risk
• Increased cost with limited benefit

Types of Assistive Gait Devices

• Assistive gait aids aim to improve stability
• Devices are categorized by support, from most to least:
  • Parallel bars
  • Walkers
  • Axillary crutches
  • Forearm crutches
  • Two canes, and
  • One cane
  • Braces
  • Walking belts
  • Adjustable in sizes (adult, child)
  • Platforms for those unable to use their hands.

Parallel Bars

• Used for maximal support and stability.
• Enables gait pattern practice and device fit assessment.
• Limits mobility, promoting progression to other aids as patient becomes mobile.
• Height is adjusted for 15-20 degrees of elbow flexion, with the bars 6 inches anterior to the hips, and 2 inches wider than the patient's hips when centered between them.

Standard Walker

• Stable device positioned beneath the patient.
• Weight is transferred through arms and hands, unweighting the legs.
• Slower walking speed.

Rolling Walker

• Faster walking speed.
• Easier to maneuver.
• Tennis balls or glides on the back legs allow easier sliding.
• Supports patients who need to move quicker and reduce foot usage.
• Wheels allow the device to roll, not rely on lifting the device.

Types of Walkers

• Regular walkers: Provide stability.
• Rolling walkers: Offer speed and maneuverability.

Walker Disadvantages

• Cumbersome and difficult to store/transport.
• Difficult to use on stairs.
• Reduces ambulation speed.
• Interferes with typical gait.
• For proper fit, the walker height should allow a 15-25 degree elbow bend.

Gait Patterns Using Aids

• 4-point gait: Used for patients with moderate leg weakness.
  • Sequential advancement of each crutch/leg, alternating legs and crutches.
• 2-point gait: Patients can bear some weight.
  • Simultanious forward advancement of a leg and a crutch.
• 3-point gait: Patients cannot weight-bearing on one leg.
  • Simultaneous forward advancement of a leg, while moving two crutches.
• Swing-to crutch gait: Requires strong upper body and coordination.
  • Simultaneous forward advancement of both crutches while moving the legs.
• Swing-through gait: Fastest but most complex.
  • Simultaneous advancement of crutches, then both legs together.

Cane Use

• Canes improve stability (increasing BOS).

• Provide tactile ground feedback to enhance balance..

• Reduce leg load.

• Standard canes: Inexpensive, wood or aluminum, half-circular handle with a rubber tip.

• Tripod/Tetrapod canes (multi-leg canes): Adjustable, wide base of support, but not suitable for stairs.

Cane Measurement

• Measure cane length from the handle's top to the tip.
• Have the patient stand naturally; their arms should fall naturally, with a slight bend at the elbow; taking the measurement from the wrist down to floor.

Cane Use Considerations

• Lean into the cane.
• The cane should be held in the opposite hand of the weaker leg.
• Movement with the weaker leg.
• Maintain upright posture to keep the cane vertical.

Crutch Types

• Axillary crutches: Fit under the armpit. Need good upper extremity strength and balance.
  • Used for weight relief (fully or partially).
  • Improves lateral stability.
  • Disadvantages: Less stable than walkers, improper use can harm neurovascular structures, and geriatic patients may lack upper body strength.
• Forearm crutches: Fit against the forearm/elbow.
  • Requires good upper body strength and balance.
  • Allows for weight transfer to the floor, but is less stable than walkers.

Axillary Crutch Measurement

• While lying down, measure 5cm down from the armpit to the bottom of the shoe (lateral to the heel).
• While standing, measure from 5cm under the armpit to 15cm out from the foot's side.
• The hand piece is positioned to allow 20-30 degrees of elbow flexion.
• The measure from wrist crease to the same point on the ground will give the hand grip height.

Crutch Considerations

• Crutch tops are placed 1-1.5 inches below armpits.
• Handgrips at wrist crease level.
• Elbows should bend slightly when using handgrips.
• Pressure on the top of crutches should be used to distribute the weight to avoid damage to nerves under the armpit.

Other aids

• Rollator: Fastest speed, seat, basket for carrying items, brakes, least stable of full walkers, weight transfer limited.
• Hemi-walker: Stable option for patients with reduced use of one limb. It provides a larger base of support, easily folds, and is bulky.
• Knee walkers/rollabouts: For patients who need to sit down but do not lean on the walker.

Test your knowledge about the proper use and adjustments of mobility aids like crutches and walkers. This quiz covers the recommended positions, adjustments, and disadvantages associated with various types of mobility assistance. Enhance your understanding of how to effectively use these aids for better stability and support.