Mobility Aids: Crutches and Walkers

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Questions and Answers

What is the recommended position of the top of the crutches when a user is standing straight?

At the level of the waist

1 to 2 inches above the shoulders

At level with the armpits

5 cm below the armpits (correct)

Which factor should be considered when adjusting the height of the handgrips on crutches?

Position of the elbows (correct)

Distance from the wrist crease to the ground

Height of the shoulders

Length of the fingers

What is a primary disadvantage of using forearm crutches?

They require poor upper-body strength

They are more stable than walkers

They are easier to store

They provide minimal stability (correct)

Which component is essential for ensuring stability when using a walker?

Number of wheels Signup and view all the answers

Where should the arm cuff location be measured for forearm crutches?

At the proximal third of the forearm Signup and view all the answers

What is a significant disadvantage of using a rollator walker?

LEAST STABLE full walker Signup and view all the answers

Which walker type is specifically designed for patients who cannot use one arm effectively?

Hemi-Walker Signup and view all the answers

What common mistake involves improper positioning of the walker during use?

Moving the walker too far ahead Signup and view all the answers

What is a primary purpose of using a cane?

To increase base of support for better stability Signup and view all the answers

What feature of a standard walker allows for increased weight transfer through arms?

Sturdy construction Signup and view all the answers

Which walker type is inappropriate for patients who need to lean weight onto it?

Knee Walker Signup and view all the answers

What should NOT be done when using a walker correctly?

Lean forward while walking Signup and view all the answers

Which type of walker offers the fastest walking speed?

Rollator Signup and view all the answers

What is the purpose of using tennis balls on the back legs of a rolling walker?

To allow easier sliding on the ground Signup and view all the answers

What defines a knee walker?

Designed for those with a lower limb injury, allowing sitting breaks Signup and view all the answers

Which of the following is NOT an indication for using ambulatory assistive devices?

Strong muscle strength in lower extremities Signup and view all the answers

What primary muscles are essential for ambulation with axillary crutches during a three-point non-weight bearing gait?

Scapula stabilizers and finger flexors Signup and view all the answers

Which factor is NOT considered when choosing an assistive gait device?

The patient’s financial situation Signup and view all the answers

Which of the following advantages is NOT associated with early ambulation after an injury?

Preventing muscle atrophy Signup and view all the answers

What is the primary role of the ankle dorsiflexors during ambulation with the unaffected lower extremity?

To position the foot to clear the floor Signup and view all the answers

When using an assistive gait device, the patient must press downward to facilitate movement. This pressurization primarily engages which muscle groups?

Upper extremity shoulder girdle muscles Signup and view all the answers

Which statement best describes the relationship between muscle strength and gait aid selection?

Lower muscle strength generally means simpler gait devices are more appropriate Signup and view all the answers

What is a disadvantage of using a wooden cane compared to other types of canes?

It is not adjustable. Signup and view all the answers

Which measurement method should be used when fitting a patient with a cane?

Measure from the wrist joint to the floor. Signup and view all the answers

What common mistake do patients make when using a cane?

Leaning into the cane while walking. Signup and view all the answers

What is an advantage of a multi-leg cane compared to a standard cane?

It provides a wide base of support. Signup and view all the answers

What disadvantage should be considered when using axillary crutches?

They may cause injury to the axillary neurovascular structures if misused. Signup and view all the answers

For a patient with a weaker leg, how should a cane be positioned?

In the opposite hand to the weak leg. Signup and view all the answers

What is a common feature of aluminum canes?

They can be adjusted quickly. Signup and view all the answers

Which aspect of multi-leg canes makes them not practical for use on stairs?

Their wide base makes maneuvering difficult. Signup and view all the answers

What is a guideline for correctly adjusting a cane for use?

15 to 25 degrees of elbow flexion is ideal when grasping the handle. Signup and view all the answers

What is the primary purpose of assistive gait devices?

To increase the patient's stability by expanding the base of support Signup and view all the answers

How should the height of the parallel bars be adjusted for a patient?

To allow for 15 to 20 degrees of elbow flexion when standing erect Signup and view all the answers

Which of the following assistive devices offers the greatest support?

Parallel bars Signup and view all the answers

What are potential consequences of poor fitting assistive devices?

Increased risk for falls Signup and view all the answers

What should be prioritized to prevent patients from becoming dependent on parallel bars?

Progressing to another assistive device for mobility Signup and view all the answers

What is a common improper use of assistive devices?

Using the device without being properly trained Signup and view all the answers

What category of gait devices follows walkers in terms of support provided?

Forearm crutches Signup and view all the answers

Why might a patient require a walker instead of crutches?

Due to poor stability and coordination Signup and view all the answers

What is the potential risk of having adjustable sizes for assistive gait devices?

Adjustment options can lead to misuse Signup and view all the answers

Study Notes

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.

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Description

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.