Walking Aids and Ambulatory Devices

Walking Aids

• Walking aids significantly modify gait patterns.
• Some use walking aids to reduce pain in a painful joint; others are unable to walk without an aid.

Indications for Ambulatory Assistive Devices

• Poor balance
• Inability to bear weight on a lower extremity due to fracture or other injury
• Paralysis involving one or both lower extremities, or amputation
• Structural deformities or diseases reducing lower extremity ability
• Muscle weakness or paralysis of the trunk

Advantages to Early Ambulation

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

General Principles

• Thorough patient evaluation is crucial for selecting the appropriate assistive device.
• Therapists must be aware of the patient's total medical condition, including weight-bearing status of the affected extremity.
• Therapists must assess the range of motion and the strength of the primary muscles required for ambulation.
• Patients must press downward on the assistive device to move forward.
• Musculature around the scapula, shoulder, and elbow supports the body.
• The unaffected extremity is moved forward.
• Finger flexors fold the hand piece of the device.

Axillary Crutches

• Muscles required for non-weight-bearing ambulation include scapular stabilizers, shoulder depressors, shoulder extensors, elbow extensors, and finger flexors.
• The primary lower extremity muscles for weight-bearing are hip extensors, hip abductors, knee extensors, knee flexors, and ankle dorsi-flexors.
• Hip and knee muscles provide stability as the unaffected leg is used.
• Ankle dorsi-flexors position the foot to clear the floor during swing phase.

Factors to Consider When Choosing an Assistive Device

• Amount of support the patient needs
• Patient's ability to manipulate the device
• Patient's level of disability
• Coordination
• Stability

Examples of Different Needs

• Patients with the same fracture type may require different aids based on stability and coordination. Poor fitting will result in inefficient gait, injury, higher fall risk, and limited benefit.

Types of Assistive Devices

• Parallel bars: maximal support and stability for practicing and assessing gait; limit mobility
• Walkers: most stable, support weight through arms, slower speed, and no rolling out
• Rolling walkers: faster speed, easier movement, tennis balls/glides allow for sliding movement, wheels enable rolling,
• Braces: for supporting specific parts of the body.
• Walking belts: adjustable, come in multiple sizes, and may have platforms for non-weight-bearing patients.
• Crutches: axillary and forearm.
• 1-canes, 2-tripod and tetrapod canes
• Rollators: fastest, seat for resting, and carrying
• Hemi-walkers: for one-arm use, stable, and large base of support
• Standard Walker: a stable walker enabling the patient to move around.

Common Errors When Using Walkers

• Leaning forward/hunching over
• Pushing the walker too far in front.
• Picking up the walker while walking
• Pushing the walker with only one arm.

Correct Walker Use

• Stand tall with both hands on the walker.
• Move the walker forward about 15 cm (6 in.) while weight is primarily on both legs.
• Stay close to the walker.
• Move one foot up near the walker while weight is borne by the opposite leg and both arms.
• Move the other foot up to meet the first while weight is on the opposite leg and both arms.
• All four legs of the walker should contact the floor while stepping.

Cane Use and Measurement

• A cane helps improve stability, provides tactile information about the ground (useful for balance), and takes some load from the legs.
• Cane types include standard (wood or aluminum), tripod, and tetrapod, with advantages and disadvantages depending on the material and design.
• Cane size is measured from the lowest point of the handle to the rubber tip, with the user's shoes on, standing upright, arms hanging naturally, and wrist crease measured to the floor.

Crutch Types and Measurement

• Axillary crutches: fit under the axilla, require upper extremity strength and coordination, and are used for full or partial weight relief.
• Forearm crutches: measure from lateral and anterior to feet, height adjusted for 20 to 30 degrees of elbow flexion and wrist crease is aligned.
• Measurement is taken from 2" laterally and 6" anteriorly to the foot.
• Crutch sizing guidelines include positioning the crutch top slightly below the armpits, wrist crease level handgrips, and a slight elbow bend.

Gait Patterns

• 4-point gait: slow and stable, used when some weight can be borne on both legs.
• 2-point gait: faster than 4-point, moves one leg and one crutch forward together.
• 3-point gait: fairly rapid, but requires arm strength to support significant body weight.
• Swing-to gait: used for patients with functional lower body issues; advance both crutches simultaneously
• Swing-through gait: fastest gait, used for paralyzed patients or those wearing braces