Walking Aids and Ambulatory Devices

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Questions and Answers

What is the optimal height setting for crutches in relation to the user's armpits?

Between 1 to 1.5 inches above the armpits

At the level of the armpits

Between 1 to 1.5 inches below the armpits (correct)

At the level of the elbows

When measuring the crutch length, what should the angle of elbow flexion be?

20-30 degrees (correct)

0-10 degrees

10-20 degrees

30-40 degrees

Which disadvantage is associated with using forearm crutches?

They are less stable than traditional canes

They may feel insecure for geriatric patients (correct)

They require less upper-body strength

They are easier to maneuver than walkers

What is the appropriate measurement for the handgrips of the crutches?

At wrist crease with arms extended Signup and view all the answers

What characteristic distinguishes walkers from other mobility aids?

They provide maximum stability and support Signup and view all the answers

Which condition is NOT an indication for using ambulatory assistive devices?

Severe joint pain Signup and view all the answers

What is a key advantage of early ambulation following an injury?

Improves circulation Signup and view all the answers

When evaluating a patient for an assistive device, which factor is least relevant?

Patient's previous occupation Signup and view all the answers

Which of the following muscles is NOT primarily involved when utilizing axillary crutches?

Hip adductors Signup and view all the answers

What does the patient need to do to effectively move the body forward using an assistive gait device?

Press downward on the device Signup and view all the answers

Which of the following is an incorrect consideration when choosing an assistive gait device?

Brand of the device Signup and view all the answers

Which muscle stabilizes the body while standing on the unaffected lower extremity?

Hip extensors Signup and view all the answers

Which assistive device provides the greatest support and stability for patients?

Parallel bars Signup and view all the answers

What is a potential consequence of improper fitting of assistive devices?

Decreased mobility Signup and view all the answers

What is the correct adjustment for the height of parallel bars for optimal use?

To allow 15 to 20 degrees of elbow flexion Signup and view all the answers

When should a patient progress from parallel bars to another assistive device?

Once proficient with the gait pattern Signup and view all the answers

Which category of assistive gait devices offers the least support?

Two canes Signup and view all the answers

Which of the following is NOT a type of assistive gait device mentioned?

Knee scooters Signup and view all the answers

Why might a patient require a walker instead of crutches?

They have poor stability and coordination Signup and view all the answers

What specific adjustment should be avoided to prevent dependency on parallel bars?

Encouraging too much time in parallel bars Signup and view all the answers

The assistive device designed for patients unable to bear weight through their hands is referred to as:

A platform attachment Signup and view all the answers

Which walker is noted for having the highest stability for users with limited use of one arm?

Hemi-Walker Signup and view all the answers

What is the main advantage of using a rolling walker compared to a standard walker?

Allows for a faster walking speed Signup and view all the answers

Which of the following is a common mistake when using a walker?

Picking up the walker while walking Signup and view all the answers

What is the primary purpose of adding tennis balls or glides to the back legs of a rolling walker?

To facilitate easier sliding across floors Signup and view all the answers

Why should a rollator not be heavily loaded through the arms or hands?

It lacks stability and sufficient weight capacity Signup and view all the answers

What is the recommended initial movement when using a walker?

Move the walker ahead 15 cm while maintaining weight on both legs Signup and view all the answers

Which type of walker is specifically designed for fast walking while allowing for breaks?

Rollator Signup and view all the answers

What is a key characteristic of standard canes compared to other mobility aids?

They are primarily used for balance and stability Signup and view all the answers

Which walker requires good balance and is only for patients needing immediate resting options?

Knee Walker Signup and view all the answers

What is a disadvantage of using a wooden cane?

It is not adjustable. Signup and view all the answers

What makes aluminum canes preferable for users who need to adjust their support?

They are quickly adjustable. Signup and view all the answers

What is a key factor to ensure a proper fit for a cane?

The cane should reach the user's wrist while standing upright. Signup and view all the answers

Which mistake is commonly made by cane users?

Dragging the cane behind the body. Signup and view all the answers

What is a disadvantage of using axillary crutches?

They can cause injury to neurovascular structures. Signup and view all the answers

Why might geriatric patients feel insecure when using axillary crutches?

They often lack necessary upper body strength. Signup and view all the answers

What is a recommended practice when moving with a cane for a patient with a weaker leg?

Keep the cane vertical and opposite the weak leg. Signup and view all the answers

When measuring for axillary crutches, what distance should be measured from the axilla?

20 cm lateral to the heel. Signup and view all the answers

What should the elbow angle be when the cane is correctly held?

15 to 25 degrees of flexion. Signup and view all the answers

What is an advantage of using a multi-leg cane?

It provides wider base of support but is not practical for stairs. Signup and view all the answers

Study Notes

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

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Description

This quiz covers the importance and use of walking aids and ambulatory assistive devices in patient care. It discusses indications for their use, advantages of early ambulation, and general principles for selecting appropriate devices. Assess your understanding of how these aids can impact mobility and rehabilitation.