Walking Aids PDF

Walking aids Walking aids can modify the gait pattern considerably. While some people using the walking aids to reduce the pain in a painful joint, some others are totally unable to walk without some form of aid.  Indications for Ambulatory Assistive Devices : ▪ Poor balance, ▪ Inability to bear w...

Walking aids Walking aids can modify the gait pattern considerably. While some people using the walking aids to reduce the pain in a painful joint, some others are totally unable to walk without some form of 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 of a lower extremity. Structural deformity, disease resulting in decreased ability of Lower extremities. Muscle weakness or paralysis of the trunk ▪ Advantages to early ambulation following an injury: Aiding circulation, Preventing calcium loss in bones Aiding the pulmonary and renal systems.  General Principles ❑ The patient to be carefully evaluated in order to select the appropriate assistive device to meet the patient’s needs. ❑ The therapist must be aware of the patient’s total medical condition, weight-bearing status of the involved extremity when considering which type of assistive device to use with the patient. ❑ The therapist will need to determine the range of motion of the extremities and the strength of the primary muscles required for ambulation. ❑ The patient must press downward on the assistive gait device in order to move the body forward. The scapular, shoulder, and elbow musculature supports the body’s weight while the non- affected lower extremity is moved forward. The finger flexors fold the hand-piece of the assistive gait device. ❑ The primary muscles required for ambulation with axillary crutches, using a three-point (non-weight bearing on one lower extremity) crutch gait pattern, are the scapula stabilizers, shoulder depressors, shoulder extensors, elbow extensors, and finger flexors for the upper extremity. ❑ The primary lower-extremity muscles in the weight- bearing lower extremity are the hip extensors, hip abductors, knee extensors, knee flexors, and ankle dorsi-flexors. ❑ While the patient is standing on the unaffected lower extremity, the muscles of the hip and knee provide stability. The ankle dorsi-flexors position the foot so that it can clear the floor when the limb is swinging forward Factors to be considered When choosing an assistive gait device, the therapist considers the following factors: 1.the amount of support the patient will need 2. the patient’s ability to manipulate the device. 3.the patient’s level of disability, 4. coordination, 5. stability.  For example, you may have two patients with the same type of fracture. One of the patients may use crutches if he or she has adequate stability and coordination to safely use them. The other patient may require a walker due to poor stability and coordination. As the patient’s abilities improve, they may advance to an assistive device providing less stability and support for easier maneuverability.  Fit of Device Poor fitting of any assistive and/or improper training of how to use the device can lead to problems. These include: – Inefficient gait pattern – Injury to other parts of the body – Increased risk for falls – Increased cost with little to no benefit  Types of assistive gait devices: Assistive gait devices are designed to improve the patient’s stability by increasing the base of support. The categories of assistive ambulation devices, in order from greatest to least amount of support, are: Parallel bars, Walkers, Axillary crutches, Forearm crutches, Two canes, and One cane. Braces Walking belts All categories of assistive gait devices are adjustable and come in tall, adult, and child sizes. Additionally, a special platform can be attached to walkers or axillary crutches for patients who are unable to bear weight through the hand, wrist, or forearm.  1) Parallel bars Parallel bars are used when maximal patient support and stability are required. The gait pattern can be practiced in parallel bars and the fit of the assistive device can be checked. The parallel bars limit mobility. So once the patient becomes proficient with the appropriate gait pattern, the patient must be progressed to another assistive gait device to be mobile. Care must be taken so that the patient does not become dependent on the parallel bars. The parallel bar height needs to be adjusted to provide 15 to 20 degrees of elbow flexion when the patient is standing erect and is grasping the bars about 6 inches anterior to the hips. The bars need to be approximately 2 inches wider than the patient’s hips when the patient is centered between the bars.  Standard Walker Most stable AD No rolling out from under the patient Allows for more weight to be pushed through arms/hands, unweighting legs Slower walking speed Braking devices for standard walkers  Rolling Walker Faster walking speed Easier to move Tennis balls or glides on back legs make for easier sliding Do NOT need to pick up back legs when walking Wheels can roll out from under patient if all four legs are not in contact with ground/floor  Walkers Stair climbing walker  Rollator Fastest walking speed Seat for resting breaks Basket for carrying items Brakes on handles LEAST STABLE full walker Does NOT allow for very much weight to be pushed through the hands/arms Walkers: Knee walkers or rollabouts ONLY for patients who: Need an immediate place for sitting break Have good balance without needing to lean weight onto walker  Hemi-Walker Most stable option for patients without functional use of one arm/hand Ability to stand upright Larger base of support Easily folds together for storage Bulky/heavy  Walkers: Common Mistakes Leaning forward/hunching over Pushing walker too far in front Picking up walker while walking Pushing walker with one arm only  Walkers: Correct Use Stand up “tall” with both hands on walker Move the walker ahead about 15 cm (6 in.) while your body weight is borne by both legs. Stay close to walker Then move the right foot up to the walker while your body weight is borne by the left leg and both arms. Next, move the left foot up to the right foot while your body weight is borne by the right leg and both arms. All four legs of walker should be in contact with ground when stepping 1-Canes: by means of which force can be transmitted to the ground through the wrist and hand. Canes can be used for three purposes: A-To improve stability, this is achieved by increasing BOS. B- provide tactile information about the ground to improve balance C- To take part of the load away from the legs.  Types of canes: 1-STANDARD CANE Made of wood Or aluminum and has half circular Handle. The distal rubber tip is at least 1inch in diameter or larger. Advantage of wooden cane: Inexpensive and fits easily on stairs and other surfaces Disadvantage of wooden cane Not adjustable Advantage of aluminum cane: Quickly adjustable , light weight Disadvantage of wooden cane its more costly than a standard cane  2- Tripod and tetrapod cane (multi leg cane) Advantage of multi leg cane: provide wide BOS , can be adjustable Disadvantage Not practical for use on stairs To fit a patient with a cane, have the patient stand and place the can parallel to the lateral aspect of the tibia and femur. Adjust the hand piece of the cane so it is level with the ulnar styloid process. This will provide 15 to 25 degrees of elbow flexion when the patient grasps the handle of the cane 1. Measure the size of an existing cane. Do this method by simply measuring from the lowest part on the top of the handle to the bottom of the rubber tip 2.Measure the cane user 1- Put on the user's walking shoes. 2- Have the user stand naturally upright as much as possible. 3- Have their arms fall to the sides naturally with a normal relaxed bend at the elbow. 4- Using a tape measure or yard stick, measure the distance from their wrist joint (bottom crease at the wrist) down to the floor  Common Mistakes Leaning into cane Holding cane on same side as weaker leg Dragging cane behind Putting cane too far in front of body  Correct Use If patient has weaker leg, cane belongs in opposite hand of the weak leg Cane moves with weaker leg Keep cane vertical with upright posture 2-Crutches: Types of crutch: 1- Axillary crutches: they fit under the axilla. Need UE strength & coordination Need some trunk support Are used to relieve weight bearing fully or partially. Are used typically bilaterally and function to increase the base of support. Improve the lateral stability and allow upper extremity to transfer weight to the floor. Disadvantages of axillary crutches: 1.Axillary crutches are less stable than walker. 2.Improper use of axillary crutches can cause injury to the neurovascular structures in the axillary region. Axillary crutches require good standing balance by the patient. 3.Geriatric patient may fell insecure or may not have the necessary upper- body strength to use axillary crutches.  MEASUREMENT OF LENGTH : A. IN LYING : WITH SHOES ON : 5cm vertically down from apex of axilla till 20 cm lateral to the heel of the shoes. Measurement from axillary pad to hand grip : Elbow is flexed 15 degrees, mark a point 5 cm below the apex of axilla and measure till the ulnar styloid process. B. IN STANDING : Measure from 5cm under the user’s armpit to a point on the ground about 15cm out from the side of the heel. This is the overall height and where the axilla pad should be set. With shoulder relaxed, the hand piece should be adjusted to provide 20-30 degress of elbow flexion. Take the measurement from the wrist crease to the same point on the ground as the first. This is the height for the hand grips to be set. Tips for proper crutch sizing include: Some basic guidelines to follow when sizing your crutches include: The top of your crutches should be between one to 1 and 1/2 inches (5cm ) below your armpits while standing up straight. The handgrips of the crutches should be at the level of wrist crease. There should be a slight bend in your elbows when you use the handgrips. Hold the top of the crutches against your sides, and use your hands to absorb the weight. Do not press the top of the crutches into your armpits. This could result in damage to the nerves that run under your arms.  Forearm crutches (elbow crutches) MEASUREMENT OF CRUTCH LENGTH : 2”inch laterally and 6” inch anteriorly to the foot. Height should be adjusted with relaxed shoulders to provide 20-30 degrees of elbow flexion. The height of the handgrips should be at the crease of your wrist when your arm is extended. Correct Arm Cuff Location : Measurement should be at proximal third of the forearm i.e. 1-1.5 inches below the elbow. Disadvantages of forearm crutches: 1.Forearm crutches are less stable than a walker. 2.They require good standing balance and upper- body strength. 3.Geriatric patient sometimes feel insecure with these crutches. They may not have the necessary upper-body strength to use forearm crutches. 3-Walking frames and rollators (walkers): The most stable walking aid, which enable the subject to walk within the area of support provided by its base. Types of walkers: Regular walker Rolling walker  Walkers provide maximum stability and support and allow the patient to be mobile. Walkers are designed in many styles, but all have four legs. Some may have two or four wheels. Wheels allow the patient to gently push the device forward as opposed to picking the walker up to move it forward. Another variation in the design of the walker is the ability to fold the walker when it is not being used. This feature allows for easier transportation in a car and for storage.  Disadvantages of using walkers: 1. Walkers are cumbersome and difficult to store and transport. 2. Walkers are very difficult to use on stairs. 3. Walkers reduce the speed of ambulation. The patient is unable to use a normal gait pattern by using walker To properly fit a patient with a walker, adjust the height of the walker so that the patient has between 15 and 25 degrees of elbow flexion when grasping the handles of the walker.  GAIT PATTERN WITH WALKING AIDS 4-point alternate crutch gait A slow but stable gait which can be used when the patient can bear some weight on both lower extremities. when both legs are in a weakened condition. is used when the patient requires maximum assistance with balance sequence (1) Move the right crutch forward. (2) Move the left foot forward. (3) Move the left crutch forward. (4) Move the right foot forward The 2-point gait is used when the patient can bear some weight on both lower extremities. Place the patient in the tripod position and instruct him to do the following. (1) Move the right leg (affected) and left crutch forward together. (2) Move the left leg and the right crutch forward together. (3) Repeat this sequence for desired ambulation This pattern is faster than the four-point gait This pattern is less stable than the four-point pattern. The 3-point gait Fairly rapid but requires arm strength to support significant body weight and maintain balance. is used when the patient should not bear any weight on the affected leg sequence (1) Move the affected (non-weight bearing) leg and both crutches forward together. (2) Move the unaffected (weight bearing) leg forward. (3) Repeat this sequence for desired ambulation. Swing-to crutch gait (Faster than any gait above) The movement of the legs is parallel and this type of gait requires considerable arm and upper body strength to support the entire body weight. Sequence: bear weight on good leg (or legs); advance both crutches forward simultaneously, lean forward while swinging the body to a position even with the crutches Swing-through gait (fastest of all gaits). is used for patients with lower extremities that are paralyzed and/or in braces. Place the patient in the tripod position and instruct him to do the following: (1) Move both crutches forward together about 6 inches. (2) Move both legs forward together about 6 inches. (3) Repeat the sequence in rhythm for desired ambulation