AMBULATION AIDS and ASSISTIVE DEVICES THE VARIOUS AMBULATION AIDS/ ASSISTIVE DEVICES COMMONLY PRESCRIBED TO PATIENTS WITH

IMPAIRMENTS & LIMITATIONS IN WALKING.  PURPOSE  BASIC FEATURES & CHARACTERISTICS  ADVANTAGES, DISADVANTAGES & LIMITATIONS  CORRECT MEASUREMENT Learn to perform 1. MEASUREMENT & FITTING 2. BASIC GAIT PATTERNS 3. WHEELCHAIR MOBILITY 4. SAFETY TECHNIQUES Ambulation Act of walking or being able to walk Ambulation aids A piece of equipment used to provide support or stability for a person as he/she walks (Pierson, 1999) Appliance to aid ambulation Provide an extension of the UE to help transmit BW & provide support for the patient Functions of the Ambulation Aids Increase area of support Increase patient s stability Redistribute & unload a weightbearing limb Improve balance Provide sensory feedback Selection of the proper ambulation devices & gait pattern is most important to provide optimal security, safety, & function with the least energy expenditure. What is my role as a physiotherapist? Know WHEN to indicate Know the RIGHT ambulation aid to use Provide PRE-Ambulation Exercises Stages: Strengthening Exe Coordination Exe Trunk Balance Exe Use of Ambulation Aids (END GOAL) FACTORS THAT INFLUENCE AMBULATION TRAINING  Joint ROM & Muscle Strength of Upper Extremity  Joint ROM & Muscle Strength of Lower Extremity

 Coordination  Trunk Balance  Impairment in Sensory Perception FACTORS THAT HELP DETERMINE AMBULATORY NEEDS  Nature of Disability  Age of the Patient  Mental Status  Physical Endurance  Energy Expenditure AMBULATION AIDS CRUTCHES

CANES

WALKERS

PARALLEL BARS

Most stable to least 1. Paralle bars 2. Walkers

3. Axillary crutches 4. Forearm crutches 5. Bilateral canes 6. Single canes Requiring coordination to least 1. Crutches 2. Canes 3. Walker 4. Parallel bars PARALLEL BARS When maximal patient stability and support is required Bars should be adjusted for proper fitting. Disadvantages: Bars severely limit mobility Pt. must progress to another ambulation aid to be mobile WALKERS When maximal stability and support, along with MOBILITY is required. Wider and more stable BOS sAdv: Lightweight Foldable Safer and provide good support Disadv: Difficult to store/transport Difficult to use on stairs Slow & awkward gait pattern Difficult to use in narrow/ crowded places Pre-requisites for the use of a walker Good grasp Good bilateral arm strength Parts Tubular aluminum, plastic hand grips & rubber tipped legs TYPES and VARIATIONS of WALKERS a) Standard Non-adjustable Adjustable b) Reciprocal Walker c) Wheeled or Rollator d) Folding e) Stair Climbing Walker f) One-hand Walker (hemiplegic)

Rollator

Lightweight Aluminium Rollator Walker Standard Lightweight Aluminium Triwalker Basic PRONE CRAWLER Walker Paraplegia (adult) Stair climbing walker RECIPROCAL WALKER Forward Hemi walker FOLDING WALKER WITH GLIDES/ ROLLATOR Platform attachment for walker CANES Used to compensate for impaired balance or to improve stability Approximately 25% of BW is transferred Oldest of all assistive devices Held opposite the affected LE Provide more physiologic gait Wider BOS Reduce stress on opposite hip Adv: More functional on stairs Can be used in narrow and confined places Easy storage and transport Disadvantages: Limited stability 2 canes do not provide sufficient stability to perform a 3-point gait pattern PARTS HANDLE ( J / T / C - shaped, PISTOL GRIP, OFFSET) SINGLE UPRIGHT RUBBER SUCTION TIP Standard Crook Cane Modified Crook Cane Cane w/ Ortho Grip

OFFSET CANE W/ WRIST STRAP Quad Cane with Offset Handle Quad cane with large inverted "V" base Quad cane w/ "U" shape hand grip CANE SEAT

CRUTCHES Provide support from axilla to floor 2 points of contact Better stability than canes Two Basic Types: Axillary Crutches -Transfers 80% of BW - Requires better trunk support - Allow selection of gait patterns & ambulation speed - Provide good support and stability  PARTS  SHOULDER PIECE  DOUBLE UPRIGHT  HAND GRIP/ BAR  RUBBER SUCTION TIP DISADVANTAGES 1. LESS STABLE THAN WALKER 2. CAN CAUSE INJURY TO AXILLARY VESSELS & NERVES IF USED PROPERLY 3. REQUIRE GOOD STANDING BALANCE 4. ELDERLY Pt. MAY FEEL INSECURE WITH THEM 5. FUNCTIONAL STRENGTH OF THE UE & TRUNK MUSCLES IS REQUIRED FOR MOST GAIT PATTERNS Non-axillary Crutches TRANSFERS 40-50% BW ELIMINATE THE DANGER OF INJURY TO AXILLARY VESSELS & NERVES MORE FUNCTIONAL ON STAIRS & IN NARROW, CONFINES AREAS RELATIVELY EASY TO STORE & TRANSPORT FOREARM CUFF RETAINS THE CRUTCH ON THE FOREARM WHEN Pt. REACHES FOR AN OBJECT DISADVANTAGES

1. PROVIDE LESS STABILITY & SUPPORT THAN AXILLARY CRUTCHES, A WALKER, OR PARALLEL BARS 2. THEY REQUIRE GOOD STANDING BALANCE & GOOD UE STRENGTH FOR MANY GAIT PATTERNS 3. THE FOREARM CUFF MAKES IT DIFFICULT TO REMOVE THE CRUTCH 4. ELDERLY Pt. MAY FEEL INSECURE WITH THEM CRUTCH ACCESSORIES  CRUTCH TIP (RUBBER SUCTION TIP)  AXILLARY PADS (RUBBER/ SPONGE)  HAND GRIPS (SPONGE PAD)  TRICEPS BAND (METAL/ STIFF LEATHER)  WRIST STRAP (LEATHER/ PLASTIC) Loftstrand Crutches

PARTS OF LOFTSTRAND CRUTCH 1. FOREARM CUFF 2. PADDED HAND BAR 3. TUBULAR ALUMINUM -SINGLE UPRIGHT PLATFORM CRUTCH FOR INDIVIDUALS WHO ARE/HAVE: UNABLE TO BEAR WEIGHT THROUGH THEIR WRISTS & HANDS SEVERE DEFORMITIES OF THE WRIST OR FINGERS BELOW ELBOW AMPUTATION UNABLE TO EXTEND ONE OR BOTH ELBOWS PASSIVELY DISADVANTAGES 1. THE PATIENT LOSES THE USE OF HIS/HER TRICEPS TO ELEVATE & MAINTAIN HIS/ HER BODY DURING THE SWING PHASE 2. ANOTHER PERSON MAY NEED TO APPLY THEM 3. THEY ARE LESS EFFECTIVE ON STAIRS MAJOR MUSCLE GROUPS USED FOR NONWEIGHTBEARING AMBULATION Upper Trunk Scapular Depressors Scapular Stabilizers Lower Trunk Trunk Extensors Trunk Flexors Upper Extremity

 Shoulder Depressors Shoulder Extensors and Flexors Elbow Extensors Finger Flexors Weight Bearing Lower Extremities Hip Abductors Hip Extensors Knee Extensors Ankle Dorsiflexors IMPORTANT SPECIFIC CRUTCH WALKING MUSCLES 1. SCAPULAR DEPRESSORS -stabilize the UE & prevent hiking of the shoulder on weight bearing  Latissimus dorsi  Lower trapezius  Pectoralis minor 2.SHOULDER ADDUCTORS - hold the crutch top to the chest wall with the arm  Pectoralis major  Latissimus dorsi 3. FLEXORS, EXTENSORS, ABDUCTORS OF THE ARM & SHOULDER - enable the placement of crutch forward, backeard, and sideward respectively  Deltoids 4. ELBOW EXTENSORS stabilize the elbow joint in weight bearing by preventing flexion or buckling; together with shoulder depressors these muscles are most important in raising the body from the floor to allow the LE to swing  Triceps  Anconeus 5. WRIST EXTENSORS hold wrist in proper position to bear weight on hand piece  ECRL/ECRB  ECU 6. FINGER AND THUMB FLEXORS to adequately grasp the hand piece  FDS  FDP  FPL & FPB Measurement and Fit  Parallel Bars

 Bars should be adjusted to provide 2025 degrees of elbow flexion when the pt stands erect  Approximately 6 inches anterior to his or her hips.  The bars should be approximately 2 inches wider than the patients greater trochanter or with the patient s ulnar styloid process