ambulation aids & assistive devices 2007
TRANSCRIPT
THE VARIOUS AMBULATION AIDS/ ASSISTIVE DEVICES COMMONLY PRESCRIBED
TO PATIENTS WITH IMPAIRMENTS &
LIMITATIONS IN WALKING.
PURPOSE BASIC FEATURES &
CHARACTERISTICS ADVANTAGES, DISADVANTAGES &
LIMITATIONS CORRECT MEASUREMENT
1. MEASUREMENT & FITTING
2.BASIC GAIT PATTERNS3. WHEELCHAIR MOBILITY4. SAFETY TECHNIQUES
•Act of walking or being able
to walk
•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)
What are the factors that influence
ambulation training
program?
FACTORS THAT INFLUENCE AMBULATION TRAINING
Joint ROM & Muscle Strength of Upper Extremity
Joint ROM & Muscle Strength of Lower Extremity
CoordinationTrunk BalanceImpairment in Sensory
Perception
What are the factors that
help determine ambulatory
needs?
FACTORS THAT HELP DETERMINE AMBULATORY
NEEDSNature of DisabilityAge of the Patient
Mental StatusPhysical EnduranceEnergy Expenditure
Arrange the following ambulation aids according to the MOST stable & supportive
to the LEAST stable & supportive.
Single CaneParallel Bars
WalkerForearm Crutches
Axillary Crutches Bilateral Canes
PARALLEL BARS
WALKERS
AXILLARY CRUTCHES
FOREARM CRUTCHES
BILATERAL CANES
SINGLE CANE
Arrange the following ambulation aids according to
the MOST REQUIRING COORDINATION to LEAST
REQUIRING COORDINATION.
WALKERCRUTCHES
CANEPARALLEL 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
•When maximal stability and support, along with MOBILITY is required.
•Wider and more stable BOS
•Adv:–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 Walkerc) Wheeled or Rollatord) Foldinge) Stair Climbing Walkerf) 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 attachmen
t for walker
•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
handle
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
•Provide support from axilla to floor
•2 points of contact•Better stability than
canes
•Two Basic Types:–Axillary Crutches–Non-axillary Crutches
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
DISADVANTAGES1. LESS STABLE THAN WALKER2. CAN CAUSE INJURY TO AXILLARY
VESSELS & NERVES IF USED PROPERLY3. REQUIRE GOOD STANDING BALANCE4. ELDERLY Pt. MAY FEEL INSECURE WITH
THEM5. 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
DISADVANTAGES1. 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 ACCESSORIESCRUTCH 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
PLATFORM CRUTCHFOR 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 NON-WEIGHTBEARING
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 dorsiLower trapeziusPectoralis 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/ECRBECU
6. FINGER AND THUMB FLEXORS
– to adequately grasp the hand piece
FDS
FDP
FPL & FPB
BASIC CRUTCH GAIT PATTERNS
1.Four Point Pattern2.Two Point Pattern
3.Modified Four Point or Two Point Pattern
4.Three Point Pattern
FOUR POINT PATTERN
• Requires the use of bilateral ambulation aids.
• Uses an alternate and reciprocal forward movement of the ambulation aid and the patient’s opposite lower extremity.
• ® crutch- (L) foot- (L) crutch- ® foot
Very slow but stable pattern, safest one to use in crowded areas
• Requires low energy expenditure• Can be used when patient requires
maximal stability or balance• Approximates a normal gait pattern
TWO POINT PATTERN•Requires the use of bilateral
ambulation aids•Uses a simultaneous &
reciprocal forward placement of the ambulation aid & the patient’s opposite extremity.
• ® crutch and (L) foot (L) crutch and ® foot
• Relatively stable pattern and faster than 4 point pattern
• Relatively low energy expenditure & similar to normal gait pattern
• Requires more coordination to move one UE & its opposite LE forward simultaneously.
MODIFIED 4- or 2- POINT PATTERN
• Require only one ambulation aid and are used for patient who only has one functional UE or who uses only one ambulation aid.
• Aid is held on the UE opposite the affected or protected LE.
THREE POINT PATTERN
• Requires bilateral ambulation aids or a walker
• Not for bilateral canes• Referred to as “step to” or
“step through” pattern rather than a “swing to” or “swing through”
•Used when the patient is able to bear weight on one LE but is NWB on the opposite LE.
•Walker or crutches and the NWB limb are advanced and then the patient steps up to the walker or through the crutches.
•Less stable pattern but more rapid ambulation
•Requires good strength of the UE, trunk and one LE.
•Higher energy expenditure
WHEELCHAIR•PURPOSE
–To promote independent mobility/functioning
–Prevention of injury / deformity
–Healthy body image–Minimize short/long term equipment cost
WHEELCHAIR
•INDICATIONS FOR USE–When ambulation is unadvisable
–When ambulation is impossible
SELECTION DETERMINANTS
1. AGE2. SIZE (height & weight)3. OPERATING CONDITIONS
• TRANSFERS• PROPULSION• MODE OF LIVING
•AREAS OF OPERATION–DOORWAY: 36” WIDTH–AVE TURNING SPACE: 60” X 60”
–HORIZONTAL WORKING TABLE REACH: 30.8”
–RAMPS: 1 ft. ELEVATION/ 12 ft. distance
•LEVEL OF DISABILITY (prognosis)
•SAFETY & COMFORT•COST•APPEARANCE
WHEELCHAIR FACTORS* SEAT X 2 CHECKLISTSUPPORT (SCALPS)- SAFETY, COMFORT OF
ARMS, LEGS, PELVIS & SPINESKINEASY PROPULSIONEASY TRANSFERALTERATION OF TONEACCOMMODATION (GROW FAST) – OF GROWTH,
OTHERS, WORSENING OF MEDICAL CONDITIONS, FUNCTIONAL ACTIVITIES, FUNCTIONAL ACTIVITIES, STRUCTURAL DEFORMITIES, TECH.
TRANSPORTABILITYTERRAIN
PARTS OF A WHEELCHAIR
Handgrips/ push
handles
Back upholstery
armrest
seat upholstery
wheel lock/lever
footplate
cross brace
Leg rest w/ calf
pad
moldedwheel
handrim
caster
clothing guard
TYPES OF WHEELCHAIR• ADULT/ PEDIATRIC• HEAVY/ MODERATE/ LIGHT WT./
ULTRALIGHT• MANUAL/ POWERED• FOLDING/ NON-FOLDING/
STAND-UP FRAME• RECLINING/ NON-RECLINING• TILTING/ NON-TILTING• METAL/ COMPOSITE
MANUAL WHEELCHAIR
POWEREDWHEELCHAIR
MANUAL vs. POWERED WHEELCHAIR
*Both types aims to increase independence level at work/school*
MANUAL vs. POWERED WHEELCHAIR
MANUAL•POOR ENDURANCE/
DISTANCE WALKING•Physical limitation is not
compatible with ambulation
MANUAL vs. POWERED WHEELCHAIR
POWERED• To spare the upper limb joints from
premature deterioration• To increase efficiency of mobility• To improve self-esteem• Physical limitations not compatible
with manual wheelchair mobility
Semi- Reclining Wheelchair
Full Reclining Wheelchair
One Arm Drive Wheelchair
Slide-On Wheelchair Lap Tray
Pediatric Wheelchair
Wheelchair Folding (With Commode)
RECREATIONAL/ SPORTS WHEELCHAIR
WHEELCHAIR MEASUREMENT
andCONFIRMATION OF
FIT
MEASUREMENT AVERAGE ADULT SIZE
INSTRUCTIONS CONFIRMATION OF FIT
SEAT HEIGHT/ LEG LENGTH
19.5 TO 20.5 INCHES
USER’S HEEL TO POPLITEAL FOLD
+ 2 IN(TO ALLOW
CLEARANCE OF FOOTREST)
A. WITH YOUR HAND // TO THE
FLOOR, YOU SHOULD BE ABLE TO INSERT 2 OR 3
FINGERS LENGTHWISE BET. THE Pt. POSTERIOR THIGH & THE SEAT UPHOLSTERY TO A DEPTH OF APPROX
2 INCHES
B. THE BOTTOM OF THE FOOT PLATE
MUST BE AT LEAST 2 IN ABOVE THE
FLOOR
SEAT DEPTH
16 INCHES POSTERIOR BUTTOCKS, ALONG LATERAL THIGH
-2 INCHES (TO AVOID PRESSURE
FROM THE FRONT EDGE OF THE SEAT AGAINST THE POPLITEAL SPACE)
WITH YOUR HAND // TO THE
FLOOR, YOU SHOULD BE ABLE
TO PLACE THE WIDTH OF 3 OR 4
FINGERS BETWEEN THE FRONT EDGE OF THE SEAT AND POPLITEAL FOLD
SEAT WIDTH 18 INCHES WIDEST ASPECT OF THE BUTTOCKS, HIPS OR
THIGH +2 INCHES
(PROVIDE SPACE FOR BULKY CLOTHING,
ORTHOSES, OR CLEARANCE OF THE
TROCHANTERS FROM THE ARMREST SIDE
PANEL
WITH YOUR HAND VERTICAL TO THE
FLOOR YOU SHOULD BE ABLE TO SLIDE EACH HAND BETWEEN
THE PATIENT’S HIPS AND THE CLOTHING
GUARD OF THE CHAIR WITH
MINIMAL CONTACT
BACK HEIGHT 16 TO 16.5 INCHES
FROM THE SEAT OF THE CHAIR TO
THE FLOOR OF THE AXILLA WITH
SHOULDER FLEXED 90˚ -4
INCHES
WITH YOUR HAND VERTICAL TO THE
FLOOR, YOU SHOULD BE ABLE TO PLACE THE WIDTH OF 4 FINGERS BETWEEN THE TOP OF
THE BACK UPHOLSTERY AND THE FLOOR OF THE
AXILLA
ARMREST HEIGHT 9 INCHES ABOVE THE CHAIR SEAT
FROM THE SEAT OF THE CHAIR TO
OLECRANON PROCESS WITH
THE ELBOW FLEXED TO 90˚
+1INCH
A. OBSERVE THE ANGLE MADE BY THE
POSTERIOR ASPECT OF THE UPPER ARM AND
THE BACK POST WHEN THE ELBOW REST ON
THE ARMREST APPROX. 4 INCHES IN FRONT OF
THE BACK POSTB. OBSERVE THE POSITION OF THE
TRUNK; IT SHOULD BE ERECT
“Pray as if everything depends on God;
Work as if everything depends on you.
Prepared & Updated by: ORTHO-PROSTHE
CLINICAL TEAMJuly 9, 2007