assistive devices - walker

Assistive DevicesAssistive Devices Assistive devices for Assistive devices for

mobility/ambulation can be referred mobility/ambulation can be referred to as ambulatory aids. to as ambulatory aids.

Ambulatory aids (canes, crutches, Ambulatory aids (canes, crutches, walkers) are used to provide an walkers) are used to provide an extension of the upper extremities to extension of the upper extremities to help transmit body weight and help transmit body weight and provide support for the patient. provide support for the patient.

The type of ambulatory aid needed The type of ambulatory aid needed depends on how much balance and depends on how much balance and weight-bearing assistance is needed.weight-bearing assistance is needed.

Generally, the more disabled the Generally, the more disabled the individual is, the greater the complexity individual is, the greater the complexity required in the walking device. required in the walking device.

A walker supplies the most support, and a A walker supplies the most support, and a standard cane or crutch provides the least standard cane or crutch provides the least

Uses of assistive devices include Uses of assistive devices include the following:the following:

Redistribute and unload a Redistribute and unload a weight-bearing lower limbweight-bearing lower limb

Improve balanceImprove balance Reduce lower limb painReduce lower limb pain Provide sensory feedbackProvide sensory feedback

Batavia and Hammer identified 4 key Batavia and Hammer identified 4 key evaluation and selection criteria for long-term evaluation and selection criteria for long-term users of assistive devices :users of assistive devices :

EffectivenessEffectiveness - The extent to which the - The extent to which the function of the device improves one's living function of the device improves one's living situation, functional capability, or situation, functional capability, or independenceindependence

AffordabilityAffordability - The extent to which the - The extent to which the purchase, maintenance, or repair of the purchase, maintenance, or repair of the device causes financial difficultydevice causes financial difficulty

OperabilityOperability - The extent to which the device - The extent to which the device is easy to operate and adequately responds is easy to operate and adequately responds to demandsto demands

DependabilityDependability - The extent to which the - The extent to which the device operates with repeatable and device operates with repeatable and predictable levels of accuracy under predictable levels of accuracy under conditions of reasonable useconditions of reasonable use

Assistive devices and their use Assistive devices and their use for impairmentsfor impairments

Moderate-to-severe unilateral Moderate-to-severe unilateral weakness/hemiplegiaweakness/hemiplegia

-(Walk cane/ hemi-walker )-(Walk cane/ hemi-walker )

Bilateral lower extremity Bilateral lower extremity weakness/paralysis weakness/paralysis

- Bilateral crutches or walker (pickup or - Bilateral crutches or walker (pickup or front-wheeled)front-wheeled)

Severely impaired stability - Severely impaired stability - Walker (pickup or front-wheeled)Walker (pickup or front-wheeled)

Impaired wrist or hand function - Impaired wrist or hand function - Platform forearm walkerPlatform forearm walker

Difficulty climbing stairs - Stair-Difficulty climbing stairs - Stair-climbing walkerclimbing walker

WalkerWalker

A walker has four broadly spaced A walker has four broadly spaced posts that surround the person using posts that surround the person using it. Walkers can support up to 50% of it. Walkers can support up to 50% of body weight, so they may be useful body weight, so they may be useful for people who have a lot of for people who have a lot of weakness or problems on both sides weakness or problems on both sides

Advantage - Maximum support for Advantage - Maximum support for the patientthe patient

Disadvantages Disadvantages • Slow and awkward gaitSlow and awkward gait• Creates bad posture and walking habitsCreates bad posture and walking habits• Limited to indoor use in most casesLimited to indoor use in most cases• Cannot be safely used to climb stairs Cannot be safely used to climb stairs

(especially the standard walker)(especially the standard walker)

Advantages and disadvantages are Advantages and disadvantages are associated with the use of a walker associated with the use of a walker and should be considered when and should be considered when prescribing a walker as an assistive prescribing a walker as an assistive device for any patient.device for any patient.

Indications Indications • Best suited for patients who are Best suited for patients who are

confused or who have an unsafe confused or who have an unsafe gait because of poor balance gait because of poor balance (patients with hemiplegia, patients (patients with hemiplegia, patients with ataxia)with ataxia)

• Early gait trainingEarly gait training

Measuring prescription Measuring prescription • Place the front of the walker 12 inches Place the front of the walker 12 inches

in front of the patient. The walker should in front of the patient. The walker should partially surround the patient.partially surround the patient.

• Measure the proper height of the walker Measure the proper height of the walker by having the patient stand upright by having the patient stand upright with his/her elbows flexed 20°.with his/her elbows flexed 20°.

Components Components •Tubular aluminum or other Tubular aluminum or other tubular metal.tubular metal.

•Plastic handgrips.Plastic handgrips.•Rubber-tipped legsRubber-tipped legs

Types of WalkersTypes of Walkers

Standard walker (pickup walker)Standard walker (pickup walker) Rolling walker (front-wheeled Rolling walker (front-wheeled

walker)walker) Reciprocal walkerReciprocal walker Forearm support walkerForearm support walker Stair-climbing walkerStair-climbing walker Heavy-wheeled walker with Heavy-wheeled walker with

foldaway seat and removable foldaway seat and removable backback

Standard walker (pickup walker)Standard walker (pickup walker)


Most walkers are lightweight and very Most walkers are lightweight and very durable.durable.

Standard walkers have adjustable legs, Standard walkers have adjustable legs, accommodating a large percentage of accommodating a large percentage of patients.patients.

To use the standard walker for ambulation, To use the standard walker for ambulation, the patient must have the upper extremity the patient must have the upper extremity strength necessary to lift the device and strength necessary to lift the device and place it forward.place it forward.


Disadvantages :Disadvantages :

Bulky to transport (but most fold)Bulky to transport (but most fold) Stairs and tight spaces are difficult Stairs and tight spaces are difficult (eg, people with Parkinson’s disease (eg, people with Parkinson’s disease

often tend to fall backward, making often tend to fall backward, making this type of walker inappropriate) this type of walker inappropriate)

Rolling walker Rolling walker (front-wheeled walker)(front-wheeled walker)


The rolling walker has wheels on the front The rolling walker has wheels on the front legs; these wheels promote the walker's legs; these wheels promote the walker's movement.movement.

The rolling walker does not require as The rolling walker does not require as much strength and balance to maneuver much strength and balance to maneuver as the standard walker does, because the as the standard walker does, because the patient does not have to lift it from the patient does not have to lift it from the floor.floor.

Rolling walkers are used by patients who, Rolling walkers are used by patients who, because of poor coordination of the upper because of poor coordination of the upper extremity and trunk, are unable to lift the extremity and trunk, are unable to lift the walker and move it forward.walker and move it forward.


Disadvantages Disadvantages •The front wheels may create The front wheels may create

instability if they are not used instability if they are not used properly.properly.

•Proper supervised training Proper supervised training session is required to ensure session is required to ensure patient safety.patient safety.

Reciprocal walkerReciprocal walker

Reciprocal walkerReciprocal walker

This device has swivel joints that This device has swivel joints that permit reciprocal action, with each permit reciprocal action, with each side of the walker moving in side of the walker moving in alternation with the other.alternation with the other.

An advantage of the reciprocal An advantage of the reciprocal walker is that it allows a quicker and walker is that it allows a quicker and less awkward gait.less awkward gait.

Forearm support walkerForearm support walker

Forearm support walkerForearm support walker

Indications Indications • Patients with forearm deformities (wrists Patients with forearm deformities (wrists

or hands) or painor hands) or pain• Patients with elbow flexion contracturePatients with elbow flexion contracture

Disadvantage - HeavyDisadvantage - Heavy

Stair-climbing walkerStair-climbing walker

Stair-climbing walkerStair-climbing walker

This device requires good balance and This device requires good balance and great strength of the upper extremities.great strength of the upper extremities.

The stair-climbing walker is prescribed for The stair-climbing walker is prescribed for young patients with paraplegia.young patients with paraplegia.

A U-shaped extension is a possible A U-shaped extension is a possible additional component. This extension additional component. This extension provides extra support in order to enhance provides extra support in order to enhance stability for stair climbing. stability for stair climbing.

Heavy-wheeled walker with Heavy-wheeled walker with foldaway seat and removable foldaway seat and removable

backback

Indication - Indoor institutional useIndication - Indoor institutional use Disadvantage - Heavy, awkward, and Disadvantage - Heavy, awkward, and

unsafeunsafe

How to Use a WalkerHow to Use a Walker

First, you have to consider the First, you have to consider the various available models of walkers. various available models of walkers. Do you want rubber grips, rubber Do you want rubber grips, rubber tips, wheels, hand-brakes, tips, wheels, hand-brakes, accessories? Lightweight or accessories? Lightweight or heavyweight? The only way to know heavyweight? The only way to know for sure is to go to a medical supply for sure is to go to a medical supply store and see for yourself.store and see for yourself.

Once you have selected the Once you have selected the model of walker you want, the model of walker you want, the "fit" of the walker becomes "fit" of the walker becomes important. When holding on to important. When holding on to your walker, your elbows should your walker, your elbows should be bent in a position that feels be bent in a position that feels comfortable and natural. comfortable and natural.

The top of your walker should be The top of your walker should be even with the crease on the even with the crease on the underside of your wrist, after underside of your wrist, after relaxing your arms at your side. relaxing your arms at your side. Walkers that are too low cause you Walkers that are too low cause you to stoop over while you walk and not to stoop over while you walk and not use proper body mechanics. If your use proper body mechanics. If your walker is at the wrong height, the walker is at the wrong height, the improper position will surely cause improper position will surely cause aches and pains.aches and pains.

Sitting With Your WalkerSitting With Your Walker

Back up until you feel the chair Back up until you feel the chair against the back of your legs. against the back of your legs.

Slide your operated leg forward and Slide your operated leg forward and lower yourself slowly into the chair lower yourself slowly into the chair using armrests.using armrests.

Try to sit in a chair that has Try to sit in a chair that has armrests. DO NOT sit in rocking armrests. DO NOT sit in rocking chairs or chairs with wheelschairs or chairs with wheels

Standing With Your WalkerStanding With Your Walker

Scoot forward in the chair with your Scoot forward in the chair with your operated leg out in front of you. operated leg out in front of you.

Use both arms to push yourself up Use both arms to push yourself up to standing, then reach for the to standing, then reach for the walker.walker.

Stand for a minute or so to be sure Stand for a minute or so to be sure you feel stable and balanced.you feel stable and balanced.

DO NOT pull up DO NOT pull up the walker when the walker when rising from rising from sitting. sitting.

To walkTo walk With Your WalkerWith Your Walker

Keep your walker Keep your walker FLAT on the floor FLAT on the floor

When you are When you are ready to start ready to start walking, push the walking, push the walker slightly walker slightly ahead of youahead of you

DO NOT lift the DO NOT lift the walker off the walker off the floor. floor.

then step into the walker. Keep that then step into the walker. Keep that pattern going -- walker slightly pattern going -- walker slightly ahead, then step into the walker. ahead, then step into the walker.

The key point is that you should The key point is that you should never have the walker too far ahead never have the walker too far ahead of you and you should have excellent of you and you should have excellent posture as you take your steps. posture as you take your steps.

Also, don't look at your feet -- look in Also, don't look at your feet -- look in front of you. front of you.

DO NOT pivot too DO NOT pivot too quickly. Take small quickly. Take small steps and turn steps and turn toward your strong toward your strong leg. leg.

If you have trouble gripping the If you have trouble gripping the walker, platform walkers are walker, platform walkers are available may prove to be a better available may prove to be a better option. option.

They are not exactly attractive They are not exactly attractive contraptions but they serve a contraptions but they serve a purpose. The platform allows you to purpose. The platform allows you to rest your elbow and forearm, taking rest your elbow and forearm, taking stress off your hands. stress off your hands.

What Are Body Mechanics? What Are Body Mechanics? Body mechanics pertain to the Body mechanics pertain to the

position of your body when it's position of your body when it's moving. Proper body mechanics are moving. Proper body mechanics are important for everyone and important for everyone and especially for people with arthritis or especially for people with arthritis or other musculoskeletal conditions. other musculoskeletal conditions. Correct body position can help:Correct body position can help:

relieve pain relieve pain reduce stress on joints reduce stress on joints reduce the risk of injuryreduce the risk of injury

With every movement, as you stand, With every movement, as you stand, sit, walk, drive, lift, reach, push, pull, sit, walk, drive, lift, reach, push, pull, exercise, and even sleep, it's exercise, and even sleep, it's important to be aware of your body important to be aware of your body position. If you can improve your position. If you can improve your posture when moving, you are posture when moving, you are essentially protecting your joints.essentially protecting your joints.

How Do Proper Body Mechanics How Do Proper Body Mechanics Protect Joints? Protect Joints?

Proper body mechanics and specifically Proper body mechanics and specifically proper posture can:proper posture can:

align bones and joints align bones and joints reduce wear and tear on joints reduce wear and tear on joints reduce stress on supporting structures reduce stress on supporting structures

(e.g., ligaments and joints)(e.g., ligaments and joints) strengthen the spine strengthen the spine strengthen muscles strengthen muscles prevent muscle pain prevent muscle pain conserve energyconserve energy

How Can a Person Ensure Proper How Can a Person Ensure Proper Posture? Posture?

Well-toned muscles, normal Well-toned muscles, normal movement of the joints, and movement of the joints, and balanced muscle on the sides of the balanced muscle on the sides of the spine promote proper posture. That spine promote proper posture. That can be difficult for people with can be difficult for people with arthritis.arthritis.

Good posture while standingGood posture while standing implies that shoulder blades are implies that shoulder blades are back, chest forward, knees straight, back, chest forward, knees straight, and the top of your head should align and the top of your head should align with the ceiling. Your pelvis should with the ceiling. Your pelvis should not tilt. Arches of your feet should be not tilt. Arches of your feet should be supported with shoes. supported with shoes.

When sitting in a chairWhen sitting in a chair, your , your buttocks should be all the way to the buttocks should be all the way to the back of the chair. Your back should back of the chair. Your back should be straight and your shoulders be straight and your shoulders should be back. Knees, bent at right should be back. Knees, bent at right angles, should be at the same height angles, should be at the same height or higher than your hips. Feet should or higher than your hips. Feet should be flat on the floor.be flat on the floor.

A proper gaitA proper gait that incorporates that incorporates good posture and good body good posture and good body mechanics will help conserve energy. mechanics will help conserve energy. Arthritis patients who have severely Arthritis patients who have severely damaged joints or who have had damaged joints or who have had joint surgery may have an abnormal joint surgery may have an abnormal gait. If you can still walk you should gait. If you can still walk you should walk. Walking builds muscle strength walk. Walking builds muscle strength that in turn helps to protect joints.that in turn helps to protect joints.

If you must liftIf you must lift something that's something that's heavy, bend at your knees and hips heavy, bend at your knees and hips and lower your body down to meet and lower your body down to meet the object you are trying to pick up. the object you are trying to pick up. Never bend at the waist while Never bend at the waist while keeping your legs straight and keeping your legs straight and reaching down to grasp the object. reaching down to grasp the object.

If you must liftIf you must lift. There is a right way . There is a right way and a wrong way to move. Your body and a wrong way to move. Your body will be healthier and joints will be will be healthier and joints will be protected if you make a conscious protected if you make a conscious effort to move the right way. If you effort to move the right way. If you need a little coaching, perhaps a need a little coaching, perhaps a consultation with a physical therapist consultation with a physical therapist would be helpful. would be helpful.

Gait is the manner or style of Gait is the manner or style of walking.walking.

There are many types of gait. There are many types of gait. Antalgic Gait:Antalgic Gait: painful gait, a limp is painful gait, a limp is

adopted to avoid pain on weight adopted to avoid pain on weight bearing structures (hip, knee, ankle).bearing structures (hip, knee, ankle).

Ataxic Gait:Ataxic Gait: an unsteady, an unsteady, uncoordinated walk, a wide base of uncoordinated walk, a wide base of support is seen. normally due to support is seen. normally due to cerebellar disease.cerebellar disease.

Festinating Gait:Festinating Gait: short, accelerating short, accelerating steps are used to move forward, steps are used to move forward, often seen in people with Parkinson's often seen in people with Parkinson's disease.disease.

Four Point Gait:Four Point Gait: utilized by crutch utilized by crutch users, first on crutch, then the users, first on crutch, then the opposite leg followed by the other opposite leg followed by the other crutch and then the other leg.crutch and then the other leg.

Hemiplegic Gait:Hemiplegic Gait: involves flexion of involves flexion of the hip because of inability to clear the hip because of inability to clear the toes from the floor at the ankle the toes from the floor at the ankle and cirumduction at the hip.and cirumduction at the hip.

Spastic Gait:Spastic Gait: walk in which the legs walk in which the legs are held close together and move in are held close together and move in a stiff manner. often due to central a stiff manner. often due to central nervous system injuries.nervous system injuries.

End OF LectureEnd OF Lecture

God BlessGod Bless

assistive devices - walker

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