Assistive Devices

 Assistive devices for

mobility/ambulation can be referred
to as ambulatory aids.

 Ambulatory aids (canes, crutches,

walkers) are used to provide an
extension of the upper extremities to
help transmit body weight and
provide support for the patient.
 The type of ambulatory aid needed
depends on how much balance and
weight-bearing assistance is needed.
 Generally, the more disabled the
individual is, the greater the complexity
required in the walking device.
 A walker supplies the most support, and a
standard cane or crutch provides the least
Uses of assistive devices include
the following:
 Redistribute and unload a

weight-bearing lower limb

 Improve balance

 Reduce lower limb pain

 Provide sensory feedback

 Batavia and Hammer identified 4 key
evaluation and selection criteria for long-term
users of assistive devices :
 Effectiveness - The extent to which the
function of the device improves one's living
situation, functional capability, or
independence
 Affordability - The extent to which the
purchase, maintenance, or repair of the
device causes financial difficulty
 Operability - The extent to which the device
is easy to operate and adequately responds
to demands
 Dependability - The extent to which the
device operates with repeatable and
predictable levels of accuracy under
conditions of reasonable use
 Assistive devices and their use
for impairments
 Moderate-to-severe unilateral
weakness/hemiplegia
-(Walk cane/ hemi-walker )

 Bilateral lower extremity

weakness/paralysis
- Bilateral crutches or walker (pickup or
front-wheeled)
 Severely impaired stability -
Walker (pickup or front-wheeled)

 Impaired wrist or hand function -

Platform forearm walker

 Difficulty climbing stairs - Stair-

climbing walker
 Walker

 A walker has four broadly spaced

posts that surround the person using
it. Walkers can support up to 50% of
body weight, so they may be useful
for people who have a lot of
weakness or problems on both sides
 Advantage - Maximum support for
the patient
 Disadvantages
• Slow and awkward gait
• Creates bad posture and walking habits
• Limited to indoor use in most cases
• Cannot be safely used to climb stairs
(especially the standard walker)
 Advantages and disadvantages are
associated with the use of a walker
and should be considered when
prescribing a walker as an assistive
device for any patient.
 Indications
• Best suited for patients who are
confused or who have an unsafe
gait because of poor balance
(patients with hemiplegia, patients
with ataxia)
• Early gait training
 Measuring prescription
• Place the front of the walker 12 inches
in front of the patient. The walker
should partially surround the patient.
• Measure the proper height of the walker
by having the patient stand upright
with his/her elbows flexed 20°.
 Components
•Tubular aluminum or other
tubular metal.
•Plastic handgrips.
•Rubber-tipped legs
 Types of Walkers

 Standard walker (pickup walker)

 Rolling walker (front-wheeled
walker)
 Reciprocal walker
 Forearm support walker
 Stair-climbing walker
 Heavy-wheeled walker with
foldaway seat and removable
back
Standard walker (pickup walker)
Standard walker (pickup walker)
 Most walkers are lightweight and very
durable.
 Standard walkers have adjustable legs,
accommodating a large percentage of
patients.
 To use the standard walker for
ambulation, the patient must have the
upper extremity strength necessary to lift
the device and place it forward.
Standard walker (pickup walker)
Disadvantages :

 Bulky to transport (but most fold)

 Stairs and tight spaces are difficult
 (eg, people with Parkinson’s disease
often tend to fall backward, making
this type of walker inappropriate)
 Rolling walker
(front-wheeled walker)
 Rolling walker
(front-wheeled walker)
 The rolling walker has wheels on the front
legs; these wheels promote the walker's
movement.
 The rolling walker does not require as
much strength and balance to maneuver
as the standard walker does, because the
patient does not have to lift it from the
floor.
 Rolling walkers are used by patients who,
because of poor coordination of the upper
extremity and trunk, are unable to lift the
walker and move it forward.
 Rolling walker
(front-wheeled walker)
 Disadvantages
• The front wheels may create
instability if they are not used
properly.
• Proper supervised training
session is required to ensure
patient safety.
Reciprocal walker
 Reciprocal walker
 This device has swivel joints that
permit reciprocal action, with each
side of the walker moving in
alternation with the other.
 An advantage of the reciprocal
walker is that it allows a quicker and
less awkward gait.
Forearm support walker
 Forearm support walker
 Indications
• Patients with forearm deformities (wrists
or hands) or pain
• Patients with elbow flexion contracture
 Disadvantage - Heavy
Stair-climbing walker
 Stair-climbing walker
 This device requires good balance and
great strength of the upper extremities.
 The stair-climbing walker is prescribed for
young patients with paraplegia.
 A U-shaped extension is a possible
additional component. This extension
provides extra support in order to enhance
stability for stair climbing.
 Heavy-wheeled walker with
foldaway seat and removable
back

 Indication - Indoor institutional use

 Disadvantage - Heavy, awkward, and
unsafe
 How to Use a Walker

 First, you have to consider the

various available models of walkers.
Do you want rubber grips, rubber
tips, wheels, hand-brakes,
accessories? Lightweight or
heavyweight? The only way to know
for sure is to go to a medical supply
store and see for yourself.
 Once you have selected the
model of walker you want, the
"fit" of the walker becomes
important. When holding on to
your walker, your elbows should
be bent in a position that feels
comfortable and natural.
 The top of your walker should be
even with the crease on the
underside of your wrist, after
relaxing your arms at your side.
Walkers that are too low cause you
to stoop over while you walk and not
use proper body mechanics. If your
walker is at the wrong height, the
improper position will surely cause
aches and pains.
 Sitting With Your Walker
 Back up until you feel the chair
against the back of your legs.
 Slide your operated leg forward and
lower yourself slowly into the chair
using armrests.
 Try to sit in a chair that has
armrests. DO NOT sit in rocking
chairs or chairs with wheels
 Standing With Your Walker
 Scoot forward in the chair with your
operated leg out in front of you.

 Use both arms to push yourself up

to standing, then reach for the
walker.
 Stand for a minute or so to be sure
you feel stable and balanced.
 DO NOT pull up
the walker when
rising from
sitting.
 To walk With Your Walker
 Keep your walker
FLAT on the floor
 When you are
ready to start
walking, push the
walker slightly
ahead of you
 DO NOT lift the
walker off the
floor.
 then step into the walker. Keep that
pattern going -- walker slightly
ahead, then step into the walker.
 The key point is that you should
never have the walker too far ahead
of you and you should have excellent
posture as you take your steps.
 Also, don't look at your feet -- look
in front of you.
 DO NOT pivot too
quickly. Take small
steps and turn
toward your strong
leg.
 If you have trouble gripping the
walker, platform walkers are
available may prove to be a better
option.
 They are not exactly attractive
contraptions but they serve a
purpose. The platform allows you to
rest your elbow and forearm, taking
stress off your hands.
 What Are Body Mechanics?
 Body mechanics pertain to the
position of your body when it's
moving. Proper body mechanics are
important for everyone and
especially for people with arthritis or
other musculoskeletal conditions.
Correct body position can help:
 relieve pain
 reduce stress on joints
 reduce the risk of injury
 With every movement, as you stand,
sit, walk, drive, lift, reach, push, pull,
exercise, and even sleep, it's
important to be aware of your body
position. If you can improve your
posture when moving, you are
essentially protecting your joints.
 How Do Proper Body Mechanics
Protect Joints?
Proper body mechanics and specifically
proper posture can:
 align bones and joints

 reduce wear and tear on joints

 reduce stress on supporting structures

(e.g., ligaments and joints)
 strengthen the spine

 strengthen muscles

 prevent muscle pain

 conserve energy
 How Can a Person Ensure Proper
Posture?

 Well-toned muscles, normal

movement of the joints, and
balanced muscle on the sides of the
spine promote proper posture. That
can be difficult for people with
arthritis.
 Good posture while standing
implies that shoulder blades are
back, chest forward, knees straight,
and the top of your head should align
with the ceiling. Your pelvis should
not tilt. Arches of your feet should be
supported with shoes.
 When sitting in a chair, your
buttocks should be all the way to the
back of the chair. Your back should
be straight and your shoulders
should be back. Knees, bent at right
angles, should be at the same height
or higher than your hips. Feet should
be flat on the floor.
 A proper gait that incorporates
good posture and good body
mechanics will help conserve energy.
Arthritis patients who have severely
damaged joints or who have had
joint surgery may have an abnormal
gait. If you can still walk you should
walk. Walking builds muscle strength
that in turn helps to protect joints.
 If you must lift something that's
heavy, bend at your knees and hips
and lower your body down to meet
the object you are trying to pick up.
Never bend at the waist while
keeping your legs straight and
reaching down to grasp the object.
 If you must lift. There is a right
way and a wrong way to move. Your
body will be healthier and joints will
be protected if you make a conscious
effort to move the right way. If you
need a little coaching, perhaps a
consultation with a physical therapist
would be helpful.
 Gait is the manner or style of
walking.
There are many types of gait.
 Antalgic Gait: painful gait, a limp is

adopted to avoid pain on weight

bearing structures (hip, knee, ankle).
 Ataxic Gait: an unsteady,

uncoordinated walk, a wide base of

support is seen. normally due to
cerebellar disease.
 Festinating Gait: short, accelerating
steps are used to move forward,
often seen in people with Parkinson's
disease.
 Four Point Gait: utilized by crutch
users, first on crutch, then the
opposite leg followed by the other
crutch and then the other leg.
 Hemiplegic Gait: involves flexion of
the hip because of inability to clear
the toes from the floor at the ankle
and cirumduction at the hip.
 Spastic Gait: walk in which the legs
are held close together and move in
a stiff manner. often due to central
nervous system injuries.
End OF Lecture
God Bless