Assistive Devices in Walking or Mobility Aids

Walking
• Walking is the manner or way in which you move from place to place with your feet.
• It is a Movement at a regular and fairly slow pace by lifting and setting down each foot in turn, never
having both feet off the ground at once.
• it is the highest level of motor control skill.
The major requirements for successful walking include:
• Support of body mass, by the lower extremities
• Production of locomotors rhythm
• Dynamic balance control of the moving body
• Propulsion of the body in the intended direction
• Basic terms
Ambulation: To walk from place to place or move about.
• It is a technique of post operative care in which a patient gets out of bed and engages in light activity
(as sitting, standing, or walking) as soon as possible after an operation.
• Some time this term is also use in the place of walking ..
Gait: Gait is a term to describe human locomotion, it is pattern of walking or a sequence of foot movements.
• Gait cycle or walking cycle
• A cycle of walking is the period from the heel-strike of one foot to the next heel-strike of the same foot
• When a subject is walking on level ground, than the movements of the lower limbs may be divided into
“swing” and “stance” phases.
• The swing phase occurs when the limb is off the ground, and the stance phase when it is in contact
with the ground and is bearing weight.
•
Walking or mobility aid is a device designed to assist walking and improve the mobility of people who
have difficulty in walking or people who cannot walk independently

Assistive Devices / Supportive Devices For Mobility

• Assistive devices are basically helpful products that improve a person’s ability to function
independently.
• They are used by people with disabilities and older adults who want to remain independent as
long as possible
• Indications for Ambulatory
Assistive Devices
• Structural deformity, amputation, injury, or disease resulting in decreased ability of Lower
extremities.
• Muscle weakness or paralysis of the trunk or Lower extremities
• Inadequate balance, pain and fatigue
 • Assistive Devices
• Commonly used Assistive devices for mobility includes :
 Cane
 Walkers
 Crutches
• Different Types of Assistive Devices

HOW TO USE:
• CANES
• WALKERS
• CRUTCHES
• Cane
- is a hand held ambulation device made of wood or aluminum; 20-25% of person’s body wt. is
transferred or transmitted in the cane
• Three types of canes are commonly used:
1. The standard straight-legged cane;
2. The tripod or crab cane, which has three feet
3. The quad cane, which has four feet and provides the most support
• Cane
• Cane
• Cane tips should have rubber caps to prevent slipping
• The standard cane is 91 cm long; some aluminum canes can be adjusted from 56 to 97 cm
INDICATIONS:
1. ½ of the body is affected (eg. Stroke patient)
2. Hip, knee & pathology on one side (eg. Arthritis)
3. Px with poor balance
• Walking with a Cane
PLACEMENT:
- Usually held on the opposite side or hand of the affected part or normal reciprocal pattern
(contralateral)
• Hold the cane with the hand on the stronger side of the body to provide maximum support and
when walking.
• Position the tip of a standard cane about 15 cm (6 in.) to the side and 15 cm (6 in.) in front of the
near foot, so that the elbow is slightly flexed.
• Walking with a Cane
 • Move the cane and weak leg forward at the same time, while the weight is borne by the stronger
leg.
• Move the stronger leg forward, while the weight is borne by the cane and the weak leg
ON STAIRS: (ASCENDING)
1. The unaffected LE leads up.
2. The cane and unaffected LE follow.
• Walking with a Cane
ON STAIRS: (DESCENDING)
1. The affected LE and cane lead down.
2. The unaffected LE follows.
• WALKERS
- are mechanical devices for ambulatory clients who need more support than a cane provides.
• The standard type is made of polished Aluminum.
• It has four legs with rubber tips and plastic hand grips.
• Many walkers have adjustable legs.
• Walker
• Walker
INDICATIONS:
1. For early ambulation training in preparation for using crutch.
2. Px with very poor balance or who are confused
3. Very weak and very old px.
• Walking With Walkers
• Move the walker ahead about 15 cm (6 in.) while your body weight is borne by both legs.
• 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.
• CRUTCHES
• Crutches may be a temporary need for some clients and a permanent one for others; prescribed
to px with poor trunk balance but with very good UE.
• The most frequently used kinds of crutches are the Underarm Crutch, Or Axillary Crutch with
hand bars, and the Lofstrand Crutch, which extends only to the forearm.
• In crutch walking, the client’s weight is borne by the muscles of the shoulder girdle and the
upper extremities.
• CRUTCHES
 • Advantages and Disadvantages of Under Arm Crutches
Advantages:
• Convenience for temporary injuries
• A large degree of support for the lower body
• Available at low cost.
• Axillary crutches allow the patient to perform a greater variety of gait patterns and ambulate at a faster
pace.
• Disadvantages:
• Limited upper body freedom
• Axillary crutches require good standing balance by the patient.
• Improper use of crutch can cause injury to axillary region, and Strain on the arms and upper body which
can lead crutch paralysis. It is a condition in which the nerves under the arms (Radial nerve and
brachial plexus) are pinched and also risk of losing balance.
• Geriatric patient may fell insecure or may not have the necessary upper- body strength to use axillary
crutches
• Elbow crutches /forearm crutches/ Lofstrand crutch
• They are made of metal an aluminum tubular shaft with a handgrip and have a metal or plastic
forearm band.
• Forearm piece bent backward and extended to 2 inches below the elbow.
• Both handgrip and forearm piece are adjustable in length by means of a press clip or metal
button and have a rubber ferrule.
• These crutches are suitable for patients with good balance and coordination with strong arms.
Weight is transmitted exactly the same way as for axillary crutches.
• Advantage of elbow crutches
 Light weight
 Easily adjustable
 freedom for hand activities
 Using forearm crutches requires no more energy, increased oxygen consumption or heart rate than
axillary crutches.
 Being easily stored and transferred.
 There is no risk of injury to the neurovascular structures in the axillary region when using this type of
crutches.
• Disadvantages of forearm crutches
• Forearm crutches are less stable .
• They require good standing balance and upper-body strength.
• Geriatric patient sometimes feel insecure with these crutches. They may not have the necessary upper-
body strength to use forearm crutches.
 • Forearm support crutches/gutter crutches/
platform crutch
• They are made of metal with a padded forearm support Platform, Velcro strap an adjustable hand piece
and a rubber ferrule.
• These are used for patients with Painful wrist and hand condition or elbow contractures, or weak hand
grip
• Elbow flexed 90 degrees, The hand rests on a grip which can be angled appropriately, depending on
the user's disability.
• Mostly In rheumatoid disease, cerebral palsy, or other conditions for providing support. In these
conditions patient cannot take weight through hands, wrists and elbows because of deformity or pain.
• MEASUREMENT :
IN LYING POSITION
With shoes on: measure from the point of fixed elbow till 20 cm lateral to the heel.
• ADVANTAGES :
• As similar like elbow crutch
• These are easily adjustable.
• More cosmetic than other crutches.
• DISADVANTAGES :
• Provide less lateral support due to absence of axillary pad.
• Cuffs may be difficult to remove.
• These can be expensive.
• Crutch walking
• During first time, when the patient is to stand and walk, the physiotherapist should have an assistant for
supporting the patient.
• Non-weight bearing: patient should always stand with a triangular base i.e. crutches either in front or
behind the weight bearing leg
• Partial weight bearing: The crutches and the affected leg are taken forward and put down together.
Weight is then taken through the crutches and the affected leg, while the unaffected leg is brought
through.
• Gait pattern with crutches
• Four point gait
• Three point gait
• Two point gait
• Two point swing through gait
• Two point swing to gait (the feet are advanced by a much shorter distance and placed behind the level
of crutches)
• Four-point gait
 In this gait pattern one crutch is advanced and then the opposite lower extremity is advanced. For
example, the left crutch is moved forward, then the right lower extremity, followed by the right crutch
and then the left lower extremity.
• Slow, Good stability - at least 3 point contact ground
• Weight is on both lower extremities and used with bilateral involvement due to poor balance,
in coordination( Ataxia) and muscle weakness
• Four-point Gait
The nurse asks the client to:
1. Move the right crutch ahead a suitable distance, such as 10 to 15 cm (4 to 6 in.).
2. Move the left foot forward.
3. Move the left crutch forward.
4. Move the right foot forward.
• Three-point gait
• In this type of gait three points of support contact the floor.
• Non-weight-bearing gait for lower limb fracture or amputation
• Three point gait
• To use this gait, the client must be able to bear the entire body weight on the unaffected leg.
• The two crutches and the unaffected leg bear weight alternately
• The nurse asks the client to
1.Move both crutches and the weaker leg forward.
2. Move the stronger leg forward.
• Non Weight Bearing
• Two-point gait
• This gait pattern is similar to the four-point gait. However, it is less stable because only two
points of floor contact are maintained. Thus, use of this gait requires better balance.
• The two-point pattern more closely stimulates normal gait, in as much as the opposite lower
and upper extremity move together.
• Two-point gait
• The nurse asks the client to:
1. Move the left crutch and the right foot forward together.
2. Move the right crutch and the left foot ahead together
• Two additional, less commonly used crutch gaits are the swing-to and swing-through patterns. These
gaits are often used when there is bilateral lower extremity involvement, such as in spinal cord injuries.
• Swing-through gait
• Fastest gait, requires functional abdominal muscles
 • In the swing-through gait, the crutches are moved forward together, but the lower extremities
are swing beyond the crutches.
• Swing-Through Gait
• The nurse asks the client to:
1. Move both crutches forward together
2. Lift body weight by the arms and swing through and beyond the crutch
• Swing-to gait
• Both crutches -> both lower limbs almost to crutch level
• The swing-to gait involves forward movement of both crutches simultaneously, and the lower
extremities “swing to” the crutches.
• Swing-to gait
• The swing gaits are used by clients with paralysis of the legs and hips
1. Move both crutches ahead together.
2. Lift body weight by the arms and swing to the crutches.
 4 point gait –Balance and confidence / full weight bearing
 3 point gait – Balance and partial weight bearing
 2 point gait – non weight-bearing/ full weight bearing
 Point gait – stability, slow
 Swing gait – more energy, fast
• Stair Climbing
Up With GOOD, Down With BAD
Stairs
To begin, place both crutches under the arm of the injured side, holding the inside handle with the thumb.
Hold onto the railing with the other hand. When using stairs, remember, “up with the good, down with the
bad.”
• To Ascend
• Leave crutches on the same level where standing.
• Support weight evenly on the crutch hand and railing.
• Raise the uninjured foot to the higher step, letting the injured foot trail behind.
• Straighten the uninjured leg and advance the crutches.
• To Descend
• Place the crutches on the lower step, while extending the injured foot forward. Place the crutches on
both sides of the body if no railing is present.
• Support weight evenly on the crutch hand and railing.
• Move the uninjured foot to the lower step.
• Narrow steps without a railing might require sitting on each step.