ASSISTIVE DEVICES and GAIT TRAINING

What are the main ambulation aids

Parallel bars, walkers, crutches, canes, knee scooters, orthotics, and trekking poles

What are parallel bars used for

Significant gait assist, strength, balance, functional, and pre-gait activities

What is the assistive device hierarchy from greatest support and least mobility to least support and most mobility

Parallel bars → walkers → bilateral crutches → single crutch → quad cane → SPC

What are walker advantages

Lightweight, easy to use, foldable, wide BOS, and very stable

What are walker disadvantages

Cumbersome, slower gait, pauses, no arm swing, forward lean, and reduced glute use

What is a pick-up walker used for

Standard walker with no wheels

What is a FWW used for

Front-wheeled walker for stable forward mobility

What is a 4WW used for

Rolling walker for greater mobility with walker support

What is a platform walker

A walker with a platform attachment

What is a hemi-walker used for

Difficulty controlling one side of the body

What are hemi-walker disadvantages

Slow abnormal gait and difficulty standing symmetrically

Where should walker handgrips be fitted

At the greater trochanter or wrist, preferably wrist level

How much elbow flexion should a walker allow

About 20°

How should a patient stand using a walker

Push off the chair with at least one hand

What are axillary crutch advantages

Adjustable, inexpensive, partial arm swing, and better mobility than walkers

What are axillary crutch disadvantages

Require good balance and UE/trunk strength with risk of axillary injury and chafing

Why should a patient not lean on axillary crutch rests

Risk of nerve and blood vessel damage in the axilla

What are forearm crutch advantages

No axillary injury risk, useful on stairs and in crowds, and good for long-term use

What are forearm crutch disadvantages

More expensive and the cuff is harder to remove during a fall

Where should a forearm crutch cuff sit

About 1–1.5 inches distal to the olecranon

Where are crutches placed during sit-to-stand or stand-to-sit with WB restrictions

On the involved side

Which hand should hold a cane

Opposite the affected side

What are cane advantages

Reciprocal gait, faster mobility, portability, and useful on stairs or in confined areas

What are cane disadvantages

Only about 30% BW support and limited balance assistance

When can a cane be used

WBAT or FWB and not with formal WB restrictions

Who may benefit from a quad cane

Patients with very slow gait or unilateral weakness

What are quad cane advantages

More stable than an SPC and useful for unilateral weakness

What are quad cane disadvantages

Can destabilize if used incorrectly and makes normal gait difficult

Where should a cane be fitted

At the greater trochanter or wrist/ulnar styloid, preferably wrist

What are knee scooter advantages

Better mobility, increased BOS, less UE stress, and less uninvolved LE stress

What are knee scooter disadvantages

Requires more coordination, cannot do stairs, can be expensive, and cannot be used for NWB injuries at the knee or higher

What is an orthosis

A support or brace used to align, correct, or prevent dysfunction or deformity

What are trekking poles used for

Balance, varied terrain, and faster speeds

What factors determine a gait pattern

Devices, movement order, stability, and WB status

When is 4-point gait used

Poor stability with no WB restrictions

What is the 4-point gait sequence

R crutch → L foot → L crutch → R foot

What are the characteristics of 4-point gait

Slow, stable, and low energy

What is the 2-point gait sequence

R crutch + L foot → L crutch + R foot

How does 2-point compare with 4-point gait

Faster and more normal but requires better coordination

Can 2-point gait be used with WB restrictions

No

What is modified 2- or 4-point gait

Same pattern using only one cane or crutch with no WB restrictions

When is 3-point gait used

Involved LE is NWB and uninvolved LE is FWB or WBAT

What devices are used for 3-point gait

Walker or bilateral axillary crutches

What is the 3-point gait sequence

Advance AD → uninvolved LE while involved LE remains NWB

What are the characteristics of 3-point gait

Faster but less stable with high energy demand

What does 3-point gait require

Good UE, trunk, uninvolved LE strength, and endurance

When is modified 3-point gait used

Involved LE is PWB or WBAT and uninvolved LE is FWB

What is the modified 3-point gait sequence

AD + involved LE → FWB uninvolved LE

How does modified 3-point compare with 3-point gait

More stable, slower, and requires less energy

What is step-to gait

LE advances even with the AD or opposite LE

What is step-through gait

LE advances past the AD or opposite LE

How do step-to and step-through compare

Step-to is slower and more stable while step-through is faster and less stable

What should be assessed before gait training

Vitals, strength, ROM, balance, motor control/coordination, and cognition

What factors determine the appropriate AD

Fit, goals, environment, support needed, balance, and coordination

What is the main rule for choosing an AD

Choose the least restrictive device that maximizes independence

What should be prepared before gait training

Area, equipment, lines/tubes, footwear, gait belt, AD, and assistance

What is the gait teaching sequence

Instruct → demonstrate → questions → practice

Where should the PT generally guard during gait

Behind and slightly to the side

Why guard toward the uninvolved side

Protect limited WB and guide COG over the uninvolved LE

Why guard toward the involved side

Assist the involved LE and encourage weight shift

How should a PT guard on stairs

Always from below with feet in stride

Which LE leads on stairs

Uninvolved LE up and involved LE down

What is the fall sequence

Move AD → control and lower patient → check injuries → get assistance

What should gait documentation include

WB status, AD/pattern, assistance, cues, distance/time, and surface