lecture 1 assistive devices and application

assistive devices (AD)

- parallel bars

- walkers

- crutches

- canes

parallel bars provide

greatest stability/max support with patients with decrease standing balance, fear/anxiety

parallel bars measurement and fit while standing:

- 2 inch lateral clearance on each side of hips

- height of bars to greater trochanters or wrist crease (ulnar styloid process

- elbow flexion of 20-25 degrees while holding bars

parallel bars abbreviation

// Bars

walkers types

PUW (pick up walker), FWW (front wheel walker), HW (hemiwalker)

walkers provide

maximum stability and support with mobility

disadvantage of walkers

- more stability means compromised mobility which leads to decrease in ambulation speed

- impedes normal flow of gait pattern

- difficult to use on stairs

- spatial awareness and transfer difficulty

measurement and fit of walker

- handles to wrist crease (ulnar styloid process)

- 20-25 degree elbow flexion

- stand as upright as possible, shoulders relaxed, head up

axillary crutches (AC)

- provides more mobility with a smaller base of support

- patient needs good standing balance and functional strength of trunks and UEs

disadvantage of axillary crutches (AC)

- if not used correctly, the pressure through the axilla can compress nerves and blood flow

- if balance and coordination is compromised

measurement and fit of axillary crutches

- space for 2-3 fingers in axilla (2 inches)

- crutch tips 2 inches lateral and 4-6 inches anterior to toe of shoe

- 20-25 degree of elbow flexion

estimating crutch length in sitting position

- shoulders abducted, one elbow in 90 degrees flexion

- measure distance from olecranon of flexed arm to tips of extended fingers of other arm

in supine position estimating crutch length

measure distance from anterior axillary line to a point 4-6 inches lateral to heel

forearm crutches aka

loftstrand or Canadian crutches

forearm crutches are good for

patients who need good standing balance and functional strength of trunk and UE

disadvantage of forearm crutches

- less stable

- difficult to remove because of cuff

- only 2 points of contact for BOS, pt feels less secure

forearm crutch measurement

- handle at ulnar styloid process

- top of cuff 1-1.5 inches from olecranon while holding hand grip

canes types

- WBQC (wide base quad cane)

- NBQC (narrow base quad cane)

- SPC (single point cane)

canes are not for

patients with weight bearing limitations

canes are carried on the sided of the

unaffected LE

disadvantages of cane

- less stable, less BOS

- not for pt without weight bearing

measurement of cane

- handle at ulnar styloid process

- 20-25 degree elbow flexion

forearm trough

attachment for crutches/waker that allows weight to be carried mainly through forearm vs wrist/hand

indications of use for forearm trough

- painful wrist/hand

- weak hand grip 2 degree pain or deformities

- elbow contractures

- below elbow amputation

disadvantage of forearm trough

- not able to fully use their triceps to unweight themselves

- trouble adjusting velcro straps on trough

- weight of AD is heavier

- impossible to use safely on stairs

measurement of forearm trough on walker

- adjust walker to proper height of patient first

- look for 90 degree elbow flexion with shoulder relaxed

- neutral position on handles or slightly pronated

factors to consider when choosing an AD

- diagnosis/prognosis

- UE involvement

- balance and coordination

- prior level of function (PLF)

- cognition

- past medical history (PMH)

- environment

- pain level

- weight bearing status

weight bearing status should always be

confirmed with MD order

types of weight bearing status

- NWB

- TTWB/TDWB

- PWB

- WBAT

- FWB

NWB

non weight bearing on affected extremity

TTWB/TDWB

toe touch or touch-down, mainly for balance assist only not full weight bearing

PWB

partial weight bearing, less than 50% pt weight or MD will specify %

WBAT

weight bearing as tolerated, may be limited secondary pain but no limitations

FWB

full weight bearing

assistance levels

- independent (indep) or I

- modified independent

- supervised (sup)

- standby assist (SBA)

- contact guard assist (CGA)

- min assist

- mod assist

- max assist

- dependent

independent (indep)

Pt requires no physical supervision or assist to consistently perform the activity safely

modified independent

pt is safe and independent with the assistance of equipment

supervised (sup)

pt requires assistance of another person to perform activity i.e: verbal cues

standby assist (SBA)

assisting person is close, but not touching the patient, providing occasional verbal/tactile cues

contact guard assist (CGA)

- caregiver is close with hand on gait belt

- pt will very likely need some form of protection during the activity

min assist

pt performs 75-90% or more of the activity with assist to complete the task

mod assist

pt performs 50-74% of the activity with assist to complete the task

max assist

pt performs 25-49% of activity with assist to complete the task

dependent (dep)

pt requires TOTAL physical assist

it is important during assistance to

try to define what the verbal cues or assist is for i.e: pacing, sequencing, posture, weight shifting

why is it important to document and define level of assist

- establish functional goals in your treatment plan with your patient

- ensure proper carryover by other staff

- record improvement or change in your patient's progress toward their set goals (insurance, MD)

hemi walker

pick up walker

front wheel walker

tricep crutches

offset crutch