Assistive Technology Lesson 4: Assistive Devices

Assistive Devices

• Provides additional means of support

• Increases base of support

● parallel bars

● walker

● crutches

● canes

Most commonly used ad in rehabilitation

Full weight-bearing (FWB)

• There are no restrictions on weight-bearing;

• 100% of body weight can be borne on the LE

Non–weight-bearing (NWB)

• No weight is borne on the involved limb; foot/toes make no contact with floor/ ground surface.

Partial weight-bearing (PWB)

• Only a portion of weight can be borne on the extremity; sometimes expressed as a percentage of body weight (e.g., 20% or 50%)

Toe-touch weight-bearing (TTWB) or touch-down weight-bearing (TDWB)

Only the toes of the affected extremity contact the floor to improve balance (not to support body weight)

Weight-bearing as tolerated (WBAT)

• Weight-bearing is limited by patient tolerance of weight borne on extremity

PARALLEL BARS

• for patient instruction in a gait pattern

• for practice

• relative safety

WALKERS

• To improve balance

• To relieve weight bearing either fully or partially on a LE

• Affords the greatest stability

• Provide a wide BOS

• Improve anterior and lateral stability

• Allows UE to transfer body weight to the floor

Glides

• part of the walker thats small, plastic attachments placed on the POSTERIOR legs in combination with wheels on the front legs

• Smooth forward progression without having to lift with each steps

• ALTERNATIVE: tennis balls

Folding Mechanism

• part of the walker thats for patients who travel

• Collapse to fit in a car or storage

HANDGRIPS/HANDLES

• part of the walker that’s for enlarge and molded handgrips available for px with arthritis

• Some with second set of handles to assists with sit to stand

WHEEL ATTACHMENTS

• “Rolling Walkers” •

• Either 2 infront or all 4 legs with wheels •

• For px who are unable to lift a conventional walker •

• Swivel wheels / fixed wheels •

• 3”, 5”, 6” diameter

• Altered weight bearing status bawal dito kasi may wheels

TRIPOD ROLLING WALKER

Type of walker thats

• Tripod design

• Rollators

• Ease in maneuverability and turning

• Folds

• Height adjustment through handles

STORAGE ATTACHMENTS

• part of the walker thats only for essential items

• May create excessive anterior load -> safety hazard

SEATING SURFACE

• part of the walker thas for px with limited endurance

• Community ambulators who require periodic rest

Measurment of Walkers

• Top of the ___at the level of the greater trochanter

• Elbow should be flexed between 20-30 degrees

Full Weight Bearing Gait Pattern (walker)

What gait is
1. The walker is picked up and moved forward about an arm’s length.

2. The first LE is moved forward.

3. The second LE is moved forward past the first.

4. The cycle is repeated

Partial Weight Bearing Gait Pattern (walker)

What gait is

1. The walker is picked up and moved forward about an arm’s length.

2. The involved ___limb is moved forward, and body weight is transferred partially onto this limb and partially through the UEs to the walker.

3. The uninvolved LE is moved forward past the involved limb.

4. The cycle is repeated.

Non-Weight Bearing Gait Pattern (Walker)

1. The walker is picked up and moved forward about an arm’s length.

2. Weight is then transferred through the UEs to the walker. The involved NWB limb is held anterior to the patient’s body but does not make contact with the floor.

3. The uninvolved limb is moved forward.

4. The cycle is repeated

crutches

• Improve balance

• Relieves weight bearing fully or partially on a LE

• Increase BOS

• Improve lateral stability

• Allow UE to transfer body weight to the floor

AXILLARY CRUTCHES

Type of crutches thats

• “Standard crutches”

• Lightweight wood or aluminum

• Has axillary bar, handpiece, double uprights joined distally by a single leg with rubber suction cap (1.5-3”)

• Handgrip adjust 1” increments

• Size: 48-60”

PLATFORM ATTACHMENTS

Type of crutches thats

• “forearm rests or troughs”

• Also used with walkers

• Allow transfer of body weight through the forearm to the assistive device.

• Used when WB is contraindicated through wrist and hand

FOREARM CRUTCHES

Type of crutches thats

• “Lofstrand” or “Canadian” crutches

• Lightweight wood or aluminum

• Has single upright, forearm cuff and handgrip

• Dual adjustment ○ Proximal: Forearm cuff ○ Distally: Height of AD

• Size: 29-35

MEASUREMENT: Axillary Crutches

Measurement for this type of crutches

Standing:

• Approximately 2” below the axilla (2 fingerbreaths)

• Distal end of crutch should be resting 2” lateral and 6” anterior to the foot

• ESTIMATE: Subtract 16” from px height

• HANDPIECE: adjusted to 20-30 deg elbow flexion

MEASUREMENT: Axillary Crutches

What AT is this measurment for
Supine:

• Anterior axillary fold to a surface point 6-8” from the lateral border of the heel

MEASUREMENT: Forearm Crutches

What AT is this measurement for
Standing:

• Distal end of crutch should be resting 2” lateral and 6” anterior to the foot

• Shoulders relaxed, elbow flexed to 20-30 deg flexion

• CUFF: proximal third of the forearm, approx. 1-1.5” below the elbow

THREE-POINT GAIT PATTERN (Crutches)

What kind of gait pattern
NWB status is required on LE

THREE-POINT GAIT PATTERN (Crutches)

What kind of gait pattern
Partial WB modification

FOUR-POINT GAIT PATTERN

What kind of gait pattern

• Slow, steady gait -> 3 point floor contact are maintained

• Used with bilateral involvement d/t poor balance, incoordination or muscle weakness

TWO-POINT GAIT PATTERN

What kind of gait pattern

• Less stable -> only two points of floor contact are maintained

• Requires better balance

• More closely simulates normal gait

canes

• Most ___used in clinical practice are lightweight and aluminum

• Evidence supports the effectiveness of ___to improve balance

• Reduce biomechanical load on LE joints

• Not intended for use with restricted weight bearing

• Typically used opposite the affected extremity

• Most closely approximates the normal gait pattern

STANDARD CANE

Type of cane thats

• Single-point cane / straight cane

• Wood or acrylic

• “crook” (half-circle) or T-shaped handle

STANDARD ADJUSTABLE ALUMINUM CANE

Type of cane thats

• Aluminum, crook handle with molded plastic cover

• Telescoping design with push button mechanism reinforced by thumb screw of rotation sleeve

• Adjustable 27-38.5”

STANDARD ADJUSTABLE OFFSET CANE

Type of cane thats

• Straight offset handle

• Adjustable 27-38.5”

HEMI CANE

type of cane thats

• Very broad base with 4 points of floor contact with rubber tips

• Legs farther from the patient are angled to maintain floor contact and to improve stability

• Fold flat

• Adjustable approx. 29-37”

ROLLING CANE

Type of cane thats

• Wide, wheeled base for uninterrupted forward progression •

• Contoured handgrip

• Adjustable 28-37”

• Pressure sensitive brake

LASER CANE

Type of cane thats

• Bright red laser line projected across the floor designed to overcome freezing episodes while walking

• Look at laser line during freezing (shufflinh and festinating- parkinsons patients) episodes only

Regular Rubber Tip

what kind of cane tip

Tripod Tip

what kind of tip

Foldable Spiked Tip

what kind of tip

CANES MEASUREMENT

what kind of measurment is this

• Place ___approx. 6’ to lateral border of toes •

• Two methods

  • Top of ___at the level of the greater trochanter ○

  • Elbow should be flexed between 20-30 degrees**

    • Allows the arm to lengthen and shorten during different phases of gait

    • Shock absorption mechanism

    • ** more impt indicator of correct cane height

CANES GAIT PATTERN

what kind of gait pattern is this

• Placing the ___too far forward or to the side will cause forward or lateral bending -> decreasing dynamic stability

• Bilateral involvement? •

  • Which side is cane more comfy?

  • Which side would make balance more stable/improve ambulatory endurance?

  • Is one side more able to correct gait deviation

  • More safer

  • Grip strength

  • Two canes? -> two or four point gait pattern

Bed rails

• Enables the patient to perform bed mobility and transfers and avoid soft-tissue pressure and dev’t of contractures as a result of prolonged immobilization

• Protects the patient from rolling off the bed

Overhead trapeze

• AT for moving a supine patient to a sitting position

Call light

• When turned activated, a light/buzz over the patient’s doorway interpreting that the patient requires assistance

Sliding board

-It can help ease the transfer by bridging the gap between a surface to another surface (i.e., bed to wheelchair)

Pivot disk

• Used to facilitate the pivoting process for patients during pivot transfers

• More commonly used for moderate and maximum-assist manual transfers

Marisa lift/sit-to-stand lift

• Designed to lift a dependent patient for the purpose of transfer

Guarding techniques during ambulatory exercis

1. The therapist stands posterior and lateral to the patient’s weaker side.

2. A wide BOS should be maintained with the therapist’s leading LE following the assistive device. The therapist’s opposite LE should be externally rotated and follow the patient’s weaker LE.

3. One of the therapist’s hands is placed posteriorly on the guarding belt and the other anterior to, but not touching, the patient’s shoulder on the weaker side.

Stair climbing

• If railing is available, it should always be used, even if it requires placing the assistive device in the hand in which it is not normally used

• GOOD LEG GOES TO HEAVEN, BAD LEG GOES TO HELL

Guarding techniques on stair climbing: ASCENDING STAIRS

1. The therapist is positioned posterior and lateral on the affected side behind the patient.

2. A wide BOS should be maintained with each foot on a different stair.

3. A step should be taken only when the patient is not moving.

4. One hand is placed posteriorly on the guarding belt and one is anterior to, but not touching, the shoulder on the weaker side.

Guarding techniques on stair climbing: DESCENDING STAIRS

1. The therapist is positioned anterior and lateral on the affected side in front of the patient.

2. A wide BOS should be maintained with each foot on a different stair.

3. A step should be taken only when the patient is not moving.

4. One hand is placed anteriorly on the guarding belt and one is anterior to, but not touching, the shoulder on the weaker side.

Guarding techniques on stair climbing:CANE- Ascending

1. The unaffected lower extremity leads up.

2. The cane and affected lower extremity follow

Guarding techniques on stair climbing:CANE- Descending

1. The affected lower extremity and cane lead down.

2. The unaffected lower extremity follows.