ASSISSTIVE DEVICES

INCOMPLETE

A person may require assistive devices to compensate for the ff:

• Impaired balance

• Dec strength

• ALteration in coordination mvmts

• Pain during WB on one or B LE

• Absence of LE

• Altered stability

Purpose of ADs

• Improve a person’s stability by expanding the base of support (BOS)

• Reduce WB on one or both LE

• Permit mobility

Purpose of ADs: 2 Classifications

Preambulatory AD

Ambulatory Assistive Devices

Preambulatory AD types

• Tilt table (not an AD) 

• Parallel bar 

• Supported suspension ambulatory aid

Ambulatory Assistive Devices Types

• Walkers

• Crutches

  • Single - we dont use single

  • Bilat

• Canes

  • Single

  • Bilat

  • Quad

  • Hemi

Types of ADs

• Parallel Bars 

• Walkers 

• Crutches 

  • Axillary Crutches 

  • Forearm (Loftstrand) Crutch

  • Forearm Platform Crutch 

• Canes

Most stable AD (preambulatory)

Parallel bars

For initial ambulation training

Parallel bars

This AD is used to check pt’s standing & amb = balance & tolerance

Parallel bars

Parallel Bars: How to measure

• Height:

• Elbows:

• Hip:

• Height: Lvl of greater troch. / wrist crease / ulnar styloid process

• Elbows: maintained @ 20-30º flex

• Hip: 2-4” gap bw each hip & the bar

Parallel bars: Wrong fitting

• Promotes trunk flexion or extension

• Bars are too high: promote trunk ext

• Bars are too low: promote trunk flexion

Parallel bars: Disadvantage 

Hard to move around

Steps for parallel bars

Walkers:

• BOS:

• Stability:

• Widens BOS 

• Gives greater lat. & ant. Stability 

AD: For pts c debilitating conditions, fair balance or LE injury

Walkers

Provides at least 75% of support

Walkers

Used when maximal pt stability & support are req.

Walkers

Walker: Styles

• Most have 4 support legs or feet 

• Some have 2 or 4 wheels

• Most can be adjusted for proper fit

Walker: Characteristics

• Most are lightweight 

• + some can be folded for storage

Walker: Types

• Standard

• Child

• Bariatric (wider, support more weight, adjustable or non-adjustable) 

• Wheeled

• Folding

• One-handed (hemiplegic)

Walker: Disadvantages

• Diff. to store / transport 

• Diff. or impossible to use on stairs 

• Reduces speed of amb.

• Diff. to perform normal gait pattern

• Diff. to use in narrow / crowded areas

Walker: How to measure 

1. Standing 

   • Height of hand grip @ lvl of greater troch / wrist crease / ulnar styloid process

2. Supine 

   • Tape measure from pt’s greater troch to heel c shoes on 

   • Knee & hip straight

Walker: How to measure:

• Hand-grip height

• Space

• Position

• Hand-grip height 

  • 20-30º elbow flex

• Space 

  • 2-4” of space in each hip

• Position walker in front of pt so rear tips are opposite to the midportion of the feet

Types of Walkers:

• Facilitate mobility in the community, cars

• Portable

Folding (collapsible)

Disadvantage of collapsible walker

Less stable

Types of Walkers: Facilitate walking as a continuous mvmt. sequence 

Rolling (Wheeled)

Disadvantage of Rolling (Wheeled) walker

Used to initiate mvmt but is contraindicated to postural instability (ex: Parkinson’s)

Type of walker: Has 2 posterior extensions & additional hand grips off of the rear legs for stair use

Stair Climbing Walker

Type of walker:

• Hinged

• Allows advancement on one side of walker at a time

Reciprocal walker

Reciprocal walker: Can mimic reciprocal gait pattern BUT iliopsoas / hip flexors should be at least __

3/5

Type of walker:

• Modified 

• For one hand use only 

• Stroke pts

Hemi walker

Walker: Attachments

• Fold down seats

• Carrying baskets 

Steps in using walker:

Type of AD: 50% support

Crutches

Type of AD: Used to inc BOS, provide modº of stability, or relieve WB on the LE

Crutches

Crutches: Correct measurements & fitting are vital to prevent __

Complications (ex: nerve damage)

Crutches: Measurement 

• Standing:

• Elbow:

• Standing: Pt’s ht - 16” or base of axilla in front (big toe), 2” lateral 

• 20-30º flex

Crutches: Measurement 

• Supine:

• Axilla -> 6-8” lateral to heel 

Crutches: Measurement 

• Sitting:

• UE abducted 90º

• 1 elbow ext, other elbow 90° flex

• Measure from olecranon of elbow flex to the tip of the fingers of the ext elbow (hand would be in like an L shape)

Forearm: crutches (Lofstrand) measurement

• Cuff over proximal 3rd of FA 

• Approx 1-1 ½ in below elbow

  • (distal to the olecranon when pt grasps hand piece c cuff applied to the wrist in a neutral flexion)

Types of Crutches 

• Axillary Crutches 

• Forearm (Loftstrand) Crutch

• Forearm Platform Crutch