Ambulatory Aids and Gait Patterns

when are canes indicated

widen base of support to improve balance

provide limited stability and unweighting (can unload forces on involved extremity by 30%)

can be used to relieve pain, antalgic gait

cane measurement

20-30 degrees of elbow flexion

measure from greater trochanter to a point 6 in to the side of the toes

types of canes

wood or aluminum (adjustable)

standard, SPC (J-shaped)

quad cane

quad cane

4 contact points with the ground

provides increased stability but slows gait

small based quad cane

useful for stairs

wide-based quad cane

does not fit on the stairs

gait pattern with a cane

held in hand opposite to the involved extremity

cane and involved extremity are advanced together followed by the uninvolved extremity

indications for crutches

increase the base of support

provide moderate degree of stability

relieve weight bearing on the LEs

crutch measurement for standing patients

20-30 degrees of elbow flexion

subtract 16 in from the pt's height or measure from a point 2 in below the axilla to a point 6 in in front and 2 in lateral to the foot

crutch measurement for supine patients

measure from the axilla to a point 6-8 in lateral to the heel

forearm crutch measurements

the cuff should cover the proximal 1/3 of the forearm

1-1.5 inches below the elbow

types of crutches

axillary

forearm (lofstrand)

forearm platform

axillary crutches

wood or aluminum designs

provide increased UE weight bearing over forearm crutches

may be difficult to use in small areas

prolonged leaning on the axillary bar can result in vascular and/or nerve damage (axillary artery/radial nerve)

forearm (lofstrand) crutches

provide slightly less stability but increased ease of movement

frees hands for movement without dropping the cuff

forearm platform crutches

allow weight bearing on the forearm

used for pts who are unable to bear weight through their hands

indications for walkers

widen base of support

provide increased lateral and anterior stability

reduce weight bearing on one or both LEs

easy to use

prescribed for pts with debilitating conditions, poor balance or LE injury

negative features of walker use

no reciprocal arm swing and increased flexed posture

types of walkers

folding

rolling

stair-climbing

reciprocal

hemi

folding walker

collapsible

facilitate mobility in the community, cars

rolling walker (wheeled)

2 or 4 wheels (4 wheels require hand brake to provide added stability in stopping)

facilitates walking as a continuous movement sequence (step through gait pattern)

allows for increased speed

stair climbing walker

2 posterior extensions and additional handgrips off the rear legs for use on stairs

reciprocal walkers

hinged, allow advancement of one side of walker at a time

used with reciprocal gait patterns

reciprocating orthoses

hemi walker

modified for use with one hand only

measurement of walker

same as cane

typical gait changes with bariatric patients

greater hip abduction and hip rotation

less knee flexion

difficulty from rotating from side to side with increased girth

non-weight bearing

no weight bearing is permitted

partial weight bearing

toes or ball of involved foot contacts with the floor

allows a limited amount of weight bearing

full weight bearing

full weight is permitted on the involved extremity

weight can be objectively controlled by means of a limb load monitor

2 point gait

one crutch and opposite extremity move together

followed by the opposite crutch and extremity

requires use of 2 assistance devices

3 point gait

both crutches and involved leg are advanced together

then uninvolved leg is advanced forward

requires use of tow assistive devices (crutches or canes) or a walker

2 point gait allows for ?

natural arm and leg motion during gait

good support and stability from two opposing points of contact

when is a 3 point gait indicated

for used with involvement of one extremity (LE fracture)

four point gait

slow gait pattern

1 crutch is advanced forward and placed on the floor

followed by advancement of the opposite leg

then the remaining crutch is advanced forward

followed by the opposite remaining leg

requires the use of 2 assistive devices

four point gait provides ?

maximum stability with 3 points of support while 1 limb is moving

swing to gait

both crutches are advanced forward together

weight is shifted onto hands for support and both legs are then swung forward to meet the crutches

requires use of 2 crutches or walker

when is a swing to gait indicated

for individuals with limited use of both LEs and trunk instability

swing through gait

both crutches are advanced forward together

weight is shifted onto hands and both legs, which are swung forward beyond the point of crutch placement

requires use of 2 crutches

when are swing to and swing through gaits used

used for bilateral LE involvement and trunk instability

pt with paraplegia, spina bifida

ascending stairs

the uninvolved legs always goes up first followed by the crutches and the involved leg together

descending stairs

the crutches or cane and involved leg go down first, followed by the uninvolved leg

guarding on level surfaces

stand slightly behind and to one side; typically on the more involved side

guarding on stairs

therapist is positioned below the pt during ascent and descent

sit to stand guarding

stand to one side and slightly behind the pt

inc levels of assistance may require the therapist to stand in front of pt

body weight support (BWS)

an overhead harness is used to support BW

- initially support is high (40% of BW)

- progresses to less weight support to no support

BWS > _______ is contraindicated as it interferes with wight cycle

55%

- unable to achieve flat foot during stepping

motorized treadmill training

progresses from treadmill walking with slow speeds (0.6-0.8) to faster, near normal walking speeds ( 2.6-2.8 mph)

- progresses from level to slight incline walking

- progresses from treadmill walking to over ground walking

manual assistance

level of assistance decreases as training progresses

assistance can include hands on pelvis (assisted pelvic motions) and hands on LE (assisted stepping)

robotic assisted walking

an exoskeletal frame with motorized, fitted braces is used with pts with complete SCI; braces support both LEs and part of upper body

- a backpack containing a computer and power supply is worn

computer programs controls hip and knee motions

crutches or walker are required

single-robotic leg brace

assists walking in individuals with single limb paralysis (chronic stroke)