Walking aids

Mobility terminology

Terms	Definition
Independent	Ability to mobilise w/o assistance/ monitoring/ verbal cues
Prompting/ verbal cues only	Ability to mobilise w/o need for staff to stand by/ provide physical assistance but prompting may be required e.g. direction finding issues
Standby assist	Staff member stands directly beside patient ready to assist if necessary  → can usually mobilise with no physical assistance  → performance may be unreliable/ inconsistent
Assist x1	Requires physical assistance of no more than 1 person
Assist x2	Requires physical assistance of 2 people

What to consider when prescribing walking aids ?

Purpose	Duration	Location	Clients’ beliefs	Potential impact of co-morbidities
Maintain prescribed weight bearing status	Short term Progression  Lessening of support	Indoors	Age	Upper limb impairments affecting weight-bearing
Poor balance	Long term	Outdoors	Cosmesis	History of falls  → poor balance
CNS problems		Both		COPD → physical capacity / energy requirements

Different weight bearing status

Status	Meaning	Percentage
Full weight bearing	No restrictions to WB	100%
Weight bearing as tolerated	Self-limited WB up to FWB if they can tolerate  Limited by pain/ swelling	=< 100%
Partial weight bearing	Bwt NWB + FWB	30-50%
Toe weight bearing	Toes touch floor to maintain balance	5%
Heel weight bearing	Can WB through heel
Non weight bearing	No weight to taken through the limb	0%

Axillary crutches considerations + indications

Considerations High cardiac + strength demand from client  2 hands occupied  Caution to protect axillary nerve ( comes out of the axilla ) → ✓fitting + education

Indications Short term  Loss of use of lower limb  Greater balance requirements

Forearm crutch considerations/ indications

Considerations Lightweight  Free hands  Adjustable  Need sufficient skill + upper limb strength  Need good trunk control + balance for reduced support

Indications Experienced clients  Long term/ permanent gait assistance  Lower balance requirements ( younger/ fitter )

Gutter crutches considerations + implications

Considerations: Heavy  High energy demand  Elbows in 90’ F  No hand usage ( strapped in )

Indications: Clients x WB through hands/ wrists → ulna WB  Weak muscles  Long term/ permanent gait assistance

Fitting process of axillary crutches

Client stand upright/ arms by side  3 finger width gap bwt padded axillary piece + axilla Hand grip aligned with wrist crease  20-30’ elbow flexion when holding handgrip  → triceps mechanical advantage  Stopper: 15 cm anterior + 15 cm lateral to foot

Fitting process for forearm crutches

Client stand upright  20-30’ elbow flexion when holding handgrip  → triceps mechanical advantage  Forearm cuff 2.5 - 5 cm below elbow  Stopper 15 cm anterior + 15 cm lateral to foot

Fitting process for guttter crutches

1. Forearm platform 1.5-2.5 cm below elbow 

→ avoid bony contact 

2. Elbow at 90’F 

3. Resting forearm to ground distance : crutch height

Walking method ( NWB )

Step-to gait  Crutches forward tgt  Limbs forward tgt to level of crutches Step through gait  Crutches forward tgt Limbs forward tgt beyond level of crutches

Walking method ( PWB )

Step-to gait 

1. Crutches + affected limb forward tgt 

2. Unaffected limb forward to level of crutches

Step through gait 

1. Crutches forward tgt w/ affected limb 

2. Unaffected limb forward beyond level of crutches

4 point reciprocal 

1. Right crutch forward 

2. Left limb forward

3. Left crutch forward 

4. Right limb forward

Transfers ( sit to stand/ stand to sit )

Sit to stand	Both crutches in 1 hand  Use arm rest  Transfer crutch to other hand
Stand to sit	Walk backwards until chair touching back of unaffected limb  Both crutches in 1 hand  Reach back for arm rest  Slow controlled lower

Transfers ( stairs )

1. Hold handrail/ 2 crutches 

2. Good leg up first 

3. Crutch + bad leg second

Type of walking sticks + function + structure

Type	Functions	Grip considerations
Standard stick		Hook grip T-grip  Arthritis grip  → good for hand pain/ stiffness
Foldable stick	For clients with intermittent usage
4 point stick	For clients who need more stability  Difficult to use on stairs

Fitting of walking sticks

1. Handle parallel to wrist crease / greater trochanter 

2. Elbow 20-30’F

Mobilisation w/ walking sticks

Gait : 

1. Hold stick in hand opp to affected limb 

2. Start with stick + feet aligned + stick 15 cm from lateral border of foot 

3. Move stick forward + step w/ affected limb 

4. Step w/ unaffected limb 

Stairs 

1. Hold handrail if present 

2. *Good leg to heaven/ bad leg to hell / stick always with bad leg

What are the different types of walking frames/ pick up frames  + considerations 

Type of frame	Structures	Considerations
Pick up frame	Fixed  Foldable	Eliminates normal arm swing  X stair usage  Difficulty in manoeuvring in small spaces  Safety : brakes/ park against wall  X develop smooth reciprocal gait
Walking frame	PUF w/ wheels  Tri-walker  4 wheeled walker
Wheeled walkers	Forearm walker  Rollator ( forearm support frame )	Bulky  Heavy

Fitting of pick up + walking frame

1. Handle level w/ wrist crease

2. Elbow 20-30’ F

Mobilisation w/ pick up / walking frames

Gait: Feet aligned w/ front of frame 

1. Move frame forward 

2. Step w/ affected limb 

3. Step w/ unaffected limb

Transfers: Use arm rests → X pull up on frame

Fitting for wheeled walker

Elbow 90’F

Mobilisation w/ wheeled walker

Gait

1. Feet aligned in front of frame 

2. Brakes off 

3. Move frame forward 

4. Step w/ affected limb → unaffected limb 

5. Wheels for a more step through gait 

6. Maintain upright trunk + X let frame get too far ahead

Transfers: Brakes on 

1. Use arm rest to push up X pull up on frame