19. Assistive Devices

Vocabulary flashcards summarizing terminology, device types, fitting guidelines, gait patterns, and safety principles from the assistive-device lecture.

Assistive Device

Any equipment (e.g., walker, crutch, cane) that improves a patient’s ability to perform gait, transfers, or daily activities.

Indications for Assistive Device

Weight-bearing limitation, weakness, decreased balance, or pain that interferes with safe mobility.

Full Weight Bearing (FWB)

No weight-bearing restriction; patient may place 100 % body weight on the limb.

Weight Bearing As Tolerated (WBAT)

Patient determines how much weight to place on limb; no specific restriction set by provider.

Partial Weight Bearing (PWB)

Limited, quantified loading (often ~50 % body weight) permitted on the involved extremity.

Toe-Touch Weight Bearing (TTWB)

Only toes rest on floor for balance; essentially no weight transmitted through limb.

Non-Weight Bearing (NWB)

Absolutely no weight permitted on the affected extremity.

Parallel Bars

Stationary rails providing the greatest stability for initial gait training but little functional carry-over.

Walker

Four-legged frame (with or without wheels) offering high stability and weight-bearing relief.

Standard Walker (SW)

Conventional non-wheeled walker that must be lifted between steps; greatest stability among walkers.

Front-Wheeled or Rolling Walker (FWW/RW)

Walker with two front wheels, permitting smoother forward glide and less energy expenditure.

4-Wheeled Walker / Tripod

Walker with four wheels (and often hand brakes/seat) that maximizes mobility but reduces stability.

Platform Walker

Walker equipped with forearm platforms for patients unable to grip or bear weight through hands.

Pediatric Walker

Walker sized and sometimes reversed-frame for children requiring gait support.

Axillary Crutches

Underarm crutches offering moderate stability and common for young or short-term NWB users.

Forearm (Lofstrand) Crutches

Crutches with forearm cuffs that allow hand use and lighter weight but require more coordination.

Hemiwalker

One-sided walker providing the greatest stability for a single upper-extremity user.

Large-Based Quad Cane (LBQC / WBQC)

Cane with large four-point base offering more stability than small-based or straight canes.

Small-Based Quad Cane (SBQC / NBQC)

Four-point cane with narrower base, used as patient progresses in balance and strength.

Straight Cane

Single-point cane offering the least stability but greatest portability and social acceptance.

Stability Hierarchy of Devices

Most to least: Parallel bars → Walker → Axillary crutches → Forearm crutches → Two canes → One cane.

Coordination Hierarchy of Devices

Least to most: Parallel bars → Walker → One cane → Two canes → Axillary crutches → Forearm crutches.

Walker Fitting

Handgrips at greater trochanter level with 20–30° elbow flexion; verify using ulnar styloid (“wristwatch”) trick.

Crutch Fitting (Axillary)

Tips 6 inches ant./lat. to foot; 2-finger gap under axilla; handgrip at greater trochanter with 20–30° elbow flexion.

Spivey Shortcut

Quick axillary-crutch length estimate: seated patient abducts both shoulders 90°, one elbow flexed, other extended; distance approximates crutch length.

Forearm Crutch Fitting

Same tip and handgrip rules as axillary crutch; cuff high enough to avoid blocking elbow flexion and snug to stay on when arm lifted.

Cane/Hemiwalker Fitting

Handgrip at greater trochanter with 20–30° elbow flexion for comfort and optimal effectiveness.

Basic Walker Gait Pattern

Advance walker → involved limb → shift weight to walker/limb → advance uninvolved limb → shift weight, repeat.

Two-Point Gait

With two crutches or canes: advance one device and opposite leg together, then repeat with other side; mimics normal gait.

Four-Point Gait

Deliberate version of two-point: device 1 → opposite leg → device 2 → remaining leg; always three contact points for maximal stability.

Three-Point Gait

For NWB: both crutches forward → weight through UEs → uninvolved limb forward to or past crutches; repeat.

Swing-Through Gait

Crutches forward → weight through UEs → both legs swing past crutch tips; faster, requires good strength/balance.

Swing-To Gait

Crutches forward → weight through UEs → both legs swing to rest even with crutch tips.

PWB Crutch Gait

Crutches forward → involved limb forward with permitted load → shift weight to devices/limb → advance uninvolved limb; repeat.

Reasons Cane Held in Opposite Hand

Enhances leverage, simulates reciprocal arm swing, widens base of support, reduces joint compression, and minimizes hip abduction effort on affected side.

Patient Safety with Walkers

Avoid pulling to stand, reach back for chair when sitting, monitor uneven surfaces, remove obstacles/children/pets, maintain upright posture, use gait belt.

Patient Safety with Crutches

Same general precautions plus avoid slick surfaces, correct crutch placement, and guard with gait belt.

Patient Safety with Canes/Hemiwalkers

Keep cane opposite affected leg, avoid pulling on device to stand, watch wet/uneven surfaces, guard with gait belt.

Factors Affecting Device Choice

Fatigue, attention, cognition, pain, weight-bearing status, strength, environment, social factors, comorbidities.