INTRODUCTION TO ASSISTIVE DEVICES

A Person may Require an Assistive Device:

• To improve _______ mobility

• To enhance ________

• To assist with ______

• To compensate for impaired ____, decreased ____, alteration in coordinated movements, pain during WB on one or both of the LE, absence of a LE (with or without prosthetic replacement), or altered stability

• To improve functional mobility

• To enhance body functions

• To assist with fracture healing

• To compensate for impaired balance, decreased strength, alteration in coordinated movements, pain during WB on one or both of the LE, absence of a LE (with or without prosthetic replacement), or altered stability

T or F:

• The faster the person walks , the more time is spent for double support

False → less time

Assistive Device

• improve a person’s stability by __________

• _____ weight bearing on one or both lower extremities

• permit _______

• T/F : it does not help alleviate pain during ambulation

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

• reduce weight bearing on one or both lower extremities

• permit mobility

• False → it helps relieves pain during ambulation

This is used for patients who must physiologically acclimate to an erect standing position before they can initiate an ambulation.

Tilt Table

(NOT AN ASSISTIVE DEVICE)

Order the following from GREATEST TO LEAST in amount of stability/support provided:

• bilateral canes

• quad canes

• single crutches

• walkers

• hemi canes

• single canes

• bilateral crutches

Walkers → bilateral crutches → single crutches → bilateral canes → quad canes → hemi canes → single canes

T or F:

• Initially, a patient may need to start ambulation with an aid that provides maximal stability or support that gives greater mobility.

False → restricts mobility

• as the pt improves, he may able to progress to an aid that provides less stability or support and allows greater mobility.

What are your PRE-AMBULATION DEVICES ?

• tilt table ( not an AD)

• Parallel Bar

• Supported Suspension Ambulatory Aid

PRE-AMBULATION DEVICES

_________ ( Most stable AD)

• used for balance training, to teach specific gait patterns, and provide support while measuring an assistive device.

• adjust the width as it should permit the hips and trunk to pass through them with clearance on both sides

• the height is at the level of the _______ when the patient stands erect.

• Each bar should be adjusted to provide ___ degrees of elbow flexion when the patient stands erect & grasps the bars approximately __ inches anterior to the hips.

Parallel bars

• greater trochanters

• 20°-30° of elbow flexion

• 6 inches anterior to the hips.

Parallel bars

• Each bar should be approximately __ inches wider than the patient’s greater trochanters when he or she is centered between the bars.

• Bars can be adjusted is 2 ways → ________ (elbow flexion) when standing

• 2 inches wider

• elbow flexion is even with greater trochanter or wrist crease (ulnar styloid process)

Parallel Bar Method for Measurement of Axillary Crutches

• Have the pt stand inside with head ___ , the shoulders __ and _, UE _ the parallel bars, the trunk_ , the hips_ , the pelvis_ , the knees___, and the feet __ on the floor.

• Measure from a point at the anterior axillary fold to a point on the floor approximately __ inches lateral and ___ inches anterior to the patient’s toes for the overall crutch length.

• head erect → shoulders level and relaxed → UE grasping the bars → trunk erect → hips straight → pelvis level → knees slightly flexed & feet flat

• 2 inches lateral & 4-6 inches anterior

Parallel Bar Method for Measurement of Axillary Crutches

• To determine the handpiece height, the crutch should be positioned in the patient’s ____ with the tip ____ and ___ to the patient’s toes.

• approx _____ degrees of elbow flexion

  • allow the patient to lift or support the body by extending the elbows during the NWB or other gait pattern

• axilla → tip forward and lateral

• 20-30° of elbow flexion

Parallel Bar Method for Measurement of Axillary Crutches

T/F: To obtain the most accurate measurement and fit, the axillary pad, handpiece pad, and crutch tip should be applied after all measurements are made and the fit is confirmed. The patient should not wear shoes.

False → patient must wear shoes & apply all things before all measurements are made

Parallel Bar Method for Measurement of Axillary Crutches

• Alternative Method

  • same position

  • Using a crutch with push-button (“quick fit”) length and handpiece adjustments, position the crutch in the ___ and along the patient’s side. Adjust the hand piece at the level of the_______ (3) ;

    • then position the tip approximately ___ inches lateral and ___ inches anterior to the forefoot (toes) and adjust the length so that approximately _____ are present between the axillary rest and the bottom of the axilla.

  • Have the patient grasp the hand piece and evaluate the amount of elbow flexion and the length of the crutch with the crutch in the proper forward, ____ position.

  • Readjust the crutch as necessary to obtain the proper length and hand- piece position.

• axilla

• at the level of the wrist crease, greater trochanter, or ulnar styloid process

• 2 inches lateral → 4-6 inches ant.

• 2 fingerbreadths

• tripod position

PRE-AMBULATION DEVICES

• ________

  • helps acclimate to an upright position as a result of a variety of conditions

    • prolonged recumbence, disturbance in balance, decreased proprioception, kinesthesia, LE circulation, or generalized weakness.

  • ability to gradually elevate a person from a horizontal to an upright position and to allow him or her to adapt or adjust to any given elevation provides a safe method for the body to accomplish physiological accommodation for upright activities

Tilt table

Tilt Table

• measure ______ each time a progression to a higher elevation occurs

• Indicates that the patient is experiencing difficulty in adapting to an upright position. → _________

• Other indicators of the patient’s intolerance include

  • changes in consciousness, excessive perspiration, formation of edema in the lower legs, a DEC in or loss of pedal pulses, reports of nausea or numbness, a change in facial or limb color , tingling in the LE, and vertigo

• VS esp BP & Pulse rate

• Excessive INC or DEC in the blood pressure and pulse rate

T/F: While using a tilt table, Strengthening and ROM exercises can be performed, and lower extremity muscle groups can be positioned so a prolonged passive stretch force can be applied to them.

True

Tilt Table

• An elevation of approx. _to_ degrees for __ minutes, for several sessions, should be sufficient

  • however, each person must be considered individually.

• When the patient is elevated more than __ degrees, the sensation of falling forward may occur because his or her COG will be shifted forward

  • as a result of the pressure from the surface of the table against the back.

• If the patient is elevated beyond __ degrees, a chest strap should be applied to prevent the upper body from falling forward.

  • necessary if the patient does not have strong _______

• 70°-80° for 15-20mins

• >80°

• >70° = Chest trap needed when pt has weak trunk extensors

Duration of Tilt Table session?

5-10 mins or 1 hr

1-2x per day or alternate days

Tilt Table Procedure

PRE-AMBULATION DEVICES

__________

• Can be used for patients who need to be partially “unweighted” during gait training.

• Uses adjustable suspension straps, a harness that fastens around the patient’s trunk, optional thigh straps to avoid loads to the groin area, and a type of suspension with a Y-shaped yoke that supports the patient from directly over each shoulder to maintain posture and balance.

Supported Suspension Ambulatory Aid

Some indications for use of this device are cerebral palsy, some spinal cord injuries, Parkinson disease, and severe weakness that necessitates the use of bilateral leg braces

Supported Suspension Ambulatory Aid

Supported Suspension Ambulatory Aid

• Include controlled ____ and ___ to correct asymmetric movement

• Facilitation of proper gait patterns, and the ability to work on balance, posture, and the _____ maneuver.

• In addition, this device can ___ patients safely to the standing position from a chair or mat.

• controlled WB & posture

• sit to stand maneuver

• lift safely

T/F: If the initial measurement is performed with the patient in a position other than standing, the fit of the aid must be evaluated and confirmed when the patient stands.

True

T/F: An aid that does not fit the patient properly will adversely affect his or her ability to perform a gait pattern and may result in an unsafe or unstable pattern.

True

Walkers

• _____ BOS

• Gives greater _and _ stability

• Can reduce __ on one or (B) LE

• For patients with debilitating conditions, fair balance or LE injury if crutches is precluded

• Patient’s elbows should be maintained at _____ flexion

• Height is at level of ________

• Provides at least ___% of support

• Widens BOS

• Gives greater lateral and anterior stability

• Can reduce WB on one or (B) LE

• For patients with debilitating conditions, fair balance or LE injury if crutches is precluded

• Patient’s elbows should be maintained at 20-30° flexion

• Height is at level of greater trochanter

• Provides at least 75% of support

Walkers Types

• _________

  • Facilitate  mobility in the community, cars 

  • Portable 

  • Less stable compared to non-folding 

Folding (Collapsible) 

Walkers Types

• _________

  • Facilitate walking as a continuous movement sequence

  • Mobile 

  • Contraindicated to postural disabilities (Parkinson's)

Rolling (Wheeled)

Walkers Types

• _________

  • Has two posterior extensions and additional hand grips off of the rear legs for use on stairs

Stair Climbing Walker

Walkers Types

• _________

  • Hinged, allows advancement on one side of the walker at a time

  • Mimics reciprocal gait patterns 

  • Reciprocal Gait Pattern = Gr __ iliopsoas ( a must)

Reciprocal Walker

• 3/5 walker

Walkers Types

• _________

  • Modified for use with one hand only 

  • Stoke patients 

Hemi Walker

Walker Attachments:

• Fold down seats 

• Carrying basket 

Walkers Fit Measurement

• height of a walker can be determined with the patient ___ or ___.

• hand grip should be placed level with the ____________ (3)

• walker positioned in front and along patient sides with patient arms straight

• feet of walker should be resting on the floor or even with the heels, the hips and knees should be ____, and shoes should be _____.

• height → standing or supine

• wrist crease, ulnar styloid process or greater trochanter

• straight and shoes are worn

Ambulatory Devices

• __________

  • Used to increase the BOS, provide moderate degree of stability, or relieve WB on the LE 

  • Correct measurements and fitting is needed to prevent nerve damage 

  • Allows ___% of support

Crutches

• 50%

Crutches

• _______

  • Provide increase UE WB over FA crutches 

  • May be difficult to use in small areas 

  • Disadvantage 

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

Axillary Crutches

Axillary Crutches

• Measurement = ______ of elbow flexion is a must

• Standing

  • Pt’s ht - ___ inches then multiply pt height to __%

  • Or base of ___ - __inches

    • Front (big toe) = __inches lateral

• 20-30° of elbow flexion

• Height of pt - 16 in → x77%

• base of axilla - 6in

• 2 inches lateral

Axillary Crutches

• Sitting:

  •  UE is _____ at shoulder level, one elbow is ____, the other elbow is flexed to __° 

    • Measure from olecranon of flexed elbow to fingertips of extended arm

• abducted → one elbow extended while 90° flexed yung isa

Axillary Crutches

• Hand Piece

  • Top of forearm cuff should be ~___ inches distal the olecranon process

  • handgrips should be adjusted to level of _____ or _____

• approx. 1-1.5 in distal to olecranon

• wrist crease or olecranon process

Axillary Crutches Length

• with the pt standing, tips of crutches approx ___ inches lateral and ____ inches anterior to toe of patient shoes

• crutches should rest on the floor at a ____° angle

• space between axillary rest and floor of axilla should be approx ___ inches or fingerbreadths

• 2 inches lateral and 4-6inches anterior

• 45° angle

• 2 inches or fingerbreadths

Forearm Crutches Types

• _________

  • Has a forearm cuff and a hand grip

  • Provides less stability but increase ease of movement 

  • Frees hands for use w/o dropping the crutch

Lofstrand Crutches 

Forearm Crutches Types

• _________

  • Allow WB on the FA, used for pts who are unable tp WB through their hands

Forearm Platform Crutch 

Forearm Crutches Add Ons

• ________

  • Rubber ~1.5 inches in diameter

  • Provide suction, minimize slippage

Crutch Tips

Forearm Crutches Types

• The cuff should cover the proximal third of the FA ~____inches below the elbow 

  • when the patient grasps the handpiece with the cuff applied to the forearm and the wrist in neutral flex-ext

• 1-1.5 inches below the elbow

T/F: The initial fit of the aid may be revised after the patient has ambulated several times. As he becomes stronger, more skilled and more efficient, initial fit wont be comfortable

True

Common Errors in Fitting Assistive Devices

Ambulatory Device

• _______

  • Widen the BOS to improve balance 

  • Provide limited stability and unweighting 

  • Used to relieve pain 

  • Provides ___% support

Canes

• 25% support

Cane Types

• ______

  • Adjustable with push pin lock

• _____

  • Single point cane

• _____

  • re-distributed force in WB = easier to use for some patients

• Wood / Aluminum

• Standard

• C angled handles

Cane Measurement

• ______ of elbow flexion 

  • Greater trochanter to a point __ inches to the side of the toes 

• In Supine

  • a tape measure can be used to measure the distance from patients ____ to the ____ with hip and knee extended

• 20-30°

• 6 inches

• Greater Trochanter → heel with hip & knee extended

Cane Types

• _________

  • 4 contact points with the ground 

  • Provides increased stabilisty but slows gait 

  • _________ (SBQC) = stairs 

  • __________ (WBQC) = not fit for stairs

Quad Cane

• Small-based quad cane (SBQC) = stairs 

• Wide-based quad canes (WBQC) = not fit for stairs

Walker in General

Axillary Crutches In general

Forearm Crutches in General

Canes in General

Gait Patterns : NON-WB

• The walker is picked up and moved forward about an______

• Weight is then transferred through the_____ to the walker

  • The involved NWB limb is held anterior to the pt’s body but does not make ________

• The uninvolved limb is moved ______

• The cycle is repeated

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

• Weight is then transferred through the UEs to the walker

  • The involved NWB limb is held anterior to the pt’s body but does not make contact with the floor

• The uninvolved limb is moved forward

• The cycle is repeated

Gait Patterns : PWB

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

• The involved PWB limb is moved _____, and body weight is transferred partially through the ___ to the walker

• The uninvolved LE is moved _______ past the involved limb

• The cycle is repeated

  • MD determines amount of weight-bearing

    • Train pt by feeling the amount of weight in comparison to the non-affected LE

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

• The involved PWB limb is moved forward, and body weight is transferred partially through the UEs to the walker

• The uninvolved LE is moved forward past the involved limb

• The cycle is repeated

• MD determines amount of weight-bearing

  • Train pt by feeling the amount of weight in comparison to the non-affected LE

Gait Patterns : Full-WB

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

• The ______ is moved forward

• The _______ is moved forward past the ____

• The cycle is repeated

• NOTE: stronger leg is always ________ to the weaker leg

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

• The first LE is moved forward

• The second LE is moved forward past the first

• The cycle is repeated

• NOTE: stronger leg is always posterior to the weaker leg

Ambulation Patterns

• 2-Point Gait Pattern

  • Use of bilateral assistive devices such as _____ or _____ is required

  • uses a simultaneous_______ placement of the AD and patient’s opposite LE

  • Use of this gait requires ______ (G to normal) 

  • It is relatively ____ and performed more _____ than 4 point gait

• Use of bilateral assistive devices such as crutches or canes is required

• uses a simultaneous reciprocal forward placement of the AD and patient’s opposite LE

• Use of this gait requires better balance (G to normal) 

• It is relatively stable and performed more rapidly than 4 point gait

Ambulation Patterns

• 2-Point Gait Pattern

  • _____ energy expenditure and very similar to normal gait pattern

  • requires coordination by pt to move one ____ and its opposite ___ forward simultaneously

  • appropriate for ______ patient affecting both LE

  • patient can ambulate more ____ but with less ____ than 4 point pattern

  • Requires Gr___ /5 Illiopsoas

• low energy expenditure and very similar to normal gait pattern

• requires coordination by pt to move one UE and its opposite LE forward simultaneously

• appropriate for antalgic gait patient affecting both LE

• patient can ambulate more rapidly but with less stability than 4 point pattern

• 3/5 illiopsoas

Ambulation Patterns

• 3-Point Gait Pattern

  • During forward progression of involved extremity, weight is borne _____ on both crutches and on the affected extremity

  • ____ gait pattern, NWB (amputated leg) is advanced with the crutch

• During forward progression of involved extremity, weight is borne partially on both crutches and on the affected extremity

• Shadow gait pattern, NWB (amputated leg) is advanced with the crutch

Ambulation Patterns

• 4 Point Pattern

  • This pattern provides ___, __ gait as three points of floor contact is maintained 

  • Weight is borne on ______ and typically is used with bilateral involvement due to poor balance, incoordination, or muscle weakness 

  • In this gait pattern, one crutch is _____ and then the opposite LE is _____

• This pattern provides slow, stable gait as three points of floor contact is maintained 

• Weight is borne on both LEs and typically is used with bilateral involvement due to poor balance, incoordination, or muscle weakness 

• In this gait pattern, one crutch is advanced and then the opposite LE is advanced

Ambulation Patterns

• 4 Point Pattern

  • requires use of ______ assistive devices like crutches or cranes

  • very ____ and performed ____

    • safest pattern used in crowded areas

  • low energy expenditure & used to reduce pain in LE from ______ gait or INC balance strategies

    • disburses weight bearing forces

  • requires significant amount of coordination and diminishes speed of ambulation

• • requires use of bilateral assistive devices like crutches or cranes

  • very stable and performed slowly

    • safest pattern used in crowded areas

  • low energy expenditure & used to reduce pain in LE from antalgic gait or INC balance strategies

    • disburses weight bearing forces

  • requires significant amount of coordination and diminishes speed of ambulation

Ambulation Patterns with Assistive Devices

Ambulation Patterns with Assistive Devices—cont’d

Stair Climbing and Guarding

• Ascent = ___________ (steps)

• Descent =___________ (steps)

“Good leg goes to heaven, bad leg goes to hell”

• uninvolved → AD → involved

• AD → involved → uninvolved

“Good leg goes to heaven, bad leg goes to hell”

Guarding ( PT)

• Ascent = PT _____ posterolateral to involved side

• Descent = PT in _____ posterolateral to involved side

• PT behind

• PT infront

READ DA TABLE

“Good leg goes to heaven 😇

bad leg goes to hell” 👹