กภ.สรายุธ มงคล
อาจารย์ส าขากายภาพบาบัด สานักวิช าวิท ยาศาสตร์สุขภาพ
มหาวิท ยาลัยแม่ฟ้ าหลวง
Part1; Transfer
Part2; Ambulation aids
Part3; Positioning
The SAFE movement of a person from
one surface or location to another or
from one position to another
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Select, position, and secure needed equipment; apply a
safety belt on the patient
 Instruct the patient how to perform the transfer;
demonstrate the transfer as necessary
 Practice components of the transfer as necessary before
attempting the entire transfer
 Watch pt for orthostatic hypotension ?
 Symptoms: dizzy, faint, blurred vision, slurred speech
 Stand slowly, deep breaths, talk during transfer..
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Position yourself to guard and protect the patient
throughout the transfer -- Do not guard the patient
by using his/her clothing or grasping his/her arm
 Request the patient to initiate and perform the
transfer; assist him/her as necessary
 Guide and direct the patient throughout the transfer
and closely guard him/her
 Be alert for unusual events that may occur
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
# Avoid simultaneous trunk bending
(flexion) and twisting (rotation)
# Stoop or squat to reach for and lift an
object below waist level
# Stand on a stable foot stool or ladder to
reach for an object above shoulder level
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
# Apply pushing and pulling forces parallel
to the surface over which the object is to
be moved
# Carry objects close to your center of
gravity and close to the midline of the
body
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
@ Carry a one-hand item alternately with
your upper extremities
@ Avoid using long lever arms to push, pull,
lift, reach, and carry objects
@ Perform push, pull, lift, reach, and carry
activities within your physical capacity
and limits
Know when to ask for help!!
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
ศูนย์สาธิตอุปกรณ์เครือ่ งช่วยคนพิการ ศูนย์สริ นิ ธรเพือ่ การฟื้นฟูสมรรถภาพทางการแพทย์แห่งชาติ
ความรูท้ วไปเกี
ั่
ย่ วกับเก้าอี้ลอ้ เข็นและการช่วยเหลือเบือ้ งต้นแก่คนพิการทางกายและการเคลือ่ นไหวในการใช้ลอ้ เข็น
ศูนย์สาธิตอุปกรณ์เครือ่ งช่วยคนพิการ ศูนย์สริ นิ ธรเพือ่ การฟื้นฟูสมรรถภาพทางการแพทย์แห่งชาติ
ความรูท้ วไปเกี
ั่
ย่ วกับเก้าอี้ลอ้ เข็นและการช่วยเหลือเบือ้ งต้นแก่คนพิการทางกายและการเคลือ่ นไหวในการใช้ลอ้ เข็น
เทคนิคการเข็นถอยหลังลงพืน้ ที่ต่างระดับการเข็น
เทคนิคการเข็นเดินหน้าลงพืน้ ทีต่ ่างระดับ
ศูนย์สาธิตอุปกรณ์เครือ่ งช่วยคนพิการ ศูนย์สริ นิ ธรเพือ่ การฟื้นฟูสมรรถภาพทางการแพทย์แห่งชาติ
ความรูท้ วไปเกี
ั่
ย่ วกับเก้าอี้ลอ้ เข็นและการช่วยเหลือเบือ้ งต้นแก่คนพิการทางกายและการเคลือ่ นไหวในการใช้ลอ้ เข็น
เทคนิคการเข็นเดินหน้ าขึน้ ทางต่างระดับ
เทคนิคการเคลื่อนล้อเข็นขึน้ และลงทางลาดชัน แบบ 4 ล้อ
ศูนย์สาธิตอุปกรณ์เครือ่ งช่วยคนพิการ ศูนย์สริ นิ ธรเพือ่ การฟื้นฟูสมรรถภาพทางการแพทย์แห่งชาติ
ความรูท้ ั ่วไปเกีย่ วกับเก้าอี้ลอ้ เข็นและการช่วยเหลือเบื้องต้นแก่คนพิการทางกายและการเคลือ่ นไหวในการใช้ลอ้ เข็น
เทคนิคการเคลือ่ นย้ ายผู้ป่วยลงบันได โดยใช้ รถเข็น
เทคนิคการเคลือ่ นย้ ายผู้ป่วยขึน้ บันได โดยใช้ รถเข็น
ศูนย์สาธิตอุปกรณ์เครือ่ งช่วยคนพิการ ศูนย์สริ นิ ธรเพือ่ การฟื้นฟูสมรรถภาพทางการแพทย์แห่งชาติ
ความรูท้ ั ่วไปเกีย่ วกับเก้าอี้ลอ้ เข็นและการช่วยเหลือเบื้องต้นแก่คนพิการทางกายและการเคลือ่ นไหวในการใช้ลอ้ เข็น
ศูนย์สาธิตอุปกรณ์เครือ่ งช่วยคนพิการ ศูนย์สริ นิ ธรเพือ่ การฟื้นฟูสมรรถภาพทางการแพทย์แห่งชาติ
ความรูท้ ั ่วไปเกีย่ วกับเก้าอี้ลอ้ เข็นและการช่วยเหลือเบื้องต้นแก่คนพิการทางกายและการเคลือ่ นไหวในการใช้ลอ้ เข็น
http://www.mountnittany.org/assets/images/krames/7626.jpg
http://www.tpub.com/content/armymedical/MD0923/MD09230124im.jpg
 Advantage; High level of stability
 Disadvantage; Difficult to move
 Measureing; As same as cane
http://medicalhardware.co.nz/images/ParallelBar.jpg
 Lightweight aluminum or wood
 Increase BOS and improve balance
 Hold a cane in the hand opposite the
affected extremity
 Reduced reaction force
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Made from aluminum, wood, or plastic
 A half circle handle and the distal rubber tip is at least 1
in. in diameter or larger
 Adjust from approximately 27 to 38.5 in. (68 to 98 cm.)
Advantage; inexpensive and fits easily on stare or other
surface
Disadvantage; Not adjustable and point of support is
anterior to the hand
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Same as the standard cane but can adjustable
 Advantage; Quickly adjustable, light weight,
and fits easily on stairs
 Disadvantage; Expensive > standard cane, and
point of support is anterior to the hand
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Shaft of cane is offset anterior creating a straight
handle
 Adjust from approximately 27 to 38.5 in. (68 to 98
cm.)
 Advantage; The design allows pressure to be borne
over the center of the cane for greater stability,
quickly adjustable, lightweight, and fits easily
 Disadvantage; mostly expensive
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 There are large and small base quad canes
 Four point contract on the floor
 Adjust from approximately 28 to 38 in. (71 to 91
cm.)
 Advantage; Several different of a broad-based
support, suitable for instability patients
 Disadvantage; difficult to use in stairs or other floor,
Slow gait pattern
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 It provides a very broad base with four points of floor
contact
 Adjust from approximately 29 to 37 in. (73 to 94
cm.)
 Advantage; very broad base, very stable
 Disadvantage; difficult to use in stairs or other floor,
Slow gait pattern, expensive
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 It provides a wide wheeled base
 Adjust from approximately 28 to 37 in. (71 to 94
cm.)
 A pressure-sensitive break built in the handle
 Advantage; Easy to move, faster walking, assist to
standing
 Disadvantage; Not stable for imbalance patient,
expensive, Don’t used in hand weakness patients
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 It provides a very broad base with four points of floor
contact
 Adjust from approximately 29 to 37 in. (73 to 94
cm.)
 Advantage; very broad base, very stable
 Disadvantage; difficult to use in stairs or other floor,
Slow gait pattern, expensive
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
www.wheelchairaccess.co.uk/walking_aids.html
http://www.rehabmart.com/imagesfromrd/KP-PRC-1.jpg
 Far from the lateral of toe about 6 in.
 Top of cane is approximately at greater
trochanter
 Elbow should be flex about 20-30°
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Used to improve balance and to either relieve
weight bearing
 Used bilateral
 Increase BOS
 Improve lateral stability
 To allow the UEs to transfer body weight to the
floor
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Regular or standard crutches
 Lightweight wood or aluminum
 Axillary bar, a handpiece, and double upright
joint
 Used screw mechanism
 Adjust from approximately 48 to 60 in. (122
to 153 cm.)
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Advantage; Improve balance and lateral
stability, can restricted weightbearing, Easy to
adjusted, inexpensive, can used for stair
climbing
 Disadvantage; be careful in small area,
pressure at axillary area to damage the radial
nerve
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Forearm rests crutch
 Use in patients that don’t weightbearing in wrist and
hand
 It has a dowel or handgrip, velcro strap to maintain
the position of forearm
 Advantage; used in patient that don’t weightbearing
in wrist and hand
 Disadvantage; expensive, difficult to move
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Compose of a single upright, a forearm cuff, and a
handgrip
 A push-button mechanism
 Adjust from approximately 29 to 35 in. (74 to 89
cm.)
 Advantage; Easy to upstairs, Easy to adjust, suitable
for stable patients
 Disadvantage; expensive, difficult to remove cuff, less
lateral support
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Axillary crutches
• Standing
- Approximately 2 in. or the width of two
fingers below axillary
- Distal end of the crutch should be resting at 2
in lateral and 6 in anterior to the foot
- Sholder relax, Elbow should be flex about 2030°
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
http://www.suncare-medical.com/UploadFile/2008126153220.jpg
 Axillary crutches
• Supine
- Measurement is taken from the anterior
axillary fold to a surface point 6 to 8 in.
(5 to 7.5 cm) from the lateral border of
the heel
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Forearm crutches
• Standing; as same as axillery crutches
- Cuff placement should be on the proximal
third of the forearm, approximately 1 to 1.5
in.(2.5 to 3.8 cm) below the elbow
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Used to improve balance and relieve weightbearing
 Greater stability and a wide BOS
 Improve anterior and lateral stability
 To allow the UEs to transfer body weight to the floor
 Adjust from approximately 32 to 37 in. (81 to 92
cm)
 Several design in other patients
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Advantage; Greater stability, easy
 Disadvantage; Difficult to move in small area
or upstairs, don’t used in hand weakness
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Advantage; Easy to move forward, can used in
impair hand weakness
 Disadvantage; Difficult to move in small area
or upstairs, don’t stable
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Allow unilateral forward progression of one side of
the walker
 Advantage; High level of stability, lightweight, easy to
adjust
 Disadvantage; Difficult to move in small area or
upstairs, Cumbersome
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
http://www.caring-for-aging-parents.com/images/standard_walker.jpg
As same as cane
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Can move about 0-90°
 Improve standing
 Improve blood circulation
 Postural drainage
 Prevent osteoporosis
 15-40  at first
 Abnormal sign; Decrease 5-10  Rest 5-10 minutes
 Strap at chest, hip, and above knee
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
http://internationalbrain.org/enews/issue1_07/Erigo_setup.jpg
 Non weight bearing (0%)
 Toe touch weight bearing (<20% body weight)
 Partial weight bearing (20-50% body weight)
 Weight bearing as tolerate (50-100% body weight)
 Full weight bearing (100%)
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 4 point gait
 3 point gait
 2 point gait
 Swing to gait
 Swing through gait
 Good stability - at
least 3 point contact
ground
 Ataxia or
incoordination
 Slowest, difficulty
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Non-weight-bearing gait for lower limb
fracture or amputation
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Faster than 4-point gait
but less stability
 Decrease both lower
limbs weight-bearing
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Both crutches -> both
lower limbs almost to
crutch level
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
 Fastest gait, requires functional abdominal muscles,
good balance
•Tetraplegia and Paraplegia (A Guide for Physiotherapists). 5th ed. London: Churchill Livingstone. 2005
http://www.pfiedler.com/1079/images/front3.jpg
 To promote comfort and relaxation
 To restore body function
 To prevent deformities
 To relieve pressure and prevent strain
 To stimulate circulation
 To give treatments
Rraddom, R. et al. (2007). Physical medicine and rehabilitation 3rd edition
 Maintain good patient’s body alignment.
 Maintain the patient’s safety.
 Reassure the patient to promote comfort and
cooperation.
 Properly handle the patient's body to prevent pain or
injury.
 Keep in mind proper body mechanics for the practically.
 Obtain assistance, if needed, to move heavy or helpless
patients.
 Do not use special devices (that is., splints, traction) unless
ordered. Ask if you do not know what is allowed
Rraddom, R. et al. (2007). Physical medicine and rehabilitation 3rd edition
http://www.annals.org/content/123/6/433/F2.large.jpg
http://www.moondragon.org/images/patientpositionsemisupine.jpg
http://www.moondragon.org/images/patientpositionprone1.jpg
http://www.moondragon.org/images/patientpositionsemiprone.jpg
http://www.moondragon.org/images/patientpositionrightlateral.jpg
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http://www.tpub.com/content/armymedical/md0905/md09050101im.jpg
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Questions?