Chapter 5
AMBULATORY DEVICES
• A piece of equipment used to provide
support or stability for a person as he/she
walks
• Appliance(Device) to aid ambulation
• Provide an extension of the UE(Upper
extremity) to help transmit BW (Body
weight) & provide support for the patient
Functions of the Ambulation Aids
• Increase area of support
• Increase patient’s stability
• Improve balance
• Redistribute & unload a weight bearing Limb
• Provide sensory feedback
The Importance of selection of
devices
• Selection of the proper ambulation devices &
gait pattern is most important to provide
- optimal security,
- safety & function with the least energy
expenditure.
The role of a Physical Therapist
• Know WHEN to indicate
• Know the RIGHT ambulation aid to use
• Provide PRE-Ambulation Exercises
Stages:
Strengthening Exe Coordination Exe
Trunk Balance Exe Use of Ambulation Aids
(END GOAL)
FACTORS THAT INFLUENCE
AMBULATION TRAINING
Joint ROM & Muscle Strength of Upper
& Lower Extremity
Coordination
Trunk Balance
Impairment in Sensory Perception
FACTORS THAT HELP DETERMINE
AMBULATORY NEEDS
 Nature of Disability
 Age of the Patient
 Mental Status
 Physical Endurance
 Energy Expenditure
SINGLE CANE
BILATERAL
CANES
FOREARM CRUTCHES
AXILLARY CRUTCHES
WALKERS
PARALLEL BARS
Most requiring coordination to least
Requiring coordination
1. CRUTCHES
2. CANE
3. WALKER
4. PARALLEL BARS
PARALLEL BARS
WALKERS
SINGLE CANES
CRUTCHES
 Parallel bars are used when maximal patient support and
stability are required.
 The gait pattern can be practiced in parallel bars and the fit of
the assistive device can be checked.
Disadvantages:
 Bars severely limit mobility
 Patient must progress to another ambulation aid to be
mobile
To properly fit
• The parallel bar height needs to be adjusted to
provide 15 to 20 degrees of elbow flexion when
the patient is standing erect.
• Grasping the bars is about 6 inches anterior to
the hips.
• The bars need to be approximately 2 inches wider
than the patient’s hips when the patient is
centered between the bars.
2) WALKERS
 Walkers provide maximum stability and support and allow
the patient to be mobile.
 Wider and more stable BOS ( base of support)
 Some may have 2 to 4 wheels (Wheels allow the patient
to gently push the device forward)
 Another variation in the design of the walker is the ability to
fold the walker when it is not being used. This feature allows
for easier transportation in a car and for storage.
To properly fit a patient with a walker, adjust the height of the
walker so that the patient has between 15 and 25 degrees of
elbow flexion when grasping the handles of the walker.
Disadvantages

Walkers are cumbersome and difficult to store and transport.

Walkers are very difficult to use on stairs.

Walkers reduce the speed of ambulation.

The patient is unable to use a normal gait pattern by using
walker.
TYPES and VARIATIONS of WALKERS
a)
Standard
•
•
Non-adjustable
Adjustable
b)
Reciprocal Walker
c)
Wheeled or Rollator
d)
Folding Walker
e)
Stair Climbing Walker
f)
One-hand Walker (hemiplegic)
ROLLATOR
Lightweight Aluminium
Rollator Walker Standard
Lightweight Aluminium
Triwalker Basic
PRONE CRAWLER
Walker
Paraplegia
(adult)
Stair
Climbing
Walker
RECIPROCAL WALKER
FORWARD
HEMIWALKER
FOLDING
WALKER
WITH
GLIDES/
ROLLATOR
3) AXILLARY CRUTCHES

Axillary crutches are used with patients who do not require as
much stability or support as provided by a walker.

Axillary crutches allow the patient to perform a greater variety
of gait patterns and ambulate at a faster pace.

Transfers 80% of Body weight

Requires better trunk support
PARTS
• SHOULDER PIECE
• DOUBLE UPRIGHT
• HAND GRIP/ BAR
• RUBBER SUCTION
TIP
Platform
attachment
for walker
• Disadvantages of axillary crutches:
 Axillary crutches are less stable than walker.
 Improper use of axillary crutches can cause
injury to the neurovascular structures in the
axillary region.
 Axillary crutches require good standing balance
by the patient.
 Geriatric patient may fell insecure or may not
have the necessary upper- body strength to use
axillary crutches.
To properly fit a patient with axillary crutches,
• The length of the axillary crutch can be two or three
fingers between the top of the axillary crutch and the
patient’s axilla.
• When standing, the tips of the crutches should be
approximately 6 inches from the toes of the patient.
• The hand piece of the axillary crutch should be
adjusted so the patient has 15 to 25 degrees of elbow
flexion.
4) FOREARM CRUTCHES
 Forearm crutches (Loftstrand or Canadian crutches) are
used when the patient need crutches permanently, or for
long periods of time.
 People who use Loftstrand crutches must have the stability
and coordination to use them.
 This type of crutch has the advantage of being easily stored
and transferred.
 There is no risk of injury to the neurovascular structures in
the axillary region when using this type of crutches.
Disadvantages of forearm crutches:
 Forearm crutches are less stable than a walker.
 They require good standing balance and upperbody strength.
 Geriatric patient sometimes feel insecure with
these crutches.
 They may not have the necessary upper-body
strength to use forearm crutches.
To fit the patient with forearm crutches:
 have the patient stand with arms hanging loosely by
the side.
 Place the crutch parallel to the lateral aspect of the
tibia and femur.
 Adjust the height of the hand-piece so that it is
level with the ulnar styloid process (elbow is flexed
between 15 and 25 degrees)
 The top of the forearm cuff should be adjusted so that
it is located 1 to 1.5 inches distal to the olecranon
process of the elbow.
PARTS OF LOFTSTRAND CRUTCH
1. FOREARM
CUFF
2. PADDED HAND
BAR
3. TUBULAR
ALUMINUM SINGLE
UPRIGHT
Platform Crutch
MAJOR MUSCLE GROUPS USED FOR NONWEIGHTBEARING AMBULATION
• Upper Trunk
– Scapular Depressors
– Scapular Stabilizers
• Lower Trunk
– Trunk Extensors
– Trunk Flexors
• Upper Extremity
– Shoulder Depressors
– Shoulder Extensors and Flexors
– Elbow Extensors
– Finger Flexors
• Weight Bearing Lower Extremities
– Hip Abductors
– Hip Extensors
– Knee Extensors
– Ankle Dorsiflexors
5) Canes
 Canes are used to compensate for impaired
balance or to increase stability while ambulating.
 Approximately 25% of Body weight is transferred
 A cane is functional on stairs and in confined
areas.
 It is also easily stored and transported.
Disadvantages
• It provides limited support due to its small base of
support.
To fit a patient with a cane:
 have the patient stand and place the cane parallel to
the lateral aspect of the tibia and femur.
 Adjust the hand piece of the cane so it is level with the
ulnar styloid process.
 This will provide 15 to 25 degrees of elbow flexion
when the patient grasps the handle of the cane.
PARTS
• HANDLE (“J”/
“T”/”C”- shaped,
PISTOL GRIP,
OFFSET)
• SINGLE UPRIGHT
• RUBBER
SUCTION TIP
handle
Standard Crook Cane
Modified Crook Cane
Cane w/ Ortho Grip
OFFSET CANE W/ WRIST STRAP
Quad Cane
Quad cane with
large inverted
"V" base
Quad cane
w/ "U"
shape hand
grip
CANE SEAT
1. Four Point gait Pattern
2. Two Point gait Pattern
3. Modified Four Point or Two Point Pattern
4. Three Point gait Pattern
FOUR POINT GAIT PATTERN
Requires the use of bilateral ambulation aids.
Uses an alternate and reciprocal forward
movement of the ambulation device and the
patient’s opposite lower extremity.
® crutch- (L) foot- (L) crutch- ®
foot
Very slow but stable pattern, safest one to use
In crowded areas
Requires low energy expenditure
Can be used when patient requires maximal
stability or balance
Approximates a normal gait pattern
TWO POINT PATTERN
Requires the use of bilateral ambulation aids
Uses a simultaneous & reciprocal forward
placement of the ambulation aid & the
patient’s opposite extremity.
® crutch and (L) foot  (L) crutch
and ® foot
Relatively stable pattern and faster than 4
point pattern
Relatively low energy expenditure & similar to
normal gait pattern
Requires more coordination to move one UE
& its opposite LE forward simultaneously.
MODIFIED 4- or 2- POINT PATTERN
The modified four-point and two-point
gait patterns require only one assistive
gait device.
The assistive device is used with the
opposite upper extremity to the
involved lower extremity.
THREE POINT GAIT PATTERN
• Requires bilateral ambulation aids or a walker
• Not for bilateral canes
• Referred to as “step to” (“swing to”) or “step
through” (“swing through”)
• The walker or crutches are moved forward first.
Next, the involved lower extremity is advanced
and then the uninvolved lower extremity
(Crutch- Involved extremity- Uninvolved
extremity)
• The energy cost (oxygen consumption) for this
type of gait is about twice as high as normal
walking.