ASSISTIVE DEVICES
WALKING AIDS
DEFINITION of ASSISTIVE DEVICES
• Also known as assistive ambulatory or walking aid.
• A device designed to assist walking and improve
mobility of people who have difficulty in walking or
people who cannot walk independently.
• They are basically useful equipment that improve a
person’s ability to function independently.
PURPOSE OF WALKING AIDS
• Walking aids is most useful to those who are in need
of ambulatory assistive devices. They are used by
people with disabilities and older adults who want to
remain independent for as long as possible. They serve
the following purposes:
• Increase area of support or base of support
• Maintain center of gravity over supported area
• Redistribute weight bearing area by decreasing
force on injured or inflamed part or limb
• To compensate for weak muscles
• Decrease pain
• Improve balance
Walkers
Canes
Crutches
CRUTCHES
•Walking aids that serve to increase the size of an
individual’s base of support to reduce weight
bearing on one or both legs.
•It is used singly or in pairs to assist in walking
when the act is impaired by a lower extremity
disability;
•Transfers weight from the legs to the upper body,
often used by people who cannot use their legs to
support their weight (short-term injuries to
lifelong disabilities).
PARTS OF A
CRUTCH
A crutch is intended to do 2 things:
•Reduce weight load on one or both legs.
•Broaden support base to improve balance and
stability for improve upright movement.
It is indicated for the following categories of people:
•A crutch becomes necessary when a person
cannot walk or walks with extreme difficulty due to
impaired balance and inadequate strength
•People with paralysis or disabilities need crutches
for upright posture and ambulation.
•Any person with leg or foot pain or injury, or an
unstable gait may benefit from using a crutch or
crutches.
GUIDELINES FOR CRUTCH SIZING
•The client needs to stand up straight when taking
the measurement.
•The top of the crutches should be between 1.5
inches to 2 inches or 2-3 fingers width below the
armpits while standing up straight.
•The hand grips of the crutches should be even with
the top of the hips.
•There should be a slight bend in the elbows
when you use the handgrips
•Instruct patient to hold the top of the
crutches against sides and use hands to
absorb the weight.
•Do not press the top of the crutches into the
armpits – this could damage the nerves that
run under the arms
TYPES OF CRUTCHES
TYPES OF CRUTCHES
•
Axillary crutches/underarm crutches
•
Forearm crutches/Lofstrand crutches
•
Elbow crutches/Gutter crutches
TYPES OF CRUTCHES
Axilla or underarm crutches:
•Made of wood or metal with axillary pads, a
hand piece and a rubber ferrule or suction tip
to allow total/proper contact with the floor.
•It is used either temporarily or permanently
to assist ambulation in various types of
locomotor disabilities
Advantages of Axillary crutches:
•Affordable at lower cost
•Provides a large degree of support for
the lower body
•Allow the patient to perform greater
variety of gait patterns and ambulate at
a faster pace
•Improper use of crutches can cause injury to
axillary region and strain on the arms and
upper body which can lead to crutch paralysis
•Crutch paralysis is the damage to nerve
endings in the axilla usually the radial nerve
and brachial plexus due to constant pressure
placed on them when using axillary crutches.
Forearm Crutches (Lofstrand Crutches):
• They were invented in the
1950s
by
Thomas
Fetterman, a polio survivor
in order to help users
suffering from long-lasting
musculoskeletal problems
such as muscular dystrophy,
polio, or arthritis.
•The user of this device find their support in
the forearm to distribute the weight more
evenly throughout the arms instead of just
from the wrist alone. It allows the transfer of
40 -50% of the patient’s body weight. It
requires a good trunk control that is why the
patient needs confidence in his/her ambulation
skills.
Advantages of Lofstrand Crutches:
•Affordable at lower cost
•Provides a large degree of support for the
lower body
•Allow the patient to perform greater variety of
gait patterns and ambulate at a faster pace
•There is no risk of injury to the
neuromuscular structures in the axillary
region
•The patient’s hands are free to perform
various tasks while the individual’s body
weight is supported through the forearm by
the forearm cuff pivots.
•The patient does not have to worry about
dropping the crutches.
Disadvantages of Lofstrand Crutches
•They provide less support for ambulation than do
axillary crutches.
•Geriatric patient sometimes feel insecure with
these crutches – they may not have the necessary
upper body strength to use forearm crutches.
GUTTER OR ARTHRITIC CRUTCHES
•
Composed
of
padded
forearm support made up of
metal, a strap and adjustable
hand piece with a rubber
ferrule specifically designed
for those suffering from
arthritis, impaired grip, painful
wrist and other hand
conditions.
Gutter Crutches
DANGERS OF CRUTCHES
• Crutch paralysis: damage to the nerve endings in the
axilla can result from constant pressure placed on them
when using axillary crutches.
• Skin irritation: additional irritation and rubbing of the
skin when using underarm crutches, especially without
padding, can be painful.
• Slipping: The smaller point tips of some crutches and
the lack of non-slip grip can lead to slipping and falls
especially on slippery and uneven surfaces. Navigating
stairways can also be extremely difficult with crutches.
•Catching tip and falling: Trip hazards on walking
surfaces like cords may cause a patient to catch the
tip of their crutch and lose their balance leading to
a fall.
•Joint or muscle pain: may occur from the use
of crutches as patients engage different muscles in
many awkward body movements and positions.
Neck, shoulder, back, elbow pain may occur
SAFETY PRECAUTIONS IN USING CRUTCHES
•Have someone nearby for assistance until patient
is accustomed to crutches
•Frequently check that all parts are securely in
place – check the screws at least once a week,
clean out crutch tips to ensure they are free of
dirt and stones
•Remove rugs or clusters from walking paths
Take care of wet or slick surfaces
Never carry anything in hand, or use backpack to
carry items
• In case of falling, throw the crutches out to the
side and use arms to break fall
•
•
•
To get up, get into a sitting position, back
up to a stool of low chair. Put your hands
backwards on to the chair. Bend the good leg
up. Pull with your hands and push with the
good leg to get up unto the chair.
•For demonstrations on how to assist patients
with the different gait patterns and the use of
crutches, please visit this link:
•https://youtu.be/K44K2qodlXc
ASSISTIVE DEVICES – WALKING AIDS
CANES
CANES
CANES
•Walking canes or walking sticks are one of the
assistive devices used for ambulation or
walking. They are generally prescribed for
people with moderate levels of mobility
impairment.
• A walking cane improves balance by increasing a
person’s base of support.
• Can be made of wood or light metals such as
aluminium. The wooden cane usually have a crook
handle and cannot easily have multipoint tips.
Aluminium walking cane can have a flat or swan-neck
top and have the advantage of being adjustable to have
multiple points.
• When used correctly, canes unload the leg opposite to the hand
with the cane by 25%. This can help keep pressure off injured
body parts or allow for optimal healing to occur while still
allowing the patient to move around safely.
• Cane handgrips have a variety of styles and sizes that are
available such as the shotgun handle, crook handle and piston
handle. The type of handgrip prescribed or used depend on 2
important factors: firstly, the comfort of the patient. Secondly,
the grip’s ability to provide adequate surface area to allow
effective transfer of weight from the upper extremity to the
floor.
TYPESOF CANE
•Canes are classified based on the number of legs
it has and the amount of body weight it can
support.
•Single canes
•Multiple-legged canes
Single canes
- Canes with only one leg. They include –
• a. Standard canes – Also called straight cane, generally made of
wood or aluminium. They are light weight and inexpensive. Used
for patients that need just an additional point of contact with the
floor for balance with little or no weight bearing needed,
therefore increasing the base of support. It can be used for
patients with mild sensory or coordination problems found in
visual, auditory, vestibular, peripheral proprioceptive, or
cerebellar disease.
•b. Offset canes
– Usually made from aluminium and the
lengths are also adjustable with no need for
custom fittings. They allow for patient’s weight
to be displaced over the shaft of the cane
Multiple-legged canes
– They have multiple legs. They include
• a.Quadripod (quad) cane – This is a four-legged cane
usually made of aluminium. It can be prescribed for
hemiplegic patients or patients with moderate to severe
antalgic gait from osteoarthritis. It permits more weight
bearing, increases base of support and provide more
stability for the patient.
Disadvantages:
i. All 4 legs of the cane must be in contact with
the floor during gait to provide stability which
hinders fast gait.
ii. It is not suitable for stair climbing
b.
Hemi Walker Cane
– Made of aluminium and has vertical component with a
handle and 2 legs; and another component with 2 additional
legs angled away from the patient. It provides more broad
based support than other canes. It is used by patients requiring
continuous weight bearing through one upper extremity like
stroke patients with hemiparesis who have moderate to severe
lower extremity disability.
DETERMINING APPROPRIATE CANE LENGTH
• 1. Elbow angle – The patient should stand erect and
hold the cane with the elbow flexed at 20 -30 degrees.
The elbow flexion is measured using goniometer. This
degree of flexion allows efficient movement while
walking with the cane, and allows the arm to shorten
and lengthen during different phases of the gait cycle,
and also provide shock absorption mechanism.
2. The floor to the greater trochanter
- The top of the cane is at
the same level as the
greater trochanter when
the patient is standing
upright
with
arms
hanging loosely by the
sides
3. The distal wrist crease to the floor
– The patient stands
erect with arms hanging
loosely by the sides and
the distance from the
distal wrist crease to the
floor is measured to get
the cane length
HOW TO AMBULATE WITH A CANE
• The cane must always be on the opposite side of the
affected leg and in tandem with it so as to simulate
normal gait and to increase balance and aid weight
distribution.
• Ex. If the right leg is the limb with disability, then the
walking cane should be held in the left hand
SAFETY TIPS IN USING A WALKING CANE:
• a. Check your cane frequently – check the rubber tip
of the cane before using it to avoid skidding across the
floor.
• b. Take care after standing – wait for a while after
standing up before moving
• c. Avoid using your cane if not feeling strong or find it
difficult to remain steady on your feet
• d. Maintain your floors – Ensure floors in the home are clutter
free, no wires or other hazards crisscrossing the floor, avoid
small rugs that can snag the walking cane, make sure the edges
of the carpets are well taped or nailed down, avoid walking on
wet floors
• Always remember when using the stairs, go up with the good leg
and go down with the affected leg.
• e. Keep head straight and look ahead – pay attention to the
path ahead and not focus on the ground beneath
WALKER
s
•A walker is a walking aid that has 4 points of
contact with the ground and usually has 3 sides
with the side closest to the patient being open. It
provides a wider base of support than a walking
stick and is used to stabilize patients with poor
balance and mobility. It is used to help people
who are still able to walk but need assistance.
•They are usually made of aluminium which make
them light enough to be picked up and moved
easily.
•They have comfort grips made of foam, gel, or
rubber to enhance the users comfort.
•The tips of the legs are covered with rubber caps
designed to prevent slipping and improve stability.
Walkers are available in wheeled and non-wheeled
versions
• Non-wheeled walkers offered stable support for
people with balance problems. It has to be picked up
and moved forward before taking another step. It is a
poor choice for people with limited arm strength.
• Wheeled walkers offer support but have 2 front wheels
that makes it easier to move
TYPES OF WALKER
• 1. Folding walkers: They can be folded easily for transport. The
walker collapses with a push button to fit easily into a car, bus or
plane.
• 2. Height adjustable walkers: Have buttons that can be used to
adjust and set the height of the walker so the handle fits properly
• 3. Hemi walkers: Allows the user to lean just on one side for
support. It is designed for people with little or no dexterity in one
arm or hand
• 4. Walker with front wheels: Has wheels on the front legs to help
maneuver difficult terrain
• 5. Rise-assistance walker: Has handle that slopes lower on the
user’s side. The user can reach the lower portion of the handle and
use it for leverage to pull themselves up
• 6. Glider Walker with platform attachment: Looks like a lowheight walker. It has a pole on each side with soft vinyl platforms for
arm rest and attached to handles for gripping. The design assist the
user’s stability if the prefer to bear their weight on their forearm
rather than elbows and shoulders.
SAFETY TIPS WHEN USING WALKER
•Take small steps
•Keep the walker close to your body
• Wear nonskid slippers, socks or shoes
• Remove throw rugs, wires, and clutter from the
floor
• Keep the head up while walking to maximize balance
• Keep hands on walker, if you need to carry items attach
a basket to the walker.
• Move the walker ahead one footstep at atime and
make sure it is firmly balanced with all 4 tips or wheels
touching the ground before proceeding.
• Check the tips and the wheels of the walker regularly
and replace them if worn out.
HOW TO WALK WITH WALKER
• Push or lift the walker a few inches/centimeters or arm’s length in
front
• Make sure all 4 tips or wheels are touching the ground before
taking a step
• Step forward with the weak leg first. If both legs are affected, start
with the leg that feels weaker.
• Step forward with the other leg and place it in front of the weaker
leg
• Go slowly and walk with good posture keeping the back straight
•For the demonstrations on how to assist
patients with the the use of cane and walkers,
please visit this link:
•https://youtu.be/K44K2qodlXc
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