EO 002.12
Learning Objectives
 The physical therapist technician will be able to:
 Fit a patient with a variety of orthopaedic equipment
including:
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Splints
Braces
Orthoses
Tape
Gait aids
 Adjust various orthopaedic equipment
 Educate patients on the proper use of various orthopaedic
equipment
Orthopaedic Equipment
 A variety of structural devices designed to stabilize,
protect, and/or correct orthopaedic disorders
 Mainly used in the branch of health care known as
orthopaedics
 Medical specialty dealing with the musculoskeletal
system
 Usually limit or prevent movement, or hold a body
part in a certain position to prevent further injury or
deformation, and allow healthy and normal
healing/development to occur
Orthopaedic Equipment
 Common forms of orthopaedic equipment include:
 Splints
 Braces
 Orthoses
 Tape
 Gait Aids:
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Wheelchairs
Canes
Crutches
Walkers
Splints
 A device used for support or immobilization of limbs or
of the spine
 Involves application of a support held in place by an
elastic bandage
 Usually used in emergency situations
 Allows for the natural swelling that occurs during the
acute inflammatory phase of an injury
 Are easily removed for inspection of the injury site
 Disadvantages include lack of patient compliance
resulting in increased motion at the injury site
Braces
 Protect, stabilize, support and correct injuries or
abnormal alignment during the process of
rehabilitation and recovery
 Meant to correct or support an injured limb or torso for
an indefinite period of time
 Usually applied to tears and sprains, but may
occasionally be utilized in the rehabilitation of broken
bones
 Most often for therapeutic use and it is meant to be used
for a longer time
Orthoses
 Orthopaedic appliances used to support, align,
prevent, or correct deformities, or to improve function
of movable parts of the body
 Includes braces and splints
 Are often custom made to the patients body
Athletic Tape
 Limits the abnormal or excessive movement of a
structure while also providing support
 Often used after an injury such as a sprain or strain
 Also used to apply compressive forces to an injury site
 Requires detailed knowledge anatomy and
biomechanics
 Used in conjunction with the rehabilitation program
whose goals are to restore ROM, strength and motor
control.
Tape Continued . . .
 Tape is used for:
 Prevention
 Assessment
 Therapy/Rehabilitation
 Taping requires the knowledge of:
 Origin and insertion of the target tissue
 Direction of the target tissue
 The role of the target tissue
Taping Continued . . .
 For successful taping, there are some basic skills and
knowledge that are required:
 Knowledge of anatomy and biomechanics
 Knowledge of the mechanisms of common injuries
 An ability to determine the appropriate technique for a
given injury
 Knowledge of basic taping techniques
 Therefore, taping is a specialized skill that
requires further education and training
Gait Aids
 Devices designed to assist
walking or improve
impaired mobility
 Type of aid based on the
patient’s weight bearing
status, conditioning,
functionality and needs
 Provide gait aids for:
 Weight bearing
 Balance
 Motor pattern
 Confidence
 Endurance
Gait Aid Function
 Gait aids can:
 Decrease pain
 Decrease weight bearing on involved limbs
 Allow for compensation when there are decreases in:




Coordination
Endurance
Balance
Strength
Wheelchairs
 A mobile chair used by individuals who have
impairments that limit their ability to walk
 The right wheelchair should maximize patient mobility
and functional potential as well as prevent comorbidity and restriction of remaining functional
capabilities
 Wheelchairs are used either as primary or secondary
means of mobility:
 Primary-patients are mobile mainly by a wheelchair
 Secondary- patients use the wheelchair for longer
distances or for longer endurance tasks
Canes
 A device used to help with ambulation
 Improves balance by increasing a person’s base of
support
 Unloads the leg opposite to the hand the cane is in by
up to 25%
 Many different shapes and sizes depending on the
sought purpose
 i.e. Quad cane has increased base size for more stability
Quad Cane
Crutches
 Type of gait aid used to help people who have suffered
an injury to one of their feet, knees, ankles, or legs
 If both sides are injured, a wheelchair is usually
prescribed
 Can cause nerve injuries to the axilla if used
improperly
 Axillary crutches are usually used temporarily for acute
conditions (6-8 weeks)
 Forearm crutches are usually used for more chronic
conditions
Walkers
 Primarily used when a patient has difficulty balancing
or is at risk of falling
 Significantly diminishes the weight borne on the
affected extremity
 The fewer the wheels, the more the stability the walker
provides
 More commonly used in the very frail and elderly
population
Summary of Ambulation Aids
Ambulation Aid
Types
Advantages
Disadvantages
Walkers
Standard or Pick-up
Two-Wheel
Four-Wheel
Allows for maximal stability for
ambulation/gait training;
Potential to increase mobility in community
Some environmental limitations
Gait pattern is altered
Walking speed is slower
Challenging to use with stairs
Wood
Aluminum
Allows for increased variability in gait
patterns
Provides support with increasing mobility
Can be used on stairs
Less stable
Requires relatively good trunk and UE
strength
Risk for nerve/vessel damage with
improper fit/use
Allows for increased mobility in patients who
are unable to use a cane
Functional on stairs and in narrow areas
Forearm cuff can make it difficult to
remove crutch
Dynamic qualities may make some
patients feel insecure (e.g., elderly)
Provide a broad base with four points of
contact on floor
Can feel unstable with transitioning
weight through the device;
Results in a slower gait pattern
Axillary Crutches
Forearm Crutches
Quad Cane
Cane
Aluminum
Large Base
Small Base
Wood
Aluminum
Offset handle
Pistol grip
Allows for progressive increased mobility
Standard variety is not adjustable;
Used for added stability during upright
must be cut to fit patient
activities
Function is to widen BOS and improve
Offset handle allows for weight distribution
balance
through shaft of cane
Relatively small BOS
Less environmental constraints
Unable to use with 3-point gait pattern
Principles of Gait Aids
Gait Cycle
 There are two major parts to a full gait cycle of one step:
 The stance part (60%); and
 The swing part (40%)
 The full cycle of one step is subdivided into four phases
(in order of occurrence):
 Heel strike
 Mid-stance
 Push-off
 Mid-swing
Gait Cycle Continued . . .
 A complete cycle is from heel strike to heel strike
 The period at the end of the stance phase of one leg and
the beginning of the stance phase of the other leg is
called the “double support” period as both extremities
support the body
Base of Support (BOS)
 Refers to the area beneath an object or person that
includes every point of contact that the object or person
makes with the supporting surface
 These points of contact may be body parts e.g. feet or
hands, or they may include things like crutches or the
chair a person is sitting in
 Important concept to understand when trying to
determine a patient's ability to balance
Base of Support
BOS With A Walker
BOS With Crutches
BOS A Cane
Which side should the cane go on?
Injured Leg
Weight Bearing
Swing Through
Phase
Same Side?
Small BOS
Swing Through
Phase
Injured Leg
Weight Bearing
Opposite Side?
Bigger BOS
Injured Leg
Weight Bearing
Swing Through
Phase
Weight Bearing Orders:
 Will be directed by the physician
 Ensure weight bearing orders are provided and
understood:
 NWB- Non-weight bearing: no weight on affected leg
 PWB- Partial-weight bearing: usually half of body weight
on affected leg
 WBAT-Weight bearing as tolerated: on affected leg within pain free limits
 FWB-Full weight bearing on affected leg
Gait Patterns
 4 Point:
 A slow gait pattern in which one crutch is advanced
forward and placed on the floor, followed by advancement
of the opposite leg
 Then the remaining crutch is advanced forward followed
by the opposite remaining leg
 Requires the use of two assistive devices (crutches or
canes)
 Provides maximum stability with three points of support
while one limb is moving
Continued . . .
 3 Point:
 Both crutches and involved leg are advanced together,
then uninvolved leg is advanced forward
 Requires use of two assistive devices (crutches or canes)
or a walker
 Indicated for use with involvement of one extremity
Continued . . .
 2 Point:
 One crutch and opposite extremity move together
followed by the opposite crutch and extremity
 Requires use of two assistive devices (canes or crutches)
 Allows for natural arm and leg motion during gait, good
support and stability from two opposing points of
contact
Continued . . .
 Swing-to-Gait:
 Both crutches are advanced forward together
 Weight is shifted onto hands for support and both legs
are then swung forward to meet the crutches
 Requires the use of two crutches or a walker
 Indicated for individuals with limited use of both lower
extremities and trunk instability
Continued . . .
 Swing-Through-Gait:
 Both crutches are advanced forward together
 Weight is shifted onto the hands for support and both
legs which are swung forward beyond the point of
crutch placement
 Requires the use of two crutches
 Not as safe as swing-to gait
Weight bearing
status
Description
NWB
No weight on the
extremity
PWB
Partial weight
bearing
Gait Pattern
Pattern description
Three-Point
Use of walker or two crutches; Step to
Step through
Aid is advanced alternately with affected limb
Three-Point
Use of walker or two crutches; Heel touch or flat
foot with a fixed or determined amount of WB in
the affected limb
Aid is advanced simultaneously with affected limb
WBAT
Three-Point, Four
Use of walker or bilateral ambulation aids
Weight bearing As
point, or two point
(crutches, canes); progression to more reciprocal
tolerated
(progress from most to pattern is dependent on patient safety, strength,
least support from aid)
confidence, and symptoms
FWB
Full weight bearing
Unequal WB
Hemi pattern
Four point, or
two point
Use of walker or bilateral ambulation aid
Reciprocal pattern (slow to fast progression)
Modified four-point
Modified two-point
Use of one ambulation aid (crutch, cane, hemi
walker) or for patients with functional use of one
upper extremity
LE and aid advance alternately (four-point) or
simultaneously (two-point) ; aid is typically used
on the contralateral side
Common Gait Abnormalities
 Abnormalities of a normal gait pattern are caused by
several factors:
 Structural factors include extremity length differences,
joint or soft-tissue factors like contractures
 Neuromuscular factors
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Central nervous system disorders
Peripheral nervous system disorders
 Pain
Antalgic Gait
 Any pattern of walking designed to relieve pain
 Typically, the patient shortens the stance phase, avoids
bearing weight, and tries to reduce the forces through
the painful or affected extremity as much as possible
 Compensatory gait patterns have one thing in
common: they all require more energy to produce
forward movement of the body
Fitting Gait Aids
Wheelchairs
Wheelchair Fitting: Seat Depth
 Determined by measuring from the dorsal buttocks to
the back of the knee and subtracting 2–3" from this
measurement. If the backrest is cushioned, the
thickness of the cushion must be added
 If the seat depth is too shallow, ischial pressure is
increased and stability of the chair is decreased
Seat Width
 Patients should not sit directly on the seat. All patients
should receive some type of cushion
 Seat width is determined by measuring across the
widest point of the hips (with clothing and any braces
or orthoses). Once this distance is obtained, add one
inch (1") to this measurement
 Too narrow: transfers and access to the chair are
difficult and pressure skin breakdown is more likely to
develop
 Too wide: trunk support is compromised, leading to
scoliosis, back pain, and difficulty with propulsion
Seat Height
 Determined by measuring from the bottom of the heel
to the posterior thigh, then adding 2" to compensate
for leg rest clearance
 Consider the cushion thickness and its relative
additional height. Foam cushions compress to 1/2 their
normal size
Backrest
 The backrest should be high enough to support the
patient, but not inhibit movement
 The scapula should not hang over the chair. This is
measured by the distance from the bottom of the
buttocks to the level of the spine of the scapula
 Too high: may interfere with shoulder movement
 Too low: it will not provide adequate trunk stability
Backrest Continued . . .
 If the patient has good trunk control and can propel a
wheelchair, 3" is subtracted from this measurement
 If the patient has poor trunk muscles, but can still
propel a wheelchair, 2" is subtracted from this
measurement
 If the patient has no upper extremity strength and
poor trunk control, a full measurement is taken with
the possible addition of a headrest and recliner
mechanism
Back Rest
Height
Seat Depth
Seat Height
Seat
Width
Armrests
 Chair arms provide arm support, lateral support, and
aid patients who must elevate their body at regular
intervals to prevent pressure breakdown
 The arm height is measured from the buttocks to the
bottom of the patient's bent elbow at 90 degrees. The
measurement must be done with the cushion; 1" is
added to this measurement
Cushions
Brakes
 Brakes or parking locks secure the wheels of the chair to
avoid rolling away on uneven surfaces and to provide
stability during transfers
 Locks should not be used to slow a chair. The abrupt
stop would result in overturning. Parking locks may be
toggle or lever
 Brakes should always be applied when the patient is not
in motion
Cane Fitting
 Ensure cane is in proper condition (Inspect tip)
 Hold handle of cane at crease of wrist with arm at side
 Ensure cane is held in hand opposite to injured leg.
This widens the base of support increasing balance and
stability
 Injured leg and cane move forward at same time, then
good foot
 Ensure patient has good posture with proper heel-toe
gait
Stairs With Canes
 To climb stairs, grasp the handrail (if
possible) and step up on the good leg first,
with the cane in the hand opposite the
injured leg. Then step up on the injured leg
 To come down stairs, grasp the handrail,
put the cane on the step first, then the
injured leg, and finally the good leg, which
carries the body weight
Crutch Fitting
 Select the proper set of crutches according to
the patient’s height
 Inspect the crutches to ensure they are in
proper condition. (Hand and underarm pads)
 Standing straight the crutch tips should be
12-20 cm to the side of and slightly in front of
the feet
 Ensure 2-3 finger widths between the armpit
and the top of the crutch
Crutch Fitting
 Standing tall, looking straight forward with arms
relaxed at sides, the handgrips should be at the crease
of the wrist. When holding the handgrips the elbow
should be at a 15 degree angle
 Ensure weight is supported through the hands, not the
armpits. The underarm pad should be squeezed by
the arms against the ribs
Standing With Crutches
 With chair steady, move forward to edge
 Place good foot flat on floor
 Hold both crutches in hand on affected leg side, and
chair with other hand
 Stand, putting weight through good leg
 Place crutches in proper position
Walking With Crutches
 Put weight through hands, arms squeezing into ribs
 Move crutches and affected leg slightly forward
 Bring good leg through crutches, transfer weight on
good foot through heel first
 Always remind the patient to shorten stride and slow
down, especially when first learning
Sitting With Crutches
 Standing in front of chair, place back of knees against
chair
 Move crutches to one hand on affected leg side
 Hold chair with the other hand and slowly lower
(placing weight through good leg) to sitting position
Using Stairs With Crutches
 Use hand rails when possible
 Place both crutches under arm furthest from the
railing and hold railing with free hand
 If no hand rails, then use crutches same as for walking
Going Up Stairs
“The Good Go Up”
 Putting weight through crutches, place good leg on
step
 Bring affected leg up
 Bring crutches onto the same step
 Repeat
Going Down Stairs
“The Bad Go Down”
 Hold affected leg in front of body, not behind.
 Lower crutches one step.
 Lower affected leg to same step.
 Step down with good leg.
Walker Fitting
 Elbow bend: Place hands on the grips. The elbows
should bend at a comfortable angle of about 15 degrees
 Wrist height: Stand inside the walker and relax arms at
the sides. The top of the walker should line up with the
crease on the inside of the wrist
 The width of a walker must provide adequate clearance
for a step. A walker that is wider than average is needed
if the patient walks with their feet far apart
Please Ensure:
 Prescribed weight-bearing orders are understood and
followed
 Crutches, canes, walkers, or wheelchairs are provided if
prescribed
 The patient is ambulating correctly and safely before
leaving the clinic or hospital
 Practice sitting, standing, and stairs
 Record what gait aid the patient received in their
physical therapy chart
 Ensure the patient has completed a loan card
Continued . . .
 Always inspect the piece of equipment for any worn or
missing parts
 Ensure matching pair (i.e. crutches)
 A range of 15 to 30 degrees of elbow flexion is optimal
 Spring clip tips are located in all holes
 For axillary crutches make sure the nuts and bolts are
tight
Questions?
Comprehension Check
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
What is orthopaedic equipment?
When is a splint used over a brace?
What is the function of a gait aid?
Which side of the body is a cane used on?
What are the 4 phases of a gait cycle?
What is a base of support?
Describe 2-point gait
What is antalgic gait?
What is the rule for going up and down stairs with a gait
aid?
What landmark should be used to measure the height of a
handle on a gait aid?
Answers
1. Orthopaedic equipment is a variety of structural
devices designed to stabilize, protect, and/or
correct orthopaedic disorders
2. A splint is used over a brace in an emergency
situation or for more temporary situations
Answers
3. The function of a gait aid is:
 Decrease pain
 Decrease weight bearing on involved limbs
 Allow for compensation when there are decreases in:




Coordination
Endurance
Balance
Strength
Answers
4. A cane used on the opposite side of an injury
5. The 4 phases of a gait cycle are:
 Heel strike
 Mid-stance
 Push-off
 Mid-swing
6. A base of support is the area beneath an object or
person that includes every point of contact that the
object or person makes with the supporting surface
Answers
7. 2-Point gait is:
 One crutch and opposite extremity move together followed
by the opposite crutch and extremity
 Requires use of two assistive devices (canes or crutches)
 Allows for natural arm and leg motion during gait, good
support and stability from two opposing points of contact
8. Antalgic gait is any pattern of walking designed to
relieve pain
Answers
9. The rule for going up and down stairs with a gait aid is;
“The good go up, the bad go down”
10. The landmark that should be used to measure the height
of a handle on a gait aid is the ulnar styloid on the wrist