Lecture 10 - Walking aids

Question 1

What are the indications for walking aids?

Answer 1

Decreased ability to weight-bear on the LE

• Alleviate pain from injury or clinical pathology (e.g., arthritis)
• Help reacquire walking skills after trauma (e.g., hip fracture)
• Compensate for weakness or impaired motor control of the leg (e.g., stroke)

Poor balance or risks of falls

• improve mobility
• help with balance during ADL
• decreasing weight bearing on 1 or both legs

Question 2

What are indications for walkers

Answer 2

• Patients with generalized weakness
• Patients with debilitating conditions
• When there is a need to reduce weight bearing on one or both lower extremity
• In the presence of poor balance and coordination
• Inability to use crutches

Question 3

What are the indications for crutches?

Answer 3

• Patients with weakness of one or both lower extremities
• When there is a need to reduce weight bearing on one lower extremity
• Patients who need some support of the trunk (axillary crutches only)

Question 4

What are the indications for canes

Answer 4

• Patients with slight weakness of muscles of the lower extremity: Cane accepts up to 15% of WB
• Pain in the lower extremity
• When assistance is needed for balance: Tactile cueing

Timing of peak force application may differ depending on functional use

• Late-stance & toe off – compensate for p-flex
• Heel strike – reduce impact force (e.g., hip OA)

Question 5

How should a load be carried in case of a painful hip

Answer 5

Object on ipsilateral side
↓ moment arm from hip
Assists activity of abductors on painful side
↓ joint compression

Question 6

How should a load be carried in case of a back or spine problem

Answer 6

Equal distribution of loads

• Removes effect of moment arm of load
• Less compression due to muscle contraction

Carry loads low down

• Less gravitational potential energy of load
• Less muscle activity to maintain spine stability

Question 7

How do we adjust:

• at wrist crease
• axillary crutches
• canadian crutches

Answer 7

Wrist crease ± 2.5 cm

Axillary crutches: 2-3 fingers below the arm pit - NWB through the arm pit

Canadian crutches: 2-4 fingers below the olecranon - requires more trunk stability than axillary crutches

Question 8

2, 3 or 4 point gait type of assisted device?

1. For bilateral weakness or balance problems
2. For weakness or balance problems
3. only one lower extremity involved
4. two canes or crutches moved forward together with the affected leg, followed by sound side
5. Three points of contact on the ground at all times
6. One cane followed by opposite leg, the other cane followed by opposite leg
7. Canes or crutches used alternately with each leg

Answer 8

1. For bilateral weakness or balance problems - 2 points
2. For weakness or balance problems - 4 points
3. only one lower extremity involved - 3 points
4. two canes or crutches moved forward together with the affected leg, followed by sound side - 3 points
5. Three points of contact on the ground at all times - 4 points
6. One cane followed by opposite leg, the other cane followed by opposite leg - 4 point
7. Canes or crutches used alternately with each leg - 2 points

Question 9

Name some safety tips

Tips

• any tools?
• position of PT
• Watch out for…

Answer 9

Parallel bars, if available
Use a gait belt
Stand to side and slightly behind patients
Make sure to address all the pt’s needs for gait
Watch out for small rugs, wet or polished floors
Check the wear and tear of the assistive device

Question 10

Why people abandon their cane after receiving it?

Answer 10

difficult and/or risky to use (>50%)

discomfort, pain, and injury (repetitive stresses on UE): may be exacerbated by inappropriate / faulty prescription

Question 11

Are these benefits / disadvantages reported for walking aids?

1. Increased confidence
2. Easy to use
3. prospective predictor of increased risk of falling in older adults
4. “Eh? Oh. No, you would not part an old man from his walking stick?”
5. Increases the BOS
6. In ipsilateral hand – reduces compressive force on hip force by up to 60% but decrease stability
7. Stabilizing biomechanical effect

Answer 11

1. Increased confidence - T
2. Easy to use - F (its proven to be not easy)
3. prospective predictor of increased risk of falling in older adults - T
4. # LOTR fans
5. Increases the BOS - T
6. In ipsilateral hand – reduces compressive force on hip force by up to 60% but decrease stability -
   F (real sentence: In contralateral hand – reduces compressive force on hip force by up to 60%)
7. Stabilizing biomechanical effect - F (Destabilizing biomechanical effect
   -> Posture control required to move the aid)