Prescription of Walking Aids Flashcards
Who needs walking aids?
- Old people
- Pts w/ musculoskeletal conditions
- Pts w/ orthopedic conditions
- Pts w/ cardiorespiratory conditions
- Pts with neurological conditions (only for those w/ chance of recovery, don’t want to prescribe too early or else can cause dependency, or to prevent further loss in degenerative conditions)
- Post-op pts
Why do we prescribe walking aids?
- Enhance functional mobility: walking sticks have been seen to have an immediate effect to improve mobility of intermediate walkers (no impact slow walkers, worse for fast walkers)
- Improve stability by increasing BoS: physios want to stop falls before they happen!
- Compensate for weakness secondary to a progressive condition: neurodegenerative, musculoskeletal, etc.
- Follow weight bearing restrictions: common after fracture/surgery
What are some common walking aids?
- Walking sticks
- Crutches (forearm/Canadian, or underarm/axilla)
- Pick up frames (PUFs)
- Two wheeled (rollator) walking frames
- Four wheeled walking frames
- Forearm support frames (FASF)
What are orthotics?
These are splints/devices which aim to improve functional walking. They are usually prescribed in conjunction with an orthotist but the simple ones can be prescribed by physios. The most common orthotic is an ankle foot orthosis (AFO). An AFO can be needed when dorsiflexors are weak or paralysed, as without active dorsiflexors we get foot drop in swing phase of gait and foot slap in stance phase of gait. We also have KAFOs (knee, ankle) and HKAFOs (hip, knee, ankle)
What are the weight bearing restrictions?
FWB: full weight bearing
WBAT: weight bearing as tolerate
PWB: partial weight bearing
TWB: touch weight bearing
NWB: non-weight bearing
Factors for prescription of walking aids: Pt goals/preferences
May not wish to use cane/walker and prefer alternate method, may not align easily with goals
Factors for prescription of walking aids: Health condition
Prognosis, stage of rehab, and acute vs chronic conditions
Factors for prescription of walking aids: Impairments
Do they have pain/weakness/poor balance? Can they use either/both upper limbs with the aid (in case of injury of dominant/better UL?)
Factors for prescription of walking aids: Activity limitations/participation restrictions
Will this impact already existing activity limitations/participation restrictions, or enhance their ability?
Factors for prescription of walking aids: Funding
Can they afford a wheelchair (electric or manual?) or only a walker, are they covered by insurance/WC/NSW health?
Instructions for use: crutches
Depends on gait what instructions are – swing-to gait, swing-through gait, or reciprocal gait? Depends on weight bearing status. Overground, crutches and the affected leg are moved at the same time, then the good leg is moved. Up/down stairs the non-affected goes up first, the crutches followed by the bad leg go down first
Instructions for use: walking sticks
Depends on the therapeutic goal. They are used in hand contralateral to affected leg, which increased BoS but keeps weight bearing away from affected leg. A taller stick discourages weight bearing through the stick itself. Overground, move stick and affected leg simultaneously. Stairs is the same as crutches
Instructions for use: pickup frame (PUF)
Lift the frame and place it down, then step into/towards the frame. Pts must be careful not to place frame to far ahead of themselves
Instructions for use: wheeled frames
For rollator, walker and FASF, the frame must be pushed ahead of pt while they walk – again being careful not to push the frame too far ahead of themselves
