Walking Aids Flashcards
Walking Frames
Provide larger base of support.
Indicated for generalized weakness, poor balance control, or inability to weight bear on lower limbs.
Hand grip at the level of greater trochanter, elbow slightly flexed (10°-20°).
Crutches and Canes
Smaller base of support. Bilateral or unilateral use. Types: axillary, forearm, elbow... Handgrip at greater trochanter, elbow 10°-20° flexed. Axillary pad 5 cm below axilla. - Weight bearing as tolerated - Toe touch weight bearing - Full weight bearing - Partial weight bearing
On which side should the crutch be during unilateral use and why?
On the contralateral side to the affected leg (healthy side).
Reduces required hip abductor momentum.
Reduces hip joint reaction force.
Tripods and Quad Sticks
Larger base of support compared to crutches or canes.
Usually unilateral.
Concavity faces forward.
Unsupported side facing patient.
Reduces postural sway in people with hemiparesis and appears to be more effective than a cane in postural stability.
Parallel Bars
Most secure form of gait training, greatest amount of support.
Can combine with other training (balance, coordination).
Adjustable height (greater trochanter, crease of wrist). 20-25° elbow flexion.
Wheelchair
Types: universal, electric, adapted for sports…
Make sure to ALWAYS put breaks on and remove foot rest when patient is standing up.
Types of Gait
- Gait with a walking frame
- 4 point gait
- 3 point gait with no weight bearing
- 3 point gait with partial weight bearing
- 2 point gait
- Gait with one crutch, cane tripod, quad stick
- Swing to gait
- Swing through gait
Gait with a Walking Frame - Leveled Surface
Walking frame → weight transfer to walking frame → affected leg → non-affected leg.
If necessary support patient with a belt.
Gait with a Walking Frame - Unleveled Surface, Ascending
Walking frame as close to step as possible → place walking frame on top of step → transfer weight to walking frame → healthy limb on step → affected limb on step.
Healthy limb first then injured!
Gait with a Walking Frame - Unleveled Surface, Descending
Walking frame to the edge of step → place walking frame on lower level → transfer weight to walking frame → affected limb down → healthy limb down.
Injured limb first, then healthy!
4 Point Gait
Slow and stable, 2 crutches, 3 points of contact at all times.
Can be a progression from walking frame gait.
Crutch → opposite limb → second crutch → opposite limb.
Mimics normal gait pattern, requires significant coordination.
3 Point Gait - Without Weight Bearing
Early stage of rehabilitation.
Weight on healthy limb → both crutches forward → Weight on crutches → injured limb forward, in line with crutches → Push on crutches, healthy limb forward beyond crutches.
Swing to or swing through.
3 Point Gait - With Partial Weight Bearing
Same sequence as non-weight bearing except injured limb has partial load upon its advance.
Weight on healthy limb → both crutches forward → Weight on crutches → injured limb forward, in line with crutches → Push on crutches, healthy limb forward beyond crutches.
Can use scale to measure % of weight bearing.
2 Point Gait
Progression from 4 point gait, less stable, also similar to normal gait.
Crutch + opposite leg → Second crutch + opposite leg.
If only have one crutch: Injured leg + crutch (on contralateral side) → healthy leg.
Gait with one crutch/cane/tripod/quad stick
Possible progression from 3 point partial weight bearing.
Assistive device contralateral to injured limb!
Weight transfer to healthy limb → assistive device forward → injured limb forward to the level of assistive device → weight transfer to assistive device → healthy limb forward.
Modified 4 and 2 point gait.
Tripod/quad stick have trouble with stairs because of the larger BOS.
4 Point Swing to Gait
Gait pattern for people with paraplegia.
Crutches forward simultaneously → Lift body using upper limb → Swing lower body in line with crutches.
Requires strong upper body and knee-ankle-foot orthosis.
4 Point Swing Through Gait
Gait pattern for people with paraplegia.
Crutches forward simultaneously → Lift body using upper limb → Swing lower body beyond the line of the crutches.
Walking Aids in Stairs - Ascending
Always use handrail when present.
Transfer weight to assistive device and handrail → Healthy limb up → assistive device and injured limb up.
When using 2 crutches, carry both in opposite side of handrail.
Walking Aids in Stairs - Descending
Transfer weight to healthy limb and handrail → descend assistive device and injured limb → transfer weight to assistive device and handrail → descend healthy limb.
Parallel Bars - Balance and Gait Patterns
Balance:
- Shifting weight from side to side, forwards and backwards.
- Lift hands briefly, one at a time first, then try both.
- Alternately or simultaneously lift opposite UL and LL.
4 point gait: hand → opposite leg → hand → opposite
4 Point Modified Gait
Only using 1 crutch on contralateral side to affected leg (to shift the weight over to the healthy leg).
Reduces required hip abductor moment and hip joint reaction force.
Crutch → opposite leg (affected) → other leg.
Modified 2 Point Gait
Only using 1 crutch on contralateral side to affected leg (to shift the weight over to the healthy leg).
Reduces required hip abductor moment and hip joint reaction force.
Crutch + opposite leg (affected) simultaneously → healthy leg.
On which side do we use the cane/walking stick/crutch?
Contralateral to affected side.
To which level is the walking frame/crutch/cane adjusted to?
Greater trochanter or wrist crease with 20° elbow flexion.
