walking aids

Walking aidsBY: REETA SAWLANI

LECTURER IPRS PUMHSW

Walking

•Walking is the manner or way in which you move from place to place with your feet.• It is a Movement at a regular and fairly slow

pace by lifting and setting down each foot in turn, never having both feet off the ground at once.

• it is the highest level of motor control skill.

• The major requirements for successful walking include:• Support of body mass, by the lower extremities • Production of locomotors rhythm• Dynamic balance control of the moving body• Propulsion of the body in the intended direction

Basic terms

• Ambulation: To walk from place to place or move about.• It is a technique of post operative care in which a patient gets

out of bed and engages in light activity (as sitting, standing, or walking) as soon as possible after an operation.• Some time this term is also use in the place of walking ..

•Gait: Gait is a term to describe human locomotion, it is pattern of walking or a sequence of foot movements.

Gait cycle or walking cycle

• A cycle of walking is the period from the heel-strike of one foot to the next heel-strike of the same foot• When a subject is walking on level ground, than the

movements of the lower limbs may be divided into “swing” and “stance” phases.• The swing phase occurs when the limb is off the ground, and

the stance phase when it is in contact with the ground and is bearing weight.

Walking aid is a device designed to assist walking and improve the mobility of people who have difficulty in walking or people who cannot walk independently

WALKING AIDS

Different Types of Walking Aids

walker Cane/Stick crutches

Purpose of walking aids

• 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• Can be compensate for weak muscles• Decrease pain• Improve balance

Crutches

• Crutches Introduction• Types of crutches• Measurement of length• Preparation for crutch walking • Crutch walking

Introduction of crutches

These are devices which are used to reduce weight bearing on one or both legs and also give support where balance is impaired and strength is inadequate

Prerequisites for crutches

• Good strength of upper limb muscles is required.• Range of motion of upper limb should be good.• Muscle group which should be strong is given below.• Shoulder flexor, extensors and depressor• Shoulder adductors • Elbow and wrist extensors• Finger flexors

Types of crutches

1. Axillary crutches/ under arm crutches

2. Elbow crutches or Lofstrands crutches

3. Forearm support crutches (gutter crutches)

1. Axillary crutches /under arm crutches

• They are made of wood or metal with an Axillary pad, a hand piece and a rubber

ferrule.

• Two upright shafts connected by axillary piece on top

• Hand piece in the middle

• Extension piece below

• Extension piece and shafts has numerous holes at regular intervals so the total

length of crutch and height of handle is easily adjustable.

• A large suction tip (rubber ferrule) is attached to extension piece to allow total

contact with floor

• The Axillary pad should rest beneath the apex of axilla and

hand grip in slight flexion when weight is not being taken.

• When weight is being taken through axillary pad, the elbow

will go into extension and weight is transmitted down the arm

to hand piece.

Measurement of length

There are variety of ways it may be in lying and also in standing position.In Lying it may be with shoes off and with shoes on

1. With shoes off: measure from apex of axilla to the lower margin of medial melleolus.

2. With shoes on: 5cm/2 inches vertically down from apex of axilla to a point 20 cm lateral to the heel of shoe. Book Resource: M. Dena Gardiner

In standing with shoe off and shoe on method is same. 2 inches below the axilla to the 2 inches anterior and 6 inch lateral to

the foot in standing position.

Measurement of axillary crutch

• Crutches that are too tall or too short can affect balance and also cause back pain.

• Incorrectly fitted crutches or poor posture can cause a disorder called crutch palsy in which the nerves under the arm mostly radial nerve (brachial plexuses) are temporarily or permanently damaged, causing weakened hand, wrist and forearm muscles.

Advantages and Disadvantages of Under Arm Crutches

•Advantages:

• Convenience for temporary injuries• A large degree of support for the lower body• Available at low cost.• Axillary crutches allow the patient to perform a greater variety

of gait patterns and ambulate at a faster pace.

Disadvantages:

• Limited upper body freedom• Axillary crutches require good standing balance by the patient.• Improper use of crutch can cause injury to axillary region, and

Strain on the arms and upper body which can lead crutch paralysis. It is a condition in which the nerves under the arms (Radial nerve and brachial plexus) are pinched and also risk of losing balance.

• Geriatric patient may fell insecure or may not have the necessary upper- body strength to use axillary crutches

Precautions • Have someone nearby for assistance until accustomed to the

crutches.• Frequently check that all pads are securely in place• Check screws at least once per week.• Clean out crutch tips to ensure they are free of dirt and

stones.• Remove small, loose rugs from walking paths.• Beware of ice, snow, wet or waxed floors• Avoid crowds, leave class early.• Never carry anything in hands ,use a backpack.

Elbow crutches /forearm crutches/ Lofstrand crutch

• They are made of metal an aluminum tubular shaft with

a handgrip and have a metal or plastic forearm band.

• Forearm piece bent backward and extended to 2 inches

below the elbow.

• Both handgrip and forearm piece are adjustable in

length by means of a press clip or metal button and

have a rubber ferrule.

• These crutches are suitable for patients with good

balance and coordination with strong arms. Weight is

transmitted exactly the same way as for axillary

crutches.

Advantage of elbow crutches

Light weight Easily adjustable freedom for hand activitiesUsing forearm crutches requires no more energy, increased

oxygen consumption or heart rate than axillary crutches. Being easily stored and transferred. There is no risk of injury to the neurovascular structures in

the axillary region when using this type of crutches.

Disadvantages of forearm crutches

• Forearm crutches are less stable .• They require good standing balance and upper-body strength.• Geriatric patient sometimes feel insecure with these crutches.

They may not have the necessary upper-body strength to use forearm crutches.

Forearm support crutches/gutter crutches/

platform crutch

• They are made of metal with a padded forearm support Platform, Velcro strap an adjustable hand piece and a rubber ferrule.• These are used for patients with Painful wrist and

hand condition or elbow contractures, or weak hand grip

• Elbow flexed 90 degrees, The hand rests on a grip which can be angled appropriately, depending on the user's disability.

• Mostly In rheumatoid disease, cerebral palsy, or other conditions for providing support. In these conditions patient cannot take weight through hands, wrists and elbows because of deformity or pain.

MEASUREMENT :

IN LYING POSITION

With shoes on: measure from the point of fixed elbow till 20 cm lateral to the heel.

• ADVANTAGES :• As similar like elbow crutch• These are easily adjustable.• More cosmetic than other crutches.• DISADVANTAGES :• Provide less lateral support due to absence of axillary pad.• Cuffs may be difficult to remove.• These can be expensive.

According to static and dynamic balance, starts from easy to hardest

UnderwaterUse parallel barsWalkerCrutchesCanesIndependent

Preparation For Crutch Walking

• Arms: shoulder extensors, adductors and elbow extensors even all muscles of arms must be assessed and strengthened before the patient starts walking. The hand grip must also be tested to see that the patient has sufficient power to grasp hand piece.• Legs: Strength and mobility of both legs should be assessed

and strengthened if necessary. Main attention to the hip abductors and extensor, the knee extensors and the plantar flexors of the ankle should be given.• Balance: sitting and standing balance must be tested.• Demonstration: the physiotherapist should demonstrate

appropriate crutch walking to the patient.

Crutch walking

• During first time, when the patient is to stand and walk, the physiotherapist should have an assistant for supporting the patient.• Non-weight bearing: patient should always stand with a

triangular base i.e. crutches either in front or behind the weight bearing leg• Partial weight bearing: The crutches and the affected leg are

taken forward and put down together. Weight is then taken through the crutches and the affected leg, while the unaffected leg is brought through.

Gait pattern with crutches

• Four point gait• Three point gait • Two point gait• Two point swing through gait• Two point swing to gait (the feet are advanced by a

much shorter distance and placed behind the level of crutches)

Four-point gait

In this gait pattern one crutch is advanced and then the opposite lower extremity is advanced. For example, the left crutch is moved forward, then the right lower extremity, followed by the right crutch and then the left lower extremity.• Slow, Good stability - at least 3 point

contact ground• Weight is on both lower extremities and

used with bilateral involvement due to poor balance, in coordination( Ataxia) and muscle weakness

Three-point gait

• In this type of gait three points of support contact the floor.

• Non-weight-bearing gait for lower limb fracture or amputation

Non Weight Bearing

Two-point gait

• This gait pattern is similar to the four-point gait. However, it is less stable because only two points of floor contact are maintained. Thus, use of this gait requires better balance.

• The two-point pattern more closely stimulates normal gait, in as much as the opposite lower and upper extremity move together.

• Two additional, less commonly used crutch gaits are the swing-to and swing-through patterns. These gaits are often used when there is bilateral lower extremity involvement, such as in spinal cord injuries.

Swing-through gait

• Fastest gait, requires functional abdominal muscles• In the swing-through gait, the

crutches are moved forward together, but the lower extremities are swing beyond the crutches.

Swing-to gait

• Both crutches -> both lower limbs almost to crutch level• The swing-to gait involves

forward movement of both crutches simultaneously, and the lower extremities “swing to” the crutches.

4 point gait –Balance and confidence / full weight bearing

3 point gait – Balance and partial weight bearing

2 point gait – non weight-bearing/ full weight bearing

Point gait – stability, slowSwing gait – more energy, fast

Stair ClimbingUp With GOOD, Down With BAD

StairsTo begin, place both crutches under the arm of the injured side, holding the inside handle with the thumb. Hold onto the railing with the other hand. When using stairs, remember, “up with the good, down with the bad.”• To Ascend

• Leave crutches on the same level where standing.

• Support weight evenly on the crutch hand and railing.

• Raise the uninjured foot to the higher step, letting the injured foot trail behind.

• Straighten the uninjured leg and advance the crutches.

• To Descend

• Place the crutches on the lower step, while extending the injured foot forward. Place the crutches on both sides of the body if no railing is present.

• Support weight evenly on the crutch hand and railing.

• Move the uninjured foot to the lower step.

• Narrow steps without a railing might require sitting on each step.

SUMMARY : So why give walking aids?

•Weight bearing •Balance •Motor pattern •Confidence • Endurance

Books References

• O’Sullivan, Susan B., Thomas J. Schmitz. Physical Rehabilitation Assessment and Treatment. 4th ed. F. A. Davis Company. 1994. p. 430-431•M.Dena Gardiner

ANY QUESTION ????

Don’t Give Up

Thanks