walking aids
TRANSCRIPT
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Walking Aids And Orthotics
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Presenters:Afifa MunafJaweriah MahmoodFatima Bhutto
Presented to:Sir Saad
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Walking• walking together with its
variants is a skilled coordinated action which involves many joints and muscles.
• The whole sensory input is involved in walking and when any part of sensory system is disordered gait may also be affected.
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Muscles involved in walking
• flexors and extensors of the toes
• planterflexors and dorsiflexors of the ankle
• flexors and extensors of the knee and hip
• Head rotators
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Walking Aids• These are the appliances which
may be a means of transferring weight from upper limb to the ground or which may be used to assist balance.
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Factors involved in choosing walking aids:• age of patient
• their disability
• general physical condition
• their home environment
• duration for which walking aids are likely to be
used.
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Walking Aids equipments
The broad subdivision of walking aids would be between:
• frames
• crutches
• sticks
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Walking frames• Have very wide base
• Very stable
• Commonly used in elderly• Also used in children
having neurological or musculo-skeletal dysfunction
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Types of walking frames
• Rigid frames
• folding frames
• reciprocal frames
• forearm supporting frames
• wheeled frames
• rollators
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Rigid frames
• It needs to be adjusted to the correct height
• patient stand upright with the elbows flexed at approximately 15 degrees
• The frames should be of light material i.e. aluminum.
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Folding frames• These frames are useful if
the patient is regularly transported by the car.
Folding frames may either be:
• three-legged
• v-shaped
• traditional four-legged collapsible design
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Reciprocal frames
• Useful for those patients who find it difficult lifting a traditional frame.
• It is hinged at the front.
• Their main indication is in certain neurological conditions where Ataxia is a dominant feature.
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Forearm supporting frames
• These may also be called pulpit or gutter frames.
• They allow walking training of patients who has difficulty in weight-bearing through the upper limb
• Used for the patient with Rheumatoid arthritis.
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Wheeled frames
• Most standard adjustable height walking frames
• The front extension legs are replaced with small wheeled legs.
• They encourage a more normal gait pattern
• They lack stability
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Rollators• Have two fixed wheels at the front and two
ferrules at the rear.
• It is stable but not very maneuverable.
• Can be awkward in tight spaces and corners
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Walking patterns with a frame
• patient lifts the frame forward transfers their weight onto it
• takes two steps up to the frame
• keep the frame well forwards
• place all four legs of frame at a time on ground before taking a step
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Crutches
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• A crutch is a mobility aid that transfers weight from the legs to the upper body.
• The muscles of the arms, shoulders, back, and chest work together to manipulate the crutches
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Categories of crutches1.Axillary or
underarm crutches:
• These are usually prescribed when non-weight bearing gait is required
• The axillary top is rested against the chest wall while the bulk of the patient’s weight is borne through the hands.
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2.Elbow crutches or forearm crutches
• These are the most functional type of crutches and are
• suitable for both non and partial weight bearing gaits.
• it consists of a metal cuff and a handle fixed at 97 degrees
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3.Forearm/gutter crutches
• Useful for the patients who are unable to use normal handgrips
• Velcro straps fix the forearm into the tough and weight is applied via the forearm
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Walking sticks
• Provide support for the patients with good grip and sound joints of the upper limb
• Suitable for partial weight bearing
• To be used in the contra lateral hand in most cases
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Tetrapods/tripods
• These are four or three-legged sticks which give greater stability than a traditional stick
• They are prescribed for the patient with poor balance and confidence
• Commonly used by hemiplegic patients
• Quite heavy as compared with the sticks and cant be used on stairs
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Tetrapod Tripod
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Effects of walking Aids
• Increases confidence• Relief of weight-bearing from affected leg• Psychological support• Relief of pain• Provides support
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Walking Aid Height
• Measure the height of walking aid, from the ulnar styloid to the ground, with the patient standing erect , shoulders relaxed & elbows flexed to 15°.
• crutches must be settled at either 77% of reported height or height minus 16 inches.
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Advantages of Contralateral Gait
• Reduce the force through affected leg
• Prevents tilting of the pelvis.
• Facilitates a reciprocal gait pattern.
• Provide stability as it has a greater BOS.
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Advantages of Ipsilateral Gait
• If used in the dominant hand, feels more natural. • May limit hip and knee flexion.
• Subjectively feels to offer more support as it is adjacent to the affected leg.
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Metabolic Cost of Walking Using Walking Aids
• A swing through gait with crutches requires a very high rate of physical effort compared with normal walking.
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• With time, crutch users become adapted so that their energy expenditure & heart rate dec. as they become habitual walking aid users, suggesting the presence of both upper limb conditioning & training response.
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Forces through the Upper limbs when using Walking Aids
• If a person is utilizing a walking aid in a non-weight bearing or partial weight bearing manners, then most of the body weight will be transmitted through the upper arms via the walking aid to ground.
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• Such a gait style creates joint moment forces on the shoulder of a similar magnitude to those on the hip joint during non-aided gait.
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Pre-walking Exercise Programmes
• As crutch walking is a learned skill, the patient must demonstrate adequate muscle strength, balance & co-ordination.
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• The strength of the upper extremities can be increased by weight-resistive exercises graduated springs, the use of theraband & PNF techniques, etc.
• Balance exercises can occur in bed or by mat work.
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Gait Patterns with Walking
Aids
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Swing-to Gait
• In this gait both crutches are brought forward together. • The trunk & lower extremities lean forwards, weight is transferred to the upper limbs & walking aids & both lower limbs are lifted & swung forwards to the level of crutches
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Swing-through Gait
• Both crutches are taken forward, then both lower limb are lifted & swung past the crutches, so that the crutches are left behind the point where the feet land on the floor.
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• This gait is most commonly used by those with no lower limb control such as Spinal cord injury patients.
• Unsuitable for those with painful lower limbs.
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Ipsilateral Two-point Gait with One Stick
• Stick in the ipsilateral hand is move forward, together with the affected leg.
• Followed by the non-affected leg.
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Contralateral Two-point Gait with One Stick
• Contralateral hand and stick are moved, together with the affected leg.
• The weight is shared b/w the stick and affected side as the non-affected leg is brought through.
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Three-point Gait
• It requires two walking aids, either crutches or sticks followed by the affected leg then unaffected leg.
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• If a minimal weight-bearing gait is required, e.g toe touching only, then a delayed three point gait must be utilized where the walking aid makes contact with the ground before the affected leg touches the floor.
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• Partial weight bearing is often prescribed in orthopaedic conditions, with a gradual progression on weight bearing over time. E.g uncemented hip arthroplasty.
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Four-point Gait
• In this gait two walking aids are used, one for each leg. • The right walking aid is put forward, followed by the left leg, then the left walking aid and the right leg.
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• A Four-point gait is ideal for balance & as a step to relearning a normal reciprocal gait pattern.
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Reciprocal Two-point Gait
• It uses two sticks, right leg and left stick being placed on the ground together, followed by left leg and right stick. • It provides a style of walking that allows fast walking speeds to be achieved. 50
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Orthotics
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• Orthotics (Greek: ortho, "to straighten" or "align") is a specialty within the medical field concerned with the design, manufacture and application of orthoses.
• An orthoses is a device applied directly and externally to the patient’s body with the object of supporting, correcting or compensating or an anatomical deformity or weakness
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Uses of orthoses
• Control, guide, limit and/or immobilize an extremity, joint or body segment
• To restrict movement in a given direction
• To assist movement generally• To reduce weight bearing forces for
a particular purpose.
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Foot orthoses
• Foot orthoses are specially designed shoe inserts that help support the feet and improve foot posture
• the foot is the point at which contact is made with the ground and reaction forces are generated
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1.Foot instability due to muscle weakness or imbalance
A. weak supinators:• On weight bearing, if supinators are
weak it will result in a pronated foot
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Corrective measures• Usage of medial flares• Wedge building into an insole• Heel cup or a flexible insole
Medial flare
Heel cups
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B.Weak pronators• A foot with a weak or
absent pronators will adopt a supinated position at foot contact.
Correction:• Valgus moment required by
a lateral flare or a wedge
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C.Weak extensors/flexors
• Claw toes: it consists of subluxation at the metatarsophalangeal joint, and flexion at the proximal (and distal interphalangeal joints)
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Continued….
• Hammer toes: plantar flexion deformity of the proximal interphalangeal joint, the abnormal plantar flexion of the distal phalanx may occur.
• Corrective measures includes Moulding using polyurethane or silicone materials
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Continued….• Metatarsalgia:it is a condition
marked by pain under the metatarsal heads
• You may experience metatarsalgia if you're physically active and you participate in activities that involve running and jumping
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Corrective measures• An insole with either a
metatarsal dome or bar • A metatarsal bar fixed to the
bottom of the shoe• conservative treatments, such
as ice and rest Metatarsal bar under the shoe
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2.Foot instability or deformity due to structural misalignments
• Structural misalignments are often congenital and generally result in a foot with mobile joints but function about abnormal positions.
• Heel cup can be used to re align the foot in children
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3.foot instability or deformity due to loss of structural integrity
• Pain may result from joint instability or excessive motion
• The patient will try to avoid this pain by changing the portion of their foot that they present to the ground
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Heel pain causing diseases
Abnormal walking styles
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Pain relief measures
• Usage of shock absorbing insoles• Flexible medial arch support• Rose-parker insole
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Ankle-foot orthoses (AFO)
• An ankle-foot orthoses (AFO) is a most common orthoses or brace that encumbers the ankle and foot.
• They are also used to immobilize the ankle and lower leg in the presence of arthritis or fracture, and to correct foot drop.
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Types of AFOs
1.metal and leather: these have a leather covered cuff band with metal bars inserting into the heel of the shoe
2.plastic moulded: thermoplastic splints moulded to fit the limbs and inserted inside the shoe
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Knee-ankle-foot orthose(KAFOs)
• A knee-ankle-foot orthoses (KAFO) is an orthoses that encumbers the knee, ankle and foot.
• A KAFO can have a great effect on motion at these lower limb areas
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Metal and leather Thermoplastic moulded
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Cast braces
• These are used to maintain normal limb function while fracture healing occurs
• Most cast braces run parallel to the broken bone to provide a protective structure and guide during the healing process.
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Knee orthoses(braces)
• A knee orthoses (KO) or knee brace extends above and below the knee joint and is generally worn to support or align the knee
• Biomechanically difficult as they have to act with a short lever arm
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Trunk and limb braces
• The HKAFO is a knee-ankle-foot-orthoses with an extension of hip joint and pelvic components. These are used on patients requiring more stability of the hip and lower torso
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Types of HKAFOs
1.Hip guidance orthoses(HGO):
• Also called the pace walker has free hip joints between stops at the limit of flexion and extension
• The patient walks by using the arms and walking aids to move the trunk forward the weight is taken on forward leg to take step
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2.Reciprocating gait orthoses
• It has hip joints linked by a cable so that extension occurs on one side causes flexion on the other side
• The patient pushes down both the crutches and pulls pelvis forward leaning on one side
• Non-weight bearing leg moves forward with the help of the cable
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76Hip guidance orthoses
Reciprocating gait orthoses
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Advantages
HGO• Has low energy
consumption • Allows user to
achieve walking speed of 50% of normal individual
• Easy to wear and take off
RGO• Cosmetically
acceptable• Lighter• Gives ability to
the patient to stand unsupported
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