WALKING AID

Lecture of English : I’in Noviana, M.Pd

By : Group 11

1. Faridatul Umroh (151001014)

2. Nelam Anggraini (151001029)
3. Okvita Tri Susanti (151001031)

SEKOLAH TINGGI ILMU KESEHATAN

PEMKAB JOMBANG

PROGRAM STUDI S1 KEPERAWATAN/1A

TAHUN AJARAN 2015 / 2016

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 PREFACE

Thank God I'm turning to the presence of Almighty God, because only for His
grace and guidance I can finish writing the paper in the form of a paper entitled “Walking
Aid”.

The source of this paper in the form of grammar books are added to the information
obtained from browsing on the Internet reference books and sources, other sources. Among
the sources I collated in accordance with this paper, so I think the data in this paper is quite
accurate.

In this paper surely there are many obstacles that I meet yet I managed to confront
and resolve this paper on time. Finally, if there is something in particular words that are not
pleasing to the reader's heart please excuse him. We hope this paper can be useful to
readers

Jombang, September 21st, 2017

Author

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 TABLE OF CONTENTS

COVER............................................................................................................................i

PREFACE.......................................................................................................................ii

TABLE OF CONTENTS...............................................................................................iii

CHAPTER 1 INTRODUCTION....................................................................................1

1.1 Issue Background......................................................................................................1

1.2 Problem Identification...............................................................................................2
1.3 Benefit.......................................................................................................................2

CHAPTER 2 DISCUSSION...........................................................................................3

2.1Definition of Walking aids.........................................................................................2

2.2Types of walking Aids................................................................................................2
2.3Crutch.........................................................................................................................3
2.4Canes........................................................................................................................13
2.5Walkers.....................................................................................................................16

CHAPTER 3 FINAL.....................................................................................................21

3.1Conclusion................................................................................................................21
3.2Advice......................................................................................................................21

REFERENCES..............................................................................................................22

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 CHAPTER 1

INTRODUCTION

1.1 Issue Background

A mobility aid is a device designed to assist walking or otherwise improve the
mobility of people with a mobility impairment.
There are various walking aids which can help people with impaired ability to
walk and wheelchairs or mobility scooters for more severe disability or longer journeys
which would otherwise be undertaken on foot. For people who are blind or visually
impaired the white cane and guide dog have a long history of use. Other aids can help
with mobility or transfer within a building or where there are changes of level.
Traditionally the phrase "mobility aid" has applied mainly to low technology
mechanical devices. The term also appears in government documents, for example
dealing with tax concessions of various kinds.[1] It refers to those devices whose use
enables a freedom of movement similar to that of unassisted walking or standing up
from a chair.

Technical advances can be expected to increase the scope of these devices

considerably, for example by use of sensors and audio or tactile feedback
1.2 Identification Problems (Background)
1. What is Walking Aids?
2. What is Cructch?
3. What is Canes?
4. What is Walkers?

1.3 Benefit
1. To understand aboutWalking Aids?
2. To understand about Crutch?
3. To understand Canes ?
4. To understand about Walkers?

CHAPTER II

DISCUSSION

2.1 Definition of Walking aids

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

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 Walking aids are tools you can use to maintain your mobility and independence. A
walking aid is used to:
• Decrease the effort and energy required to walk
• Decrease the weight on an injured, fragile or weak leg
• Compensate for a lack of balance
• Reduce the risk of falls
• 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
2.2 Types of walking aids
There are many types of walking aids. The three main categories are:
• Crutches: Standard (underarm brace), and Canadian (forearm brace)
• Canes: Standard, 3-point, and 4-point
• Walkers: Standard, 2-wheeled, and 4-wheeled (with or without a seat)
Your health condition, size and age are key considerations when selecting a walking aid
along with comfort, ease of use, stability and safety. Consult your physiotherapist if
you require assistance in selecting a walking aid that is right for you.

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2.3 Crutches
a. 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
b. 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
c. 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

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 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

Pict1. Crutch standar

 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

Pict2. Crutch
Measurement of length
 There are variety of ways it may be in lying and also in standing
position.

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 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

Pict3. 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.

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  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
2. 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.

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 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.

Pict4.Lofstrand crutch
Advantage of elbow crutches
 Light weight
 Easily adjustable
 freedom for hand activities

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  Using 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
3. Forearm support crutches/gutter crutches/ platform crutch

Pict5. 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

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 Pict6. platform crutch

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.
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.
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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.

Pict7.crutch tips

Gait pattern with crutches

1. Four point gait
2. Three point gait
3. Two point gait
4. Two point swing through gait
5. Two point swing to gait (the feet are advanced by a much shorter distance
and placed behind the level of crutches)
1. 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

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  Weight is on both lower extremities and used with bilateral
involvement due to poor balance, in coordination( Ataxia) and
muscle weakness

Pict8. Four-point gait

2. 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

Pict9. Three-point gait & amputation

3. Two-point gait

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 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.

Pict9. Two-point gait

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.
4. 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.

Pict10. Swing-through gait

5. Swing-to gait
 Both crutches -> both lower limbs almost to crutch level

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  The swing-to gait involves forward movement of both
crutches simultaneously, and the lower extremities
“swing to” the crutches.

Pict11. Swing-to gait

2.4 Canes

 Most common mobility aid

 Commonly made of wood or aluminium

 Transmits 20-25% of body weight

 Held in hand opposite the involved side

 Increase stability

 Compensates for muscle weakness

 Relieves pain

 Elbow at 30° flexion

Measurement:

 Upside down

 Handle at shoe heel and Lower end at greater trochanter or radial styloid in
standing Adjustible canes Non Adjustible canes

How To Use Canes

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 Walking with a Stick

Walk placing the stick or cane on the ground at the same time as the affected
leg. Remember, the stick should normally be held in the hand opposite the
effected leg.

 Chairs - Getting up

The stick or cane should be near the arm of the chair. Lean forward and, with
hands on the arms of the chair, push forward and stand up.

 Chairs - Sitting down

When returning to the chair, turn around, feel the chair behind the legs, place
hands gently on the chair arms, bend forward and lower gently into the chair.
The stick or cane can be held or rested nearby.

 Stairs

Hold onto a handrail if at all possible. The stick goes on the same step as the
affected leg.

The unaffected leg should lead when going upstairs, and the affected leg leads
when coming down. However where possible, go up and down stairs in the
normal manner.

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2.5 Walkers
 Walkers are mechanical devices for ambulatory clients who need more support than
a cane provides.
 The standard type is made of polished Aluminum.
 It has four legs with rubber tips and plastic hand grips.
 Many walkers have adjustable legs

HOW TO TELL IF A WALKER IS THE RIGHT SIZE

 With your arms hanging at your sides, the walker handles should be at wrist
level. If you cannot find the exact fit, choose the height that is most
comfortable.

 If you have been instructed to not place weight on one of your legs, you may
feel more comfortable with a shorter height. If you are using the walker for
balance, you may prefer a taller height.

 Adjust the height by using the push buttons on the legs of your walker.

 In rest position, the back leg of the walkers should be no further ahead than
your toes. With your hands resting on the grips, your elbows should be slightly
bent at about a 30 degree angle.

 Ask your physical therapist or caregiver if you have any concerns.

HOW TO USE A STANDARD WALKER (NO WHEELS)

 Pick your walker up (do not slide your walker) and place it one step length in
front of you. The back legs of the walker should be no further ahead than your
toes. You should not feel like you need to lean forward to keep your hands on
the grips. As you set the walker down, make sure all 4 leg tips contact the
ground at the same time.

 Hold onto the walker for support and step forward with your weaker leg into the
middle of the walker. Follow the weight bearing instructions your caregiver has
given you.

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  Push down with your hands and step forward with your stronger leg.

 Be careful not to let the walker get too far ahead of you as you walk.

 Repeat the process for each step.

HOW TO USE A FRONT-WHEELED WALKER

 Slide your walker forward. The back legs of the walker should be no further
ahead than your toes. You should not feel like you need to lean forward to keep
your hands on the grips.

 Hold onto the walker for support and step forward with your weaker leg into the
middle of the walker. Follow the weight bearing instructions your caregiver has
given you.

 Push down with your hands and step forward with your stronger leg.

 Be careful not to let the walker get too far ahead of you as you walk.

 Repeat the process for each step.

 If your walker does not glide well over carpet, consider cutting an "x" in 2 old
tennis balls and placing them over the back legs of your walker.

STANDING UP FROM A CHAIR WITH ARMRESTS

 It is best to sit in a firm chair with armrests.

 Position your walker directly in front of your chair. Do not pull on the walker
when standing up. It is too unstable to support weight when pulled on.

 Slide forward in the chair, with your weaker leg ahead and stronger leg bent
near the chair.

 Lean forward and push up from your chair with both hands on the armrests.
Straighten your stronger leg, rising to standing. Do not pull yourself up from
the walker. This may cause it to tip.

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  When you feel steady on your feet, carefully move one hand at a time to the
walker.

 Stand for a few seconds to stabilize your balance before you start to walk.

STANDING UP FROM A CHAIR WITHOUT ARMRESTS

 It is best to sit in a firm chair. A low seat or an overstuffed chair or sofa is hard
to get out of.

 Place the walker in front of you. Do not pull on the walker when coming to a
standing position.

 Slide forward in the chair, with your weaker leg ahead and stronger leg bent
near the chair.

 Push down on the chair seat with the hand opposite your weaker leg. Keep your
other hand on the center of the walker's crossbar.

 Stand, steady your balance, and place your hands on the walker handgrips.

 SITTING DOWN

 Always back up toward your chair, using your walker, until you feel the back of
your legs touch the chair.

 If the chair has armrests, carefully reach back to put your hands on the armrests,
and slowly lower your weight.

 If the chair does not have armrests, consider backing up to the side of the chair.
You can then hold onto the back of the chair and the front of the seat to slowly
lower yourself.

 You should never feel like you are falling into your chair.

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USING A WALKER ON STEPS

 Before attempting to use your walker on steps, practice with your physical
therapist.

 If you are going up a step wide enough to accommodate the entire walker and
yourself:

 First, place the walker up on the step.

 Second, get your feet as close to the step as you can.

 Third, press down on the walker with your hands as you step up with your
stronger leg. Then step up with your weaker leg.

 If you are going down a step wide enough to accommodate the entire walker
and yourself:

 First, place the walker down on the step.

 Second, hold onto the walker as you step down with your weaker leg. Then step
down with your stronger leg.

 If you are going up more than 1 step and have a railing:

 First, turn the walker sideways, so the opening is facing in toward you.

 Second, place the front 2 legs of the walker on the first step. These front legs
should be positioned at the base of the next step.

 Third, test the steadiness of the walker. It should feel sturdy when you press
down on the handgrip that is facing the top of the steps.

 Finally, placing your weight on the railing and the walker, step up with your
stronger leg first. Then step up with your weaker leg.

 If you are going down more than 1 step and have a railing:

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 First, turn the walker sideways, so the opening is facing in toward you.

 Second, place the front 2 legs of the walker down on the first step. When
possible, the back legs of the walker should be positioned at the base of the
previous step.

 Third, test the steadiness of the walker. It should feel sturdy when you press
down on the handgrip that is facing the top of the steps.

 Finally, placing your weight on the railing and the walker, step down with your
weaker leg first. Then step down with your stronger leg.

 Be sure to check the sturdiness of the walker before each step.

 Make sure you have good rubber tips on the legs of your walker to prevent it
from slipping.

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 CHAPTER 3

CLOSING

3.1 Conclusion
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
There are many types of walking aids. The three main categories are:
• Crutches: Standard (underarm brace), and Canadian (forearm brace)
• Canes: Standard, 3-point, and 4-point
• Walkers: Standard, 2-wheeled, and 4-wheeled (with or without a seat)

3.2 Advice
This paper is not perfect. So, advice from reader is very important to make
perfect this paper.

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 REFERENCES

http://hesperian.org/wp-content/uploads/pdf/en_dvc_2009/en_dvc_2009_63.pdf

https://www.slideshare.net/khushisawlani/walking-aids-38765452

https://www.slideshare.net/fatimabhutto9/walking-aids-and-orthotics

https://en.wikipedia.org/wiki/Mobility_aid

https://www.slideshare.net/amitmallik/mobility-aids-44750011

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