By:
FUNCTION:
1. Widen base of support
2. Reduce weight bearing
3. Improve balance
4. Provide support for weak and/or
paralyzed muscles thereby allowing
mobility
PRESCRIBES FOR PATIENTS WITH;
1. CRUTCHES
2. CANE
3. WALKER
4. PARALLEL BARS
PARALLEL BARS:
►HEIGHT: should be level with the greater
trochanter
►or level with the ulnar styloid process
when the arm is extended & adducted to
the side of the body.
►places the elbow in 15-25º flexion
►WIDTH: 2 inch gap or space between the
greater trochanter & the bar on each side.
►ARMS/HAND: 6 inches ant. to the hip jt.
PARALLEL BARS
WALKER
WALKER:
►ideal when safety is the main
consideration
► often used in early ambulation training before
going to a lesser support assistive devices
► needs the ability to bear at least partial weight
on both legs (PWB)
► can be adjusted or nonadjustable
► folding or non folding
►INDICATION:
1. patient’s with poor balance
2. best suited also for confused patient
ADVANTAGE OF WALKER:
1. Standard walker
2. Two-wheeled walker
3. Four-wheeled walker
or Rolling walker
4. Reciprocal walker
TYPES OF WALKER:
1. STANDARD WALKER:
► made and polished by aluminum
► has 4 legs and 4 rubber tips
► needs to be picked up to be used
► pt. requires partial strength in both
hands and wrist
TYPES OF WALKER:
2. TWO-WHEELED WALKER:
►have 2 small wheels in front and 2
rubber tips at the back
►does not need to be picked up to be
moved
► used by pt’s who are too weak or unable
to pick up and move the walker
TYPES OF WALKER:
3. FOUR-WHEELED WALKER:
►have 4 small wheels (front and back)
►does not need to be picked up to be
moved
► used by pt’s who are too weak or unable
to pick up and move the walker
► can be ordered with brakes
DISADVANTAGE:
► less stable as compared to the standard
walker
FOUR WHEELED WALKER
TYPES OF WALKER:
4. RECIPROCAL WALKER:
HOW TO USE:
► the left side of the walker and the right
lower limb move forward together and vice
versa
ADVANTAGES:
► allows for a two-point gait
► provides greater stability than a cane
► permits fast gait
RECIPROCAL WALKER
HOW TO MEASURE: WALKER
1. STANDING:
►place walker 10-12” ant. to the pt.
►so that it partially surrounds him
►this is important for swing and drag gait
►HEIGHT: level with the greater
trochanter or ulnar styloid process
(when arms is at the side)
►places elbows in 15-20º flexion
►when used pt. should NOT swing the feet
to the level of the crossbar or beyond it.
GUARDING TECHNIQUES:
► always stay at the affected side and slightly at
the back of the pt.
WALKING CANE
CANES:
►customarily 36 inches
►can transmit 20-25% of the body weight
away from the LE
► adjustable or nonadjustable cane
► cane tips should have rubber caps/rubber
tips to provide friction against the ground
and minimize or prevent slipping
►single point of contact with body:
provided less support
►hold the cane on the stronger side
1. provide more physiological gait
2. UNILATERAL LE:
►this method will widen the BOS &
reduce stress on the opposite hip
because of the shift in COG produced
by the contralateral arm movement.
3. prevent lurching & tilting
4. cane held on same side/affected side:
►IF has instability of the affected limb
2º hip or knee pain/weakness
CONSTRUCTION/MADE OF;
1. WOODEN CANE:
ADVANTAGE:
► not expensive
► can be used in stairs as compared to the
standard walker
DISADVANTAGE:
► easily broken when it is frequently dropped
► point of support in front of hand
► has small base of support, no arm support
► non-adjustable
2. ALUMINUM CANE:
ADVANTAGE:
► light weight
► durable
► can be used in stairs
► adjustable
DISADVANTAGE:
► expensive
► point of support in front of hand
► has small base of support, no arm
support
TYPES OF CANE:
METHOD 1:
STANDING POSITION:
►cane held parallel to femur, tibia & heel
►highest point of cane (handle):
should be level with the
GREATER TROCHANTER
HOW TO MEASURE:
►BEST fitted in standing position
METHOD 2:
STANDING POSITION:
►cane held parallel to femur, tibia & heel
►highest point of cane (handle):
should be level with the
GREATER TROCHANTER
►when holding the cane will put elbow
in 15-25º flexion
METHOD 3:
STANDING POSITION:
►place cane tip 6 inches lateral to the
base of the 5th toe
►highest point of cane: will now be level
with the ULNAR STYLOID PROCESS
►will place elbow in 20-30º flexion
Note:
►short cane: causes inefficient gait
►long cane: will place elbow in excessive
flexion increasing the demand for triceps &
shoulder muscles.
METHOD 1 in using a CANE:
1. move the cane 6-12 inches in front of the pt.
2. followed by the affected leg
3. then the sound leg/normal leg
1. AXILLARY CRUTCH:
►transfer as much as 80% of body weight
►better trunk support
►best for pt. with good trunk balance and
confidence with ambulation
2. NON-AXILLARY CRUTCH:
►transfer 40-45% of body weight
ADVANTAGES OF NON-AXILLARY:
1. Better maneuverability
2. Can free hand to open doors etc.. Without
dropping crutches
3. Less wear & tear on upper garment
1. LOFSTRAND CRUTCH
3. PLATFORM CRUTCH
1. LOFSTRAND CRUTCH:
►MOST POPULAR non-axillary crutch
►fit with top of forearm cuff 1-1.5 inches
distal to the olecranon process when
patient grasp the hand piece
►cuff is applied to the forearm with wrist
in neutral position
►made of tubular aluminum with padded
hand bar and forearm cuff
►cuff helps stabilize forearm during weight
bearing
LOFTSTRAND CRUTCH
► cuffs: made of plastic or steel and may
be padded for comfort or to
reduce noise or clicking
► most useful substitute for canes because
forearm support stabilizes wrist during
weight bearing and makes ambulation
easier and safer
► person using 2 canes can’t free hand to
grasp stair rail open door handles or
adjust his clothes
ADVANTAGE (LOFSTRAND):
► using loftstrand crutch can release hand
to perform these tasks without dropping
the crutches
► less cumbersome
► fits stairs
► easy to use
DISADVANTAGE (LOFSTRAND):
3. PLATFORM CRUTCH:
►for patient’s with ARTHRITIS with elbow
flexion contracture
►patient’s with weak or painful hand grip
Note: Have different ways of measuring crutch but
final fit done in STANDING POSITION
while pt. holds on to the device.
MEASUREMENT FOR CRUTCHES:
1. SUPINE:
A. WITH SHOE:
►measure from ant. axillary fold to sole
of the shoe
B. WITHOUT SHOE:
► measure from ant. axillary fold to heel
MALE: + I inch
FEMALE: + 1.5 inches
2. SUPINE:
►from ant. axillary fold to a point 6-8 inches
lateral to the patient’s heel
3. FOR AXILLARY CRUTCH ONLY:
►estimate length by getting 77% of the
patient’s height in inches
►patient’s height in inches minus 16 inches
4. SITTING:
►position patient with 1 UE in 90º shoulder
abduction with elbow flexed 90º while the
other UE is in 90º shoulder abduction with
elbow extended
►CRUTCH LENGTH: estimated by
measuring tip of flexed elbow to tip of
middle finger of the extended arm.
5. STANDING:
►BEST method for measuring crutches
►measure from a point 2 finger breadths
below the axilla from the anterior axillary
fold to a point 6 inches lateral to the 5th
toe.
IMPORTANT CRUTCH WALKING MUSCLES:
1. SCAPULAR DEPRESSORS:
►stabilize the UE & prevent hiking of the
shoulder on weight bearing
►latissimus dorsi, pectoralis minor
►lower trapezius ms
2. SHOULDER ADDUCTORS:
►hold the crutch top to the chest wall with
the arm
►pectoralis major, latissimus dorsi ms
3. SHOULDER FLEXORS, EXTENSORS, ABDUCTORS:
►enable placement of crutch forward,
backward & sideward respectively.
►deltoid ms
4. ELBOW EXTENSORS:
►stabilize the elbow joint in weight bearing
by preventing flexion or buckling
►together with shoulder depressors these
muscles are most important in raising the
body from the floor to allow the LE to
swing.
►triceps & anconeus ms
5. WRIST EXTENSORS:
►hold wrist in proper position to bear
weight on hand piece (although the
position of extension is more important
than the ms action)
►ext. carpi radialis longus, ext. carpi radialis
►
brevis & ext. carpi ulnaris ms
6. FINGER & THUMB FLEXORS:
►flexor digitorum superficialis, flexor
diditorum profundus, flexor pollicis longus
& flexor pollicis brevis ms
TYPES OF CRUTCH GAIT:
1. SWING THROUGH
2. SWING TO
3. 3 POINT GAIT (NWB)
4. 3 POINT GAIT (PWB)
5. 2 POINT GAIT
6. 4 POINT GAIT
7. DRAG TO GAIT
8. TRIPOD DRAG TO
Thank you…
Sir Roel