ASSISTIVE DEVICES

Rehabilitation

• is a dynamic, health-oriented process that

assists an ill person or a person with disability
(restriction in performance or function in
everyday activities) to achieve the greatest
possible level of physical, mental, spiritual,
social, and economic functioning.
 ASSISTIVE DEVICES

• Assistive devices for mobility/ambulation

can be referred to as ambulatory aids.
• Any item, piece of equipment, or product
system—whether acquired commercially,
off the shelf, modified, or customized—
that is used to improve the functional
capabilities of individuals with
disabilities.
 Note!

• The type of ambulatory aid needed depends

on how much balance and weight-bearing
assistance is needed. 
Uses of assistive devices include the following:
• Redistribute and unload a weight-bearing lower
limb
• Improve balance
• Reduce lower limb pain
• Provide sensory feedback

Adequate upper limb strength, coordination, and hand

function are required for the proper use of ambulatory
aids.
 Evaluation and Selection
Criteria

• Batavia and Hammer identified 4 key evaluation and

selection criteria for long-term users of assistive
devices8 :
• Effectiveness
• Affordability
• Operability
• Dependability
 Canes

• Canes widen the base of support and decrease stress on the

opposite lower extremity.
• Canes can unload the lower limb weight by bearing up to 25%
of a patient's body weight.
• Determining the proper cane length is important. A cane that
is fitted incorrectly produces an inefficient gait pattern.
• To determine the proper cane length, measure from the tip of
the cane to the level of the greater trochanter while the
patient is in an upright position. The elbow should be flexed
approximately 20°.
1. Adjustable aluminum cane. 2. Unadjustable
aluminum cane. 3. T-top cane. 4. Quad cane. 5.
Walk cane (hemiwalker).
 Biomechanics

• The cane usually is used on the side opposite the

affected lower limb.
• The cane helps decrease the force generated across
the affected hip joint by decreasing the work of the
gluteus medius-minimus complex.
• The force is exerted by the upper extremity through
the cane to help minimize pelvic drop on the side
opposite the weight-bearing lower limb.
 Function

 Ambulation
• The cane usually is held on the patient's unaffected
side so that it provides support to the opposite lower
limb.
• The cane is advanced simultaneously with the
opposite, affected lower limb.
• The patient always should have the unaffected lower
limb assume the first full weight-bearing step on level
surfaces.
 Stair climbing

• The mnemonic "up with the good and down with

the bad" can help patients to recall the appropriate
step pattern for stair climbing.
• Advance the unaffected lower limb first when going
upstairs, and advance the affected lower limb first
when coming downstairs.
• The patient always should have the unaffected lower
limb assume the first full weight-bearing step on level
surfaces.
 CRUTCHES\

• Crutch Types 

Crutches have 2 points of contact with the

body, providing better stability than do canes.
 
Two types of crutches (ie, axillary, nonaxillary)
currently are in use.
• The measurement prescription for axillary crutches is
determined in the following manner:
• With the patient standing, determine the crutch length by
measuring the distance from the anterior axillary fold to a
point 6 inches lateral to the fifth toe.
• With the proper crutch length determined and the crutch
then placed 3 inches lateral to the foot, proper handpiece
location can be measured. The patient's elbow should be
flexed 30°, the wrist should be in maximal extension, and the
fingers should be held in a fist.
• The patient should be able to raise his/her body 1-2 inches
by performing complete elbow extension.
 Measurement
• A standing patient is positioned against the wall with the feet
slightly apart and away from the wall.
• Then a distance of 5 cm (2 inches) is marked on the floor, out
to the side from the tip of the toe; 15 cm (6 inches) is
measured straight ahead from the first mark, and this point
is marked on the floor. Next, 5 cm (2 inches) is measured
below the axilla to the second mark for the approximate
crutch length.
• If the patient has to be measured while lying down, he or she
is measured from the anterior fold of the axilla to the sole of
the foot, and then 5 cm (2 inches) is added. If the patient’s
height is used, 40 cm (16 inches) is subtracted to obtain the
approximate crutch length. The hand piece should be
adjusted to allow 20 to 30 degrees of flexion at the elbow. The
wrist should be extended and the hand dorsiflexed
 Nonaxillary
Crutches
• Nonaxillary crutches allow the transfer of 40-50% of the
patient's body weight. Also called forearm or arm canes (or
forearm or arm orthoses), these devices require good trunk
control. The patient needs confidence in his/her ambulation
skills.16
• Measurement prescription - With the proper crutch length
determined and the crutch then placed 3 inches lateral to the
foot, the proper handpiece location can be measured. The
patient's elbow should be flexed 20°, the wrist should be in
maximal extension, and the fingers should be held in a fist.
 Gait Training and
Preambulation Exercises

At a minimum, gait training should include the following:

• Aerobic conditioning exercises
• Coordination and balancing exercises
• ROM of both upper and lower limbs
• Muscle strengthening of both upper and lower limbs

• Performing upper limb strengthening exercises is one of the

most important components of the preambulatory exercise
program.
To sit down:
• 1. Grasp the crutches at the hand pieces for control.
• 2. Bend forward slightly while assuming a sitting position.
• 3. Place the affected leg forward to prevent weight-bearing
• and flexion.
To stand up:
• 1. Move forward to the edge of the chair with the strong leg
• slightly under the seat.
• 2. Place both crutches in the hand on the side of the affected
• extremity.
• 3. Push down on the hand piece while raising the body to a
• standing position.
 GAITS
Four-Point Gait
1. Left crutch
2. Right foot
3. Right crutch
4. Left foot
Stability (at least 3 points are always in contact
with the ground)
Difficult to learn
Relatively slow walking gait
Weakness in the lower limbs or poor
coordination (ataxic)
Three-Point (Non –
Weight-Bearing) Gait
1. Both crutches and the weaker
lower limb
2. The stronger or unaffected limb

Eliminates weight-bearing on the

affected lower limb

Requires good balance and

coordination

Lower limb fracture, amputation, or

pain
Two-Point Gait
1. Left crutch and right foot
2. Right crutch and left foot
Stability
Faster than the 4-point gait
Reduces weight-bearing on both
lower limbs

Weakness in the lower limbs or

poor coordination (ataxic)
Swing-to Gait
1. Both crutches
2. Move both limbs almost TO
THE CRUTCHES.
Easy to learn
Lower energy consumption

Paraplegia
Swing-through Gait
1. Both crutches
2. Move both lower limbs PAST THE crutches
Fastest gait (faster than normal walking gait)
Patient must expend a large amount of energy
Difficult to learn
Strong, functional abdominal and upper limb
muscles and good trunk balance are required.
Paraplegia, with strong upper body muscles
Drag-to (Tripod) Gait
1. Left crutch
2. Right crutch
3. Drag both lower limbs to the
crutchesor (simultaneous sequence)
1. Both crutches
2. Drag both lower limbs to the crutches
Stability
Patient must expend a large amount of energy
Slow
Initial gait pattern used during gait training for patients
with paraplegia; once they improve their balance,
patients can advance to the swing gait
 1. Adjustable axillary crutch 2.
Permanent axillary crutch. 3.
Forearm crutch with closed leather
circle cuff. 4. Ortho crutch.
1. Platform crutch. 2. Forearm
aluminum crutch with
adjustable forearm piece.
 Walkers
• Advantage - Maximum support for the patient
• Disadvantages
– Slow and awkward gait
– Creates bad posture and walking habits
– Limited to indoor use in most cases
– Cannot be safely used to climb stairs (especially the
standard walker)
• Indications
– Best suited for patients who are confused or who have an
unsafe gait because of poor balance (eg, patients with
hemiplegia, patients with ataxia)
– Early gait training
• Measuring prescription
– Place the front of the walker 12 inches in front of the patient. The
walker should partially surround the patient.
– Measure the proper height of the walker by having the patient stand
upright with his/her elbows flexed 20°.
• Components
– Tubular aluminum or other tubular metal
– Plastic handgrips
– Rubber-tipped legs
1. Standard walker. 2. Forearm
support walker. 3. Stair-
climbing walker.
 references

• Delmar's.Fundamental.&.Advanced.Nursing.Skills.
• Brunner and Suddarth's Textbook of Medical-Surgical Nursing_
• eMedicine Specialties > Clinical Procedures > Medical Devices>Assistive
Devices to Improve Independence.emedicine.medscape.com