Assistive Devices

(1)



Assistive devices for Assistive devices for

mobility/ambulation can be referred

to as ambulatory aids.

 Ambulatory aids (canes, crutches, Ambulatory aids (canes, crutches,

walkers) are used to provide an

extension of the upper extremities to

help transmit body weight and

provide support for the patient.

(2)

 The type of ambulatory aid needed The type of ambulatory aid needed depends on how much balance and

depends on how much balance and

weight-bearing assistance is needed.

 Generally, the more disabled the Generally, the more disabled the

individual is, the greater the complexity

required in the walking device.

 A walker supplies the most support, and a A walker supplies the most support, and a standard cane or crutch provides the least

(3)

Uses of assistive devices include

the following:



Redistribute and unload a

weight-bearing lower limb



Improve balance



Reduce lower limb pain

(4)

Batavia and Hammer identified 4 key Batavia and Hammer identified 4 key

evaluation and selection criteria for long-term evaluation and selection criteria for long-term

users of assistive devices : users of assistive devices :

 EffectivenessEffectiveness - The extent to which the - The extent to which the function of the device improves one's living function of the device improves one's living

situation, functional capability, or situation, functional capability, or

independence independence

 AffordabilityAffordability - The extent to which the - The extent to which the purchase, maintenance, or repair of the purchase, maintenance, or repair of the

device causes financial difficulty device causes financial difficulty

 OperabilityOperability - The extent to which the device - The extent to which the device is easy to operate and adequately responds is easy to operate and adequately responds

to demands to demands

 DependabilityDependability - The extent to which the - The extent to which the device operates with repeatable and

device operates with repeatable and predictable levels of accuracy under predictable levels of accuracy under

conditions of reasonable use conditions of reasonable use

(5)

Assistive devices and their use

for impairments

 Moderate-to-severe unilateral Moderate-to-severe unilateral

weakness/hemiplegia

-(Walk cane/ hemi-walker )_{-(Walk cane/ hemi-walker )}  Bilateral lower extremity Bilateral lower extremity

weakness/paralysis

- Bilateral crutches or walker (pickup or - Bilateral crutches or walker (pickup or front-wheeled)

(6)



Severely impaired stability -

Walker (pickup or front-wheeled)



Impaired wrist or hand function -

Platform forearm walker



Difficulty climbing stairs - Stair-

Difficulty climbing stairs -

Stair-climbing walker

(7)

 WalkerWalker

 A walker has four broadly spaced A walker has four broadly spaced

posts that surround the person using

it. Walkers can support up to 50% of

body weight, so they may be useful

for people who have a lot of

weakness or problems on both sides

(8)

 Advantage - Maximum support for Advantage - Maximum support for

the patient

 Disadvantages Disadvantages

• Slow and awkward gaitSlow and awkward gait

• Creates bad posture and walking habitsCreates bad posture and walking habits

• Limited to indoor use in most casesLimited to indoor use in most cases

• Cannot be safely used to climb stairs Cannot be safely used to climb stairs (especially the standard walker)

(9)

 Advantages and disadvantages are Advantages and disadvantages are

associated with the use of a walker

and should be considered when

prescribing a walker as an assistive

device for any patient.

(10)

 Indications Indications

• Best suited for patients who are Best suited for patients who are confused or who have an unsafe

confused or who have an unsafe

gait because of poor balance

(patients with hemiplegia, patients

with ataxia)

(11)

 Measuring prescription Measuring prescription

• Place the front of the walker 12 inches Place the front of the walker 12 inches in front of the patient. The walker

in front of the patient. The walker

should partially surround the patient.

• Measure the proper height of the walker Measure the proper height of the walker by having the patient stand upright

by having the patient stand upright

with his/her elbows flexed 20°.

(12)



Components

• Tubular aluminum or other

_{Tubular aluminum or other}

tubular metal.

• Plastic handgrips.

_{Plastic handgrips.}

• Rubber-tipped legs

_{Rubber-tipped legs}

(13)

 Types of WalkersTypes of Walkers

 Standard walker (pickup walker)Standard walker (pickup walker)  Rolling walker (front-wheeled Rolling walker (front-wheeled

walker) walker)

 Reciprocal walkerReciprocal walker

 Forearm support walkerForearm support walker  Stair-climbing walkerStair-climbing walker

 Heavy-wheeled walker with Heavy-wheeled walker with foldaway seat and removable foldaway seat and removable

back back

(14)

Standard walker (pickup walker)

(15)

Standard walker (pickup walker)

 Most walkers are lightweight and very Most walkers are lightweight and very durable.

durable.

 Standard walkers have adjustable legs, Standard walkers have adjustable legs, accommodating a large percentage of

accommodating a large percentage of

patients.

 To use the standard walker for To use the standard walker for

ambulation, the patient must have the

upper extremity strength necessary to lift

the device and place it forward.

(16)

Standard walker (pickup walker)

Disadvantages :

 Bulky to transport (but most fold)Bulky to transport (but most fold)  Stairs and tight spaces are difficult Stairs and tight spaces are difficult  (eg, people with Parkinson’s disease (eg, people with Parkinson’s disease

often tend to fall backward, making

this type of walker inappropriate)

(17)

Rolling walker

(front-wheeled walker)

(18)

Rolling walker

(front-wheeled walker)

 The rolling walker has wheels on the front The rolling walker has wheels on the front legs; these wheels promote the walker's

legs; these wheels promote the walker's

movement.

 The rolling walker does not require as The rolling walker does not require as

much strength and balance to maneuver

as the standard walker does, because the

patient does not have to lift it from the

floor.

 Rolling walkers are used by patients who, Rolling walkers are used by patients who, because of poor coordination of the upper

because of poor coordination of the upper

extremity and trunk, are unable to lift the

walker and move it forward.

(19)

Rolling walker

(front-wheeled walker)



Disadvantages

• The front wheels may create

_{The front wheels may create}

instability if they are not used

properly.

• Proper supervised training

Proper supervised training

session is required to ensure

patient safety.

(20)

Reciprocal walker

(21)

Reciprocal walker

 This device has swivel joints that This device has swivel joints that

permit reciprocal action, with each

side of the walker moving in

alternation with the other.

 An advantage of the reciprocal An advantage of the reciprocal

walker is that it allows a quicker and

less awkward gait.

(22)

Forearm support walker

(23)

Forearm support walker

 Indications Indications

• Patients with forearm deformities (wrists Patients with forearm deformities (wrists or hands) or pain

or hands) or pain

• Patients with elbow flexion contracture_{Patients with elbow flexion contracture}

(24)

Stair-climbing walker

(25)

Stair-climbing walker

 This device requires good balance and This device requires good balance and great strength of the upper extremities.

great strength of the upper extremities.

 The stair-climbing walker is prescribed for The stair-climbing walker is prescribed for young patients with paraplegia.

young patients with paraplegia.

 A U-shaped extension is a possible A U-shaped extension is a possible

additional component. This extension

provides extra support in order to enhance

stability for stair climbing.

(26)

Heavy-wheeled walker with

foldaway seat and removable

back

 Indication - Indoor institutional useIndication - Indoor institutional use

 Disadvantage - Heavy, awkward, and Disadvantage - Heavy, awkward, and

unsafe

(27)

How to Use a Walker

 First, you have to consider the First, you have to consider the

various available

various available models of walkersmodels of walkers. . Do you want rubber grips, rubber

Do you want rubber grips, rubber

tips, wheels, hand-brakes,

accessories? Lightweight or

heavyweight? The only way to know

for sure is to go to a medical supply

store and see for yourself.

(28)



Once you have selected the

model of walker you want, the

"fit" of the walker becomes

important. When holding on to

your walker, your elbows should

be bent in a position that feels

comfortable and natural.

(29)

 The top of your walker should be The top of your walker should be

even with the crease on the

underside of your wrist, after

relaxing your arms at your side.

Walkers that are too low cause you

to stoop over while you walk and not

use proper

use proper body mechanicsbody mechanics. If your . If your walker is at the wrong height, the

walker is at the wrong height, the

improper position will surely cause

aches and pains.

(30)

Sitting With Your Walker

 Back up until you feel the chair Back up until you feel the chair

against the back of your legs.

 Slide your operated leg forward and Slide your operated leg forward and

lower yourself slowly into the chair

using armrests.

 Try to sit in a chair that has Try to sit in a chair that has

armrests. DO NOT sit in rocking

chairs or chairs with wheels

(31)

(32)

Standing With Your Walker

 Scoot forward in the chair with your Scoot forward in the chair with your

operated leg out in front of you.

 Use both arms to push yourself up Use both arms to push yourself up

to standing, then reach for the

walker.

 Stand for a minute or so to be sure Stand for a minute or so to be sure

you feel stable and balanced.

(33)

 DO NOT pull up DO NOT pull up

the walker when

rising from

sitting.

(34)

To walk

With Your Walker

_{With Your Walker}

 Keep your walker Keep your walker

FLAT on the floor

FLAT on the floor  When you are When you are

ready to start

walking, push the

walker slightly

ahead of you

(35)

 DO NOT lift the DO NOT lift the

walker off the

floor.

(36)

 then step into the walker. Keep that then step into the walker. Keep that

pattern going -- walker slightly

ahead, then step into the walker.

ahead, then step into the walker.  The key point is that you should The key point is that you should

never have the walker too far ahead

of you and you should have excellent

posture as you take your steps.

 Also, don't look at your feet -- look Also, don't look at your feet -- look

in front of you.

(37)

 DO NOT pivot too DO NOT pivot too quickly. Take small

quickly. Take small

steps and turn

toward your strong

leg.

(38)

 If you have trouble gripping the If you have trouble gripping the

walker, platform walkers are

available may prove to be a better

option.

 They are not exactly attractive They are not exactly attractive

contraptions but they serve a

purpose. The platform allows you to

rest your elbow and forearm, taking

stress off your hands.

(39)

What Are Body Mechanics?

 Body mechanics pertain to the Body mechanics pertain to the

position of your body when it's

moving. Proper body mechanics are

important for everyone and

especially for people with

especially for people with arthritis_arthritis or _or

other

other musculoskeletalmusculoskeletal conditions. conditions. Correct body position can help:

Correct body position can help:  relieve pain relieve pain

 reduce stress on joints reduce stress on joints  reduce the risk of injuryreduce the risk of injury

(40)

 With every movement, as you stand, With every movement, as you stand,

sit, walk, drive, lift, reach, push, pull,

exercise, and even sleep, it's

important to be aware of your body

position. If you can improve your

posture when moving, you are

essentially

(41)

How Do Proper Body Mechanics

Protect Joints?

Proper body mechanics and specifically

proper posture can:

 align bones and joints align bones and joints

 reduce wear and tear on joints reduce wear and tear on joints

 reduce stress on supporting structures reduce stress on supporting structures (e.g., ligaments and joints)

(e.g., ligaments and joints)

 strengthen the spine strengthen the spine  strengthen muscles strengthen muscles  prevent muscle pain prevent muscle pain  conserve energyconserve energy

(42)

How Can a Person Ensure Proper

Posture?

 Well-toned muscles, normal Well-toned muscles, normal

movement of the joints, and

balanced muscle on the sides of the

spine promote proper posture. That

can be difficult for people with

arthritis.

(43)

 Good posture while standingGood posture while standing

implies that shoulder blades are

back, chest forward, knees straight,

and the top of your head should align

with the ceiling. Your pelvis should

not tilt. Arches of your feet should be

supported with shoes.

(44)

 When sitting in a chairWhen sitting in a chair, your , your

buttocks should be all the way to the

back of the chair. Your back should

be straight and your shoulders

should be back. Knees, bent at right

angles, should be at the same height

or higher than your hips. Feet should

be flat on the floor.

(45)

 A proper gaitA proper gait that incorporates that incorporates

good posture and good body

mechanics will help conserve energy.

Arthritis patients who have severely

damaged joints or who have had

joint surgery may have an abnormal

gait. If you can still walk you should

walk. Walking builds muscle strength

that in turn helps to protect joints.

(46)

 If you must liftIf you must lift something that's something that's

heavy, bend at your knees and hips

and lower your body down to meet

the object you are trying to pick up.

Never bend at the waist while

keeping your legs straight and

reaching down to grasp the object.

(47)

 If you must liftIf you must lift. There is a right . There is a right

way and a wrong way to move. Your

body will be healthier and joints will

be protected if you make a conscious

effort to move the right way. If you

need a little coaching, perhaps a

consultation with a physical therapist

would be helpful.

(48)

Gait is the manner or style of

walking.

There are many types of gait.

 Antalgic Gait:Antalgic Gait: painful gait, a limp is painful gait, a limp is

adopted to avoid pain on weight

bearing structures (hip, knee, ankle).

bearing structures (hip, knee, ankle).  Ataxic Gait:Ataxic Gait: an unsteady, an unsteady,

uncoordinated walk, a wide base of

support is seen. normally due to

cerebellar disease.

(49)

 Festinating Gait:Festinating Gait: short, accelerating short, accelerating

steps are used to move forward,

often seen in people with Parkinson's

disease.

 Four Point Gait:Four Point Gait: utilized by crutch utilized by crutch

users, first on crutch, then the

opposite leg followed by the other

crutch and then the other leg.

(50)

 Hemiplegic Gait:Hemiplegic Gait: involves flexion of involves flexion of

the hip because of inability to clear

the toes from the floor at the ankle

and cirumduction at the hip.

 Spastic Gait:Spastic Gait: walk in which the legs walk in which the legs

are held close together and move in

a stiff manner. often due to central

nervous system injuries.

(51)