Professional Documents
Culture Documents
Adequate upper limb strength, coordination, and hand function are required
for the proper use of ambulatory aids.
Assistive devices for ADL, as well as for self-care and leisure activities, range
from simple objects for daily use (eg, plate guards, spoons with built-up
handles, elastic shoelaces, doorknobs with rubber levers) to complex
electronic devices, such as voice-activated environmental control systems.
Batavia and Hammer identified 4 key evaluation and selection criteria for
long-term users of assistive devices.
Impairments and the associated assistive devices that aid in ADL are as
follows:
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.
Types of canes
• C cane - This is the most commonly used cane. Other names used for
this device include the crook-top cane, the J cane, and the single-point
cane.
• Functional-grip cane
o This type of cane provides better grip and more controlled
balance for patients.
o The grip of a functional-grip cane is more comfortable than that
of a C cane.
o The ortho cane is an example of a functional-grip cane.
• Quad cane
o Quad canes provide more support than do other standard canes.
o Narrow- and wide-based forms of quad canes are available.
o Quad canes are especially helpful for patients with hemiplegia.
o Slow gait is one disadvantage of quad canes.
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. If the cane is held on the
affected side, the affected hip in turn experiences an increased load of 4
times the body weight during ambulation.
Function
• Ambulation
o The cane usually is held on the patient's unaffected side so that
it provides support to the opposite lower limb.
o The cane is advanced simultaneously with the opposite, affected
lower limb.
o The weight is borne through the arm as needed.
o The patient always should have the unaffected lower limb
assume the first full weight-bearing step on level surfaces.
• Stair climbing
o The mnemonic "up with the good and down with the bad" can
help patients to recall the appropriate step pattern for stair
climbing. The cane is used for extra support when
ascending/descending stairs. Often, the patient also has a rail to
hold on the other side for added safety.
o Advance the unaffected lower limb first when going upstairs,
and advance the affected lower limb first when coming
downstairs.
o The patient always should have the unaffected lower limb
assume the first full weight-bearing step on level surfaces.
Crutches
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.
Axillary crutches
An axillary crutch is a type of orthosis that provides support from the axilla to
the floor. Wood and aluminum axillary crutches, both of which are adjustable,
are available. An extension crutch (ie, one with an adjustable length) is
heavier than a regular crutch because of the extra piece of wood. Standard
axillary crutches have double uprights with a shoulder piece, as well as
a handgrip or bar.
Ortho crutch
Nonaxillary crutches
• The wooden forearm orthosis, also known as the Kenney stick (named
after Sister Kenney), resembles the axillary crutch but ends proximally,
with a leather band situated around the proximal portion of the
forearm.
• Indications for this orthosis include the following:
o Originally developed for patients with poliomyelitis
o For patients who have good proximal upper limb strength but
weak distal strength and who are unable to hold and control the
orthosis effectively
• An advantage to this type of crutch is that use of the closed leather
band will prevent the patient from dropping the orthosis. (This is even
truer than it is with the Lofstrand forearm orthosis.)
Crutch gaits
• Shoulder depressors
• Latissimus dorsi
• Lower trapezius
• Pectoralis minor
• Shoulder flexors
• Elbow and wrist extensors
• Finger flexors
• Trunk (deep back) muscles - To help improve balance and endurance
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.
Types of walkers
Reciprocal walker
• 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 walker is that it allows a quicker and
less awkward gait.
• Indications
o Patients with forearm deformities (wrists or hands) or pain
o Patients with elbow flexion contracture
• Disadvantage - Heavy
Stair-climbing walker
• This device requires good balance and great strength of the upper
extremities.
• The stair-climbing walker is prescribed for young patients with
paraplegia.
• A U-shaped extension is a possible additional component. This
extension provides extra support in order to enhance stability for stair
climbing.
Reduces weight-
bearing on both
lower limbs
Disadvantages Difficult to learn Requires good Patient must expend a Patient must expend a large
and/or balance and large amount of amount of energy
Requirements Relatively slow coordination energy
walking gait Slow
Difficult to learn
Strong, functional
abdominal and upper
limb muscles and good
trunk balance are
required.
Indications Weakness in the Lower limb Weakness in the Paraplegia, with strong Paraplegia Initial gait pattern used during gait
lower limbs or poor fracture, lower limbs or upper body muscles training for patients with
coordination amputation, or poor coordination paraplegia; once they improve their
(ataxic) pain (ataxic) balance, patients can advance to
the swing gait
Appropriate 1. Left crutch 1. Both crutches 1. Left crutch and 1. Both crutches 1. Both crutches 1. Left crutch
Sequence 2. Right foot and the weaker right foot 2. Move both lower 2. Move both 2. Right crutch
3. Right crutch lower limb 2. Right crutch limbs past the limbs almost to 3. Drag both lower limbs to the
4. Left foot 2. The stronger and left foot crutches the crutches. crutches or (simultaneous
or unaffected sequence)
limb 1. Both crutches
2. Drag both lower limbs to the
crutches
Advantages Stability (at least 3 Eliminates Stability Fastest gait (faster Easy to learn Stability
points are always weight-bearing than normal walking
in contact with the on the affected Faster than the 4- gait) Lower energy
ground) lower limb point gait consumption
Reduces weight-