Walking aids
- 1. Walking aids By Prof Dr. MM Makkawy Prof. of rheumatology & rehabilitation Faculty of medicine- Zagazig university
- 2. Include: 1. Parallel bars. 2. Walkers. 3. Crutches. 4. Canes.
- 3. These walking aids enable the patients with lesion in their lower limbs to move and go up and down stairs. They enable some of body weight to be supported by upper limbs.
- 4. The correct selection of a walking aid for a particular patient is very important and depends on: a. Stability of the patient b. Strength of the patient lower limbs. c. Strength of the patient upper limbs. d. Degree of coordination of movements of upper and lower limbs. e. Degree of relief from weight bearing required.
- 5. As the patient improves he may progress through the different types of walking aids.
- 7. They are used in starting to teach the patient how to walk; being rigid and stable they give the patient more confidence and are safer. A full length mirror is put at one end of the bar. The patient must look through the mirror and not looking to his feet.
- 8. Adjustment: The height and the distance are adjusted so that when they are held by patient; his elbows are in 30° of flexion.
- 9. Walkers They are the next step after the use of parallel bar. They are light, rigid, stable, and easy to use.
- 10. Components: a. Frame with 4 adjustable legs, each has a rubber tip to prevent sliding. b. Usually made of aluminum. c. Hand grips are fitted to the upper horizontal tubes.
- 11. Adjustment When the patient stands inside it, the upper frame is at level of greater trochanter and elbows are flexed at 30°.
- 12. How to use: The patient stands in the walker lefts the walker with both hands Place it forwards 25-30 cm steps into it, first with the strong LL, then with the diseased one.
- 13. Crutches Types: 1. Axillary. 2. Kenny crutch. 3. Elbow crutch (Lofstrand's crutch). 4. Gutter crutch.
- 14. Muscles needed during the use of a walking aid: When using a walking aid part of body weight is taken by the muscles of the shoulder girdle and upper extremity. Attention must be paid to strength of these muscles when planning for rehabilitation of a patient. During ambulation by walking aids the following muscles are in need:
- 15. • Patient elevates his pelvis, arches his spine to swing his LL . Also, shoulder girdles are depressed to support the body weight using shoulder depressors, erector spinae, latissimus dorsi, pectoralis minor, lower fibers of trapezius.
- 16. • Adductors of the arms to keep the crutches close to chest wall: mainly pectoralis major and latissmus dorsi. • Flexor of shoulders to move walking aid forward: deltoid and corachobrachialis.
- 17. • Extensors of elbow to extend and stabilize the elbow in slight flexion when the body weight is taken through upper limb: tricepsand anconous. • Extensors of wrist to stabilize the wrist in dorsiflexion, thus obtaining the best position of function for powerful hand grip. • Flexors of the fingers and thumb to hold hand grips firmly. When flexors of fingers are weak we can tighten the hand to the hand piece.
- 18. Types of tips used in crutches and canes: Rubber cup: to prevent noise and to stick to the ground. Suction cup: some degree of suction is achieved, so it is more stable and does not slide.
- 19. 1 - Axillary crutch Usually made of wood. Consists of 2 uprights joined at the top by an axillary piece, which is made of wood and padded with foam rubber and covered by leather. Hand grip is fixed between the uprights.
- 20. The lower ends are attached by screws to a vertical piece of wood, which is fixed by screws, so its length can be adjusted. A non slip rubber tip covers the lower ends. Crutches are either of standard height or adjustable which is better.
- 21. Usually prescribed bilateral in case: Paraplegia. Early case of fracture femur. All cases necessitating non weight bearing or partial weight bearing. * N.B: Sometimes the axillary piece is replaced by a piece of leather to avoid compression on axillary nerves and vessels.
- 22. Adjustment: Axillary piece is against the chest wall 2-3 fingers bellow anterior axillary fold. Hand grip is at height that the elbow is flexed 30° and the wrist is in full extension.
- 23. When taking the measurement to patient in bed, the height of the crutches is equal to the distance from the lower part of anterior axillary fold to the middleof the heel plus one inch for men and 1.5 inch for female (for the high heel).
- 24. When the patient is able to stand up by crutches, the height is readjusted. In standing position the tip of the crutch must be 3 inches lateral to tip of toes up to 6 inches if this makes the patients more stable, and 3-6 inches in front of tips of the toes.
- 25. Crutches are sometimes made of aluminum with telescoping lower end to be adjusted. In case of weak triceps; support can be provided to it by short metal gutter piece to the posterior upright, as a half loop band between the double uprights to which the arm is pressed backwards.
- 26. 2- Kenny crutch Was previously used for cases of polio and affection of UL also. It is formed of a ring present between the 2 uprights in addition to the other parts of the previous crutch.
- 27. The ring encircles the arm so it gives some support to the triceps when weak, also it does not fall from the patient accidentally.
- 28. 3- Elbow crutch (Lofstrand's crutch) Made of a single adjustable tube of aluminum alloy to which is added a U shaped metal cuff (arm band) to accommodate the forearm just below the elbow and a rubber or plastic covered hand grip, the lower end is protected by a rubber tip.
- 29. The arm band is made usually from spring steel. It grips the forearm, thus enabling the crutch to be controlled when freedom of hand movement is required.
- 30. Elbow crutches give more support of body weight and more stability than a walking sticks (canes) but less than axillary crutches. They are prescribed for patients who can take some weight on both feet but require an aid for balance and confidence.
- 31. Adjustment: Must be carried out with the patient standing up and wearing shoes. The tips of crutches are on the grounds -6 inches in front and lateral to the tips of the toes and the patient is standing upright, with his shoulders depressed and his elbows in 30° flexion
- 32. The arm band is adjusted so that there is 2 inches between the top of the arm band and flexor crease of elbow
- 33. 4- Gutter crutch (plateform crutch) Consists of a single adjustable tube of aluminum alloy. Attached to the upper end is a short horizontal metal gutter or trough in which forearm rests with the elbow in 90° of flexion.
- 34. Projecting forwards from the gutter is an adjustable bar carrying a vertical hand grip. The gutter which may be padded is secured to the forearm by Velcro fastenings. On some crutches the angle between the gutter and the alloy tube and the position of rotation of the handgrip in relation of the gutter may be adjusted.
- 35. The lower end of the crutch is protected by a rubber tip. Adjustment of length is by means of a spring-loaded double -ball catch.
- 36. Indications: Fixed flexion deformity of the elbow joint. Weakness of muscles controlling the elbow joint or hand. A deformity of the hand causing difficulty in gripping. When the patient experiences pain in the hand or wrist on taking weight trough the UL.
- 37. Adjustment: Strap the forearm into the gutter so that the point of the elbow lies at or just behind the posterior edge of the gutter. Adjust the distance between the front of the gutter and -the hand grip, so that the handgrip can be grasped firmly With patient standing straight, place the tip of the crutch on the ground 6 inches in front and lateral to the tips of the toes.
- 38. Adjust the height of the crutch by means of the spring -loaded double ball catch so that the elbow is in 90° of flexion. If the patient is unable to flex his elbow to 90 degrees, then a crutch with adjustable angle between the gutter and the crutch is required.
- 39. Walking sticks Usually made of wood with a C curved handle. A T shaped handle may be preferred by some patients. A rubber tip protects the lower end. Adjustable sticks made from aluminum alloy tubes with rubber or plastic hand grips are availabe.
- 40. Canes are less stable than elbow crutches but are lighter. They assist balance and provide moderate support for a lower limb and thus can improve gait and help to relief pain e.g., painful hip. Canes are not used unless the disabled lower limb can bear weight.
- 41. The side of use: Cane is used on the opposite side of the lesion (healthy side), so it take the weight instead of the affected limb, but if it is more comfortable for the patient to use the cane on the affected side can be left so.
- 42. Adjustment: The upper part of the handle of the cane is at level of the greater trochanter (at the level of the most prominent part of the greater trochanter) and the elbows flexed - 25-30°.
- 43. To give more stability in elderly people 3 or 4 legged cane can be used, which allows only a slow gait, they are called tripod or quadripod canes. They are given to elderly people or to patient with hemiplegia after stroke.
- 44. Another walking aid that is used as a cane is the so called reversed or hemiwalker. The patient holds it like a cane on the opposite side with one hand. Walking is slow.
- 45. The walking aids can be used only on even ground or on stairs with very wide and slow steps.
- 46. The height of all these walking aids should be adjusted to such a level that the elbow is flexed at 25-30° when the patient is standing and be sure that the rubber tips that prevent slipping on the floor are correctly applied and that none of the fastening screws are loose.