Assistive or Gait Device Basics

Question 1

Assisstive Devices typically are used to:

Answer 1

Increase support of load
Increase stability through enlarged base of support (BoS)

Question 2

Choosing an AD

Answer 2

Stability Mobiltiy Trade-off
– The more stability a device provides, the more it restricts mobility in eitherthe amount or the speed of movement​
The faster or agile a device allows the user to be, the less stability it provides​

Energy Cost

Functional Purpose
– Walking over level surfaces​
– Managing uneven surfaces
(When approaching the stairs with a walker to get up the stairs how they are going to get the walker up)

Question 3

Energy Cost of AD

Answer 3

• Gait deviations tend to increase energy expenditure.
• Older adults tend to expend more energy walking longdistances than younger adults.
• Using standard walkers (walker without wheels; have to use more UE) requires significantly more energyexpenditure than using rolling walkers or canes.

Question 4

General Rules ofr Choosing Gait Devices

Answer 4

1. Single- hand device
   – Cannot use if any LE WBingrestriction (NWB, PWB, TTWB) exists
   – Watch for compensations that require two-hand device
2. Consider Transfer, Gait and Stair/Ramp needs
   – Ex: If someone compensates when going to less assistance consider going back to more assistance
3. Consider mobility distances
   – In home single cane is okay BUT when going outside they get distracted and off balance which may require a different device for outside with more assistance.

Question 5

Fitting an Assistive DeviceGeneral Considerations

Answer 5

• Have the patient standing in good posture and wearing typicalfootwear (not socks!)
• Device handle is typically at the level of the greater trochanter or ulnarstyloidprocess.
  – Elbow flexion 20 degrees to maximize biomechanical use of device.
• Estimate with patientseated.
• Guard appropriately duringfitting.
• Seat patient before readjusting!

Question 6

Gait Devices: Most to Least Supportive

Answer 6

• Parallel Bars (Hemibar is one bar; not as stable but can be used to help someone get up early in treatment)
• Walker
  – Standard (Has no wheels; large energy cost)
  – Two-wheeled Walker (2ww)
  – Four-wheeled Walker (4ww - never FWW)
  – Three wheeled Walker (3ww)
• Bilateral Axillary Crutches (B axillary crutches)
• Bilateral Forearm Crutches (B forearm crutches)
• Hemi-walker
• Quad Cane
  – Large-based quad cane (LBQC)
  – Small-based quad cane (SMQC)
• Single-point cane (SPC)

FWW is a front wheel walker.

Make sure to state what side axillary crutch is on if only one.

Question 7

Parallel Bars (// bars)

Answer 7

• Very stable; usuallyused to prepare forearly transfer training and ambulation with lessrestrictive assistivedevices.
• Guarding within barsprovides greaterprotection against falls.
• Can keep w/c directly behind patient in early mobility skills practice

Can be very good for CVA patients

Think of Steve!

Question 8

Walkers

Answer 8

• Provides stabilityand unloading oflower extremities
• Standard walkersrequire more energyto use than wheeledwalkers
• Rolling walkers are less stable (than standard walkers) butallow faster, continuous gait.
• Glides or tennis balls attached toback legs of a wheeled two-walkerincrease ease of advancement.
• Upper extremity (UE) platformscan also be attached. (One arm on device normal and the other up raised on a platform)

Question 9

Walkers allow for:

Answer 9

-Stability
-Mobility in environment
-Portability
-Fit
-Energy cost

Question 10

What would be the benefits to function and posture when using a reverse walker?

Answer 10

• Keeps them in extension
• Allows them to pull up and sit down
• Gives kids mobility and confidence

Question 11

Axillary and Forearm Crutches (3 types)

Answer 11

Allow greater mobility at cost of less stability than a walker

• wooden and metal crutches
• Ortho crutches
• Forearm crutches

Question 12

Hemi Walker

Answer 12

• One-sided support with morestability than a cane (wide BOS)
• Patient must be Full Weight Bearing or Weight Bearing as Tolerated to utilized single hand device

Question 13

Canes

Answer 13

• Canes serve to widen the patient’s BoS and to decrease load on the LE joints
• The cane is typically placed contralateral to the involved LE (unless the goal is toincreaseWB on the involved side)
• When using quad canes, flat sideshould be closer topatient
• Progress from wide-based andsmall-based quad canes to single-point cane.

Question 14

What is this? Why do we typically not use it?

Answer 14

Hurri-cane; claims to stand on own, not true. Don’t last long. Don’t perscribe.