MSK- Assistive Gait Devices

Question 1

What should you consider when prescribing a device

Answer 1

Needs
Abilities
Preferences

Question 2

How do devices help?

Answer 2

Increase:
Support
Stability
(Reduce fear of falling)

Question 3

Indicati9ns for using a device

Answer 3

Pain
Weakness
Limited PROM
Decrease strength
Decrease endurance
Impaired motor control
ImpairEd balance
Unstable structures
Fear of falling
Open wounds on WB surface

Question 4

Weight bearing restrictions

Answer 4

Non weight bearing- NWB (crutches)
Toe touch weight bearing-TTWB (like walking on an egg<20%)
Partial weight bearing- PWB 25-50%
Weight bearing as tolerated- WBAT
Full weight bearing- FWB

Question 5

Co,mom types

Answer 5

Parallel bars
Walkers
Crutches
He,i walkers
Canes

Question 6

Fitting a device

Answer 6

Weight capacity-300 lbs is the limit
Handgrip placement
-measure whilempatien is standing wearing the shoes they would normally walk in
- elbow flexed 20-30 deg
- wristbcrease

Confirm in functional standing. 6 inches forward 2 inches to the side
Feet should be within the box of the walker

Question 7

Guarding

Answer 7

Use a gait belt in available
Stand posterior and to the side of the patient
Stand towards the side that the patient is ,most likely to fall

Question 8

Gait pattern

Answer 8

Two point- device and contra lateral LE progress simultaneously
Three point - device and one weight bearing LE are in contact with the ground
Modified 3 point- sequential order of progression
Four point- sequential order of progression with bilateral device
Step to- LE in swing phase goes on,y as far as the device
Step through- LE in swing phase steps past device
Swing to - crutches are both progressed first followed by both LE progressing as far as the device
Swing through- crutches are both progressed first followed by both LEs progressing past the device

Question 9

S T S guidance

Answer 9

Edge of chair
Place weight bearing leg as fair back as possible
Extend weight bearing restricted leg out in front
COMs over BOS
Push up on a stable surface
Using standing aids if needed

Question 10

Stand to sit

Answer 10

Only sit on a table chair
Back until you feel chair behind them
Reach back with one or both hands until you feel armrest
Extend weight bearing restricted leg out front
Slowly and CONTRIOLLED decent to chair

Question 11

Turning

Answer 11

Initially turn to unaffected/ affected side (turn to weaker as they progress)
Use multiple small steps

Question 12

Stairs

Answer 12

Step to pattern initially (progress as needed to step through)
Secure handrails should be used if available
Ascending “good go to heaven”
-Device moves with unaffected LE
-Guard from behind (below patient)
Descending “bad go to hell”
- device moves with the affected LE
- guard from the front (below patient)

Question 13

Parrel bars

Answer 13

Advantages
- maximum support/stability
- use to teach to walk again

Disadvantage
- not mobile or portable
- expensive

Question 14

Walkers- standards

Answer 14

Ad
- high stability
- wide BOS
- allows for functional mobility
- can be used to unload a limb

Dis
- high energy expenditure
- cannot be used on stair
- difficult to transport

Question 15

Folding walker

Answer 15

Easy to transport

Question 16

Wheeled/ rolling walking

Answer 16

PWB and above
Not for NWB
Cannot for stairs

Question 17

Posterior (reverse) walker

Answer 17

Commonly used for CP

Promotes posture

Question 18

Rollator

Answer 18

High mobility- swivel wheels
Built in seat- good for those with endurance issues

Low stability- not good for those who have difficulty turning

Question 19

Crutches- axillary

Answer 19

Advantages
- NWB
- stairs
- high mobility

Distav
- low stability
- requires good standing balance And upper body/ trunk strength
- requires good coordination
- high energy expenditure
- risk of brachial plexus or radial nerve compression injury
Only for TEMP use

Question 20

Fitting for axillary crutch

Answer 20

1- estimate height of cructches (height markers, ATNR method sitting, auxiliary fold to a spot 6-8 inched lateral to heel of show)
2- estimate height of handles (auxiliary fold to greater trochanter, bottom of shoe to greater trochanter
3- confirm fit in functional standing (2 inches lateral, 6 inches anterior to small toe. Fit 2 fingers b/w axilla and axillarypad 2 inches. Hand grips at wrist crease, ulnar styloid, greater trochanter @ 20-30 degrees

Question 21

Forearm crutches

Answer 21

No risk of brachial plexus or radial nerve compression
Allows for release of handgrips to use hand for functional activities
Sightly better for stability than auxiliary crutches
Used for long term crutch use.

Question 22

Forearm crutches fitting

Answer 22

Cuff
- 1/3rd of forearm, 1-1.5 in below the olecranon
- squeeze cuff together or pull apart to create proper fit

Question 23

Hemi walker

Answer 23

Good stability
But only use one side

Low mobility
High energy expenditure
Cannot be used on stairs

Question 24

Quadruped cane

Answer 24

High mobility
Good stability
Does not offload much weight
Can be used on stairs

Challenges balance
Slower gait pattern

Question 25

Single point cane

Answer 25

High mobility
Low energy expenditure
Can be used on stairs
Low energy expenditure

Low stability- requires lots of balance

Question 26

Saftey notes

Answer 26

Inspect regularly
Replace rubber tips
Avoid slippery surfaces
Beware of ice and snow