7/25/2019 107493_ASSIST-1

1/25

Using assistive gait devicesin rehabilitation

7/25/2019 107493_ASSIST-1

2/25

Reasons for using an assistive gait deviceare:

Poor balance, Inability to bear weight on a lower extremity due to

fracture or other injury,

Paralysis involving one or both lower extremities, or

Amputation of a lower extremity.

Advantages to early ambulation following aninjury:

Aiding circulation,

Preventing calcium loss in bones, and Aiding the pulmonary and renal systems.

7/25/2019 107493_ASSIST-1

3/25

General Principles

he patient to be carefully evaluated in order to select theappropriate assistive device to meet the patient!s needs.

he therapist must be aware of the patient!s total medical

condition, weight"bearing status of the involved extremity when

considering which type of assistive device to use with the patient. he therapist will need to determine the range of motion of the

extremities and the strength of the primary muscles re#uired forambulation.

he patient must press downward on the assistive gait device inorder to move the body forward. he scapular, shoulder, andelbow musculature supports the body!s weight while the non"affected lower extremity is moved forward. he finger flexors foldthe hand"piece of the assistive gait device.

7/25/2019 107493_ASSIST-1

4/25

he primary muscles re#uired for ambulation with

axillary crutches, using a three"point $non"weight

bearing on one lower extremity% crutch gait pattern, arethe scapula stabili&ers, shoulder depressors, shoulder

extensors, elbow extensors, and finger flexors for the

upper extremity.

he primary lower"extremity muscles in the weight"

bearing lower extremity are the hip extensors, hip

abductors, 'nee extensors, 'nee flexors, and an'le

dorsi"flexors. (hile the patient is standing on theunaffected lower extremity, the muscles of the hip and

'nee provide stability. he an'le dorsi"flexors position

the foot so that it can clear the floor when the limb is

swinging forward

7/25/2019 107493_ASSIST-1

5/25

Types of assistive gait devices

(hen choosing an assistive gait device, the therapist

considers the amount of support the patient will need

and the patient!s ability to manipulate the device.

he selection of an assistive gait device is based on the

patient!s disability, coordination, and stability.

)or example, you may have two patients with the same

type of fracture. *ne of the patients may use crutches if

he or she has ade#uate stability and coordination to

safely use them. he other patient may re#uire a wal'er

due to poor stability and coordination. As the patient!s abilities improve, they may advance to

an assistive device providing less stability and support

for easier maneuverability.

7/25/2019 107493_ASSIST-1

6/25

Types of assistive gait devices: Assistive gait devices are designed to improve the

patient!s stability by increasing the base of support. he categories of assistive ambulation devices, in order

from greatest to least amount of support, are: Parallel bars,

al!ers, A"illary crutches,

#orearm $%oftstrand& crutches,

Two canes, and

'ne cane(

All categories of assistive gait devices are adjustable and come intall, adult, and child si&es. Additionally, a special platform can beattached to wal'ers or axillary crutches for patients who are unableto bear weight through the hand, wrist, or forearm.

7/25/2019 107493_ASSIST-1

7/25

)&Parallel bars

Parallel bars are used when maximal patient support and stabilityare re#uired.

he gait pattern can be practiced in parallel bars and the fit of theassistive device can be chec'ed.

he parallel bars limit mobility. +o once the patient becomes

proficient with the appropriate gait pattern, the patient must beprogressed to another assistive gait device to be mobile. are must be ta'en so that the patient does not become dependent

on the parallel bars.

he parallel bar height needs to be adjusted to provide - to /0

degrees of elbow flexion when the patient is standing erect and isgrasping the bars about 1 inches anterior to the hips. he bars needto be approximately / inches wider than the patient!s hips when thepatient is centered between the bars.

7/25/2019 107493_ASSIST-1

8/25

*&al!ers

(al'ers provide maximum stability and support andallow the patient to be mobile.

(al'ers are designed in many styles, but all have four

legs. +ome may have two or four wheels.

(heels allow the patient to gently push the deviceforward as opposed to pic'ing the wal'er up to move itforward.

Another variation in the design of the wal'er is the abilityto fold the wal'er when it is not being used. his featureallows for easier transportation in a car and for storage.

7/25/2019 107493_ASSIST-1

9/25

+isadvantages of using wal!ers:

(al'ers are cumbersome and difficult to store andtransport.

(al'ers are very difficult to use on stairs.

(al'ers reduce the speed of ambulation. he patient is unable to use a normal gait pattern by

using wal'er.

o properly fit a patient with a wal'er, adjust the heightof the wal'er so that the patient has between - and/ degrees of elbow flexion when grasping the handlesof the wal'er.

7/25/2019 107493_ASSIST-1

10/25

&A"illary crutches

Axillary crutches are used with patients who do not

re#uire as much stability or support as provided by a

wal'er.

Axillary crutches allow the patient to perform a greater

variety of gait patterns and ambulate at a faster pace.

7/25/2019 107493_ASSIST-1

11/25

+isadvantages of a"illary crutches:

Axillary crutches are less stable than wal'er.

Improper use of axillary crutches can cause injury to the

neurovascular structures in the axillary region. Axillary crutches re#uire good standing balance by the

patient.

2eriatric patient may fell insecure or may not have the

necessary upper" body strength to use axillary crutches.

7/25/2019 107493_ASSIST-1

12/25

o properly fit a patient with axillary crutches, both the

length of the crutches and the height of the hand piecemust be properly adjusted.

he length of the axillary crutch should be adjusted so

the therapist can fit two or three fingers between the top

of the axillary crutch and the patient!s axilla.

(hen standing, the tips of the crutches should be

approximately 1 inches from the toes of the patient!s

shoes at a 3"degree angle.

he handpiece of the axillary crutch should be adjusted

so the patient has - to / degrees of elbow flexion.

7/25/2019 107493_ASSIST-1

13/25

-orearm crutches

)orearm crutches $4oftstrand or anadian crutches% areused when the patient need crutches permanently, or for

long periods of time.

People who use 4oftstand crutches must have the

stability and coordination to use them. 5sing forearm crutches re#uires no more energy,

increased oxygen consumption or heart rate than axillary

crutches.

his type of crutch has the advantage of being easilystored and transferred.

here is no ris' of injury to the neurovascular structures

in the axillary region when using this type of crutches.

7/25/2019 107493_ASSIST-1

14/25

+isadvantages of forearm crutches:

)orearm crutches are less stable than a wal'er.

hey re#uire good standing balance and upper"body

strength. 2eriatric patient sometimes feel insecure with these

crutches.

hey may not have the necessary upper"body strength

to use forearm crutches.

7/25/2019 107493_ASSIST-1

15/25

To fit the patient with forearm crutches:

have the patient stand with arms hanging loosely by theside.

Place the crutch parallel to the lateral aspect of the tibiaand femur.

Adjust the height of the hand"piece so that it is level withthe ulnar styloid process. his will insure the elbow isflexed between - and / degrees.

he top of the forearm cuff should be adjusted so that itis located - to -. inches distal to the olecranon processof the elbow while the patient is grasping the hand"pieceof the crutch with the wrist in neutral flexion"extension.

7/25/2019 107493_ASSIST-1

16/25

.&/anes

anes are used to compensate for impaired balance or

to increase stability while ambulating. here are several styles of canes but the standard is

'nown as the 6 cane.

A cane is functional on stairs and in confined areas.

It is also easily stored and transported.

7/25/2019 107493_ASSIST-1

17/25

+isadvantage of a cane

It provides limited support due to its small base of

support.

To fit a patient with a cane:

have the patient stand and place the can parallel to the

lateral aspect of the tibia and femur.

Adjust the hand piece of the cane so it is level with the ulnar

styloid process.

his will provide - to / degrees of elbow flexion when the

patient grasps the handle of the cane.

7/25/2019 107493_ASSIST-1

18/25

0asic gait patterns

The selection of the proper gait pattern is dependent

upon the patient1s

balance,

strength,

coordination,

functional needs, and weight2bearing status(

7/25/2019 107493_ASSIST-1

19/25

)(#our2point gait pattern

A four"point gait pattern is used when the patient

re#uires maximum assistance with balance.

It re#uires the use of bilateral assistive gait devices

$canes or crutches%.

he pattern begins with the forward movement of one of

the assistive gait devices, and then the contralateral

lower extremity, the other assistive gait device, and

finally the opposite lower extremity $e.g., right cane, thenleft foot7 left cane, then right foot%. his is a slow gait

pattern, but a stable one.

7/25/2019 107493_ASSIST-1

20/25

*(Two2point gait pattern

he two"point gait pattern re#uires the use of bilateral

assistive gait devices.

his pattern is faster than the four"point gait. he two"point gait pattern closely approximates a normal

gait pattern and should be encouraged.

his pattern does re#uire the patient to coordinate

moving an assistive gait device and the contralaterallower extremity at the same time.

his pattern is less stable than the four"point pattern.

7/25/2019 107493_ASSIST-1

21/25

(3odified four2point and two2point Gait

patterns

he modified four"point and two"point gait patterns

re#uire only one assistive gait device.

he assistive device is used with the opposite upperextremity to the involved lower extremity, if possible.

his widens the base of support, increase stride lengths,

cadence, and wal'ing velocities than when using the

cane on the same side as the involved lower extremity.

7/25/2019 107493_ASSIST-1

22/25

-(Three2point gait pattern

he three"point pattern re#uires two crutches or awal'er, but it cannot be performed with two canes.

his pattern is used when the patient is only able to bearfull weight on one lower extremity.

(hen using axillary crutches and a three"point gaitpattern, between 33.3 and 38 percent of the patient!sbody weight is transmitted through the upper extremities.+o the strength of the upper extremities and uninvolvedlower extremity must be assessed prior to attemptingambulation.

he energy cost $oxygen consumption% for this type ofgait is about twice as high as normal wal'ing.

7/25/2019 107493_ASSIST-1

23/25

he wal'er or crutches are moved forward first. 9ext, theinvolved lower extremity is advanced.

hen the patient presses down on the assistive gait

device and advances the uninvolved lower extremity.

If the uninvolved lower extremity is advanced to where itis parallel to the involved lower extremity, then this would

be a swing to pattern.

If the uninvolved lower extremity is advanced ahead of

the uninvolved lower extremity, then this would be aswing through pattern.

7/25/2019 107493_ASSIST-1

24/25

.(3odified three2point gait pattern

he modified three"point gait pattern re#uires two

crutches or a wal'er.

his pattern is used when the patient can bear full

weight with one lower extremity but is only allowed to

touch the involved lower extremity to the floor.

his is 'nown as touchdown weight bearing $(;%.

he term

7/25/2019 107493_ASSIST-1

25/25

In this pattern, the wal'er or crutches are advanced first,

and then the involved lower extremity is advanced

forward. he patient presses down on the assistive gait

device and advances the uninvolved lower extremity

using either a