Walking aids and orthotics


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Walking aids and orthotics

  1. 1. 1
  2. 2. Walking Aids And Orthotics 2
  3. 3. Presenters: Afifa Munaf Jaweriah Mahmood Fatima Bhutto Presented to: Sir Saad 3
  4. 4. Walking • walking together with its variants is a skilled coordinated action which involves many joints and muscles. • The whole sensory input is involved in walking 4
  5. 5. Muscles involved in walking • flexors and extensors of the toes • planterflexors and dorsiflexors of the ankle • flexors and extensors of the knee and hip 5
  6. 6. Walking Aids • These are the appliances which may be a means of transferring weight from upper limb to the ground or which may be used to assist balance. 6
  7. 7. Continued.. Factors involved in choosing walking aids: • age of patient • their disability • general physical condition 7
  8. 8. Walking Aids equipments  The broad subdivision of walking aids would be between: • frames • crutches • sticks 8
  9. 9. Walking frames • Have very wide base • Very stable • Commonly used in elderly 9
  10. 10. Types of walking frames • Rigid frames • folding frames • reciprocal frames • forearm supporting frames • wheeled frames 10
  11. 11. Rigid frames • It needs to be adjusted to the correct height • patient stand upright with the elbows flexed at approximately 15 degrees • The frames should be of light material i.e. aluminum. 11
  12. 12. Folding frames • These frames are useful if the patient is regularly transported by the car.  Folding frames may either be: • three-legged 12
  13. 13. Reciprocal frames • Useful for those patients who find it difficult lifting a traditional frame. • It is hinged at the front. 13
  14. 14. Forearm supporting frames • These may also be called pulpit or gutter frames. • They allow walking training of patients who has difficulty in weight-bearing through the upper 14
  15. 15. Wheeled frames • Most standard adjustable height walking frames • The front extension legs are replaced with small wheeled legs. • They encourage a more normal gait pattern • They lack stability 15
  16. 16. Rollators • Have two fixed wheels at the front and two ferrules at the rear. • It is stable but not very maneuverable. • Can be awkward in tight spaces and corners 16
  17. 17. Walking patterns with a frame • patient lifts the frame forward transfers their weight onto it • takes two steps up to the frame • keep the frame well forwards • place all four legs of frame at a time on ground 17
  18. 18. Crutches 18
  19. 19. • A crutch is a mobility aid that transfers weight from the legs to the upper body. • The muscles of the arms, shoulders, back, and chest work together to manipulate the crutches 19
  20. 20. Categories of crutches 1.Axillary or underarm crutches: • These are usually prescribed when nonweight bearing gait is required • The axillary top is rested against the chest wall while the bulk of the patient’s weight is borne through the hands. 20
  21. 21. 2.Elbow crutches or forearm crutches • These are the most functional type of crutches and are • suitable for both non and partial weight bearing gaits. • it consists of a metal cuff and a handle fixed at 97 degrees 21
  22. 22. 3.Forearm/gutter crutches • Useful for the patients who are unable to use normal handgrips • Velcro straps fix the forearm into the tough and weight is applied via the forearm 22
  23. 23. Walking sticks • Provide support for the patients with good grip and sound joints of the upper limb • Suitable for partial weight bearing • To be used in the contra lateral hand in most cases 23
  24. 24. Tetrapods/tripods • These are four or three-legged sticks which give greater stability than a traditional stick • They are prescribed for the patient with poor balance and confidence • Commonly used by hemiplegic patients • Quite heavy as compared with the sticks and cant be used on stairs 24
  25. 25. Tetrapod Tripod 25
  26. 26. Effects of walking Aids • • • • • Increases confidence Relief of weight-bearing from affected leg Psychological support Relief of pain Provides support 26
  27. 27. Walking Aid Height • Measure the height of walking aid, from the ulnar styloid to the ground, with the patient standing erect , shoulders relaxed & elbows flexed to 15°. • crutches must be settled at either 77% of reported height or height minus 16 inches. 27
  28. 28. Advantages of Contralateral Gait • Reduce the force through affected leg • Prevents tilting of the pelvis. • Facilitates a reciprocal gait pattern. • Provide stability as it has a greater BOS. 28
  29. 29. Advantages of Ipsilateral Gait • If used in the dominant hand, feels more natural. • May limit hip and knee flexion. • Subjectively feels to offer more support as it is 29
  30. 30. Metabolic Cost of Walking Using Walking Aids • A swing through gait with crutches requires a very high rate of physical effort compared with normal walking. 30
  31. 31. Continued.. • With time, crutch users become adapted so that their energy expenditure & heart rate dec. as they become habitual walking aid users, suggesting the presence of both upper limb conditioning & training response. 31
  32. 32. 32
  33. 33. Forces through the Upper limbs when using Walking Aids • If a person is utilizing a walking aid in a nonweight bearing or partial weight bearing manners, then most of the body weight will be transmitted through the upper arms via the walking aid to ground. 33
  34. 34. Continued.. • Such a gait style creates joint moment forces on the shoulder of a similar magnitude to those on the hip joint during non-aided gait. 34
  35. 35. Pre-walking Exercise Programmes • As crutch walking is a learned skill, the patient must demonstrate adequate muscle strength, balance & co-ordination. 35
  36. 36. Continued.. • The strength of the upper extremities can be increased by weight-resistive exercises graduated springs, the use of theraband & PNF techniques, etc. • Balance exercises can occur in bed or by mat work. 36
  37. 37. 37
  38. 38. Gait Patterns with Walking Aids 38
  39. 39. Swing-to Gait • In this gait both crutches are brought forward together. • The trunk & lower extremities lean forwards, weight is transferred to the upper limbs & walking aids & both lower limbs are lifted & swung forwards to the level of crutches 39
  40. 40. Continued…
  41. 41. Swing-through Gait • Both crutches are taken forward, then both lower limb are lifted & swung past the crutches, so that the crutches are left behind the point where the feet land on the floor. 41
  42. 42. Continued.. • This gait is most commonly used by those with no lower limb control such as Spinal cord injury patients. • Unsuitable for those with painful lower limbs. 42
  43. 43. Ipsilateral Two-point Gait with One Stick • Stick in the ipsilateral hand is move forward, together with the affected leg. • Followed by the nonaffected leg. 43
  44. 44. Contralateral Two-point Gait with One Stick • Contralateral hand and stick are moved, together with the affected leg. • The weight is shared b/w the stick and affected side as the non-affected leg is brought through. 44
  45. 45. Three-point Gait • It requires two walking aids, either crutches or sticks followed by the affected leg then unaffected leg. 45
  46. 46. Continued.. • If a minimal weight-bearing gait is required, e.g toe touching only, then a delayed three point gait must be utilized where the walking aid makes contact with the ground before the affected leg touches the floor. 46
  47. 47. Continued.. • Partial weight bearing is often prescribed in orthopaedic conditions, with a gradual progression on weight bearing over time. E.g uncemented hip arthroplasty. 47
  48. 48. Four-point Gait • In this gait two walking aids are used, one for each leg. • The right walking aid is put forward, followed by the left leg, then the left walking aid and the right leg. 48
  49. 49. Continued.. • A Four-point gait is ideal for balance & as a step to relearning a normal reciprocal gait pattern. 49
  50. 50. Reciprocal Two-point Gait • It uses two sticks, right leg and left stick being placed on the ground together, followed by left leg and right stick. • It provides a style of walking that allows fast walking speeds to be achieved. 50
  51. 51. Orthotics 51
  52. 52. • Orthotics (Greek: ortho, "to straighten" or "align") is a specialty within the medical field concerned with the design, manufacture and application of orthoses. • An orthoses is a device applied directly and externally to the patient’s body with the object of supporting, correcting or compensating or an anatomical deformity or weakness 52
  53. 53. Uses of orthoses • Control, guide, limit and/or immobilize an extremity, joint or body segment • To restrict movement in a given direction • To assist movement generally • To reduce weight bearing forces for a particular purpose. 53
  54. 54. Foot orthoses • Foot orthoses are specially designed shoe inserts that help support the feet and improve foot posture • the foot is the point at which contact is made with the ground and reaction forces are generated 54
  55. 55. 1.Foot instability due to muscle weakness or imbalance A. weak supinators: • On weight bearing, if supinators are weak it will result in a pronated foot 55
  56. 56. Corrective measures • Usage of medial flares • Wedge building into an insole • Heel cup or a flexible insole Heel cups Medial flare 56
  57. 57. B.Weak pronators • A foot with a weak or absent pronators will adopt a supinated position at foot contact.  Correction: • Valgus moment required by a lateral flare or a wedge 57
  58. 58. C.Weak extensors/flexors • Claw toes: it consists of subluxation at the metatarsophalangeal joint, and flexion at the proximal (and distal interphalangeal joints) 58
  59. 59. Continued…. • Hammer toes: plantar flexion deformity of the proximal interphalangeal joint, the abnormal plantar flexion of the distal phalanx may occur. • Corrective measures includes Moulding using polyurethane or silicone materials 59
  60. 60. Continued…. • Metatarsalgia:it is a condition marked by pain under the metatarsal heads • You may experience metatarsalgia if you're physically active and you participate in activities that involve running and jumping 60
  61. 61. Corrective measures • An insole with either a metatarsal dome or bar • A metatarsal bar fixed to the bottom of the shoe • conservative treatments, such as ice and rest Metatarsal bar under the shoe 61
  62. 62. 2.Foot instability or deformity due to structural misalignments • Structural misalignments are often congenital and generally result in a foot with mobile joints but function about abnormal positions. • Heel cup can be used to re align the foot in children 62
  63. 63. 63
  64. 64. 3.foot instability or deformity due to loss of structural integrity • Pain may result from joint instability or excessive motion • The patient will try to avoid this pain by changing the portion of their foot that they present to the ground 64
  65. 65. Heel pain causing diseases Abnormal walking styles 65
  66. 66. Pain relief measures • Usage of shock absorbing insoles • Flexible medial arch support • Rose-parker insole 66
  67. 67. Ankle-foot orthoses (AFO) • An ankle-foot orthoses (AFO) is a most common orthoses or brace that encumbers the ankle and foot. • They are also used to immobilize the ankle and lower leg in the presence of arthritis or fracture, and to correct foot drop. 67
  68. 68. Types of AFOs 1.metal and leather: these have a leather covered cuff band with metal bars inserting into the heel of the shoe 2.plastic moulded: thermoplastic splints moulded to fit the limbs and inserted inside the shoe 68
  69. 69. Knee-ankle-foot orthose(KAFOs) • A knee-ankle-foot orthoses (KAFO) is an orthoses that encumbers the knee, ankle and foot. • A KAFO can have a great effect on motion at these lower limb areas 69
  70. 70. Metal and leather Thermoplastic moulded 70
  71. 71. Cast braces • These are used to maintain normal limb function while fracture healing occurs • Most cast braces run parallel to the broken bone to provide a protective structure and guide during the healing process. 71
  72. 72. Knee orthoses(braces) • A knee orthoses (KO) or knee brace extends above and below the knee joint and is generally worn to support or align the knee • Biomechanically difficult as they have to act with a short lever arm 72
  73. 73. Trunk and limb braces • The HKAFO is a knee-ankle-foot-orthoses with an extension of hip joint and pelvic components. These are used on patients requiring more stability of the hip and lower torso 73
  74. 74. Types of HKAFOs 1.Hip guidance orthoses(HGO): • Also called the pace walker has free hip joints between stops at the limit of flexion and extension • The patient walks by using the arms and walking aids to move the trunk forward the weight 74
  75. 75. 2.Reciprocating gait orthoses • It has hip joints linked by a cable so that extension occurs on one side causes flexion on the other side • The patient pushes down both the crutches and pulls pelvis forward leaning on one side • Non-weight bearing leg moves forward with the help 75
  76. 76. Hip guidance Reciprocating gait 76
  77. 77. Advantages HGO • Has low energy consumption • Allows user to achieve walking speed of 50% of normal individual • Easy to wear and take off RGO • Cosmetically acceptable • Lighter • Gives ability to the patient to stand unsupported 77
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