The document discusses assistive technologies that enhance functionality for individuals with disabilities, comparing them to orthotic devices. It covers various categories of assistive devices, including ambulatory aids like canes and crutches, as well as wheelchairs, detailing their designs and uses. The importance of proper fitting and client-specific considerations for each type of device is emphasized to ensure optimal utilization and safety.

1. ASSISTIVE TECHNOLOGIES

2. INTRODUCTION
• Rehabilitative technologies vs Assistive technology
• “Assistive devices encompass a wide range of items that enhance or
facilitate function or the ability to participate in activities. Whereas
orthotic devices are applied to the body to stabilize and facilitate
movement, assistive devices are an extension of the body, and allow for
control over the environment.” (AAOS, 2008)
• Assistive technologies are designed to facilitate the process of
compensation and restoration of function.
• Universal design/ Inclusive design - Considering diverse range of abilities
in functional design of products, communications and built environment
e.g. talking books on Kindle, curb cuts and ramps.

3. Electronic Enabling Technologies
• Electronics Aids to Daily Living (EADLs)
• They are designed to control electrical devices that are within the
client’s environment; previously known as environmental control
units.
• Generic forms are built for control of lighting, radios, television, etc.
• Augmentative and Alternative Communications (AACs)
• This term is used to describe systems that supplement (augment) OR
replace (alternative) communication by voice or gestures between
people.

4. Ambulatory Devices
• Ambulatory assistive devices serve one of the following functions:
• Improve balance
• Assist propulsion
• Reduce loads on one or both limbs
• Transmit sensory cues throgh the hands
• Notify external observers on the need for assistance
• Simple ambulatory aids: canes, crutches, and walkers

5. Canes
• Canes are made of study materials such as wood like walnut, oak,
and metals such as aluminum; plastics such as acrylics AND fiberglass,
and carbon fiber.
• Canes used in rehabilitation, unlike walking sticks, must have a
handle; ergonomic handles are designed to improve hand-handle
contact area.
• Cane shaft may be solid, height adjustable or foldable.
• Advanced canes possess a weight-measuring and feedback system
that can give client feedback on amount of weight borne.
• A cane often terminates in a rubber tip; spring-loaded tip serve for
shock absorbence at initial contact.

6. • Base designs for cane include the
quadruped design which may be
adjustable OR base with caster
wheels.
• Canes with haptic feedbacks are
useful for persons with visual
impairments and often have the
lower part of the shaft coloured
red.

8. Crutches
• Typically, four categories:
• Underarm or Axillary crutches
• Triceps crutches
• Forearm or Loftsrand crutches
• Platform crutches
• Axillary crutches, a misnomer. The axilla should never be used as
support beause of the risk of compression on blood vessels and nerve
supply in the axilla.
• A triceps crutch has two posterior bands intended to keep the elbow
in extension. Loftstrand crutches have adjustable lengths and
adjustable cuff positions.
• Platform crutches provides a trough for weight bearing in patients

10. Walkers
• “Walkers are frames that provide bilateral support without the need
to control two canes or crutches”.
• Variations in designs according to:
• Base: Four tips, two tips and two wheels (front-wheeled), four wheels, three
wheels [last two, usually rollator walkers]
• Uprights: Rigid, folding, reciprocating and stair climbing
• Proximal portion: Hand grips, platform
• There are also variations of reverse walkers used in children with CP.
• See this video

11. Measuring Ambulatory Aids
Canes
• Canes are held in the hand opposite the involved side or limb.
• Cane is placed in a position where it is about 5cm lateral and 15cm
anterior to the foot.
• The patient stands with the elbow slightly flexed; flexion must not be
beyond 30 degrees.
• The top of cane handle should either be at the wrist crease or the
greater trochanter.
• If cane is too long, it causes abnormal forward leaning, if too short, it
increases stress on the lumbosacral region.
• However, shorter canes may be be better suited for persons with

12. • Forearm Crutches
• 15-30 degrees of elbow flexion; if user is required to lift both feet
from the floor simultaneously in ambulation, more acute flexion can
be allowed.
• Tip should be 5-10cm lateral and 15cm anterior to the toes
• Cuff should lie on the proximal third of the forearm; about 2.5-4cm
below the olecranon process.
• Triceps Crutches
• Upper cuff should be in contact with arm within proximal 1/3rd,
approximately 5cm. Lower cuff should lie about 1 - 4 cm below the
olecranon

13. • Platform Crutches
• Comfort and control of the crutch should be prioritiy when deciding
optimal position for use. Ideally, 90-degree to the upper arm is used.
• Short height platform will compel forward leaning while a long height
platform will force elevation of shoulders and radial nerve is at risk of
compression.
• There is risk of redness, abrasion, tenderness over medial side of arm,
cramping of triceps, bruiding of the medial epicondyle, shoulder pain
and ulnar neuropathy IN use of all these stated variants of crutches;
watch out for them.
• See this video for details on measurement and use of ambulatory

14. Gait Patterns
• Selected gait pattern depends on:
• Ability of client to move both feet reciprocally
• Tolerate full load on each leg
• Lift the body of the floor by pressing on hands
• Maintain balance
• Alternating (Reciprocal) Gait Pattern
• Four-point gait: Right aid ; left foot; left aid; right foot
• Two-point gait: Right aid and left foot; Left aid and right foot
• Three-point gait: Both aids and affected limb; unaffected foot

15. • Cane gait
• Cane is held on opposite side of the involved limb; patient moves
cane and affected foot; unaffected foot.
• Walker gait: Advance walker and make alternate leg movement
• Swinging (Simultaneous) gait
• Drag-to gait: Advance both crutches; drag both legs to imaginary line
• Swing-to gait: Both crutches are moved separately or simultaneously; feet
swung to imaginary line just behind the crutches
• Swing-through gait: Crutches advanced together: Both legs swung beyond
imaginary line

16. Wheelchairs
• Wheelchairs are broadly categorised as manual and powered wheel
chairs.
• NB: A mismatch between client and technoogy will lead will at best
lead to abandonement of the technology OR at worst, will inflict
harm. To prevent either, there are preliminary considerations before
suggesting a type
• Physical Considerations
• Prognosis of condition: Rate of disease progression, severity of weakness or
spasticity,
• Strength, Posture and Stability: Evaluate abilities requisite for self-propelling;
assess coordination of available movement; postural response to requisite
movement.
• Power mobility access: e.g.joystick vs switches
• Cognition and perceptual motor skills: Problem solving skills for safety, ability

17. • Environmental and transportation considerations
• Width, length and turning radii must match clients’ built
environment. Terrain of client’s environment must also be considered.
• Following prescription, the wheelchair should be tried in the
environment of the client
• Technology Tolerance
• This is particularly important when dealing with geriatric clients, for
example, will the client remember to charge the wheelchair?
• There must be high motivation to follow through with training,
maintenance and follow-up.

18. Types
• Categories: Manual and powered wheelchairs
• Manual Wheelchairs: Categorised into those designed for dependent
and independent mobility.
• Dependent manual wheelchairs
• Independent manual wheelchair
• Assignment: Learn the different parts of the wheelchair and proper
seating alignment
• See article for reference on measurement.