this is my first presentation in my life and i wish to be useful for every one >> this is talk about the different types of assisted aids in physical therapy rehabilitation

1. Crutches and walkers in orthopedic
patient

2. Introduction:
Locomotion is the act of moving from one place to another,
regardless of the method used-crawling, swimming or
propelling a wheelchair. Ambulation is bipedal
locomotion, or walking. An ambulation aid is a hand-held
device used to help a person stand and walk. The most
common varieties are Orthoses (splints and braces) and
prostheses (artificial limbs) are not considered ambulation
aids. Ambulation aids are most of ten prescribed to
increase stability, to augment muscle action or to reduce
the load on weight-bearing structures.

3. Introduction:
STABILITY:
For a person to be stable while standing or walking, the force
line from the body's center of mass (just anterior to the
second sacral vertebra) must fall within the base of
support. The base of support is the area bounded by a line
connecting the perimeter of all points touching the ground.
Stability can be increased by enlarging the base of
support.
Stability can also be enhanced by lowering the center of
gravity of the patientambulation aid combination. For the
ataxic patient, this strategy involves hanging sandbags
from the lower crossbars of the patient's walker. Patients
who walk behind wheelchairs as an ambulation aid also
use this principle.

4. CRUTCHES:
Crutches are used by patients who must transfer more weight
to their arms than is possible with canes. Axillary crutches
have an axillary bar and a hand grip. Using two such
crutches, patients can transfer as much as 100 percent of
body weight to the arms during swinging gaits. Cushioning
pads are often used for the axillary bars and handgrips. A
retractable, shock-absorbing axillary bar ("pogo crutch")
has been developed but is not widely available.

5. components of crutch:
Crutch tip*
-Crutch tips are made of rubber and are attached to the foot of the crutch.
-The crutch tips should be at least 1.5 inches in diameter.
-A retractable metal-spiked tip is available for use on ice, enhancing patient
safety (prevents slippage). This special tip absorbs shock but may be
uncomfortable for the patient.
-Crutches without rubber tips or with inadequate rubber tips are dangerous.
*Handgrips:
-Made of sponge rubber
-Could be built up or contoured to the needs of the patient
-Function to reduce pressure on the hands
-Enhance safety (prevent slippage)

6. components of crutch:
*Axillary pads
-Made of sponge rubber
-Function to prevent unnecessary pressure under the axillary region
*Triceps band
-Made of metal or stiff leather and are attached to the upper part of the
crutch.
- Function to assist the patient in maintaining elbow
extension during weight bearing
-Very helpful for patients with weak triceps
*Wrist strap
-Made of either leather or plastic
-Functions to assist patients in making their handgrip
-Very helpful for patients with weak wrist extensors

7. Types of crutches:
Crutches have 2 points of contact with the body, providing
better stability than canes. Two types of crutches:-
1-Axillary.
2-Non Axillary.

8. Axillary crutches:
An axillary crutch is a type of orthosis that provides support
from the axilla to the floor. Wood and aluminum axillary
crutches are available, both of which are adjustable. The
extension crutch (ie, the length can be adjusted) is heavier
than the regular crutch because of the one extra piece of
wood. Standard axillary crutches have double uprights
with a shoulder piece and handgrip or bar.

9. Axillary crutches:
The primary advantage of an axillary crutch is that it allows
transfer of 80% of the individual's body weight. Axillary
crutches provide better
trunk support than nonaxillary or forearm crutches, and
patients can free their hands for activities by leaning on the
shoulder piece. However, the patient should be advised of
the possibility of sustaining compressive brachial
neuropathies with the use of axillary crutches. The axillary
crutch is not designed for the patient to rest for body
support. Patients should avoid resting their body weight on
the axillary area. Providing extra padding to the axillary
area should be discouraged for this reason.

10. The measurement of axillary crutches:
1-Determine the crutch length by measuring the distance
from the anterior axillary fold to a point 6 inches
lateral to the fifth toe with the patient standing.
2-With the proper crutch length determined and the crutch
then placed 3 inches lateral to the foot, proper hand
piece location can be measured. The patient's elbow
should be flexed 30°, the wrist should be in maximal
extension, and the fingers should be held in a fist.
3-The patient should be able to raise the body 1-2 inches by
performing complete elbow extension.

11. Nonaxillary crutches:
Nonaxillary crutches allow
transfer of 40-50% of the
patient's body weight.
Also called forearm or
arm canes or forearm or
arm orthoses, these
devices require good trunk
control. The patient needs
confidence in his/her
ambulation skills.

12. forearm crutches (Lofstrand crutches(:
1-Most popular of nonaxillary crutches.
2-Most useful substitute for canes.
3-Most often used bilaterally.
4-Made of tubular aluminum.
5-Padded hand bar.
6-Forearm cuff.
*The open end of the cuff is placed on the lateral aspect of the forearm
to permit elbow flexion and grasping without dropping the orthosis.
*The proximal portion of the orthosis is angled at 20° to provide a
comfortable stable fit.

13. Measurement of forearm crutches:
With the proper crutch length determined and the crutch then placed 3
inches lateral to the foot, proper hand piece location can be measured.
The patient's elbow should be flexed 20°, the wrist should be in
maximal extension, and the fingers should be held in a fist.
Advantages associated with Lofstrand crutches include the following:
1-Ambulation is safer and easier.
2-This type of crutch is a good substitution for the cane because the
forearm support stabilizes the wrist during weight bearing.
3-The patient's hands are free to perform various tasks while the
body weight is supported through the forearm by the forearm
cuff pivots.
4-The patient does not have to worry about dropping the crutches.
5-These crutches are shorter than axillary crutches.
Disadvantage of Lofstrand crutches is that they provide less support for
ambulation than axillary crutches.

14. Types of crutch gaits:
 Two-point crutch gait:
The proper sequence is the left crutch and right foot, then the right crutch and left foot. Repeat.
Advantages
Provides stability
Faster than the 4-point gait
Reduces weight bearing to both lower limbs
Indication - Patients with weakness in lower limbs or poor coordination (ataxic(
1-Swing-through gait:
The sequence involves both crutches, moving both lower limbs past the crutches.
Advantage - Fastest gait (faster than normal walking gait(
Disadvantage - Very energy-consuming gait that is difficult to learn
Requires strong functional abdominal and upper limb muscles and good trunk balance
2-Swing-to gait:
The proper sequence includes both crutches; the patient moves both lower limbs almost to the
crutches.
Advantage - Easy to learn
Indication - Patients with paraplegia

15. Types of crutch gaits:
 Drag-to (tripod) gait:
An alternate sequence involves using the left crutch, the right crutch, and
then dragging both lower limbs to the crutches.
Simultaneous sequence involves both crutches. The patient should drag
both lower limbs to the crutches.
Indication - Used as the initial gait pattern during gait training for patients
with paraplegia
Patients could advance to swing gait once they improve their balance.
Advantage - Provides good stability
Disadvantage - Very energy-consuming and slow gait

16. Types of crutch gaits:
 Three-point gait (non–weight-bearing gait( :
The appropriate sequence is first both crutches and the weaker lower limb, then the
stronger or unaffected lower limb. Repeat.
Advantage - Eliminates all weight bearing on the affected lower limb
Indications - Lower limb fractures, amputations, or pain
Requires good balance and coordination
 Four-point crutch gait
The appropriate sequence is left crutch, right foot, right crutch, left foot. Then repeat.
Advantages
Stability
Always have at least 3 points in contact with the ground
Disadvantages
Difficult to learn
Relatively slow walking gait
Indication - Patients with weakness in lower limbs or poor coordination (ataxic(

17. WALKERS:
Walkers are particularly useful for patients who have poor balance. The
disadvantages of walkers are that ambulation is slow and patient
posture is often poor. Walkers also make it difficult to climb stairs. A
walker has been specifically designed for stairs, but its extra weight
and size have limited its use.
The standard walker is made of aluminum, is rigid, has four feet and is
adjustable in height. Foldable models are less durable but are easier to
transport. When folded, these walkers can provide some assistance
with stairs. An articulated reciprocal walker, which allows the patient
to advance each side of the device independently of the other, has been
developed but is not widely used. Platform walkers, like platform
crutches, provide a horizontal surface for the forearms.

18. WALKERS

19. WALKERS:
Some walkers have wheels on the front legs or all four legs to assist patients who
have difficulty lifting the walker because of limited balance or endurance. 10
Wheels should not be used by patients who put much weight on the walker
(unless the walker is specifically designed for such use(, since the device may
roll forward while being loaded. One type of walker has wheels that retract
when weight is applied. Although this is a helpful innovation, the retractable
wheels do not resist forward slippage as well as standard, rubber-tipped feet.
Other walkers have fold-down seats to allow patients to rest.
To achieve 15 to 30 degrees of elbow flexion, the handgrip of the aid should be at
about the level of the greater trochanter or at the level of the wrist crease when
the arm is hanging at the side. A cane that is too short forces the patient to lean
toward the cane during the walking cycle. An aid with a handgrip that is too
high may mechanically decrease the tricep's effectiveness. Improper length
can therefore cause a poor gait pattern with a resulting increase in discomfort
and energy expenditure.
The upper end of an axillary crutch should rest on the ribs approximately 5 cm
below the anterior axillary fold. Resting the axillary bar in the axilla can lead
to axillary artery thrombosis or compression neuropathy of the radial nerve.