Rehabilitation Aid

1. BY
TAPAS P. BEHERA
Prosthetist & Orthotist
PDUNIPPD, New Delhiନଭେମ୍ବର 20 1

2. Introduction
 “ Devices are used to increase the mobility of a patient”
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3. MOBILITY AIDS
 Mobility aid is a device designed to assist
walking & improve the mobility of people
who have difficulty in walking or people
with mobility impairment.
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4. Indications for Mobility Aids
Structural deformity, amputation,
injury, or disease resulting in decreased
ability to WB through LE
Muscle weakness or paralysis of the
trunk or LE
Inadequate balance
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5. Functions
 Improve balance
Give proprioception
Decrease pain
Reduce weight bearing on injured structures
Compensate for weak muscles
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6. Types
Crutches
Walkers
Canes
Parallel bars
Tripods
Wheelchairs
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7. Selection
o Patient concern
o Stability of the patient
o Strength of U/E & L/E
o Co-ordination of U/E & L/E
o Prognosis of rehabilitation
o Home / Work environment
o Patient Goal
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8. Crutches
 Axillary / underarm Crutches
 Elbow Crutches
 Forearm / Gutter Crutches
 Canadian Crutches
 Rocker-Bottom Crutches
 Spring-loaded Crutches
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gns
Traditional
Crutches

9. The patient’s ability to use crutches depends on
 Vision
Strengths of the muscles
Sense of balance
Correct selection and
adjustment of crutches
 range of motion (U/E)
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10. Axillary Crutches
Consists of double uprights joined at the
top of crutch pad, a handgrip and a
rubber tip at the lower end.
Axillary/crutch pad rest against chest
wall and 5 cm from Axillary apex.
Handgrip adjusted to make 30* elbow
flexion
Wt transmitted through the hands
Support up to 8O% of body wt.
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11. Crutch Muscles
 Flexors of finger and thumb
 Wrist dorsiflexors
 Elbow extensors
 Shoulder flexors
 Shoulder depressors
 Shoulder adductors
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12. MEASUREMENT OF AXILLARY CRUTCH
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13. Advantages
 Convenience for temporary injury (Shortell et al.,
2001)
 Large degree of support for L/E
 Ambulation with axillary crutches is less tiring
than ambulation with elbow crutches
( Sankarankutty, Stallard, and Rose (1979) )
 Physiological and Psychological benefits
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14. Disadvantages
 limitation in U/E AROM
 Requires good standing balance by patient
 Ambulation with axillary crutches
increases the heart rate from resting rate is
about 20% higher in compared to
ambulation with elbow crutches. (Sankarankutty
et al., 1979).
 Acne mechanica
 Crutch palsy
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15. Elbow Crutches
 made of Al alloy
 U shaped cuff at the upper end to
accommodate forearm
 Rubber or plastic covered
handgrip
Rubber tip at the lower end
 Adjustable length
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16.  transmits 40 % to 50 % of body
wt
Less cumbersome
More stable than walking stick
 No risk of injury at axilla region
For the patient who can take some
wt on feet
Paraplegic patient
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17. Forearm / Gutter crutches
Single adjustable Al alloy tube
Short horizontal metal gutter at upper
end
Vertical handgrip forward from gutter
lower end protected with rubber tip
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18. Indications of Gutter Crutches
o Flexed flexion deformity
o Weakness of muscles controlling
elbow joint and hand
o Painful wrist and hand condition
o Weak handgrip
ADJUSTMENT
 Elbow at 90* of flexion
Palm on the handgrip
 Elbow lies at or just behind the
posterior edge of the gutter
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19. Crutch Accessories
 Crutch tip
 Handgrip
 Axillary pad
 Tricep band
 Wrist strap
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20. Crutch Tip
 Attached to the end of the crutch
 Crutch tip diameter of at least 1.5
inches
 Acts as shock absorption
 Prevent slippage
Types
1. Suction crutch tip
2. Snow boot crutch tip
3. Rain guard crutch tip
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21. Handgrips
 Sponge pad to relieve pressure
 Can be increase girth with rubber
sponge
 can be modified to accommodate a
stiff or deformed hand
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22. Crutch walking
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23. Gait pattern with crutches
 Four point gait
 Three point gait
 Two point gait
 Swing through gait
 Swing to gait
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24. 4 Point Gait Pattern
 Bilateral assistive devices
 Slow gait speed
 Provides maximum stability to
patient
 Wt on both LE
 Low energy required by patient
 Pattern: advance right crutch,
then left foot, left crutch, right
foot
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25. 3 Point Gait Pattern
 Used when patient has one FWB and one
NWB LE
 3 point of support contact the floor
 Most rapid gait speed
 Provides the least amount of stability for
the patient
 High energy required by patient
 Pattern: advance walker/crutches & NWB
LE first, followed by FWB LE in a step
through or step to pattern
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26. 2 Point Gait Pattern
 Bilateral assistive devices
 Gait speed is faster than 4 point
 Provides good stability for patient,
but less than the 4 point pattern
 Low energy required by patient
 Pattern: advance right crutch & left
foot together, then advance the left
crutch & right foot together
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27. Swing-through gait pattern
 Fastest gait
 Requires functional abdominal
muscles
PATTERN
Advance both crutches forward, lift
the legs off the ground & swing
beyond the crutches.
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28. Swing-to gait pattern
 In this gait, both crutches are moved
forward either individually or
together , followed by swing the feet
slightly off the floor landing just on
behind the crutch .
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29. Stair Climbing
Up With GOOD, Down With BAD
GOOD goes to HEAVEN , BAD goes to HELL
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30. Patient Instruction
 Patient concentration
 Look straight rather than down
 Step with upright posture
 Don’t walk too far behind or lean too far
forward
Top of the crutches should be placed
against ribcage with majority of Wt
bearing through hand.
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31. Parallel Bars
 Gait training with AD often begins in parallel
bars
 They provide maximum stability while
requiring the least amount of coordination
from patients
 Patients can practice being upright & a gait
pattern with relative safety
 AD can be measured while pt stands in
parallel bars
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32. Walkers
 pts with poor balance and coordination,
decreased weight bearing on 1 or 2 LE.
Used more often with elderly
 adjustable
 Height
 Wheels?
 Collapsible
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33. CANES
 Used with pts with slight weakness of
LE, pain in LE, or with pts who need
assistance with balance during
ambulation
 aluminum or wood
 adjustable
 quad cane or single point
 offset handle
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34. Measuring for a Cane
top of the cane
 @ the level of the greater trochanter
OR
 @ the level of the styloid process of the ulna
 with the elbow in about 20-300of flexion
cane tip
 about 3-4” from the foot and @ a 450angle
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35. SUMMERY-So why give walking Aids ?
 Wt bearing
 Balance
Motor Pattern
Confidence
Endurance
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36. Looking Ahead
o Modified Crutches , Canes & Walker
o Wheel Chairs
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37. Book References
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• AAOS Atlas of Orthoses and Assistive Devices,4th
ed,2008,p-533-538

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