001 p ambulatory aids presentation

AMBULATORY AIDS, AMBULATORY AIDS, WHEELCHAIR, GAIT WHEELCHAIR, GAIT

PATTERNSPATTERNS

CANESCANES

CANESCANES

- INDICATED FOR PATIENT’S INDICATED FOR PATIENT’S SUFFERING FROM ANTALGIC GAITSUFFERING FROM ANTALGIC GAIT

- For stability and increase base of For stability and increase base of supportsupport

- Weight transmission is 20-25% Weight transmission is 20-25% - NPTE 30%NPTE 30%- Lessens the stance phaseLessens the stance phase

- Measurements:Measurements:

a.a. Greater trochanter to floor without shoe Greater trochanter to floor without shoe or heelor heel

b.b. Elbow is 20-30 degrees flexion, from Elbow is 20-30 degrees flexion, from hand to floor – MOST ACCURATEhand to floor – MOST ACCURATE

** Pt with leg length discrepancy – you cant ** Pt with leg length discrepancy – you cant use greater trochanter as basis for use greater trochanter as basis for measuring but instead you get the measuring but instead you get the measurement of the elbow.measurement of the elbow.

TYPES OF CANESTYPES OF CANES

1.1. C, J, CROOK – weight is in FRONT of the C, J, CROOK – weight is in FRONT of the handhand

2.2. Offset – weight is at the CENTER of the Offset – weight is at the CENTER of the handhand

3.3. Quad – for geriatric patients and who Quad – for geriatric patients and who needs more stabilityneeds more stability

4.4. Walk cane/ Hemiwalker – can be foldedWalk cane/ Hemiwalker – can be folded** Geria patients – 75 years old and above, ** Geria patients – 75 years old and above,

give standard walkergive standard walker

TYPES OF CANESTYPES OF CANESStandardStandard C/J/crookC/J/crook

offsetoffset

-adjustable: 27-38.5 -adjustable: 27-38.5 inin

Quad CaneQuad Cane– adjustable: 28-38 inadjustable: 28-38 in

Walk cane/hemiwalkerWalk cane/hemiwalker– -adjustable: 29-37 in-adjustable: 29-37 in– fold flatfold flat

GAIT PATTERNS FOR CANEGAIT PATTERNS FOR CANE

Level Ground: cane + involvedLevel Ground: cane + involved

uninvolveduninvolved

Curb Curb – Ascending Ascending

good good ►cane►cane ►bad►bad

DescendingDescending

cane cane ►bad ►bad ►good►good

StairStair– Ascending Ascending uninvolveduninvolved

cane + involvedcane + involved

--Descending --Descending involved + caneinvolved + cane


** POINTS OF CONTROL:** POINTS OF CONTROL:

- HIPS AND SHOULDERHIPS AND SHOULDER- PT should hold the patient here for PT should hold the patient here for

safetysafety

WALKERWALKER

WALKERWALKER- INDICATED FOR PATIENT’S WHO NEED INDICATED FOR PATIENT’S WHO NEED

MAXIMUM STABILITY AND SUPPORTMAXIMUM STABILITY AND SUPPORT- Weight transmission – 85% of body weightWeight transmission – 85% of body weight

** Pt elderly, with THR, Pt lives alone in the ** Pt elderly, with THR, Pt lives alone in the house GIVE: standard walkerhouse GIVE: standard walker

** Pt elderly but travels GIVE: collapsible ** Pt elderly but travels GIVE: collapsible walkerwalker

DisadvantagesDisadvantages– Difficult to store or transportDifficult to store or transport– Difficult or impossible to use on stairsDifficult or impossible to use on stairs– Reduces speed of transmissionReduces speed of transmission– Difficult to perform a normal gait patternDifficult to perform a normal gait pattern– Difficult to use in narrow or crowded areasDifficult to use in narrow or crowded areas– CANT DO A FUNCTIONAL AMBULATION – CANT DO A FUNCTIONAL AMBULATION –

because there is no swinging of the hands because there is no swinging of the hands because the hands is holding the walkerbecause the hands is holding the walker

TYPES OF WALKERTYPES OF WALKER

1.1. StandardStandard

2.2. Rolling – CI for Parkinson’s diseaseRolling – CI for Parkinson’s disease

3.3. ReciprocatingReciprocating

4.4. CollapsibleCollapsible

5.5. Stair climbingStair climbing

** Parkinson’s pt has akinesia, GIVE: ** Parkinson’s pt has akinesia, GIVE: Rolling walkerRolling walker

** Parkinson’s pt cant stop motion due ** Parkinson’s pt cant stop motion due to festinating gait GIVE: standard to festinating gait GIVE: standard walkerwalker

TYPES OF WALKERTYPES OF WALKERRolling or wheeledRolling or wheeled

- Prescribed to patient’s with Prescribed to patient’s with difficulty lifting the walkerdifficulty lifting the walker

- 2 wheels – for Pt with 2 wheels – for Pt with speed problem initially speed problem initially givengiven

- 4 wheels – for CP 4 wheels – for CP patients with patients with increased energy increased energy expenditureexpenditure (with hand break)(with hand break)

Folding or CollapsibleFolding or Collapsible

– For mobility in community or carsFor mobility in community or cars– INDICATED FOR PATIENT’S WHO INDICATED FOR PATIENT’S WHO

ALWAYS TRAVELALWAYS TRAVEL– Easy to storeEasy to store

Stair ClimbingStair Climbing– With 2 posterior With 2 posterior

extensions and extensions and additional hand additional hand grips off of the rear grips off of the rear legs for use on legs for use on stairsstairs

ReciprocalReciprocal

– Used with RGOUsed with RGO– For SCI and Spina bifida level T12 to L1For SCI and Spina bifida level T12 to L1

MEASUREMENT:MEASUREMENT:

1.1. Distance of tummy from walker 10-Distance of tummy from walker 10-12 inches12 inches

2.2. Greater trochanter to floor without Greater trochanter to floor without shoesshoes

3.3. 20-30 degrees of elbow flexion20-30 degrees of elbow flexion

Gait Patterns in WalkerGait Patterns in Walker

Level SurfaceLevel Surface– FWB: walkerFWB: walker►1►1stst LE►2 LE►2ndnd LE LE

– PWB: walker +involved►uninvolvedPWB: walker +involved►uninvolved

– NWB: walker►uninvolvedNWB: walker►uninvolved

Curb (ascending)Curb (ascending) walker + walker +


involvedinvolved

Curb (Descending)Curb (Descending)

walker walker

involvedinvolved


Stair (ascending)Stair (ascending) walkerwalker

uninvoleduninvoled

involvedinvolved

Stair (descending)Stair (descending)

walkerwalker

involvedinvolved


CRUTCHESCRUTCHES- FOR MODERATE STABILITYFOR MODERATE STABILITY- Gives lateral stabilityGives lateral stability- Widens the BOS Widens the BOS - PROVIDE FUNCTIONAL AMBULATION PROVIDE FUNCTIONAL AMBULATION

WITH RESTRICTED WEIGHT BEARINGWITH RESTRICTED WEIGHT BEARING- Axillary – 80-90% weight transmissionAxillary – 80-90% weight transmission- Non-axillary – 40-50% weight transmissionNon-axillary – 40-50% weight transmission

MEASUREMENT:MEASUREMENT:1.1. Measure height of patient – 16 inchesMeasure height of patient – 16 inches2.2. In standing, 2 inches below the axilla, 2 In standing, 2 inches below the axilla, 2

inches lateral to the heel 6-8 inches inches lateral to the heel 6-8 inches anterior to MTPanterior to MTP

3.3. Sitting, shoulder abducted 90 degrees, Sitting, shoulder abducted 90 degrees, elbow flexed 90 degrees and the other elbow flexed 90 degrees and the other arm shoulder abducted. Measure from arm shoulder abducted. Measure from olecranon to 3olecranon to 3rdrd finger finger

4.4. Supine, axilla to lateral 6-8 inches to heelSupine, axilla to lateral 6-8 inches to heel

NON AXILLARY CRUTCHESNON AXILLARY CRUTCHESPlatformPlatform

- Pt with - Pt with arthritis, arthritis, bear weight bear weight on the on the forearmforearm

Forearm/LofstrandForearm/Lofstrand

Loftstrand crutchLoftstrand crutch- Given to patient’s with paraplegiaGiven to patient’s with paraplegia- In paraplegia, the Pt does a jacknife, In paraplegia, the Pt does a jacknife,

where to put the tips of the Loftstand where to put the tips of the Loftstand – FRONT OF THE STEP– FRONT OF THE STEP

- Cuff should be 11/2 inches below the Cuff should be 11/2 inches below the elbow or proximal 3elbow or proximal 3rdrd of the forearm of the forearm

Canadian crutchCanadian crutch- INDICATE FOR PATIENT’S WITH INDICATE FOR PATIENT’S WITH

TRICEPS WEAKNESSTRICEPS WEAKNESS- 2 cuffs, one at the forearm, and 2 cuffs, one at the forearm, and

another at the triceps cuffanother at the triceps cuff

Kenny StickKenny Stick

GAIT PATTERNS ON AXILLARY GAIT PATTERNS ON AXILLARY CRUTCHCRUTCH

Emphasize the ff:Emphasize the ff:– Weight: borne by the handsWeight: borne by the hands– Wide BOS (at least 4” to the front and Wide BOS (at least 4” to the front and

to the side)to the side)

--axillary bars: held close to the chest wall --axillary bars: held close to the chest wall to provide improved lateral stabilityto provide improved lateral stability

--head up--head up

--turning: step in small circle, DON’T --turning: step in small circle, DON’T PIVOT!PIVOT!

> > 4-pt4-pt- Slow gait- Slow gait 2-pt2-pt- Fast gaitFast gait- TYPES:TYPES:A.A. Ipsilateral – Right cruytch, right legIpsilateral – Right cruytch, right legB.B.Alternating – Right crutch, left legAlternating – Right crutch, left leg

** 4 pt and 3 pt – INDICATED FOR ATAXIC ** 4 pt and 3 pt – INDICATED FOR ATAXIC PATIENTS AND WITH POSTERIOR COLUMN PATIENTS AND WITH POSTERIOR COLUMN PATIENTS COMPENSATING WITH THEIR PATIENTS COMPENSATING WITH THEIR VISIONVISION

> > 3-pt3-pt- Crutch and toe touchCrutch and toe touchDrag gaitDrag gait – just drag feet – just drag feetDrag to and throughDrag to and throughSwing to and throughSwing to and throughShadowShadow – for amputee, residual leg – for amputee, residual leg

will kick the ballwill kick the ball

WHEELCHAIR MEASUREMENTSWHEELCHAIR MEASUREMENTS

Seat heightSeat height- Popliteal fossa to ground or heel + 2 Popliteal fossa to ground or heel + 2

inchesinches- If too high – sacral tilting/ post tilting If too high – sacral tilting/ post tilting

and slide forwardand slide forward- If too low – excessive pressure on If too low – excessive pressure on

ischial tuberosityischial tuberosity

WHEELCHAIRWHEELCHAIR

Seat height Seat height – Too highToo high– Too lowToo low

Seat depthSeat depth- Popliteal fossa to posterior buttocks – Popliteal fossa to posterior buttocks –

2 inches2 inches- Too long – irritation on popliteal Too long – irritation on popliteal

fossa, sacral sittingfossa, sacral sitting- Too short – uneven distribution of Too short – uneven distribution of

weight on the thighweight on the thigh

Seat depthSeat depth– Too longToo long– Too shortToo short

(sling seat, (sling seat, insert/countour insert/countour seat)seat)

(cushions: foam, (cushions: foam, fluid/gel, air)fluid/gel, air)

Back heightBack height- Inferior angle of the scapula to seat – Inferior angle of the scapula to seat –

2 inches2 inches- To high – irritation of the scapulaTo high – irritation of the scapula- Too low – unstable trunkToo low – unstable trunk

Back HeightBack Height– Too highToo high– Too lowToo low

Seat widthSeat width- 1 inch on each side1 inch on each side- Wide – scoliosisWide – scoliosis- Narrow – irritation on greater Narrow – irritation on greater

trochantertrochanter

** parallel bars – 2 inches on both ** parallel bars – 2 inches on both sidessides

Seat WidthSeat Width– Too wideToo wide– Too narrowToo narrow

Arm rest heightArm rest height- Sitting to 90 degrees elbow flexionSitting to 90 degrees elbow flexion- Too high – shoulder elevationToo high – shoulder elevation- Too low – trink forward leanToo low – trink forward lean

Armrest HeightArmrest Height– Too highToo high– Too lowToo low

ArmrestsArmrests– Adjustable (sit-to-stand)Adjustable (sit-to-stand)– Removable (transfers)Removable (transfers)– Wraparound/space saverWraparound/space saver

(reduce overall width by 1 ½ (reduce overall width by 1 ½ in)in)

--Trays/Troughs--Trays/Troughs

(secured to the armrests; (secured to the armrests; additional postural additional postural assistance for patients with assistance for patients with decreased use of upper decreased use of upper extremities)extremities)

CamberCamber- Normal – 3-9 Normal – 3-9

degreesdegrees- Increase BOSIncrease BOS

Hanger Hanger angleangle

- 60-70 degrees 60-70 degrees of knee flexionof knee flexion

STANDARD DIMENSIONSSTANDARD DIMENSIONSChair Style Chair Style SW SW SD SD

SHSH

AdultAdult 1818 1616 2020

Narrow AdultNarrow Adult 16 16 1616 2020

Slim AdultSlim Adult 1414 1616 2020

Hemi/Low SeatHemi/Low Seat 1818 161617.517.5

JuniorJunior 1616 1616 18.518.5

ChildChild 1414 11.511.5 18.7518.75

Tiny TotTiny Tot 1212 11.511.519.519.5

CODE:CODE:

DpWh = 2DpWh = 2

D – DepthD – Depth

W – widthW – width

H - heightH - height

STANDARD ADULT STANDARD ADULT WHEELCHAIR SIMENSIONSWHEELCHAIR SIMENSIONS

- Height (push handles to floor): 36 inHeight (push handles to floor): 36 in- Height (armrest to floor): 29 to 30 inHeight (armrest to floor): 29 to 30 in- Width: 24 to 26 inWidth: 24 to 26 in- Length: 42 to 43 inLength: 42 to 43 in- Doorwidth (min: 32 in; ideal: 36 in)Doorwidth (min: 32 in; ideal: 36 in)- Reach Reach

forward (high: 48 in; low: 15 in)forward (high: 48 in; low: 15 in) side: 24 inside: 24 in

Leg RestsLeg Rests– FixedFixed– Swing-away, detachableSwing-away, detachable

(easy transfer)(easy transfer)– ElevatingElevating

(LE edema, postural (LE edema, postural support)support)

(C/I: hams hypertonicity or (C/I: hams hypertonicity or tightness)tightness)

Wheels/ Handrims/Wheels/ Handrims/

BrakesBrakes– Casters – 8 inch in Casters – 8 inch in

diameter for easy diameter for easy propulsionpropulsion

– Drive wheels and rimsDrive wheels and rims

(projection,friction/(projection,friction/

leather,)leather,)

--Tires (Standard,--Tires (Standard,

Pneumatic)Pneumatic)

AttachmentsAttachments– Seat belts (pelvic Seat belts (pelvic

positioner)positioner)– Adductor pommel – Adductor pommel –

for spasticityfor spasticity– Seat wedge – for Seat wedge – for

fallsfalls– Anti-tippingAnti-tipping– Hill-holderHill-holder

SPECIALIZED WHEELCHAIRSSPECIALIZED WHEELCHAIRS

SportsSports– Solid framesSolid frames– LightweightLightweight– Low backLow back– Low seatLow seat– Greater camberGreater camber

A PT has to order a wheelchair for a A PT has to order a wheelchair for a patient with T9-T10 SCI who wishes patient with T9-T10 SCI who wishes to engage in sports activities. The to engage in sports activities. The wheelchair will not need:wheelchair will not need:

a.a. Low backLow backb.b. Swing away footrestSwing away footrestc.c. A high backA high backd.d. Removable arm restsRemovable arm rests

A patient with paraplegia at the T10 level A patient with paraplegia at the T10 level wants to participate in wheelchair wants to participate in wheelchair basketball. An option that should be basketball. An option that should be considered in ordering a wheelchair for considered in ordering a wheelchair for this patient is:this patient is:

a.a. Rigid frameRigid frameb.b. Hard rubber tiresHard rubber tiresc.c. Mid scapular seat backMid scapular seat backd.d. Folding frameFolding frame

Tilt-in spaceTilt-in space– Extensor spasmsExtensor spasms– Pressure reliefPressure relief

QUESTION:QUESTION:A tilt in space wheelchair has been ordered A tilt in space wheelchair has been ordered

for a patient with C4 quadriplegia. This for a patient with C4 quadriplegia. This type of chair is ordered to:type of chair is ordered to:

a.a. Improve the patient’s ability to relieve Improve the patient’s ability to relieve pressure and transfer independentlypressure and transfer independently

b.b. Improve positioning for pressure relief or Improve positioning for pressure relief or extensor spasmextensor spasm

c.c. Improve leg position and lower extremity Improve leg position and lower extremity edemaedema

d.d. Facilitate handgrip and propulsionFacilitate handgrip and propulsion

QUESTION:QUESTION:A tilt in space wheelchair has been ordered A tilt in space wheelchair has been ordered

for a patient with C4 quadriplegia. This for a patient with C4 quadriplegia. This type of chair is ordered to:type of chair is ordered to:

a.a. Improve the patient’s ability to relieve Improve the patient’s ability to relieve pressure and transfer independentlypressure and transfer independently

b.b. Improve positioning for pressure Improve positioning for pressure relief or extensor spasmrelief or extensor spasm

c.c. Improve leg position and lower extremity Improve leg position and lower extremity edemaedema

d.d. Facilitate handgrip and propulsionFacilitate handgrip and propulsion

Reclining BackReclining Back– For patients who For patients who

are unable to are unable to independently independently maintain an upright maintain an upright sitting positionsitting position

** Duchenne Muscular Dystrophy** Duchenne Muscular Dystrophy- Late stageLate stage- GIVE – Electric wheelchairGIVE – Electric wheelchair

One-arm driveOne-arm drive– 2 outer rims2 outer rims– Difficult: (L) Difficult: (L)

hemiplegiahemiplegia

Hemiplegic ChairHemiplegic Chair– lowlow

Amputee ChairAmputee Chair

> > C1-C4 SCIC1-C4 SCI- PoweredPowered- Joystick, head controlsJoystick, head controls- Sip-and-puff Sip-and-puff C5 – ObliqueC5 – Oblique C6 – VerticalC6 – Vertical C7 – Friction handrimsC7 – Friction handrims C8 – Standard wheelchairC8 – Standard wheelchairCODE : OVFSCODE : OVFS

A PT orders a wheelchair for a patient with A PT orders a wheelchair for a patient with C4 tetraplegia. Which wheelchair would C4 tetraplegia. Which wheelchair would be the most appropriate for the patient?be the most appropriate for the patient?

a.a. Manual wheelchair with friction surface Manual wheelchair with friction surface hand rimshand rims

b.b. Manual wheelchair with hand rim Manual wheelchair with hand rim projectionsprojections

c.c. Power wheelchair with sip and puff Power wheelchair with sip and puff controlscontrols

d.d. Power wheelchair with joystick controlsPower wheelchair with joystick controls

Ramps (Descending)Ramps (Descending)

lean forwardlean forward

use shorter strokesuse shorter strokes

move hands quicklymove hands quickly

Ramps (Descending)Ramps (Descending)

grip handrims looselygrip handrims loosely

wheelie (steep ramp)wheelie (steep ramp)

TurningTurning push harder with one handpush harder with one hand sharp turningsharp turning pull one wheel backward pull one wheel backward

while while pushing other wheel forwardpushing other wheel forward

90 deg: 36”90 deg: 36”180 deg: 60”180 deg: 60”360 deg: 60” x 60 in360 deg: 60” x 60 in

CODE: 360 – 369 – 90-36CODE: 360 – 369 – 90-36

WheelieWheelie hands back on handrimshands back on handrims pulls hands forward abruptly/forcefully then pulls hands forward abruptly/forcefully then

posteriorlyposteriorly

move head and trunk forward to keep from move head and trunk forward to keep from

going over backwardgoing over backward practice: lightweight w/cpractice: lightweight w/c***wheels pulled back: tips toward UPRIGHT***wheels pulled back: tips toward UPRIGHT***wheels pushed forward: tips further BACK***wheels pushed forward: tips further BACK

Curb (Ascending)Curb (Ascending)

place front casters up place front casters up

push rear wheels uppush rear wheels up

Curb (Descending)Curb (Descending)

backward: forward head and backward: forward head and trunk leantrunk lean

forward: wheelieforward: wheelie

A patient with SCI at the level of T1 is in community A patient with SCI at the level of T1 is in community phase of his mobility training. In order for him phase of his mobility training. In order for him to navigate a standard height curb with his to navigate a standard height curb with his wheelchair, the PT tells him to:wheelchair, the PT tells him to:

a.a. Descend backwards with the trunk and arms Descend backwards with the trunk and arms hooked around the push handleshooked around the push handles

b.b. Ascend backwards with the large wheels firstAscend backwards with the large wheels firstc.c. Lift the front casters and ascend in the wheelie Lift the front casters and ascend in the wheelie

positionpositiond.d. Place the front casters down first during descentPlace the front casters down first during descent

A patient with SCI at the level of T1 is in community A patient with SCI at the level of T1 is in community phase of his mobility training. In order for him phase of his mobility training. In order for him to navigate a standard height curb with his to navigate a standard height curb with his wheelchair, the PT tells him to:wheelchair, the PT tells him to:

a.a. Descend backwards with the trunk and arms Descend backwards with the trunk and arms hooked around the push handleshooked around the push handles

b.b. Ascend backwards with the large wheels firstAscend backwards with the large wheels firstc.c. Lift the front casters and ascend in the Lift the front casters and ascend in the

wheelie positionwheelie positiond.d. Place the front casters down first during descentPlace the front casters down first during descent

A PT attempts to secure a wheelchair for a patient A PT attempts to secure a wheelchair for a patient with an incomplete SCI. The patient is a 28 year with an incomplete SCI. The patient is a 28 year old female that is very active and relies on old female that is very active and relies on wheelchair as her primary mode of wheelchair as her primary mode of transportation. Which type of wheelchair design transportation. Which type of wheelchair design would be the most appropriate for the patient?would be the most appropriate for the patient?

a.a. Standard wheelchair with as rigid frameStandard wheelchair with as rigid frameb.b. Lightweight chair with a rigid frameLightweight chair with a rigid framec.c. Standard chair with a folding frameStandard chair with a folding framed.d. Lightweight chair with a folding frameLightweight chair with a folding frame

When recommending a wheelchair for a When recommending a wheelchair for a patient with a lesion at T11 resulting in patient with a lesion at T11 resulting in paraplegia, the modification least needed paraplegia, the modification least needed by a patient with this disability would be:by a patient with this disability would be:

a.a. Swing away footrestsSwing away footrests

b.b. High seat back High seat back

c.c. Pneumatic tiresPneumatic tires

d.d. Caster locksCaster locks

When recommending a wheelchair for a When recommending a wheelchair for a patient with a lesion at T11 resulting in patient with a lesion at T11 resulting in paraplegia, the modification least needed paraplegia, the modification least needed by a patient with this disability would be:by a patient with this disability would be:

a.a. Swing away footrestsSwing away footrests

b.b. High seat backHigh seat back

c.c. Pneumatic tiresPneumatic tires

d.d. Caster locksCaster locks

THE ENDTHE END

001 p ambulatory aids presentation

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