Walking aids PDF

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How to use walking aids in treatment ...

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Walking aids Measurement A standard walking aid is measured with the patient standing upright, with their arms resting by there sides. The handle of the walking aid is adjusted so that it is in line with the proximal wrist crease. You need to check that the height is appropriate and comfortable for that particular patient. Body types, proportions and postures are all different and so the standard starting height may need further adjustment. • Too high – shoulders hunched, elbows too flexed and unable to put weight through fully. • Too low – elbows fully extended, shoulders depressed, flexed forward. • Correct – erect posture, elbows in some flexion (as a rough guide 30 degrees) and shoulders in neural. Crutches There are four different types of crutches: Elbow Crutches - The most commonly used. You will see these used on every orthopaedic ward or out patient department. Auxiliary crutches - used to be used as standard, but as discussed these are hardly ever seen now, due to their association with shoulder and auxiliary nerve pain after use. Fissure crutches - Shaped handles to allow for a more comfortable grip and are only used when a patient has OA/RA or any other condition that affects the ability to grip the standard crutch handle – they are more expensive. Gutter crutches - Used for those people who are unable to weight bear through the hand or forearm (e.g. those with a wrist fracture as well as the lower limb problem) and consist of a ‘gutter’ that supports along the whole length of the forearm, with the elbow flexed. These are measured to the elbow, with the patient standing upright and then following the same principles as the standard crutches - ensuring that the patient has an erect posture with the shoulder is in neutral. Sticks The sticks are generally only used as measuring sticks in the hospital environment and they are then used to cut a cheaper, wooden stick to the right size. The metal sticks also come in a fissure variety for patients with OA/RA or any other condition that affects the ability to grip the standard handle, but again they are significantly more expensive than the wooden type. The tripods or quadripods - when a stick is preferred but the patient requires extra stability. Frames Standard frames - Has four ferrules, two on the front and two on the back, to grip the floor and must be lifted forward with each gait phase. Rotator frame - Used by most patients in a hospital or home environment. It has 2 wheels on the front and two ferrules on the back, allowing it to be pushed forward as the patient walks. The benefit of the rolator frame is that it allows the patient to use a step through gate, whereas the standard frame that has to be lifted, only allows for a step to gait.

Fissure Frame - The handles of the frame are shaped as seen in the fissure crutches. There is also a frame with a single handle in the centre to allow for use when only one arm is functional, for whatever reason. These are rarely seen and this is for placement information only where they may be encountered and will not be required for the DOPS exam. Step to or step through In all situations on level ground (there are variations when going down stairs) the affected leg steps first. • Step to gait means that the patient takes a step with their affected leg and then steps up level with that leg, with the unaffected. • Step through gait is a progression of a more normal gait pattern, where the patient steps with the affected leg and then steps in front of that leg with the unaffected, to make a more normal gait cycle. Weight bearing • Full weight bearing (FWB) – able to put full weight through the leg and will only use the walking aid due to pain or instability. • Partial weight bearing (PWB) – the patient is not allowed to take full weight through the limb and so needs to take part of their weight through their hands as they step on the affected limb. • Touch or eggshell weight bearing (TWB) – the foot is placed on the floor during the normal gait cycle, but minimal weight is allowed through the limb. The majority of the patient’s weight is taken through the hands as they step over the affected side. • Non weight bearing (NWB) – no weight is allowed on the affected limb and the patient must hop. Types of Gait • Two point – this is where the patient has a normal walking pattern and the opposite arm and leg move together, so one point is left arm(plus crutch or stick) with the right leg and the other point is right arm (plus crutch or stick) with the left leg. • Three point – this is where the frame or sticks/crutches (together) go forward, followed by the affected leg, then the unaffected leg. When NWB some definitions will still describe this as three point, even though the affected leg is off the floor. You may also hear this described as two points because there is no contact with the floor from the affected side - you will not be penalised for either definition. • Four point – this is used with sticks or crutches only and just breaks down the two point gait into four individual phases e.g. left arm (crutch/stick), then right leg, then right arm (crutch/stick) then left leg....