Walking aids

BY: REETA SAWLANI

LECTURER IPRS PUMHSW
Walking
• Walking is the manner or way in which you
move from place to place with your feet.
• It is a Movement at a regular and fairly slow
pace by lifting and setting down each foot in
turn, never having both feet off the ground at
once.

• it is the highest level of motor control skill.

• The major requirements for successful walking
include:
• Support of body mass, by the lower extremities
• Production of locomotors rhythm
• Dynamic balance control of the moving body
• Propulsion of the body in the intended direction
Basic terms

• Ambulation: To walk from place to place or move about.

• It is a technique of post operative care in which a patient gets
out of bed and engages in light activity (as sitting, standing, or
walking) as soon as possible after an operation.
• Some time this term is also use in the place of walking ..

• Gait: Gait is a term to describe human locomotion, it is

pattern of walking or a sequence of foot movements.
Gait cycle or walking cycle

• A cycle of walking is the period from the heel-strike of one

foot to the next heel-strike of the same foot
• When a subject is walking on level ground, than the
movements of the lower limbs may be divided into “swing”
and “stance” phases.
• The swing phase occurs when the limb is off the ground, and
the stance phase when it is in contact with the ground and is
bearing weight.
 WALKING AIDS

Walking aid is a device designed

to assist walking and improve the
mobility of people who have
difficulty in walking or people
who cannot walk independently
Different Types of Walking Aids

walker Cane/Stick crutches

Purpose of walking aids
• Increase area of support or base of support
• Maintain center of gravity over supported area
• Redistribute weight-bearing area by decreasing force
on injured or inflamed part or limb
• Can be compensate for weak muscles
• Decrease pain
• Improve balance
Crutches
• Crutches Introduction
• Types of crutches
• Measurement of length
• Preparation for crutch walking
• Crutch walking
Introduction of crutches

These are devices which

are used to reduce
weight bearing on one or
both legs and also give
support where balance is
impaired and strength is
inadequate
Prerequisites for crutches

• Good strength of upper limb muscles is required.

• Range of motion of upper limb should be good.
• Muscle group which should be strong is given below.
• Shoulder flexor, extensors and depressor
• Shoulder adductors
• Elbow and wrist extensors
• Finger flexors
Types of crutches

1. Axillary crutches/ under

arm crutches
2. Elbow crutches or
Lofstrands crutches
3. Forearm support crutches
(gutter crutches)
 1. Axillary crutches /under arm crutches
• They are made of wood or metal with an Axillary pad, a hand piece and a rubber
ferrule.

• Two upright shafts connected by axillary piece on top

• Hand piece in the middle

• Extension piece below

• Extension piece and shafts has numerous holes at regular intervals so the total
length of crutch and height of handle is easily adjustable.

• A large suction tip (rubber ferrule) is attached to extension piece to allow total
contact with floor
• The Axillary pad should rest beneath the apex of axilla and
hand grip in slight flexion when weight is not being taken.

• When weight is being taken through axillary pad, the elbow

will go into extension and weight is transmitted down the arm
to hand piece.
Measurement of length
 There are variety of ways it may be in lying and also in standing
position.
In Lying it may be with shoes off and with shoes on
1. With shoes off: measure from apex of axilla to the lower margin of
medial melleolus.
2. With shoes on: 5cm/2 inches vertically down from apex of axilla to a
point 20 cm lateral to the heel of shoe. Book Resource: M. Dena
Gardiner

 In standing with shoe off and shoe on method is same.

 2 inches below the axilla to the 2 inches anterior and 6 inch lateral to
the foot in standing position.
Measurement of axillary crutch
• Crutches that are too tall or too short can affect
balance and also cause back pain.

• Incorrectly fitted crutches or poor posture can cause a

disorder called crutch palsy in which the nerves under
the arm mostly radial nerve (brachial plexuses) are
temporarily or permanently damaged, causing
weakened hand, wrist and forearm muscles.
Advantages and Disadvantages of Under Arm
Crutches

• Advantages:

• Convenience for temporary injuries

• A large degree of support for the lower body
• Available at low cost.
• Axillary crutches allow the patient to perform a greater variety
of gait patterns and ambulate at a faster pace.
Disadvantages:

• Limited upper body freedom

• Axillary crutches require good standing balance by the patient.
• Improper use of crutch can cause injury to axillary region, and
Strain on the arms and upper body which can lead crutch
paralysis. It is a condition in which the nerves under the arms
(Radial nerve and brachial plexus) are pinched and also risk of
losing balance.

• Geriatric patient may fell insecure or may not have the

necessary upper- body strength to use axillary crutches
Precautions
• Have someone nearby for assistance until accustomed to the
crutches.
• Frequently check that all pads are securely in place
• Check screws at least once per week.
• Clean out crutch tips to ensure they are free of dirt and
stones.
• Remove small, loose rugs from walking paths.
• Beware of ice, snow, wet or waxed floors
• Avoid crowds, leave class early.
• Never carry anything in hands ,use a backpack.
 Elbow crutches /forearm crutches/ Lofstrand crutch
• They are made of metal an aluminum tubular shaft with
a handgrip and have a metal or plastic forearm band.

• Forearm piece bent backward and extended to 2 inches

below the elbow.

• Both handgrip and forearm piece are adjustable in

length by means of a press clip or metal button and
have a rubber ferrule.

• These crutches are suitable for patients with good

balance and coordination with strong arms. Weight is
transmitted exactly the same way as for axillary
crutches.
Advantage of elbow crutches

 Light weight
 Easily adjustable
 freedom for hand activities
Using forearm crutches requires no more energy, increased
oxygen consumption or heart rate than axillary crutches.
Being easily stored and transferred.
There is no risk of injury to the neurovascular structures in
the axillary region when using this type of crutches.
Disadvantages of forearm crutches

• Forearm crutches are less stable .

• They require good standing balance and upper-body strength.
• Geriatric patient sometimes feel insecure with these crutches.
They may not have the necessary upper-body strength to use
forearm crutches.
 Forearm support crutches/gutter crutches/
platform crutch

• They are made of metal with a padded forearm

support Platform, Velcro strap an adjustable hand
piece and a rubber ferrule.
• These are used for patients with Painful wrist and
hand condition or elbow contractures, or weak hand
grip
• Elbow flexed 90 degrees, The hand rests on a grip
which can be angled appropriately, depending on the
user's disability.
• Mostly In rheumatoid
disease, cerebral palsy, or
other conditions for
providing support. In
these conditions patient
cannot take weight
through hands, wrists and
elbows because of
deformity or pain.
MEASUREMENT :

IN LYING POSITION

With shoes on: measure from the point of fixed

elbow till 20 cm lateral to the heel.
• ADVANTAGES :
• As similar like elbow crutch
• These are easily adjustable.
• More cosmetic than other crutches.
• DISADVANTAGES :
• Provide less lateral support due to absence of axillary pad.
• Cuffs may be difficult to remove.
• These can be expensive.
According to static and dynamic balance, starts from easy to hardest

Underwater
Use parallel bars
Walker
Crutches
Canes
Independent
Preparation For Crutch Walking

• Arms: shoulder extensors, adductors and elbow extensors

even all muscles of arms must be assessed and strengthened
before the patient starts walking. The hand grip must also be
tested to see that the patient has sufficient power to grasp
hand piece.
• Legs: Strength and mobility of both legs should be assessed
and strengthened if necessary. Main attention to the hip
abductors and extensor, the knee extensors and the plantar
flexors of the ankle should be given.
• Balance: sitting and standing balance must be tested.
• Demonstration: the physiotherapist should demonstrate
appropriate crutch walking to the patient.
Crutch walking

• During first time, when the patient is to stand and walk, the
physiotherapist should have an assistant for supporting the
patient.
• Non-weight bearing: patient should always stand with a
triangular base i.e. crutches either in front or behind the
weight bearing leg
• Partial weight bearing: The crutches and the affected leg are
taken forward and put down together. Weight is then taken
through the crutches and the affected leg, while the
unaffected leg is brought through.
Gait pattern with crutches

• Four point gait

• Three point gait
• Two point gait
• Two point swing through gait
• Two point swing to gait (the feet are advanced by a
much shorter distance and placed behind the level of
crutches)
 Four-point gait
In this gait pattern one crutch is
advanced and then the opposite lower
extremity is advanced. For example,
the left crutch is moved forward, then
the right lower extremity, followed by
the right crutch and then the left lower
extremity.
• Slow, Good stability - at least 3 point
contact ground
• Weight is on both lower extremities
and used with bilateral involvement
due to poor balance, in coordination(
Ataxia) and muscle weakness
 Three-point gait
• In this type of gait three points of support contact the floor.
• Non-weight-bearing gait for lower limb fracture or amputation
Non Weight Bearing
Two-point gait

• This gait pattern is similar to the

four-point gait. However, it is less
stable because only two points of
floor contact are maintained. Thus,
use of this gait requires better
balance.
• The two-point pattern more closely
stimulates normal gait, in as much as
the opposite lower and upper
extremity move together.
• Two additional, less commonly used crutch gaits are the
swing-to and swing-through patterns. These gaits are often
used when there is bilateral lower extremity involvement,
such as in spinal cord injuries.
 Swing-through gait

• Fastest gait, requires functional

abdominal muscles
• In the swing-through gait, the
crutches are moved forward
together, but the lower
extremities are swing beyond
the crutches.
Swing-to gait

• Both crutches -> both lower

limbs almost to crutch level
• The swing-to gait involves
forward movement of both
crutches simultaneously, and
the lower extremities “swing
to” the crutches.
4 point gait –Balance and confidence / full
weight bearing
3 point gait – Balance and partial weight
bearing
2 point gait – non weight-bearing/ full weight
bearing

Point gait – stability, slow

Swing gait – more energy, fast
 Stair Climbing
Up With GOOD, Down With BAD
Stairs
To begin, place both crutches under the arm of the injured side, holding the inside
handle with the thumb. Hold onto the railing with the other hand. When using stairs,
remember, “up with the good, down with the bad.”
• To Ascend
• Leave crutches on the same level where standing.
• Support weight evenly on the crutch hand and railing.
• Raise the uninjured foot to the higher step, letting the injured foot trail behind.
• Straighten the uninjured leg and advance the crutches.
• To Descend
• Place the crutches on the lower step, while extending the injured foot forward. Place
the crutches on both sides of the body if no railing is present.
• Support weight evenly on the crutch hand and railing.
• Move the uninjured foot to the lower step.
• Narrow steps without a railing might require sitting on each step.
SUMMARY : So why give walking aids?

• Weight bearing
• Balance
• Motor pattern
• Confidence
• Endurance
Books References

• O’Sullivan, Susan B., Thomas J. Schmitz. Physical

Rehabilitation Assessment and Treatment. 4th ed. F. A.
Davis Company. 1994. p. 430-431
• M.Dena Gardiner
ANY QUESTION ????
Don’t Give Up