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•Act of
walking or
being able
to walk
• Appliance to aid ambulation
• Aka assistive devices
• Provide an extension of the UE
• designed to improve a person’s to help transmit BW & provide
stability by: support for the patient
– Expanding the BOS
– Reducing weight bearing on one or (B) LE
– Permit mobility
What is my role as a physiotherapist?
Selection of the proper • Know WHEN to indicate
ambulation devices & gait • Know the RIGHT ambulation
pattern is most important aid to use
to provide optimal • Provide PRE-Ambulation
security, safety, & function Exercises
with the least energy – Stages: Strengthening Exe
expenditure. Coordination Exe Trunk
Balance Exe Use of Ambulation
Aids (END GOAL)
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FACTORS THAT INFLUENCE
AMBULATION TRAINING
What are the
Joint ROM & Muscle Strength
factors that of Upper Extremity
influence Joint ROM & Muscle Strength
of Lower Extremity
ambulation
Coordination
training Trunk Balance
program? Impairment in Sensory
Perception
FACTORS THAT HELP
What are the DETERMINE AMBULATORY
NEEDS
factors that
Nature of Disability
help
Age of the Patient
determine
Mental Status
ambulatory
Physical Endurance
needs?
Energy Expenditure
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SINGLE CANE
BILATERAL
CANES
FOREARM CRUTCHES
AXILLARY CRUTCHES
WALKERS
PARALLEL BARS
Arrange the following ambulation aids
according to the MOST REQUIRING
COORDINATION to LEAST
REQUIRING COORDINATION.
WALKER
CRUTCHES
CANE
PARALLEL BARS
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• When maximal patient
stability and support is
required
• Bars should be adjusted
for proper fitting.
• When maximal stability
•Disadvantages:
and support, along with
–Bars severely limit MOBILITY is required.
mobility
–Pt. must progress to • Wider and more stable
another ambulation aid to BOS
be mobile
• Adv: • Disadv:
–Lightweight –Difficult to store/transport
–Foldable –Difficult to use on stairs
–Slow & awkward gait
–Safer and provide good pattern
support –Difficult to use in narrow/
crowded places
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TYPES and VARIATIONS of
WALKERS
• Pre-requisites for the use of a a) Standard
• Non-adjustable
walker
• Adjustable
– Good grasp
b) Reciprocal Walker
– Good bilateral arm strength
c) Wheeled or Rollator
• Parts d) Folding
– Tubular aluminum, plastic hand e) Stair Climbing Walker
grips & rubber tipped legs
f) One-hand Walker (hemiplegic)
Lightweight Aluminium
ROLLATOR Triwalker Basic
PRONE CRAWLER
Walker
Paraplegia
(adult)
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RECIPROCAL WALKER
Stair
Climbing
Walker
FOLDING
WALKER
WITH
GLIDES/
ROLLATOR
Platform
attachment
for walker
•Used to compensate for •Oldest of all assistive devices
impaired balance or to •Held opposite the affected LE
improve stability •Provide more physiologic gait
•Wider BOS
•Approximately 25% of
BW is transferred •Reduce stress on opposite hip
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• Adv: • Disadvantages:
–More functional on –Limited stability
stairs
–Can be used in narrow –2 canes do not provide
and confined places sufficient stability to
–Easy storage and perform a 3-point gait
transport pattern
Standard Crook Cane
PARTS
• HANDLE (“J”/
“T”/”C”- shaped, handle
PISTOL GRIP,
OFFSET)
• SINGLE UPRIGHT
• RUBBER
SUCTION TIP
Modified Crook Cane Cane w/ Ortho Grip
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OFFSET CANE W/ WRIST STRAP Quad Cane with Offset Handle
Quad cane
Quad cane with
w/ "U"
large inverted
shape hand
"V" base
grip
CANE SEAT
• Provide support from
axilla to floor
• 2 points of contact
• Better stability than
canes
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AXILLARY CRUTCHES
-Transfers 80% of
BW
- Requires better
• Two Basic Types: trunk support
- Allow selection of
–Axillary Crutches gait patterns &
–Non-axillary Crutches ambulation speed
- Provide good
support and stability
PARTS DISADVANTAGES
• SHOULDER
1. LESS STABLE THAN WALKER
PIECE
2. CAN CAUSE INJURY TO AXILLARY
• DOUBLE VESSELS & NERVES IF NOT USED
UPRIGHT PROPERLY
• HAND GRIP/ 3. REQUIRE GOOD STANDING BALANCE
BAR 4. ELDERLY Pt. MAY FEEL UNSECURED
WITH THEM
• RUBBER
SUCTION TIP 5. FUNCTIONAL STRENGTH OF THE UE
& TRUNK MUSCLES IS REQUIRED
FOR MOST GAIT PATTERNS
NON-AXILLARY CRUTCHES DISADVANTAGES
1. PROVIDE LESS STABILITY &
• TRANSFERS 40-50% BW SUPPORT THAN AXILLARY
• ELIMINATE THE DANGER OF INJURY CRUTCHES, A WALKER, OR
TO AXILLARY VESSELS & NERVES PARALLEL BARS
• MORE FUNCTIONAL ON STAIRS & IN 2. THEY REQUIRE GOOD STANDING
NARROW, CONFINED AREAS BALANCE & GOOD UE STRENGTH
FOR MANY GAIT PATTERNS
• RELATIVELY EASY TO STORE &
TRANSPORT 3. THE FOREARM CUFF MAKES IT
DIFFICULT TO REMOVE THE CRUTCH
• FOREARM CUFF RETAINS THE
CRUTCH ON THE FOREARM WHEN Pt. 4. ELDERLY Pt. MAY FEEL INSECURE
REACHES FOR AN OBJECT WITH THEM
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Loftstrand Crutches
CRUTCH ACCESSORIES
CRUTCH TIP (RUBBER SUCTION
TIP)
AXILLARY PADS (RUBBER/
SPONGE)
HAND GRIPS (SPONGE PAD)
TRICEPS BAND (METAL/ STIFF
LEATHER)
WRIST STRAP – (LEATHER/
PLASTIC)
PARTS OF LOFTSTRAND CRUTCH Platform Crutch
1. FOREARM
CUFF
2. PADDED HAND
BAR
3. TUBULAR
ALUMINUM -
SINGLE
UPRIGHT
PLATFORM CRUTCH DISADVANTAGES
FOR INDIVIDUALS WHO
ARE/HAVE: 1. THE PATIENT LOSES THE
• UNABLE TO BEAR USE OF HIS/HER TRICEPS
WEIGHT THROUGH THEIR
WRISTS & HANDS TO ELEVATE & MAINTAIN
• SEVERE DEFORMITIES OF
HIS/ HER BODY DURING
THE WRIST OR FINGERS THE SWING PHASE
• BELOW ELBOW 2. ANOTHER PERSON MAY
AMPUTATION NEED TO APPLY THEM
• UNABLE TO EXTEND ONE 3. THEY ARE LESS EFFECTIVE
OR BOTH ELBOWS ON STAIRS
PASSIVELY
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• Upper Extremity
MAJOR MUSCLE GROUPS USED FOR – Shoulder Depressors
NON-WEIGHTBEARING AMBULATION – Shoulder Extensors and Flexors
– Elbow Extensors
• Upper Trunk
– Finger Flexors
– Scapular Depressors
– Scapular Stabilizers • Weight Bearing Lower
Extremities
• Lower Trunk – Hip Abductors
– Trunk Extensors – Hip Extensors
– Trunk Flexors – Knee Extensors
– Ankle Dorsiflexors
IMPORTANT SPECIFIC CRUTCH 2.SHOULDER ADDUCTORS
WALKING MUSCLES - hold the crutch top to the chest
wall with the arm
Pectoralis major
1. SCAPULAR DEPRESSORS
Latissimus dorsi
-stabilize the UE & prevent 3. FLEXORS, EXTENSORS,
hiking of the shoulder on ABDUCTORS OF THE ARM &
SHOULDER
weight bearing
- enable the placement of crutch
forward, backeard, and sideward
Latissimus dorsi respectively
Lower trapezius Deltoids
Pectoralis minor
4. ELBOW EXTENSORS
– stabilize the elbow joint in weight 6. FINGER AND THUMB
bearing by preventing flexion or
buckling; together with shoulder FLEXORS
depressors these muscles are most
important in raising the body from the – to adequately grasp
floor to allow the LE to swing the hand piece
Triceps
Anconeus FDS
5. WRIST EXTENSORS
– hold wrist in proper position to bear FDP
weight on hand piece
ECRL/ECRB FPL & FPB
ECU
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BASIC CRUTCH
GAIT PATTERNS
1.Four Point Pattern
2.Two Point Pattern
3.Modified Four Point or
Two Point Pattern
4.Three Point Pattern
FOUR POINT PATTERN
• ® crutch- (L) foot- (L) crutch-
® foot
• Requires the use of bilateral
Very slow but stable pattern,
ambulation aids. safest one to use in crowded
• Uses an alternate and areas
reciprocal forward movement • Requires low energy expenditure
of the ambulation aid and the • Can be used when patient
patient’s opposite lower requires maximal stability or
balance
extremity.
• Approximates a normal gait
pattern
TWO POINT PATTERN • ® crutch and (L) foot (L)
crutch and ® foot
• Requires the use of • Relatively stable pattern and
bilateral ambulation aids faster than 4 point pattern
• Uses a simultaneous & • Relatively low energy
reciprocal forward expenditure & similar to
placement of the normal gait pattern
ambulation aid & the • Requires more coordination
patient’s opposite to move one UE & its
extremity. opposite LE forward
simultaneously.
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MODIFIED 4- or 2- POINT
THREE POINT PATTERN
PATTERN
• Require only one ambulation • Requires bilateral
aid and are used for patient ambulation aids or a walker
who only has one functional • Not for bilateral canes
UE or who uses only one • Referred to as “step to” or
ambulation aid.
“step through” pattern
• Aid is held on the UE rather than a “swing to” or
opposite the affected or
protected LE. “swing through”
• Used when the patient is
able to bear weight on one • Less stable pattern but
LE but is NWB on the more rapid ambulation
opposite LE.
• Requires good strength of
• Walker or crutches and the
NWB limb are advanced the UE, trunk and one LE.
and then the patient steps • Higher energy
up to the walker or through expenditure
the crutches.
“Pray as if everything
depends on God;
Work as if everything
depends on you.
THE END!
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