AMBULATORY AIDS, WHEELCHAIR, GAIT PATTERNS

CANES

CANES
- INDICATED FOR PATIENTS SUFFERING FROM ANTALGIC GAIT - For stability and increase base of support - Weight transmission is 20-25% - NPTE 30% - Lessens the stance phase

- Measurements: a. Greater trochanter to floor without shoe or heel b. Elbow is 20-30 degrees flexion, from hand to floor MOST ACCURATE ** Pt with leg length discrepancy you cant use greater trochanter as basis for measuring but instead you get the measurement of the elbow.

TYPES OF CANES
1. C, J, CROOK weight is in FRONT of the hand 2. Offset weight is at the CENTER of the hand 3. Quad for geriatric patients and who needs more stability 4. Walk cane/ Hemiwalker can be folded ** Geria patients 75 years old and above, give standard walker

TYPES OF CANES
Standard
C/J/crook offset -adjustable: 2738.5 in

Quad Cane
adjustable: 28-38 in

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

GAIT PATTERNS FOR CANE

Level Ground: cane + involved uninvolved

Curb
Ascending good cane bad Descending cane
bad good

Stair
Ascending
uninvolved cane + involved --Descending involved + cane uninvolved

** POINTS OF CONTROL: - HIPS AND SHOULDER - PT should hold the patient here for safety

WALKER

WALKER
- INDICATED FOR PATIENTS WHO NEED MAXIMUM STABILITY AND SUPPORT - Weight transmission 85% of body weight ** Pt elderly, with THR, Pt lives alone in the house GIVE: standard walker ** Pt elderly but travels GIVE: collapsible walker

Disadvantages
Difficult to store or transport Difficult or impossible to use on stairs Reduces speed of transmission Difficult to perform a normal gait pattern Difficult to use in narrow or crowded areas CANT DO A FUNCTIONAL AMBULATION because there is no swinging of the hands because the hands is holding the walker

TYPES OF WALKER
1. 2. 3. 4. 5. Standard Rolling CI for Parkinsons disease Reciprocating Collapsible Stair climbing

** Parkinsons pt has akinesia, GIVE: Rolling walker ** Parkinsons pt cant stop motion due to festinating gait GIVE: standard walker

TYPES OF WALKER
Rolling or wheeled
- Prescribed to patients with difficulty lifting the walker

- 2 wheels for Pt with speed problem initially given - 4 wheels for CP patients with increased energy expenditure
(with hand break)

Folding or Collapsible
For mobility in community or cars INDICATED FOR PATIENTS WHO ALWAYS TRAVEL Easy to store

Stair Climbing
With 2 posterior extensions and additional hand grips off of the rear legs for use on stairs

Reciprocal
Used with RGO For SCI and Spina bifida level T12 to L1

MEASUREMENT:
1. Distance of tummy from walker 1012 inches 2. Greater trochanter to floor without shoes 3. 20-30 degrees of elbow flexion

Gait Patterns in Walker

Level Surface
FWB: walker1st LE2nd LE
PWB: walker +involveduninvolved NWB: walkeruninvolved

Curb (ascending)
walker + uninvolved involved

Curb (Descending) walker involved uninvolved

Stair (ascending)
walker uninvoled involved

Stair (descending) walker involved uninvolved

CRUTCHES
FOR MODERATE STABILITY Gives lateral stability Widens the BOS PROVIDE FUNCTIONAL AMBULATION WITH RESTRICTED WEIGHT BEARING - Axillary 80-90% weight transmission - Non-axillary 40-50% weight transmission

MEASUREMENT:
1. Measure height of patient 16 inches 2. In standing, 2 inches below the axilla, 2 inches lateral to the heel 6-8 inches anterior to MTP 3. Sitting, shoulder abducted 90 degrees, elbow flexed 90 degrees and the other arm shoulder abducted. Measure from olecranon to 3rd finger 4. Supine, axilla to lateral 6-8 inches to heel

NON AXILLARY CRUTCHES

Platform - Pt with arthritis, bear weight on the forearm

Forearm/Lofstrand

Loftstrand crutch - Given to patients with paraplegia - In paraplegia, the Pt does a jacknife, where to put the tips of the Loftstand FRONT OF THE STEP - Cuff should be 11/2 inches below the elbow or proximal 3rd of the forearm

Canadian crutch - INDICATE FOR PATIENTS WITH TRICEPS WEAKNESS - 2 cuffs, one at the forearm, and another at the triceps cuff

Kenny Stick

GAIT PATTERNS ON AXILLARY CRUTCH

Emphasize the ff:
Weight: borne by the hands Wide BOS (at least 4 to the front and to the side) --axillary bars: held close to the chest wall to provide improved lateral stability --head up --turning: step in small circle, DONT PIVOT!

> 4-pt - Slow gait 2-pt - Fast gait - TYPES: A.Ipsilateral Right cruytch, right leg B.Alternating Right crutch, left leg ** 4 pt and 3 pt INDICATED FOR ATAXIC PATIENTS AND WITH POSTERIOR COLUMN PATIENTS COMPENSATING WITH THEIR VISION

> 3-pt - Crutch and toe touch Drag gait just drag feet Drag to and through Swing to and through Shadow for amputee, residual leg will kick the ball

WHEELCHAIR MEASUREMENTS
Seat height - Popliteal fossa to ground or heel + 2 inches - If too high sacral tilting/ post tilting and slide forward - If too low excessive pressure on ischial tuberosity

WHEELCHAIR
Seat height
Too high Too low

Seat depth - Popliteal fossa to posterior buttocks 2 inches - Too long irritation on popliteal fossa, sacral sitting - Too short uneven distribution of weight on the thigh

Seat depth
Too long Too short (sling seat, insert/countour seat) (cushions: foam, fluid/gel, air)

Back height - Inferior angle of the scapula to seat 2 inches - To high irritation of the scapula - Too low unstable trunk

Back Height
Too high Too low

Seat width - 1 inch on each side - Wide scoliosis - Narrow irritation on greater trochanter ** parallel bars 2 inches on both sides

Seat Width
Too wide Too narrow

Arm rest height - Sitting to 90 degrees elbow flexion - Too high shoulder elevation - Too low trink forward lean

Armrest Height
Too high Too low

Armrests
Adjustable (sit-to-stand) Removable (transfers) Wraparound/space saver (reduce overall width by 1 in) --Trays/Troughs (secured to the armrests; additional postural assistance for patients with decreased use of upper extremities)

Camber - Normal 3-9 degrees - Increase BOS

Hanger angle - 60-70 degrees of knee flexion

STANDARD DIMENSIONS
Chair Style SH Adult Narrow Adult Slim Adult Hemi/Low Seat Junior Child 18.75 Tiny Tot SW SD 18 16 14 18 16 14 12 16 16 16 16 16 11.5 11.5 20 20 20 17.5 18.5

19.5

CODE: DpWh = 2 D Depth W width H - height

STANDARD ADULT WHEELCHAIR SIMENSIONS

Height (push handles to floor): 36 in Height (armrest to floor): 29 to 30 in Width: 24 to 26 in Length: 42 to 43 in Doorwidth (min: 32 in; ideal: 36 in) Reach forward (high: 48 in; low: 15 in) side: 24 in

Leg Rests
Fixed Swing-away, detachable (easy transfer) Elevating (LE edema, postural support) (C/I: hams hypertonicity or tightness)

Wheels/ Handrims/ Brakes

Casters 8 inch in diameter for easy propulsion Drive wheels and rims (projection,friction/ leather,) --Tires (Standard, Pneumatic)

Attachments
Seat belts (pelvic positioner) Adductor pommel for spasticity Seat wedge for falls Anti-tipping Hill-holder

SPECIALIZED WHEELCHAIRS
Sports
Solid frames Lightweight Low back Low seat Greater camber

A PT has to order a wheelchair for a patient with T9-T10 SCI who wishes to engage in sports activities. The wheelchair will not need: a. b. c. d. Low back Swing away footrest A high back Removable arm rests

A PT has to order a wheelchair for a patient with T9-T10 SCI who wishes to engage in sports activities. The wheelchair will not need: a. b. c. d. Low back Swing away footrest A high back Removable arm rests

A patient with paraplegia at the T10 level wants to participate in wheelchair basketball. An option that should be considered in ordering a wheelchair for this patient is: a. b. c. d. Rigid frame Hard rubber tires Mid scapular seat back Folding frame

A patient with paraplegia at the T10 level wants to participate in wheelchair basketball. An option that should be considered in ordering a wheelchair for this patient is: a. b. c. d. Rigid frame Hard rubber tires Mid scapular seat back Folding frame

Tilt-in space
Extensor spasms Pressure relief

QUESTION:
A tilt in space wheelchair has been ordered for a patient with C4 quadriplegia. This type of chair is ordered to: a. Improve the patients ability to relieve pressure and transfer independently b. Improve positioning for pressure relief or extensor spasm c. Improve leg position and lower extremity edema d. Facilitate handgrip and propulsion

QUESTION:
A tilt in space wheelchair has been ordered for a patient with C4 quadriplegia. This type of chair is ordered to: a. Improve the patients ability to relieve pressure and transfer independently b. Improve positioning for pressure relief or extensor spasm c. Improve leg position and lower extremity edema d. Facilitate handgrip and propulsion

Reclining Back
For patients who are unable to independently maintain an upright sitting position

** Duchenne Muscular Dystrophy - Late stage - GIVE Electric wheelchair

One-arm drive
2 outer rims Difficult: (L) hemiplegia

Hemiplegic Chair
low

Amputee Chair

> C1-C4 SCI - Powered - Joystick, head controls - Sip-and-puff C5 Oblique C6 Vertical C7 Friction handrims C8 Standard wheelchair CODE : OVFS

A PT orders a wheelchair for a patient with C4 tetraplegia. Which wheelchair would be the most appropriate for the patient? a. Manual wheelchair with friction surface hand rims b. Manual wheelchair with hand rim projections c. Power wheelchair with sip and puff controls d. Power wheelchair with joystick controls

A PT orders a wheelchair for a patient with C4 tetraplegia. Which wheelchair would be the most appropriate for the patient? a. Manual wheelchair with friction surface hand rims b. Manual wheelchair with hand rim projections c. Power wheelchair with sip and puff controls d. Power wheelchair with joystick controls

Ramps (Descending) lean forward use shorter strokes move hands quickly

Ramps (Descending) grip handrims loosely wheelie (steep ramp)

Turning

push harder with one hand sharp turning pull one wheel backward while pushing other wheel forward 90 deg: 36 180 deg: 60 360 deg: 60 x 60 in CODE: 360 369 90-36

Wheelie
hands back on handrims pulls hands forward abruptly/forcefully then posteriorly move head and trunk forward to keep from going over backward practice: lightweight w/c ***wheels pulled back: tips toward UPRIGHT ***wheels pushed forward: tips further BACK

Curb (Ascending) place front casters up push rear wheels up

Curb (Descending) backward: forward head and trunk lean forward: wheelie

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

a.
b. c. d.

Descend backwards with the trunk and arms hooked around the push handles Ascend backwards with the large wheels first Lift the front casters and ascend in the wheelie position Place the front casters down first during descent

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

a.
b. c. d.

Descend backwards with the trunk and arms hooked around the push handles Ascend backwards with the large wheels first Lift the front casters and ascend in the wheelie position Place the front casters down first during descent

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

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

When recommending a wheelchair for a patient with a lesion at T11 resulting in paraplegia, the modification least needed by a patient with this disability would be: a. b. c. d. Swing away footrests High seat back Pneumatic tires Caster locks

When recommending a wheelchair for a patient with a lesion at T11 resulting in paraplegia, the modification least needed by a patient with this disability would be: a. b. c. d. Swing away footrests High seat back Pneumatic tires Caster locks

THE END