Download MBBS Physical Medicine and Rehabilitation Presentations 2 Ambulatory Aids And Gait Training Lecture Notes

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TRAINING

Department of PMR

Ambulatory Aids

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Assistive devices for mobility/ambulation.

Provide support and transmit body weight.

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Types

Canes

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Crutches

Walkers

Whom to be given?

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who have dif iculty maintaining their center of gravity

within support area.

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It increases the area of support.
How it works?

Improve balance

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Redistribute and extend the weight-bearing area

Reduce lower limb pain

Provide small propulsive forces

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Provide sensory feedback.

They should be considered an extension of the upper limb.

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Pre-requisite for use

Adequate upper limb strength and coordination

Endurance

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Stability

An exercise program for the upper limbs and a supervised

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period of training program is recommended.


Which type of aid needed ?

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Depends on how much balance and weight-bearing assistance is

required.

The body weight transmission -

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Unilateral cane - 20% to 25%

Forearm or Arm cane - 40% to 50%

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Bilateral crutches - up to 80%.

Canes

Length Measurement ?

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Tip of the cane at the level of the greater trochanter in an

upright position.

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Elbow flexed approximately 20 degrees

Cane with height adjustable notches - "one cane fits all"

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Canes

Parts - handle, shaft, and base

Material ? woods, metal especially aluminum, plastics, and

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carbon fibre.

Types - C cane (crook top cane or J cane), Functional grip

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Cane, Quad cane

Canes

The cane usually is held on the side opposite the affected

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leg.

The patient advances the cane and the affected foot,

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then moves the unaffected foot.


Crutches

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Types -

Underarm (Axil ary)

Forearm (Lofstrand)

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Canadian (Triceps crutch)

Forearm support (Platform crutch)

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Axil ary crutch

Length: anterior axil ary fold to a point 6 inches

lateral to the fifth toe with the shoulders relaxed.

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Crutch handle : elbow flexed 30 degrees, the wrist

in maximal extension, and the fingers forming a

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fist, crutch 3 inches lateral to the foot.


Forearm (Lofstrand)

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Length: standing upright with elbow in 20 degrees of

flexion.

Less supportive than axil ary crutches for ambulation.

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Platform Forearm Crutch

Length: The distance from the ground to the

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forearm rest with the shoulders relaxed and the

elbows flexed 90 degrees

Indications - painful wrist & hand conditions,

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elbow contractures.


Commonly used crutches and canes

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Walker

Length: patient stand upright and the elbows flexed 20

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degrees. Front of the walker 12 inches in front of the patient.

Provides maximum support but a slow gait.

Front wheels facilitate movement of the walker for those who

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lack upper limb coordination.

Useful for hemiplegia and ataxia.

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Walker types

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Standard walker

Platform walker

Reverse walker

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Wheel walker

Gait Patterns
Foot sequence of an individual using

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assistive devices.

Gait pattern depends upon ability to-
Move the feet reciprocally

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Tolerate ful load on each leg

Lift the body off the floor

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Maintain the balance


Gait Patterns

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q Alternating (reciprocal) gait pattern

Four-point gait

Two-point gait

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Three-point gait

q Swinging (simultaneous) gait pattern

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Swing-to gait

Swing-through gait

Four-point Gait

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Three-point Gait

Two-point Gait

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Swinging (Simultaneous) Gait Pattern

Swing-to gait

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Swing-through gait

AMPUTATION - GAIT TRAINING

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Amputation - Gait Training

Steps:

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a) Weight-bearing and balance training

b) Basic Gait training

c) Advance gait training

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d) Functional training

Weight Bearing and Balance

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1. Partial weight bearing (with & without support)

2. Partial weight shift (with & without support)

3. Pelvic rotation training

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4. Sideward walking (two-hand support)

5. Full weight shift (with & without support)

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6. Heel strike (with or without support)

7. Handball (with or without support)

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Partial Weight Bearing

Partial Weight Shift

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Pelvic Rotation Training & Sideward

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Walking

Full Weight Shift

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Heel Strike

Handball

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Basic Gait Training

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1. Sound-leg step forward & backward (two-hand

support)

2. Sound-leg step through (with & without support)

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3. Prosthetic-leg step forward & backward (two-hand

support)

4. Prosthetic-leg step through (two-hand support)

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5. Prosthetic-leg step forward (one-hand support)
6. Prosthetic-leg step through (without support)
7. Walking between the parallel bars (with & without

support)

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Sound-leg Steps

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Sound-leg step through

Sound-leg step through

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Walking between the parallel bars


Thank You