walking aids, aids, cane, crutch, walker, sticks, wheel chair, axillary crutch, elbow crutch, gutter crutch, gait, walking, walking patterns, gait determinants, physiotherapy, physio, healthcare

1. WALKING AIDS
Dr. Mumux Mirani
MPT Sports,
Assistant professor,
SSAIP.
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2. 2

3. What is walking aids???
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4. Relate this image…
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5. Walking
 Walking is the manner or way in which you
move from one place to another .
 It is the forward propulsion of the body via
coordinated and integrated action of
neuromuscular system of the body.
 It is the highest level of motor control skill.
 Walking is a complex activity which requires
the co operation and control of the whole
body.
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6.  The major requirements for successful walking
include:
• Support of body mass, by the lower extremities.
• Production of locomotors rhythm.
• Balance control of the moving body.
• Propulsion of the body in the intended direction.
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7. 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
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8. Types of Walking aids
 There are a number of aids available to assist
people who have difficulty in walking or who
cannot walk independently without one.
 These external aids are crutches ,sticks and
frames.
 Others include braces and splints
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9. Crutches
 Crutches Introduction
 Types of crutches
 Measurement of length
 Preparation for crutch walking
 Crutch walking
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10. 10

11. What is a crutch?
 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.
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12. 12

13. Pre requisites 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
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14. Types of crutches
1. Axillary crutches/ under arm crutches
2. Elbow crutches or Lofstrands crutches
3. Forearm support crutches (gutter crutches)
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15. 1) Axillary 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
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16.  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
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17. 17

18.  The Axillary pad should rest against the chest
wall approx. 5 cm, beneath the apex of axilla
and hand grip in slight flexion when weight is
not being taken.
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19.  The elbow will go into extension and weight is
transmitted down the arm to hand piece.
 On no account should weight be taken by
axillary pad as this could lead to neuropraxia of
the radial nerve or the brachial plexus.
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20. 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)
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21.  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.
2
1

22.  The measurement from the axillary pad to the
hand grip should be taken with the elbow
slightly flexed (approx. 15 degree) from a point
5 cm below the apex of the axilla to the ulnar
styloid .
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23. Measurement of axillary
crutches -
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24.  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.
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25.  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.
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26. 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 to crutch paralysis.
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27.  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
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28. 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.
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29.  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.
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31. ELBOW /LOFSTRAND
CRUTCHES
 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.
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32.  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.
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33.  Measurement - usually taken with the
patient in the lying position with shoe on
 Elbow is slightly flexed (approximately 15˚)
and the measurement is taken from the ulnar
styloid to a point 20cm lateral to the heel of
the shoe
 Once the patient is standing with support,
the length must be checked
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36. 36

37. ADVANTAGES
 Light weight
 Easily adjustable
 Using forearm crutches requires no more
energy, increased oxygen consumption or
heart rate than axillary crutches.
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38.  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.
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39. Disadvantages
 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.
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40. Gutter crutches
 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
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41.  Elbow flexed 90 degrees, The hand rests on a
grip which can be angled appropriately,
depending on the user's disability.
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42. 42
 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.

43. 43

44. Measurement of length :
IN LYING POSITION
With shoes on: measure from the point
of fixed elbow till 20 cm lateral to the
heel.
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45. 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.
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46. 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.
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47.  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.
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48. 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
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49.  To walk, the patient first moves the
crutches a little further forward, takes
weight down through the crutches and lifts
the foot forward to a position just behind
the line of crutches.
 Once this is mastered the patient may
progress to lifting the foot forward to a
position just in front of the line of the
crutches.
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50.  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.
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52. 52

53. 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)
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54. What is GAIT?
• Human locomotion, or gait, may be described
as a translatory progression of the body as a
whole, Produced by coordinated, rotatory
movements of body segments.
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55. • The alternating movements of the lower
extremities essentially support and carry
along the head, arms, and trunk (HAT).
• HAT constitutes about 75% of total body
weight,
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56. Gait
 Phases of the Gait Cycle
 A gait cycle spans two successive events of
the same limb, usually initial contact of the
lower extremity with the supporting surface.
 During one gait cycle, each extremity passes
through two major phases:
 a stance phase, when some part of the foot
is in contact with the floor, which makes up
about 60% of the gait cycle, and
 a swing phase, when the foot is not in
contact with the floor, which makes up the
remaining 40% 56

57.  There are two periods of double support
occurring between the time one limb
makes initial contact and the other one
leaves the floor at toe off.
 At a normal walking speed, each period of
double support occupies about 11% of the
gait cycle,
 Which makes a total of approximately 22%
for a full cycle.
 The body is thus supported by only one
limb for nearly 80% of the cycle
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59. 59

60. Gait terminology
 Temporal variables include
 Stance time,
 single-limb and double-support time,
 swing time,
 stride and step time,
 cadence, and
 speed.
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61.  The distance (spatial) variables include
 stride length,
 step length and
 Width and
 degree of toe-out
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62.  Stance time is the amount of time that
elapses during the stance phase of one
extremity in a gait cycle.
 Single-support time is the amount of time
that elapses during the period when only one
extremity is on the supporting surface in a gait
cycle.
 Double-support time is the amount of time
spent with both feet on the ground during one
gait cycle.
 The percentage of time spent in double
support may be increased in elderly persons
and in those with balance disorders.
 The percentage of time spent in double
support decreases as the speed of walking
increases
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63.  Stride length is the linear distance
between two successive events that are
accomplished by the same lower
extremity during gait.
 stride length is not always twice the
length of a single step, because right and
left steps may be unequal
 Stride length varies greatly among
individuals, because it is affected by leg
length, height, age, sex, and other
variables
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65.  Stride duration refers to the amount of
time it takes to accomplish one stride.
 Stride duration and gait cycle duration
are synonymous.
 One stride, for a normal adult, lasts
approximately 1 second.
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66.  Step length is the linear distance
between two successive points of
contact of opposite extremities.
 It is usually measured from the heel
strike of one extremity to the heel strike
of the opposite extremity
 A comparison of right and left step
lengths will provide an indication of gait
symmetry.
 The more equal the step lengths, the
more symmetrical is the gait
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67. 67

68.  Step duration refers to the amount of
time spent during a single step.
 Measurement usually is expressed as
seconds per step.
 When there is weakness or pain in an
extremity, step duration may be
decreased on the affected side and
increased on the unaffected (stronger) or
less painful
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69.  Cadence is the number of steps taken
by a person per unit of time.
 Cadence may be measured as the number
of steps per second or per minute,
Cadence = number of steps/time
 A shorter step length will result in an
increased cadence at any given velocity.
 when a person walks with a cadence
between 80 and 120 steps per minute,
cadence and stride length had a linear
relationship
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70.  As a person walks with increased cadence, the
duration of the double-support period
decreases.
 When the cadence of walking approaches 180
steps per minute, the period of double support
disappears, and running commences.
 A step frequency or cadence of about 110 steps
per minute can be considered as “typical” for
adult men;
 a typical cadence for women is about 116 steps
per minute.
 stride cadence, is exactly half the step
cadence
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71.  Walking velocity is the rate of linear
forward motion of the body,
 which can be measured in meters or
centimeters per second, meters per minute,
or miles per hour.
 Women tend to walk with shorter and faster
steps than do men at the same velocity.
 Increases in velocity up to 120 steps per
minute are brought about by increases in
both cadence and stride length,
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72.  But above 120 steps per minute, step length
levels off, and speed increases are achieved
with only cadence increases.
 Speed of gait may be referred to as slow, free,
and fast.
 Free speed of gait refers to a person’s
normal walking speed;
 slow and fast speeds of gait refer to speeds
slower or faster than the person’s normal
comfortable
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73.  Step width, or width of the walking base,
may be found by measuring the linear distance
between the midpoint of the heel of one foot
and the same point on the other foot
 Step width has been found to increase when
there is an increased demand for side-to-side
stability, such as occurs in elderly persons and
in small children. 73

74. 74

75.  In toddlers and young children, the center of
gravity is higher than in adults, and a wide base
of support is necessary for stability.
 In the normal population, the mean width of
the base of support is about 3.5 inches and
varies within a range of 1 to 5 inches.
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76.  Degree of toe-out represents the angle of
foot placement (FP) and may be found by
measuring the angle formed by each foot’s line
of progression and a line intersecting the
center of the heel and the second toe.
 The angle for men normally is about 7 from the
line of progression of each foot at free speed
walking
 The degree of toe-out decreases as the speed
of walking increases in normal men.
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77. 77

78.  Power generation is accomplished when muscles
shorten (concentric contraction). They do positive
work and add to the total energy of the body.
 Power absorption is accomplished when muscles
perform a lengthening (eccentric) contraction.
They do negative work and reduce the energy of
the body.
 If joint motion and moment are in opposite
directions, negative work is being performed
through energy absorption. 78

79. STICK/CANES
 They are wooden / metal sticks, which
have to be cut to the correct length for
the patient or there are adjustable metal
sticks.
 Can are not normally recommended for
non weight bearing and partial weight
bearing cases.
 It is useful for increasing the base of
support and to improve the balance .
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80.  Canes are preferred to provide opposite
to affected side.
 During the normal gait the stance hip
abductors counterbalance the swinging
hip and prevent it from tilting.
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81. Types of canes
 Standard canes
 Standard adjustable canes
 Standard adjustable offset canes
 Tripod cans
 Quadruped canes
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83. 83

84. Standard canes
 Made up of aluminium, wood and plastic
 It has half circle handpiece
 Height is not adjustable
 Inexpensive
Standard adjustable canes
 Made up of aluminium and may be having
the plastic cover
 Height is adjustable
 Easy to carry anywhere
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85. Adjustable aluminium offset
canes
 Upper half of the cane is offset anteriorly
so that COG falls on the cane and it gives
more stability it may be available in the
standard adjustable canes
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86. Quadruped and tripod canes
 It has the 4 or 3 leg with rubber tip and
gives the broader base. As the result BOS of
canes are huge.
 Give more stability than other canes
 More use full in neurological cases like
hemiplegia and other elderly patient
 It is difficult to carry the cane in the
staircase if the base is broader
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87. Measurement
87
 Usually taken with the patient in the standing
position
 The elbow is slightly flexed and the measurement
is taken from the ulnar styloid to floor
approximately 15 cm from the heel

88. FRAMES
 Made of metal and adjustable.
 Light in weight
 Have ferrules attached to four struts. some
have wheels attached but should be carefully
used.
 There are reciprocal frames which are hinged
So that one side can be moved forward than
the other. 88

89. 89

90.  Uses:
 Use full fro the NWB,PWB and FWB.
 In elderly patients with unsteady gait.
 In patients with cerebral palsy or spina bifida.
 The patient lifts the frame forward, then leans
on it and takes two steps. The patient should
take even steps, keeping the frame well
forward. A bag can be attached to the front of
the frame to carry small items.
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91.  Safety:
• The physiotherapist must check the safety of all
walking aids not only when giving them to a
patient, but regularly throughout a treatment
programme.
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92. Wheel chair
 This is one of the variety of mobility aids.
 The patient who has both lower limb non
functioning or partial functioning has to be
recommended for the wheel chair.
 It gives 100 percent stability to the patient
 Normally, wheelchair are recommended for
paraplegic, quadriplegic, muscular dystrophy
spinal cord injury and fracture conditions
 It provide physical as well as mental support
to the patient.
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93. Types
 Rigid
 foldable
 One arm driven wheelchair
 Powered wheelchair
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96. THANK YOU….
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