1. WALKING AID PRESCRIPTION
Calvary Health Care Sydney
WALKING AID PRESCRIPTION
Updated May 2013

2. Why Use Walking Aids? Provide support
Reducing or totally relieving weight and therefore pain
E.g. Recent fractures/surgery of lower extremity
Provide stability
E.g. For decreased balance, an amputee, paraplegic, or weakness
Relieve Pain
E.g. Severe OA
In many cases it will be a combination of the above
May be temporary while recovering from surgery, or permanent
Aim is to provide the support required but allow as normal a gait pattern as possible.
Pain management/falls prevention!

3. Considerations in Selecting a Walking Aid
Age and functional needs of the person
Nature and pathology of the disease
E.g. fractures, sprains, rheumatoid arthritis, medications causing dizziness
The extent of disability
Joint range, pain, coordination, balance, sensation, comprehension, communication and sight.
Mental and Physical capacity (muscle strength)
E.g. If NWB on right (R), then need adequate strength in (L) to support total body weight, UL need sufficient power to use the aid
Short or long term basis
Requires assessment of the patient, careful fitting and measuring, instructions and training of its use, and monitoring for safety and progression.
ONLY RECOMMEND WHAT HAS BEEN TESTED BY THE PATIENT

4. Types of Walking Aids

5. People

6. People Advantages: Stable and safe
May be only option for people with UL issues and unable to use walking aid
Disadvantages:
Not realistic for independence
Large carer burden

7. Parallel Bars

8. Parallel Bars Advantages:
Stable for practicing walking/balance in the gym provides maximal support
Useful for initial training prior to walking stick, crutches
Disadvantages:
Not readily available
Cannot mimic normal gait
Difficult to wean off if on them too long
Does not train balance, obviously very restrictive

9. Forearm Support Frame (FASF)

10. Forearm Support Frame (FASF)
May have 2 wheels or 4 wheels: 2 wheels have increased stability, 4 wheels allow increased mobility
Advantages:
Provides +++ support so able to take weight through arms for initially post op # NOF, hip replacement etc
Very supportive to compensate for very poor balance
Used in patients who are Non Weight Bearing (NWB) or Touch Weight Bearing (TWB) in one lower limb (LL)
Suitable for patients with Rheumatoid Arthritis in hands as unable to grasp handles of other frames
Disadvantages:
Large and may not be compatible with peoples homes especially bathrooms
not really community accessible
FITTING
Shoulders should be relaxed although the patient should be able to push through their forearms to allow some lift, as well as clearance for the leg to swing forward. Can adjust the rotation of the forearm for patient comfort. Elbows are at 90 degrees.

11. Pick Up Frame (PUF)

12. Pick Up Frame (PUF) Advantages: Usually light weight aluminium
May fold up to go in car
Progression from FASF
Disadvantages:
Only allows step to gait
Slow due to need to pick up frame which is inefficient and provides a period of instability during which there is no support from the assistive device
Cannot be used on steps
Provides maximal support
Difficult to negotiate small spaces

13. 2 Wheel Rollator (2WRF)

14. 2 Wheel Rollator (2WRF) Advantages: Light weight and transportable
Normal gait can develop
Increased stability due to skis/stoppers on back and rigid front wheels
Good progression from FASF
Disadvantages:
Difficult to maintain contact with ground and turn
Cannot be used on steps
Difficult to negotiate small spaces.
FITTING:
Patient erect, arms at comfortable angle

15. 4 Wheel Rollator (4WRF)

16. 4 Wheel Rollator (4WRF) Advantages: Light weight and transportable
Normal gait can develop, step through with increased speed
Has accessories such as seats, brakes, (pull up or push down), and baskets enabling them to carry things increasing independence
Disadvantages:
Decreased stability due to 4 wheels, some have 2 wheels and skids which have increased stability
FITTING:
Patient erect, arms at comfortable angle
Important to teach the patient use of the brakes which should be suited to their hand function, as well as stationary positioning for use of the seat , and in preventing the rollator from running away down slopes .

17. Crutches

18. Auxiliary Crutches Advantages: Cheap Adjustable Readily available
Disadvantages:
They are difficult to stow
Temptation to weight bear under axilla leading to potential danger to axillary vessels and nerves
Both hands are occupied so difficult to perform manual tasks or transport objects in hands.
FITTING:
Patient erect, shoes on, 3cm space between top of the crutch and the axilla when the shoulders are relaxed.
Hand piece adjusted so that there is approximately 30 degrees elbow flexion when in use, and at level of ulnar styloid process or proximal wrist crease when arm relaxed.
When measuring the ferrule of the crutch should be approximately 14 cm out from the side of the lateral side of the foot, to allow space for the patient’s body.

19. Elbow or Canadian Crutches
Advantages:
Shorter and easier to store, possible to free hands.
Cheap and adjustable
Disadvantages:
Need more control of shoulder and elbows.
FITTING:
As per Auxiliary crutches

20. Single Prong Stick (SPS)

21. Single Prong Stick (SPS)
Advantages:
Light and cheap
Easily managed
Readily available one hand available for tasks
Community accessible
For patients requiring minimal support
Decreases the load on the hip contralateral to the hand it is held
Disadvantages:
Provide little stability
Cannot NWB/TWB
Need good wrist strength and rhythm
FITTING:
Elbow flexion is at degrees

22. Four Prong Stick (FPS)

23. Four Prong Stick (FPS) Advantages: Provides stability in standing
Most supportive device if 1 UL not functional
Disadvantages:
Normal gait impossible because it promotes uneven weight bearing towards side of stick
Difficult outdoors on uneven terrain to get four prongs flat on ground
Heavy for some patients to hold
FITTING:
As per single prong stick

24. Wheelchair (W/C)

25. Wheelchair (W/C) Advantages:
Allows more dependent patients to mobilise
Allows patients with poor exercise tolerance to mobilise longer distances/outdoors
Disadvantages:
Large and may not be home accessible
Need good shoulder function
Speak to OT if needing to prescribe

26. Provision of Other Devices
Ankle Foot Orthosis (AFO)
For patients with a foot drop, as a result of CVA or peripheral neuropathy.
Zimmer splints
for example for distal femoral # to restrict knee ROM,
useful for patients with knee flexion contractures to provide prolonged stretch,
useful for patients with poor knee control to mobilise with splint holding knee in extension.
Other
Pre and post spirometry
Incentive spirometers
Slings, Collar and cuffs
Hoists
Etac turner
Slide transfer board

27. NWB Ankle