Presentation on theme: "WALKING AID PRESCRIPTION"— Presentation transcript:
1WALKING AID PRESCRIPTION Calvary Health Care SydneyWALKING AID PRESCRIPTIONUpdated May 2013
2Why Use Walking Aids? Provide support Reducing or totally relieving weight and therefore painE.g. Recent fractures/surgery of lower extremityProvide stabilityE.g. For decreased balance, an amputee, paraplegic, or weaknessRelieve PainE.g. Severe OAIn many cases it will be a combination of the aboveMay be temporary while recovering from surgery, or permanentAim is to provide the support required but allow as normal a gait pattern as possible.Pain management/falls prevention!
3Considerations in Selecting a Walking Aid Age and functional needs of the personNature and pathology of the diseaseE.g. fractures, sprains, rheumatoid arthritis, medications causing dizzinessThe extent of disabilityJoint 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 aidShort or long term basisRequires 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
8Parallel Bars Advantages: Stable for practicing walking/balance in the gym provides maximal supportUseful for initial training prior to walking stick, crutchesDisadvantages:Not readily availableCannot mimic normal gaitDifficult to wean off if on them too longDoes not train balance, obviously very restrictive
10Forearm Support Frame (FASF) May have 2 wheels or 4 wheels: 2 wheels have increased stability, 4 wheels allow increased mobilityAdvantages:Provides +++ support so able to take weight through arms for initially post op # NOF, hip replacement etcVery supportive to compensate for very poor balanceUsed 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 framesDisadvantages:Large and may not be compatible with peoples homes especially bathroomsnot really community accessibleFITTINGShoulders 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.
12Pick Up Frame (PUF) Advantages: Usually light weight aluminium May fold up to go in carProgression from FASFDisadvantages:Only allows step to gaitSlow 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 deviceCannot be used on stepsProvides maximal supportDifficult to negotiate small spaces
142 Wheel Rollator (2WRF) Advantages: Light weight and transportable Normal gait can developIncreased stability due to skis/stoppers on back and rigid front wheelsGood progression from FASFDisadvantages:Difficult to maintain contact with ground and turnCannot be used on stepsDifficult to negotiate small spaces.FITTING:Patient erect, arms at comfortable angle
164 Wheel Rollator (4WRF) Advantages: Light weight and transportable Normal gait can develop, step through with increased speedHas accessories such as seats, brakes, (pull up or push down), and baskets enabling them to carry things increasing independenceDisadvantages:Decreased stability due to 4 wheels, some have 2 wheels and skids which have increased stabilityFITTING:Patient erect, arms at comfortable angleImportant 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.
18Auxiliary Crutches Advantages: Cheap Adjustable Readily available Disadvantages:They are difficult to stowTemptation to weight bear under axilla leading to potential danger to axillary vessels and nervesBoth 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.
19Elbow or Canadian Crutches Advantages:Shorter and easier to store, possible to free hands.Cheap and adjustableDisadvantages:Need more control of shoulder and elbows.FITTING:As per Auxiliary crutches
21Single Prong Stick (SPS) Advantages:Light and cheapEasily managedReadily available one hand available for tasksCommunity accessibleFor patients requiring minimal supportDecreases the load on the hip contralateral to the hand it is heldDisadvantages:Provide little stabilityCannot NWB/TWBNeed good wrist strength and rhythmFITTING:Elbow flexion is at degrees
23Four Prong Stick (FPS) Advantages: Provides stability in standing Most supportive device if 1 UL not functionalDisadvantages:Normal gait impossible because it promotes uneven weight bearing towards side of stickDifficult outdoors on uneven terrain to get four prongs flat on groundHeavy for some patients to holdFITTING:As per single prong stick
25Wheelchair (W/C) Advantages: Allows more dependent patients to mobiliseAllows patients with poor exercise tolerance to mobilise longer distances/outdoorsDisadvantages:Large and may not be home accessibleNeed good shoulder functionSpeak to OT if needing to prescribe
26Provision of Other Devices Ankle Foot Orthosis (AFO)For patients with a foot drop, as a result of CVA or peripheral neuropathy.Zimmer splintsfor 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.OtherPre and post spirometryIncentive spirometersSlings, Collar and cuffsHoistsEtac turnerSlide transfer board