Locomotion and Assistive Technology
Locomotion and Assistive Technology
An assistive/ ambulation device is used to help a client with balance, strength, mobility, independence, and can help decrease pain. Fitting them properly is important to ensure safety and to decrease further injury. Nobody is the same size so knowing how to adjust them per client is important for the individual needs. Inaccurate fitting can further injure the client or make them uncomfortable, causing other negative compensating movements. Improper fittings can also increase the risk for falling or tripping
Canes:
Fitting:
Canes are the easiest to move around the environment, but the least stable. To fit a cane, the client should stand straight up and look ahead, with their arms to their side. There are a few different types of canes, depending on the client’s needs, mobility, and balance. There are standard canes and quad canes. Standard canes have one leg which provides 4 point of contact. Quad canes have 4 legs, which provide 4 points of contact, which has a little more stability. There are also narrow and wide base quad canes, which are similar, but the wide base is a little bit more stable.
We need to make sure the client is stable standing up, so balancing them or being cautious when they are standing is important. The handle needs to be in line with the wrist crease ulnar styloid, or greater trochanter. The elbow should be slightly flexed at 20-30 degrees. The cane should be on the unaffected side, and for quad canes, the wider legs should be pointing away from the client. To fit the cane up or down, you release the locking mechanism to then move the buttons where they need to go.
Transferring and Ambulation:
For a client to stand up from a seating position, the need to be on the edge of the bed to decrease their base of support making it easier to stand up. Their feet need to be flat on the ground, with their toes under their knees. Have them have one hand on the cane on the uninvolved side, and then one on the surface they are sitting on to push themselves to the standing position. When moving around, the client should put pressure on the cane and affected leg at the same time to release pressure from the injured leg. They can then step through with the uninvolved leg. The pattern should be cane and involved leg, and then uninvolved leg. Once they are ready to sit back down, they need to turn around and have their legs against the surface that they are ready to sit down on. The client should then put one hand on the surface and one hand on the cane and slowly go back down. They need to sit down slowly. Ambulation using a quad cane is the same for when using a standard cane, except when sitting down or standing up. When using a quad cane, the person should not hold onto the cane when standing up or sitting down. Instead, they should hold onto the surface with both hands.
Safety:
Make sure that the cane is never too far out in front of them or too close.
Quad cane legs should be positioned to where the shorter legs are towards the client, and the long ones are away.
Use a gait belt when training client in case they fall.
Axillary & Loftstrand Crutches:
Fitting:
Axillary crutches are what we think of as "standard crutches". They are lightweight and durable, and less expensive. To fit axillary crutches, there are two adjustments that need to be made. The axillary rest should be 5cm or 3 fingers below the axilla. Like the cane, the hand grips should be in line with the greater trochanter, wrist crease, or ulnar styloid. The elbows should be in slight flexion.
Forearm crutches allow the use of hands while keeping the crutch in place. This helps the strain on the arms and the axilla. Forearm crutches also have two adjustments. The cuff should be about 2/3 the ways up the forearm. It should not be on or above the elbow. The handgrip is the same as the axillary crutches. The grip should be in line with the greater trochanter, wrist crease, or ulnar styloid. The elbows should be in slight flexion. The handle should also be facing forward.
Transferring and Ambulation:
When going from sitting to standing using axillary crutches, the client should scoot to the edge of the surface with both crutches on the affected side. To stand, they should push with one hand on the surface, and one hand on the crutches. Once standing and balanced, the client can then move the second crutch to the unaffected side.
While navigating the environment with axillary crutches, weight should be on the handgrips, not the axilla. If the client is non-weight bearing on their affected leg, they should keep it extended off the ground. They should swing through the crutches, in the pattern: crutches, unweight, swing through.
Once they are ready to sit back down, the client should turn around and leg their legs touch the edge of the surface they will be sitting on. They should then place the crutches back on the affected side and hold the handgrips. Then they reach back on the surface to support them siting down. These steps are the same as from sitting to stand, only this time they are sitting back. If they are non-weight bearing, the extended involved leg should be in front and off the ground.
For forearm crutches, these movements are almost the same other than a few small differences. Once standing, the client should place their arm in the forearm cuff. The handgrip should be facing forward unless the client wants to place them perpendicular to each other during standing.
Safety:
Have the client avoid having the crutches too far in front of them, as this can cause bad posture and further injure the client.
Avoid having them rest on the axilla part of the axillary crutches, as this can cause injury to the brachial plexus.
Always use a gait belt during training.
Walkers:
Fitting:
Walkers offer the most stability. They are beneficial when weight bearing is limited, and they are lightweight and can fold. They have 4 points of contact and come in different forms. Rolling walking provide a lot of stability, but they are less stable than normal walkers due to their wheels. While fitting rolling walkers, the handles should be positioned at the level of the greater trochanter. Platforms are additional devices that can be added to a walker to ensure there is no weight bearing through the client’s wrist or hand or they have weak trunk support. The platform should be positioned to allow weight bearing through the forearm when the elbow is bent to 90 degrees. The client should be able to stand tall with their scapula relaxed. The proximal ulna should be positioned 1-2 inches off the platform in order to avoid nerve compression. The platform handle should be positioned medially for the client to grip comfortably.
Transferring and Ambulation:
When the client is sitting and is ready to stand, there are some steps involving the walker. The walker should be placed in front of the client. They should then scoot to the front of their seat and use both hands on the surface to push themselves up. Do not let the client use the walker to stand up. This is too unstable and dangerous. Once they are standing, they can place both hands on the walker. If the walker is a platform walker, they should place their arms on the platform after they are standing.
Once up, the client can start walking around. They should not push the walker more than an arm’s length, and their involved leg should be forward. They should transfer their weight onto their hands. Their pattern should be walker, unweight, swing through. By putting more weight onto their wrists, arms, and unaffected leg, they are protecting their affected leg. This is the same for a platform walker, except the weight is on their forearms.
Once the client is ready to sit back down, the steps are the same as standing up. They should back up until the back of their legs touch the surface they are going to sit on. If they are non-weight-bearing, they should extend the leg off the ground. They need to reach back with both hands and lean forward while sitting down. They should not hold onto the walker as they sit down!
Safety:
The walker should never be used as support for sitting and standing.
Use a gait belt while helping client.
The walker should not be too far or too close to the client, as this can cause tripping or falling forward. Too far can cause posture problems and back pain.
References:
Giles, A. K. & Kraft, S. (2019). MOBI– Mobility Aids. Available from
https://itunes.apple.com/us/app/mobi-mobility-aids-id1205309397?
Weisser-Pike, O. (2023, June). Lecture 12: Gait & Locomotion. OT 430 Biomechanics, University of Tennessee Health Science Center.
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