PPT Clinical Resource - Walking aid prescription

Report
Calvary Health Care Sydney
WALKING AID
PRESCRIPTION
Updated May 2013
Why Use Walking Aids?
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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
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In many cases it will be a combination of the above
May be temporary while recovering from surgery, or permanent
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Aim is to provide the support required but allow as normal a gait
pattern as possible.
Pain management/falls prevention!
Considerations in Selecting a
Walking Aid
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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
TYPES OF WALKING AIDS
People
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
Parallel Bars
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
Forearm Support Frame (FASF)
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.
Pick Up Frame (PUF)
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
2 Wheel Rollator (2WRF)
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
4 Wheel Rollator (4WRF)
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
Crutches
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.
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
Single Prong Stick (SPS)
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 15-30 degrees
Four Prong Stick (FPS)
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
Wheelchair (W/C)
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
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
NWB Ankle

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