Therapeutic methods I

Mobility and mobility aids

Dr. Mahdi Khaled Qadir

mahdiqader@epu.edu.iq
 What is mobility
• Mobility is the body's ability to move
or be moved

• Mobilisation is the process by which a

part is made moveable, or motion is
restored to a fixed joint or body part
Problems in mobilising that may be
experienced by a person with a disability

• Handling food
• Manipulating clothes
• Positioning of limbs
• Weight bearing
• Use of devices to assist
mobility
• Co-ordination of muscles and
limbs
 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!

Considerations in Selecting a Walking Aid
1. Age and functional needs of the person

2. Nature and pathology of the disease

•E.g. fractures, sprains, rheumatoid arthritis,
medications causing dizziness

3. The extent of disability

•Joint range, pain, coordination, balance,
sensation, comprehension, communication
and sight.
4. 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
5. Short or long term basis

6. 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

NWB Ankle