ASSISTIVE DEVICES

By:

Roel B. del Rosario, PTRP

Instructor – PT1
 ASSISTIVE DEVICES

FUNCTION:
1. Widen base of support
2. Reduce weight bearing
3. Improve balance
4. Provide support for weak and/or
paralyzed muscles thereby allowing
mobility
PRESCRIBES FOR PATIENTS WITH;

1. poor balance (elderly pt’s, ataxic pt’s, CP

(etc..)
2. pain in the LE (e.q. arthritis, OA, Fx etc…)
3. fatigue
4. LE muscle weakness
5. excessive loading due to deformity
LIST OF AMBULATION AIDS:
►from MOST stable/supportive
to LEAST stable/supportive
1. PARALLEL BARS:
►most stable and provides greatest
support
2. WALKER
3. AXILLARY CRUTCHES
4. FOREARM CRUTCHES
4.1 LOFTSTRAND CRUTCH
4.2 CANADIAN CRUTCH
5. TWO CANES
6. ONE CANE: LEAST stable and supportive
LIST OF AMBULATION AIDS:
►from MOST required coordination to
LEAST required coordination.

1. CRUTCHES
2. CANE
3. WALKER
4. PARALLEL BARS
PARALLEL BARS:
►HEIGHT: should be level with the greater
trochanter
►or level with the ulnar styloid process
when the arm is extended & adducted to
the side of the body.
►places the elbow in 15-25º flexion
►WIDTH: 2 inch gap or space between the
greater trochanter & the bar on each side.
►ARMS/HAND: 6 inches ant. to the hip jt.
PARALLEL BARS
WALKER
WALKER:
►ideal when safety is the main
consideration
► often used in early ambulation training before
going to a lesser support assistive devices
► needs the ability to bear at least partial weight
on both legs (PWB)
► can be adjusted or nonadjustable
► folding or non folding
►INDICATION:
1. patient’s with poor balance
2. best suited also for confused patient
ADVANTAGE OF WALKER:

1. provides maximum support as compared to

cane and crutches
2. has wide base for support
3. greater stability than quadruped cane
4. provides stability with bilateral lower limb
weakness
DISADVANTAGE OF WALKER:
1. cumbersome: occupies more space; cannot
fit all through passages
2. difficult to store and transport if not
foldable
3. limited to indoor use
4. difficult to use & cannot be used in stairs
5. allows only slow speed of ambulation (main)
6. inconvenient for use in narrow & crowded
places
7. dependency produce bad posture and
walking habits
 TYPES OF WALKER:

1. Standard walker
2. Two-wheeled walker
3. Four-wheeled walker
or Rolling walker
4. Reciprocal walker
 TYPES OF WALKER:

1. STANDARD WALKER:
► made and polished by aluminum
► has 4 legs and 4 rubber tips
► needs to be picked up to be used
► pt. requires partial strength in both
hands and wrist
 TYPES OF WALKER:

2. TWO-WHEELED WALKER:
►have 2 small wheels in front and 2
rubber tips at the back
►does not need to be picked up to be
moved
► used by pt’s who are too weak or unable
to pick up and move the walker
 TYPES OF WALKER:
3. FOUR-WHEELED WALKER:
►have 4 small wheels (front and back)
►does not need to be picked up to be
moved
► used by pt’s who are too weak or unable
to pick up and move the walker
► can be ordered with brakes
DISADVANTAGE:
► less stable as compared to the standard
walker
FOUR WHEELED WALKER
 TYPES OF WALKER:

4. RECIPROCAL WALKER:
HOW TO USE:
► the left side of the walker and the right
lower limb move forward together and vice
versa
ADVANTAGES:
► allows for a two-point gait
► provides greater stability than a cane
► permits fast gait
RECIPROCAL WALKER
HOW TO MEASURE: WALKER
1. STANDING:
►place walker 10-12” ant. to the pt.
►so that it partially surrounds him
►this is important for swing and drag gait
►HEIGHT: level with the greater
trochanter or ulnar styloid process
(when arms is at the side)
►places elbows in 15-20º flexion
►when used pt. should NOT swing the feet
to the level of the crossbar or beyond it.

►with standard walker can use;

1. 3 point gait
2. swing point gait
3. swing to gait
4. drag to gait
HOW TO USE: (with one leg involvement)

1. move walker 6-12 inches in front

2. followed by affected leg
3. then the sound leg/normal leg

GUARDING TECHNIQUES:
► always stay at the affected side and slightly at
the back of the pt.
WALKING CANE
CANES:
►customarily 36 inches
►can transmit 20-25% of the body weight
away from the LE
► adjustable or nonadjustable cane
► cane tips should have rubber caps/rubber
tips to provide friction against the ground
and minimize or prevent slipping
►single point of contact with body:
provided less support
►hold the cane on the stronger side
1. provide more physiological gait
2. UNILATERAL LE:
►this method will widen the BOS &
reduce stress on the opposite hip
because of the shift in COG produced
by the contralateral arm movement.
3. prevent lurching & tilting
4. cane held on same side/affected side:
►IF has instability of the affected limb
2º hip or knee pain/weakness
CONSTRUCTION/MADE OF;
1. WOODEN CANE:
ADVANTAGE:
► not expensive
► can be used in stairs as compared to the
standard walker
DISADVANTAGE:
► easily broken when it is frequently dropped
► point of support in front of hand
► has small base of support, no arm support
► non-adjustable
2. ALUMINUM CANE:
ADVANTAGE:
► light weight
► durable
► can be used in stairs
► adjustable
DISADVANTAGE:
► expensive
► point of support in front of hand
► has small base of support, no arm
support
 TYPES OF CANE:

1. STANDARD STRAIGHT LEGGED CANE

►has single point of contact
2. TRIPOD OR CRAB CANE
►has 3 feet
3. QUADRIPED CANE/QUAD CANE
►has 4 feet
TRIPOD CANE
 TYPES OF CANE:
3. QUADRIPED CANE/QUAD CANE
►has 4 feet
ADVANTAGE:
► bases available in several sizes
► provides the most support
► most stable of all types of cane
DISADVANTAGE:
► point of support not centered
► large size does not fit stairs
► difficult to carry up stairs while using handrail
HOW TO MEASURE:
►BEST fitted in standing position

METHOD 1:

STANDING POSITION:
►cane held parallel to femur, tibia & heel
►highest point of cane (handle):
should be level with the
GREATER TROCHANTER
HOW TO MEASURE:
►BEST fitted in standing position
METHOD 2:
STANDING POSITION:
►cane held parallel to femur, tibia & heel
►highest point of cane (handle):
should be level with the
GREATER TROCHANTER
►when holding the cane will put elbow
in 15-25º flexion
METHOD 3:
STANDING POSITION:
►place cane tip 6 inches lateral to the
base of the 5th toe
►highest point of cane: will now be level
with the ULNAR STYLOID PROCESS
►will place elbow in 20-30º flexion
Note:
►short cane: causes inefficient gait
►long cane: will place elbow in excessive
flexion increasing the demand for triceps &
shoulder muscles.
METHOD 1 in using a CANE:
1. move the cane 6-12 inches in front of the pt.
2. followed by the affected leg
3. then the sound leg/normal leg

METHOD 2 in using a CANE:

1. simultaneously move the cane 6-12 inches and
the affected leg forward
2. then the sound leg/normal leg
ASCENDING STAIRS:
1. sound/good leg first
2. followed by the affected leg
3. then the cane
GUARDING TECHNIQUE:
► stand at the affected side and slightly at the back
ASCENDING STAIRS: (ALTERNATE METHOD)
1. sound leg/normal leg first
2. simultaneously move the affected leg and the cane
GUARDING TECHNIQUE:
► stand at the affected side and slightly at the back
DESCENDING STAIRS:
1. cane
2. followed by the affected leg
3. then the good leg
GUARDING TECHNIQUE:
► stand on the affected side and slightly in front of
the patient
DESCENDING STAIRS: (ALTERNATE METHOD)
1. simultaneously move the cane and the affected leg
2. then good leg/sound leg/normal leg
GUARDING TECHNIQUE:
► stand on the affected side and slightly in front of
the patient
CRUTCHES:
► provides 2 points of contact with body so
better stability
► used with good to normal UE muscle
strength
► used when the pt. is unable to put complete
weight on one or both legs
► prescribed by a physician and fit by Physical
Therapist
► may free hand in opening doors by leaning on
shoulder piece
► can be made up of wooden or aluminum
PARTS OF AXILLARY CRUTCH
1. STANDARD WOODEN AXILLARY CRUTCHES:
ADVANTAGE:
► inexpensive
► provides lateral stability
► fits stairs/ can be used in stairs
DISADVANTAGE:
► easily broken if it is frequently dropped
► nonadjustable
► cumbersome
► tendency to exert axillary pressure resulting to
damage to radial nerve known as
“CRUTCH PALSY”
2. STANDARD ALUMINUM AXILLARY CRUTCHES:
ADVANTAGE:
► adjustable
► light weight
► durable
► fits stairs/ can be used in stairs
DISADVANTAGE:
► expensive
► cumbersome
► tendency to exert axillary pressure resulting to
damage to radial nerve known as
“CRUTCH PALSY”
► 2 BASIC TYPES:
1. AXILLARY CRUTCH
2. NON-AXILLARY CRUTCHES

1. AXILLARY CRUTCH:
►transfer as much as 80% of body weight
►better trunk support
►best for pt. with good trunk balance and
confidence with ambulation
2. NON-AXILLARY CRUTCH:
►transfer 40-45% of body weight
ADVANTAGES OF NON-AXILLARY:
1. Better maneuverability
2. Can free hand to open doors etc.. Without
dropping crutches
3. Less wear & tear on upper garment

DISADVANTAGES of AXILLARY CRUTCH:

1. Can cause CRUTCH PALSY
►due to radial nerve injury
2. Difficult to free 1 hand without dropping crutches or
without having to lean on it
NON-AXILLARY CRUTCH:
INDICATION:
1. persons who will need crutches
permanently
►but pt. must have stability strength &
coordination to use them since non-
axillary crutches provide less stability &
support compared to axillary crutches

►less weight when compared to axillary

crutches
SPECIFICATION ON CRUTCHES:

Rubber crutch tip:

►2 inches in height
►1.5 to 2 inches in diameter
►rubber suction tip
►place rubber pads in axillary crosspiece
or shoulder piece
►hand grip: should also be padded
CRUTCH ACCESSORIES:
1. TRICEPS BAND:
►for patient’s with triceps weakness
►metal cuff shaped band attached to
posterior upright about 3-4 inches above
elbow.
2. WRIST STRAP:
►for patient’s with weak wrist extensors
►FUNCTION:
1. to assist in holding hand grip
2. place around both uprights
SPECIAL CRUTCHES:

1. LOFSTRAND CRUTCH

2. TRICEPS or CANADIAN CRUTCH

3. PLATFORM CRUTCH
1. LOFSTRAND CRUTCH:
►MOST POPULAR non-axillary crutch
►fit with top of forearm cuff 1-1.5 inches
distal to the olecranon process when
patient grasp the hand piece
►cuff is applied to the forearm with wrist
in neutral position
►made of tubular aluminum with padded
hand bar and forearm cuff
►cuff helps stabilize forearm during weight
bearing
LOFTSTRAND CRUTCH
► cuffs: made of plastic or steel and may
be padded for comfort or to
reduce noise or clicking
► most useful substitute for canes because
forearm support stabilizes wrist during
weight bearing and makes ambulation
easier and safer
► person using 2 canes can’t free hand to
grasp stair rail open door handles or
adjust his clothes
ADVANTAGE (LOFSTRAND):
► using loftstrand crutch can release hand
to perform these tasks without dropping
the crutches
► less cumbersome
► fits stairs
► easy to use
DISADVANTAGE (LOFSTRAND):

► cuffs difficult to remove

► requires better control
► more expensive than wooden axillary
crutch
2. TRICEPS OR CANADIAN CRUTCH:
►for patient’s with TRICEPS WEAKNESS
►differs from Lofstrand because it has an
extension above the elbow
►thus have 2 cuffs: above & below elbow

ADVANTAGE of CANADIAN CRUTCH:

► aids weak elbow extensors
► fits stairs
TRICEPS OR CANADIAN
CRUTCH
DISADVANTAGE of CANADIAN CRUTCH:
► somewhat cumbersome
► cuffs difficult to remove

3. PLATFORM CRUTCH:
►for patient’s with ARTHRITIS with elbow
flexion contracture
►patient’s with weak or painful hand grip
Note: Have different ways of measuring crutch but
final fit done in STANDING POSITION
while pt. holds on to the device.
MEASUREMENT FOR CRUTCHES:
1. SUPINE:
A. WITH SHOE:
►measure from ant. axillary fold to sole
of the shoe
B. WITHOUT SHOE:
► measure from ant. axillary fold to heel
MALE: + I inch
FEMALE: + 1.5 inches
2. SUPINE:
►from ant. axillary fold to a point 6-8 inches
lateral to the patient’s heel
3. FOR AXILLARY CRUTCH ONLY:
►estimate length by getting 77% of the
patient’s height in inches
►patient’s height in inches minus 16 inches
4. SITTING:
►position patient with 1 UE in 90º shoulder
abduction with elbow flexed 90º while the
other UE is in 90º shoulder abduction with
elbow extended
 ►CRUTCH LENGTH: estimated by
measuring tip of flexed elbow to tip of
middle finger of the extended arm.
5. STANDING:
►BEST method for measuring crutches
►measure from a point 2 finger breadths
below the axilla from the anterior axillary
fold to a point 6 inches lateral to the 5th
toe.
IMPORTANT CRUTCH WALKING MUSCLES:
1. SCAPULAR DEPRESSORS:
►stabilize the UE & prevent hiking of the
shoulder on weight bearing
►latissimus dorsi, pectoralis minor
►lower trapezius ms
2. SHOULDER ADDUCTORS:
►hold the crutch top to the chest wall with
the arm
►pectoralis major, latissimus dorsi ms
3. SHOULDER FLEXORS, EXTENSORS, ABDUCTORS:
►enable placement of crutch forward,
backward & sideward respectively.
►deltoid ms
4. ELBOW EXTENSORS:
►stabilize the elbow joint in weight bearing
by preventing flexion or buckling
►together with shoulder depressors these
muscles are most important in raising the
body from the floor to allow the LE to
swing.
►triceps & anconeus ms
5. WRIST EXTENSORS:
►hold wrist in proper position to bear
weight on hand piece (although the
position of extension is more important
than the ms action)
►ext. carpi radialis longus, ext. carpi radialis
►
brevis & ext. carpi ulnaris ms
6. FINGER & THUMB FLEXORS:
►flexor digitorum superficialis, flexor
diditorum profundus, flexor pollicis longus
& flexor pollicis brevis ms
TYPES OF CRUTCH GAIT:
1. SWING THROUGH
2. SWING TO
3. 3 POINT GAIT (NWB)
4. 3 POINT GAIT (PWB)
5. 2 POINT GAIT
6. 4 POINT GAIT
7. DRAG TO GAIT
8. TRIPOD DRAG TO
Thank you…

Sir Roel