ASSISTIVE DEVICES

BY SHIELAH VIC T. PERJES,RN,CNN

ASSISTIVE DEVICES are….

commonly used assistive devices relating to

mobility and ambulation include canes,
walkers, wheelchairs, crutches, and
prosthetic limbs.
Barriers to Assistive Devices

UNICEF describes barriers to individuals using assistive devices as follows [2]:

 Lack of awareness
 Lack of governance including legislation, policies and national programmes
 Lack of services
 Lack of products
 Inaccessible environments
 Lack of human resources
 Financial barriers
Strategies for Providing Assistive Devices

As per UNICEF, strategies for providing assistive technology/ devices need to consider the
principles of 5 As &Q [2]:
 Availability
 Accessibility
 Affordability
 Adaptability
 Acceptability
 Quality
Availability
 Services and products are available in sufficient quantity as close as possible to children’s
communities.
Accessibility
 Services and products are accessible to everyone who needs them. Their delivery should
be equitable to avoid discrepancies between genders, impairment groups, socioeconomic
groups and geographic regions.
Affordability
 Services and products are affordable to everyone who needs them.
Adaptability
 Services and products are adapted and modified to ensure they are appropriate to the needs and requirements
of individuals. They need to accommodate differences in terms of individual factors (for example, health
condition, body structure, body function, capacity, gender, age, ethnicity and preference) as well as
environmental factors (for example, physical environment, psychosocial environment, climate and culture).
Acceptability
 Services and products are acceptable to everyone. Factors such as efficiency, reliability, simplicity, safety,
comfort and aesthetics should be taken into account to ensure that devices and related services are
acceptable.
Quality
 Services and products are of appropriate quality. Product quality can be measured through applicable
technical standards or guidelines in terms of strength, durability, capacity, safety and comfort.
Types of Assistive Devices
•Mobility
• Wheelchairs
• Canes
• Crutches
• Walkers or walking frames
• Walking stick
• Tricycles
• White cane
• Prosthetics
• Clubfoot brace
•Vision
• Eyeglasses, magnifier, magnifying software for computer
• Communication cards
• GPs app for walking poles
•Hearing
• Hearing aids
• Hearing loops
•Positioning
• Cushions
• Splints
•Communication
• Communication Cards
• Communication Boards that use eye movements
• Picture Based Instructions / Picture Exchange
Communication System
• Communication Electronic Devices
WHEELCHAIR

 Wheelchairs provide mobility, postural support and freedom to

those who cannot walk or have difficulty walking, enabling them to
move around, participate in everyday activities and live life on their
own terms.
3 CATEGORIES OF WHEELCHAIR
 Manual Wheelchairs
 Power Wheelchairs
 Transport Wheelchairs
Manual Wheelchairs

1. Lightweight Wheelchairs
 13.5 LBS. FEATHERWEIGHT WHEELCHAIR
 The featherweight wheelchair is the world’s lightest wheelchair, weighing only 13.5 lbs.
Anyone can effortlessly raise the wheelchair, fold it up, and conveniently store it in the
back of their car. The wheelchair was designed with safety in mind, including a wheel
lock that stops it from sliding forward or backward. The wheelchair comes with green,
blue, and red seat choices, allowing you to ride in style.
FEATHERWEIGHT WHEELCHAIR

 Transporting the Feather Chair™ could not be easier. The

chair folds down into a compact package of 29” x 28” x
15”. Optional, quick-release wheels allow a caregiver to
remove the larger, back wheels with the push of the button
making the chair even lighter and more compact.Standard
features include wheel lock breaks, easily accessible by
the seated user, at the front of the frame. We added
additional hand breaks at the rear of the chair for the
caregiver. These handbrakes provide the caregiver control,
security, and convenience to stop or slow down the chair
at any time even when descending or pausing in a slope.
2. Standard Weight

 INVACARE TRACER EX2 WHEELCHAIR (36LBS.)

 The Invacare manual wheelchair establishes a high standard for
manual wheelchairs. It offers the choice of a removable full-length
or desk-length armchair. The carbon steel frame is long-lasting. The
hemi seat floor length height makes it easier for users to operate the
wheelchair, and the wheel locks keep you safe.
Invacare Tracer EX2 36 lbs. Wheelchair

 The Invacare Tracer EX2 Manual Wheelchair

sets the standard in manual wheelchairs.
Choose between desk-length or full-length
armrests plus a full range of accessories.
Standard features on this wheelchair include
8" solid rubber casters, composite handrims,
black vinyl upholstery, padded armrest pads
and wheel locks.The EX2 offers a hemi seat-
to-floor height, which allows seated users to
propel their chair with their feet. Five-year
warranty on frame and cross-braces. Meets
RESNA standards for manual wheelchairs in
product performance.
3. Reclining Back

 PROBASICS RECLINING MANUAL

WHEELCHAIR
 The ProBasics reclining wheelchair allows
users to recline from 90 to 160-degree angles.
It has a 13-inch-long headrest that gives
maximum comfort. If you have difficulty
getting out of your wheelchair, recline it and
relax comfortably on it. A chip-resistant and
long-lasting silver varnish protect its frame.
These lightweight wheelchairs come with
wheels positioned back on the frame to
prevent the user from tipping over while
reclining.
4. Heavy Duty

The featherweight wide seat HD wheelchair is the most lightweight heavy-duty wheelchair to
date. A 22-inch broad seat makes sitting on the feather weight wide seat HD
wheelchair pleasant. It also weighs only 22 lbs. and has a 350lb capacity. If you have used
wheelchairs for some time, you must know how heavy-duty wheelchairs are extremely heavy/
 Hence, to make it easier to transport a wheelchair and load it into a car, we created this
fantastic wheelchair that only weighs 22 lbs. and has a capacity of 250 lbs. The pop-off
wheels also allow you to reduce the weight even further. The weight of the wheelchair is
only 15 lbs. when the wheels are removed.
 With a full-length armrest and a swing-away footrest, you can move around in the
wheelchair and sit for long periods without becoming uncomfortable.
5. Rigid Ultra-Light Weight

 QUICKIE 5R (LIGHTWEIGHT WHEELCHAIR)

 If you are looking for rigid and lightweight wheelchairs,
the quickie 5R is one of the ideal options. The Quickie 5R
is made to adjust to any environment. It comes with two
options: a traditional frame and a shortened performance
frame length. The color can be customized from 25
unique color options.
6. Sport Wheelchairs

 QUICKIE TITANIUM MATCH POINT WHEELCHAIR

 The Quickie Titanium tennis wheelchair has a lightweight frame
that allows users to maneuver and move at the pace demanded for
playing tennis. The strong caster wheels prevent speed and mobility
from being consumed by the wheels. The titanium frame is robust
and durable, and it will last you many games without being
harmed. The wheelchair can accommodate users weighing up to
250 lbs.
7. Beach Wheelchairs

 MOBI-CHAIR (FLOATING BEACH WHEEL CHAIR)

 The Mobi chair is a revolutionary beach chair that provides
mobility assistance to individuals with injuries or other forms of
impaired movement to enjoy the beach. The wheelchair has
pneumatic tires that make it easier to maneuver in beach
environments.
 The steal is noncorrosive, and the wheelchair has a marine-grade
aluminum body, making it long-lasting and sturdy. It is also one of
the lightest wheelchairs available, and the quick-release
components make it simple to disassemble and transport.
8. Pediatric Wheelchairs

 ZIGGO LIGHTWEIGHT WHEELCHAIR (FOR KIDS)

 Lightweight wheelchairs are ideal for children since they allow them to move
freely without managing a bulky wheelchair. The chair weighs only 28 lbs.
without the pop-off wheels. The wheelchair is designed to meet the needs of
children with various impairments.
 The headrest provides neck support to children who may require it. The
elevating leg rests let children raise their legs for improved blood circulation.
The safety harness and anti-tippers guarantee no accidents occur while your
child is in the wheelchair.
9. Bathroom Wheelchairs

 AQUATEC OCEAN ERGO SHOWER

CHAIR COMMODE
 The aquatic ocean chair is a shower chair that
also functions as a commode. This innovative
wheelchair can easily be maneuvered in tight
places and allows users to perform personal
care tasks more conveniently.
The wheelchair has several features, including
an adjustable seat and footrest that can be
adjusted without needing tools.
10. Commercial Use Wheelchairs

 Commercial wheelchairs are not typically bought for a single user. The terminal
wheelchair, for example, is used to transport passengers with mobility challenges
from the airport to their planes.
 HEAVY DUTY WHEELCHAIR
 The heavy-duty transport wheelchair has a robust reinforced steel frame that can
support individuals weighing up to 450 pounds. It has desk-length removable
armrests and adjustable leg support to offer users comfort. The wheelchairs also
have flat-free tires, so you don’t have to worry about transferring to new
wheelchairs in the middle of the airport while rushing to catch your flight.
Power Wheelchairs
1. Lightweight
Featherweight Electric Wheelchair (Power Chair)
A featherweight electric wheelchair is an excellent option if you want an affordable and
lightweight electric wheelchair. This power chair is a game changer since it folds to a
small size. If you’ve ever used a power chair, you know how difficult it is to disassemble
it into a few pieces to fit it into a car. However, thanks to the innovative design of the
featherweight electric wheelchair, the seat shrinks to 13 inches, and the back folds
down to 28 inches.
Hence, the wheelchair folds up tiny enough to fit into any car or coat closet. Users
enjoy complete independence since they can operate the featherweight power chair
independently. Moreover, it only weighs around 33 lbs.; the best thing is that a single
battery charge may take up to 13 miles.
All airlines accept these electric wheelchairs as the Lithium-ion batbattery is removable,
so you can conveniently travel with them. The one-inch seat and soft back cushions
add to the comfort of sitting in this wheelchair. The armrests have a soft padding, and
you can push them back to sit and get up whenever you need them quickly.
2. Folding/Portable
2. Folding/Portable
MOVE LITE FOLDING POWER CHAIR
This electric mobility chair is one of the lightest foldable
electric wheelchairs on the market. It weighs lbs. and can be folded
into a sin

 MOVE LITE FOLDING POWER CHAIR

 This electric mobility chair is one of the lightest foldable electric wheelchairs on
the market. It weighs lbs. and can be folded into a sin
 single piece without disassembling. It is made of long-lasting, sturdy, and
lightweight aluminum. This wheelchair’s strong material can support people
weighing up to 300 pounds.
 The tires are flat-free, so you can effortlessly operate the wheelchair across
rugged terrain without worrying about the tire falling flat. The wheelchair has a
horn and adjustable speed control for safety. The wheelchair can easily be fit into
any vehicle and is also approved by airlines
3. Outdoor

 EVOLT TRAVELER POWER CHAIR

 The eVolt electric wheelchair is powered
by two strong motors totaling 500 watts.
It also has large 12-inch wheels that allow
users to navigate rough terrain
comfortably. This foldable electric
wheelchair folds in 3 seconds and fits in
the trunk of any car. It also weighs only
48 lbs., making it easy to transport.
4.
Heavy-Duty
GOLDEN COMPASS (HEAVY-DUTY
POWER CHAIR)
 The golden compass electric wheelchair
features a foldable seat hinge design and
the regular two-tone captain seat. The
revolutionary sliding seat system makes
seat removal simple and quick. The
wheelchair has adjustable head and
armrests for maximum comfort as you do
your daily chores. It also includes two
batteries with a one-year warranty.
Transport Wheelchairs

 Transport wheelchairs vary from regular wheelchairs in that they have four small
wheels instead of two small and two big wheels. These wheelchairs are only
designed for transportation. Moreover, they should only be pushed by attendants
or caregivers, and riders should not attempt to use them on their own.
 1. Transport Chairs
 DRIVE ALUMINUM TRANSPORT WHEELCHAIR
 2. Travel Chairs
 NISSIN LIGHT-WEIGHT TRAVEL CHAIR
 3. Heavy Duty
 NOVA TRANSPORT CHAIR (12-INCH REAR WHEELS AND
REMOVABLE ARMS)
CANES

 Canes or walking sticks are designed to:

 Provide balance support in standing and walking
 Take some pressure off one or both legs
 Improve sensory feedback for safety and security when
walking
s
y of handgrips are available, each with characteristics that may be beneficial to a given patient.

Type of Hand Grip Benefit[9]

Anatomical Handle Stable and comfortable; force through handle kept directly over shaft

Crook Handle Allows for fluid movement of cane; typically one piece construction offering
great strength
Derby Handle Stable; similar to anatomical handle; often separate from shaft allowing
customizability
Fritz Handle Flatter handle intended to be more comfortable for those with arthritis of the
hand

Contour Handle Handle is contoured to the hand of the user offering stability and greater ease
of holding
Palm Grip / Fisher Wide flat handle that offers greater comfort for those with pain or arthritis of
the hand
Three major varieties of canes are available and
offer a range of support
 Standard cane
 Offset cane
 Quadriped cane
Measuring/Fitting Canes
 To measure the height of any cane the following procedure should
be used:
 Have the patient stand upright, with a normal stance, arms at the
sides, and shoulders relaxed
 The tip of the cane is positioned touching the floor, next to the
small toe, OPPOSITE the involved or weaker side
 The height of the cane is adjusted so the handle sits at the level of
the ulnar styloid process (fold of the wrist) with the arm still at the
side
 **When fitting a quad cane, be sure to orient it properly - the
shorter legs are ALWAYS closer to the body to reduce tripping risk
How to use a Cane
Gait
Canes should be used on the unaffected/strongest side of the body, so that
support can be provided while the weaker side is bearing weight. The one
instance where this does not apply is if there is a specific therapy goal of
promoting increased weight bearing on the weaker or affected side. This
instance will be initiated and guided by a physical therapist. [12]
Basic gait pattern with a cane:[12]
•Advance the cane approximately one step length
•Advance the affected/weaker leg, placing it in line with the cane
•Shift weight to the cane and affected/weaker leg, and then advance the
unaffected/stronger leg
• Begin with a step-to pattern, advancing the unaffected/stronger leg to a
point in line with the cane and other leg
• Progress to step-through pattern, where the unaffected/stronger leg is
advanced past the cane and other leg
Stairs
Ascending stairs with a handrail:[12]
•Grasp the handrail with the hand opposite the cane
•Raise the unaffected/stronger leg to the next step
•Step up, bringing the affected/weaker leg and cane up to the step with the other
Descending stairs with a handrail:[12]
•Grasp the handrail with the hand opposite the cane
•Place the cane on the next lower step
•Lower the affected/weaker leg to the same step as the cane
•Shift weight to the cane, affected/weaker leg, and handrail before bringing the
remaining leg down to the lower step
Sit to Stand
From sitting to standing:[12][15]
1.Position the cane on the unaffected side of the user
2.Ask the user to move to the edge of the seat before
3.One hand is placed on the armrest/seat and the other holds the
cane
4.Use the hand on the chair and the cane to provide support to
come up to the standing position
5.Make sure the cane is 2 inches in front of the affected leg and 6
inches to the side of the affected leg
Standing to sitting:[12][15]
1.Instruct the user to approach the chair (or bed), and turn toward
the stronger side until the back is facing the chair or bed
2.Assist the user to back up to the chair until the chair can be felt
against the back of their legs
3.Instruct the user to reach for the armrest, chair seat, or bed with
the free hand
4.The user then lowers themselves into the chair in a controlled
manner using the cane and chair/bed surface for support
Safety Tips
Inspect the cane on a regular basis. Make sure the
cane has a rubber top for shock absorption and
grip to prevent slipping. Always check the cane
for worn tips and handles. Always make sure that
the cane is at proper height to avoid imbalance
and bad posture.[17]
CRUTCHES

 Crutches are a type of walking aid that serve to increase

the size of an individual's base of support. They transfer
weight from the legs to the upper body and are often used
by people who cannot use their legs to support their
weight (from short-term injuries to lifelong disabilities).
Crutch Type

•Axilla or underarm crutches: They should be positioned with 2 fingers of distance

between the axilla and the axilla pad with the elbow flexed between 20-30 degrees. [1] The
design includes an axilla bar, a handpiece and double uprights joined distally by a single
leg. They are adjustable in height; both the overall height and handgrip height can be
adjusted (adjustable approximately 48 to 60 inches / 12 to 153 cm).[2]
•Forearm crutches: (or lofstrand, elbow or Canadian crutches). Their design includes a
single upright, a forearm cuff and a handgrip. The height of forearm crutches is indicated
from handgrip to the floor (adjustable from 29 to 35 inches / 74 to 89 cm). [2]
•Gutter Crutches: (or adjustable arthritic crutches, forearm support crutches) An
additional type of crutch, which is composed of a padded forearm support, made up of
metal, a strap and adjustable handpiece with a rubber ferrule. These crutches are used for
patients who are partial weight bearing, and are particularly useful for clients with
rheumatoid conditions.[3]
Walking Pattern
There are several different walking patterns an individual using
crutches may adopt,] including:
•Two-point crutch gait: Please note the difference between two-
point gait and two-point crutch gait. In two-point crutch gait, the
crutches and the non-weight bearing / affected limb (due to fracture,
amputation, joint replacement etc) make up one point and the
uninvolved leg makes up the other point. The crutches and affected
limb are advanced as one unit, and the uninvolved weight-bearing
limb is brought forward to the crutches as the second unit. This gait
pattern is less stable as only two points are in contact with floor.
Thus, good balance is needed to achieve two-point crutch gait.

•Two-point gait: the right foot and left crutch are advanced
simultaneously, followed by the left foot and right crutch. There are
two points in contact with the floor at any one time!
•Three-point: this gait pattern is used when one of the lower extremities (LE) is
unable to fully bear weight (due to fracture, amputation, joint replacement etc).
There are three points of contact with the floor. The crutches serve as one point,
the involved leg as the second point, and the uninvolved leg as the third point.
Both crutches move forward, the affected limb then steps up to the crutches. This
is followed by the weight-bearing limb which steps through, beyond the
crutches. There are always three points of contact with the floor at any given
time.[6]
•Four-point: this gait pattern is used when there is a lack of coordination, poor
balance and muscle weakness in both LE. This is because it provides a slow and
stable gait pattern with four points of support. Point one is the crutch on the
involved side, point two is the uninvolved leg, point three is the involved leg,
and point four is the crutch on the uninvolved side. The crutches and limbs are
advanced separately, with three of the four points on the ground and bearing
weight at any given time.
•Step-to: the fractured/injured limb is advanced, and then the
intact limb is brought to the same position. When weight-bearing
status is restricted to partial, toe-touch, or as tolerated, crutches or
a walker are necessary. They help the patient step to the
fractured/injured limb by pushing down with the upper
extremities, thus transferring weight from the fractured/injured
limb to the assistive device.
•Step-through: Firstly, the fractured/injured leg goes forward.
Then, the intact leg is advanced past the injured leg. With
restricted weight-bearing, crutches are used instead of the injured
limb; the patient steps past the crutches with the weight-bearing
lower extremity. Thus, the gait assumes a two-point or three-point
pattern.
WALKERS

 A walker is a walking aid that provides a wider base of support

than a walking stick. It usually has three sides with the side closest
to the patient being open. While walkers are often used to help
stabilise patients with poor balance and mobility or lower extremity
impairment,[1] their use has been associated with an increased risk
of falls in both community-dwellers and those who live in
residential care.
Types of Walkers
Many walkers exist on the market, but physiotherapists are well placed to help select the
correct walker based on the differing needs of users.[13]
Four Wheeled Walker
•Wheel size: large wheels for outdoors, small wheels for indoors.
•Push down brakes or grip on brakes.
•Ability to be folded.
•Made of lightweight material such as carbon fiber or aluminum, which makes. traveling
with the frame easier.
•Trays, seats and baskets may be attached.
•Other modifications such as a light that projects a red line on the ground in order to guide
step length in individuals with Parkinson's
Gutter Frame Walkers/Platform Walkers/Podium Walkers/Pulpit Frame
Walkers/Upright Walkers
•Going by several different names and with several different styles, these four
wheeled walkers are for users who need more support. The user weight bears
through their forearms on supports, with the elbows flexed to approximately 90
degrees

Two Wheeled Walkers

Two front legs have wheels, no wheels on the two rear legs
Made of aluminum
Usually fold flat for transport and storage
No brakes
Standard Walker/Four Point Walker/Zimmer Frame
Four legs, no wheels