Assistive Devices - Walker

Assistive Devices 

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Assistive devices for mobility/ambulation can be referred to as ambulatory aids. Ambulatory aids (canes, crutches, walkers) are used to provide an extension of the upper extremities to help transmit body weight and provide support for the patient.

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The type of ambulatory aid needed depends on how much balance and weight-bearing assistance is needed. Generally, the more disabled the individual is, the greater the complexity required in the walking device. A walker supplies the most support, and a standard cane or crutch provides the least

Uses of assistive devices include the following:  Redistribute and unload a weight-bearing lower limb  Improve balance  Reduce lower limb pain  Provide sensory feedback

Batavia and Hammer identified 4 key evaluation and selection criteria for long-term users of assistive devices :  Effectiveness - The extent to which the function of the device improves one's living situation, functional capability, or independence  Affordability - The extent to which the purchase, maintenance, or repair of the device causes financial difficulty  Operability - The extent to which the device is easy to operate and adequately responds to demands  Dependability - The extent to which the device operates with repeatable and predictable levels of accuracy under conditions of reasonable use

Assistive devices and their use for impairments 

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Moderate-to-severe unilateral weakness/hemiplegia -(Walk cane/ hemi-walker ) Bilateral lower extremity weakness/paralysis - Bilateral crutches or walker (pickup or front-wheeled)

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Severely impaired stability Walker (pickup or front-wheeled) Impaired wrist or hand function Platform forearm walker Difficulty climbing stairs - Stairclimbing walker

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Walker A walker has four broadly spaced posts that surround the person using it. Walkers can support up to 50% of body weight, so they may be useful for people who have a lot of weakness or problems on both sides

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Advantage - Maximum support for the patient Disadvantages • Slow and awkward gait • Creates bad posture and walking habits • Limited to indoor use in most cases • Cannot be safely used to climb stairs (especially the standard walker)

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Advantages and disadvantages are associated with the use of a walker and should be considered when prescribing a walker as an assistive device for any patient.

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Indications • Best suited for patients who are confused or who have an unsafe gait because of poor balance (patients with hemiplegia, patients with ataxia) • Early gait training

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Measuring prescription • Place the front of the walker 12 inches in front of the patient. The walker should partially surround the patient. • Measure the proper height of the walker by having the patient stand upright with his/her elbows flexed 20°.

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Components •Tubular aluminum or other tubular metal. •Plastic handgrips. •Rubber-tipped legs

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Types of Walkers Standard walker (pickup walker) Rolling walker (front-wheeled walker) Reciprocal walker Forearm support walker Stair-climbing walker Heavy-wheeled walker with foldaway seat and removable back

Standard walker (pickup walker)

Standard walker (pickup walker) 

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Most walkers are lightweight and very durable. Standard walkers have adjustable legs, accommodating a large percentage of patients. To use the standard walker for ambulation, the patient must have the upper extremity strength necessary to lift the device and place it forward.

Standard walker (pickup walker) Disadvantages :   

Bulky to transport (but most fold) Stairs and tight spaces are difficult (eg, people with Parkinson’s disease often tend to fall backward, making this type of walker inappropriate)

Rolling walker (front-wheeled walker)

Rolling walker (front-wheeled walker) 

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The rolling walker has wheels on the front legs; these wheels promote the walker's movement. The rolling walker does not require as much strength and balance to maneuver as the standard walker does, because the patient does not have to lift it from the floor. Rolling walkers are used by patients who, because of poor coordination of the upper extremity and trunk, are unable to lift the walker and move it forward.

Rolling walker (front-wheeled walker) 

Disadvantages • The front wheels may create instability if they are not used properly. • Proper supervised training session is required to ensure patient safety.

Reciprocal walker

Reciprocal walker 

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This device has swivel joints that permit reciprocal action, with each side of the walker moving in alternation with the other. An advantage of the reciprocal walker is that it allows a quicker and less awkward gait.

Forearm support walker

Forearm support walker 

Indications • Patients with forearm deformities (wrists or hands) or pain • Patients with elbow flexion contracture

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Disadvantage - Heavy

Stair-climbing walker

Stair-climbing walker 

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This device requires good balance and great strength of the upper extremities. The stair-climbing walker is prescribed for young patients with paraplegia. A U-shaped extension is a possible additional component. This extension provides extra support in order to enhance stability for stair climbing.

Heavy-wheeled walker with foldaway seat and removable back  

Indication - Indoor institutional use Disadvantage - Heavy, awkward, and unsafe

How to Use a Walker 

First, you have to consider the various available models of walkers. Do you want rubber grips, rubber tips, wheels, hand-brakes, accessories? Lightweight or heavyweight? The only way to know for sure is to go to a medical supply store and see for yourself.

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Once you have selected the model of walker you want, the "fit" of the walker becomes important. When holding on to your walker, your elbows should be bent in a position that feels comfortable and natural.

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The top of your walker should be even with the crease on the underside of your wrist, after relaxing your arms at your side. Walkers that are too low cause you to stoop over while you walk and not use proper body mechanics. If your walker is at the wrong height, the improper position will surely cause aches and pains.

Sitting With Your Walker 

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Back up until you feel the chair against the back of your legs. Slide your operated leg forward and lower yourself slowly into the chair using armrests. Try to sit in a chair that has armrests. DO NOT sit in rocking chairs or chairs with wheels

Standing With Your Walker 

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Scoot forward in the chair with your operated leg out in front of you. Use both arms to push yourself up to standing, then reach for the walker. Stand for a minute or so to be sure you feel stable and balanced.

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DO NOT pull up the walker when rising from sitting.

To walk With Your Walker 

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Keep your walker FLAT on the floor When you are ready to start walking, push the walker slightly ahead of you

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DO NOT lift the walker off the floor.

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then step into the walker. Keep that pattern going -- walker slightly ahead, then step into the walker. The key point is that you should never have the walker too far ahead of you and you should have excellent posture as you take your steps. Also, don't look at your feet -- look in front of you.

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DO NOT pivot too quickly. Take small steps and turn toward your strong leg.

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If you have trouble gripping the walker, platform walkers are available may prove to be a better option. They are not exactly attractive contraptions but they serve a purpose. The platform allows you to rest your elbow and forearm, taking stress off your hands.

What Are Body Mechanics? 

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Body mechanics pertain to the position of your body when it's moving. Proper body mechanics are important for everyone and especially for people with arthritis or other musculoskeletal conditions. Correct body position can help: relieve pain reduce stress on joints reduce the risk of injury

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With every movement, as you stand, sit, walk, drive, lift, reach, push, pull, exercise, and even sleep, it's important to be aware of your body position. If you can improve your posture when moving, you are essentially protecting your joints.

How Do Proper Body Mechanics Protect Joints? Proper body mechanics and specifically proper posture can:  align bones and joints  reduce wear and tear on joints  reduce stress on supporting structures (e.g., ligaments and joints)  strengthen the spine  strengthen muscles  prevent muscle pain  conserve energy

How Can a Person Ensure Proper Posture? 

Well-toned muscles, normal movement of the joints, and balanced muscle on the sides of the spine promote proper posture. That can be difficult for people with arthritis.

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Good posture while standing implies that shoulder blades are back, chest forward, knees straight, and the top of your head should align with the ceiling. Your pelvis should not tilt. Arches of your feet should be supported with shoes.

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When sitting in a chair, your buttocks should be all the way to the back of the chair. Your back should be straight and your shoulders should be back. Knees, bent at right angles, should be at the same height or higher than your hips. Feet should be flat on the floor.

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A proper gait that incorporates good posture and good body mechanics will help conserve energy. Arthritis patients who have severely damaged joints or who have had joint surgery may have an abnormal gait. If you can still walk you should walk. Walking builds muscle strength that in turn helps to protect joints.

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If you must lift something that's heavy, bend at your knees and hips and lower your body down to meet the object you are trying to pick up. Never bend at the waist while keeping your legs straight and reaching down to grasp the object.

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If you must lift. There is a right way and a wrong way to move. Your body will be healthier and joints will be protected if you make a conscious effort to move the right way. If you need a little coaching, perhaps a consultation with a physical therapist would be helpful.

Gait is the manner or style of walking. There are many types of gait.  Antalgic Gait: painful gait, a limp is adopted to avoid pain on weight bearing structures (hip, knee, ankle).  Ataxic Gait: an unsteady, uncoordinated walk, a wide base of support is seen. normally due to cerebellar disease.

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Festinating Gait: short, accelerating steps are used to move forward, often seen in people with Parkinson's disease. Four Point Gait: utilized by crutch users, first on crutch, then the opposite leg followed by the other crutch and then the other leg.

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Hemiplegic Gait: involves flexion of the hip because of inability to clear the toes from the floor at the ankle and cirumduction at the hip. Spastic Gait: walk in which the legs are held close together and move in a stiff manner. often due to central nervous system injuries.

End OF Lecture God Bless