ASS TECH: ASSISTIVE DEVICES 

©ATRAL || PT 2022 
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PARALLEL BARS  HEMI-WALKER 
  ➔ modified fours with one hand only  
➔ Most stable assistive device  ◆ Pt c stroke  
➔ Used for initial ambulation training  ◆ Hemiplegic pt 
◆ The moment the pt is out of w/c this is what you prescribe  ◆ Held c good arm  
◆ First assistive device prescribed for ambulation training    
  ATTACHMENTS 
INDICATIONS  ➔ fold down seats, carrying baskets  
   
➔ Prior to parallel bars, check static and dynamic balance and  ➔ Second most stable after parallel bars 
tolerance   
● POOR = only erect standing  GAIT PATTERNS 
○ As low as poor, the pt can be prescribed with // bar   
exercises   ➔ Pt leg should be able to WB at least 75% on the walker  
◆ Ultimate goal of bars is to be trained here before other   
devices   NON-WEIGHT BEARING 
● FAIR = assume, maintain at least 5 s  ➔ The walker is picked up and over forward about an arm’s length  
● GOOD = assume, maintain, WB  ➔ Weight is then transferred through  
● NORMAL = assume, maintain, WB, and challenged    
➔ Elbows maintained at 20-30 deg flexion  PARTIAL WEIGHT BEARING 
◆ Ensures smooth progression of amb exercises   ➔ Other leg can carry at least 50% of BW  
➔ Hand grip should be at level of greater trochanter   ➔ Walker - bad leg - weight on the walker - good leg  
➔ Initial training of // bars should be postural assessment   ➔ STEP TO GAIT 
  ◆ Walker - bad leg - 
WALKER  ◆ Initial 
  ➔ STEP THROUGH GAIT 
➔ Need at least a grade of fair to be able to use a walker  ◆ Walker — bad leg — weight on walker — lags bad leg   
➔ Widens BOS of patient    
➔ Greater anterior and lateral anterior stability   FULL WEIGHT BEARING 
◆ Because of its frames   ◆ The stronger leg is always at the back of the weaker leg  
➔ Reduces WB on one or B LE   ● Adds support  
➔ More mobile than parallel bars  ◆ Walker is picked up and moved forward at an arm’s length  
➔ Elbows maintained at 20-30 deg and level of greater trochanter    
  AXILLARY CRUTCHES  
TYPES OF WALKERS   
  ➔ Requires at least a good standing balance  
FOLDING/COLLAPSIBLE   ➔ Used to increase the balance providing moderate degree of stability 
➔ facilitate mobility in communities  ➔ Elbow at 20-30 deg flexion  
◆ More mobility, less stability   ➔ At least 2 fingers under the axilla  
◆ Requires good UE strength for normal walker manoeuvre   ➔ Hand grip at level of the greater trochanter  
  ➔ Best to fit it in standing  
ROLLING/WHEELED  ◆ Pt’s height - 16 — less accurate  
➔ facilitate amb as continuous movement sequence   ◆ Measure the base of the axilla to 6 in in front of the big toe and 2 
◆ Good if the pt has poor UE strength   in lateral  
◆ Highly contraindicated for patients with Parkinson’s Disease and  ◆ Can do it in supine as an alternative  
festinating gait   ● Axilla to 6-8 in lateral to the heel  
● Unstable   ◆ Alternative is also 3rd finger to olecranon process  
◆ Good for Parkinson’s disease c bradykinesia   ➔ Too short = flexion posture / kyphotic 
  ➔ Too long = extension poster / lordotic  
STAIR-CLIMBING WALKER  ➔ Should be the right measurement to protect the axillary artery/ 
➔ two posterior extensions and additional hand grips off of the rear  radial nerve 
legs for use on stairs    
◆ All four limbs are adjustable   MODIFICATIONS 
● Ascend — shorter front    
● Descent — shorter back   FOREARM 
◆ Should have brakes   ➔ Olecranon process then down 1-1.5 inc, attach the forearm band 
  and the hand grip at trochanter level  
RECIPROCAL WALKERS  ➔ Prescribed to pt c sci  
➔ hinged, allows advancement on one side of walker at a time, use  ◆ Balance issues  
reciprocal gait pattern   ◆ Good UE and LE strength  
◆ Facilitates natural smooth flow of walking   ➔ Less stability but more movement  
◆ Pt should have grade 3/5 iliopsoas    
● Requires good hip flexion   FOREARM PLATFORM CRUTCH 
  ➔ Used if pt is not allowed to bear weight on hands  
  ◆ RA 
ASS TECH: ASSISTIVE DEVICES 
©ATRAL || PT 2022 
2||
◆ Position elbow at io and positioned edge your trunk  
 
➔ Crutch tip  
◆ 1.5 in  
◆ Provides suction  
 
GAIT PATTERNS 
 
4-POINT GAIT 
➔ R crutch - L leg - L crutch - R leg  
➔ slow, stable  
➔ For poor balance, incoordination, or muscle weakness  
 
3-POINT GAIT 
➔ R crutch - shadow - L crutch - R leg  
➔ Shadow gait pattern 
 
2-POINT GAIT 
➔ Most progressive  
◆ Mimics smooth amb  
◆ L crutch c R leg - R crutch c L leg  
➔ STEP TO  
◆ Both crutches forward, followed by bad leg - good leg  
➔ STEP THROUGH  
➔ Both crutches forward - bad leg - good leg beyond bad leg  
 
STAIR CLIMBING 
➔ Ascending using crutches — good leg - ad - bad leg  
➔ Descending — ad — bad leg — good leg  
➔ Guarding  
◆ Guard belt  
◆ Ascent: Posterolateral to bad side   
◆ Descent: anterolateral to bad side  
 
CANE 
➔ Widens BOS to improve balance  
➔ Provide limited stability and unweighting  
➔ Used to relieve pain  
➔ Can be used if good standing balance but better to have normal 
standing balance  
➔ Held opposite the involved side  
➔ Less stable  
➔ Too long = extension posture  
➔ Too short = flexion posture level of greater trochanter  
 
TYPES OF CANES 
 
MATERIAL 
➔ Wood — secure but non-adjustable  
➔ Aluminum — light and adjustable but less secure 
 
HANDLE 
➔ Standard: most commonly seen in stores, harder ground reaction 
force 
➔ J point : distribute ground reaction force  
➔ C point: conforms hand position  
 
STANDARD, SINGLE POINT 
 
QUAD CANE 
➔ Inc stability and dec stability  
➔ Small based is good for stair neg  
➔ Wide based is good for amb exercises  
 
➔ Cane — bad leg — good leg