WALKING AIDS

DR.SNEHA BHALALA

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WALKING
 Walking is the manner or way in which you move
from one place to another .
 It is the forward propulsion of the body via
coordinated and integrated action of
neuromuscular system of the body.
 It is the highest level of motor control skill.
 Walking is a complex activity which requires
the co operation and control of the whole body.
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 The major requirements for successful
walking include:
• Support of body mass, by the lower
extremities.
• Production of locomotors rhythm.
• Balance control of the moving body.
• Propulsion of the body in the intended
direction.

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PURPOSE OF WALKING AIDS
 Increase area of support or base of support
 Maintain center of gravity over supported
area
 Redistribute weight-bearing area by
decreasing force on injured or inflamed part
or limb
 Can be compensate for weak muscles
 Decrease pain
 Improve balance

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TYPES OF WALKING AIDS
 There are a number of aids available to assist

people who have difficulty in walking or who

cannot walk independently without one.

 These external aids are crutches ,sticks and

frames.

 Others include braces and splints

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CRUTCHES

 Crutches Introduction

 Types of crutches

 Measurement of length

 Preparation for crutch walking

 Crutch walking

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WHAT IS A CRUTCH?

 These are devices which are used to

reduce weight bearing on one or both legs

and also give support where balance is

impaired and strength is inadequate.

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PRE REQUISITES FOR CRUTCHES
 Good strength of upper limb muscles is
required.
 Range of motion of upper limb should be
good.
 Muscle group which should be strong is given
below -
 Shoulder flexor, extensors and depressor
 Shoulder adductors
 Elbow and wrist extensors
 Finger flexors

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TYPES OF CRUTCHES
1. Axillary crutches/ under arm crutches
2. Elbow crutches or Lofstrands crutches
3. Forearm support crutches (gutter crutches)

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1) AXILLARY CRUTCHES -
 They are made of wood or metal
with an Axillary pad, a hand piece
and a rubber ferrule.
 Two upright shafts connected by
axillary piece on top
 Hand piece in the middle
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 Extension piece below
 Extension piece and shafts has numerous
holes at regular intervals so the total
length of crutch and height of handle is
easily adjustable.
 A large suction tip (rubber ferrule) is
attached to extension piece to allow
total contact with floor

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 The Axillary pad should rest against the chest

wall approx. 5 cm, beneath the apex of

axilla and hand grip in slight flexion when

weight is not being taken.

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 The elbow will go into extension and weight

is transmitted down the arm to hand piece.

 On no account should weight be taken by

axillary pad as this could lead to neuropraxia

of the radial nerve or the brachial plexus.

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MEASUREMENT OF LENGTH
 There are variety of ways it may be in lying
and also in standing position.
 In Lying it may be with shoes off and with
shoes on
1. With shoes off: measure from apex of axilla
to the lower margin of medial melleolus.
2. With shoes on: 5cm/2 inches vertically
down from apex of axilla to a point 20 cm
lateral to the heel of shoe. (Book Resource:
M. Dena Gardiner)

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 In standing with shoe off and shoe on

method is same.

 2 inches below the axilla to the 2 inches

anterior and 6 inch lateral to the foot in

standing position.

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 The measurement from the axillary pad to

the hand grip should be taken with the

elbow slightly flexed (approx. 15 degree)

from a point 5 cm below the apex of the

axilla to the ulnar styloid .

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MEASUREMENT OF AXILLARY
CRUTCHES -

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 Crutches that are too tall or too short can affect

balance and also cause back pain.

 Incorrectly fitted crutches or poor posture can

cause a disorder called crutch palsy in which the

nerves under the arm mostly radial nerve (brachial

plexuses) are temporarily or permanently damaged,

causing weakened hand, wrist and forearm muscles.

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 Advantages:

 Convenience for temporary injuries

 A large degree of support for the lower body
 Available at low cost.
 Axillary crutches allow the patient to
perform a greater variety of gait patterns and
ambulate at a faster pace.

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DISADVANTAGES
 Limited upper body freedom

 Axillary crutches require good standing balance

by the patient.

 Improper use of crutch can cause injury to

axillary region, and Strain on the arms and

upper body which can lead to crutch paralysis.

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 It is a condition in which the nerves under

the arms (Radial nerve and brachial plexus)

are pinched and also risk of losing balance.

- Geriatric patient may fell insecure or may

not have the necessary upper- body strength

to use axillary crutches

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PRECAUTIONS
 Have someone nearby for assistance until

accustomed to the crutches.

 Frequently check that all pads are securely

in place

 Check screws at least once per week.

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 Clean out crutch tips to ensure they are free
of dirt and stones.
 Remove small, loose rugs from walking
paths.
 Beware of ice, snow, wet or waxed floors
 Avoid crowds, leave class early.
 Never carry anything in hands ,use a
backpack.

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ELBOW /FOREARM/LOFSTRAND
CRUTCHES
 They are made of metal, an aluminum

tubular shaft with a handgrip and have a

metal or plastic forearm band.

 Forearm piece bent backward and extended

to 2 inches below the elbow.

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 Both handgrip and forearm piece are
adjustable in length by means of a press
clip or metal button and have a rubber
ferrule.
 These crutches are suitable for patients with
good balance and coordination with strong
arms. Weight is transmitted exactly the
same way as for axillary crutches.

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ADVANTAGES
 Light weight

 Easily adjustable

 Using forearm crutches requires no more

energy, increased oxygen consumption or

heart rate than axillary crutches.

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 Being easily stored and transferred.

 There is no risk of injury to the

neurovascular structures in the axillary

region when using this type of crutches.

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DISADVANTAGES
 Forearm crutches are less stable .

 They require good standing balance and upper-

body strength.

 Geriatric patient sometimes feel insecure with

these crutches. They may not have the necessary

upper-body strength to use forearm crutches.

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GUTTER CRUTCHES
 They are made of metal with a padded

forearm support Platform, Velcro strap, an

adjustable hand piece and a rubber ferrule.

 These are used for patients with Painful wrist

and hand condition or elbow contractures, or

weak hand grip

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 Elbow flexed 90 degrees, The hand rests on a

grip which can be angled appropriately,

depending on the user's disability.

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Mostly In rheumatoid disease,

cerebral palsy, or other

conditions for providing

support. In these conditions

patient cannot take weight

through hands, wrists and

elbows because of deformity. 37

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MEASUREMENT OF LENGTH :

IN LYING POSITION

With shoes on: measure from the

point of fixed elbow till 20 cm lateral

to the heel.

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 ADVANTAGES :

 As similar like elbow crutch

 These are easily adjustable.

 More cosmetic than other crutches.

DISADVANTAGES :

 Provide less lateral support due to absence of

axillary pad.

 Cuffs may be difficult to remove.

 These can be expensive.

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PREPARATION FOR CRUTCH
WALKING
 Arms: shoulder extensors, adductors and

elbow extensors, even all muscles of arms

must be assessed and strengthened before

the patient starts walking. The hand grip

must also be tested to see that the patient

has sufficient power to grasp hand piece.

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 Legs: Strength and mobility of both legs should
be assessed and strengthened if necessary. Main
attention to the hip abductors and extensor,
the knee extensors and the plantar flexors of
the ankle should be given.
 Balance: sitting and standing balance must be
tested.
 Demonstration: The physiotherapist should
demonstrate appropriate crutch walking to the
patient.
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CRUTCH WALKING
 During first time, when the patient is to stand

and walk, the physiotherapist should have an

assistant for supporting the patient.

 Non-weight bearing: patient should always

stand with a triangular base i.e. crutches

either in front or behind the weight bearing leg

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 To walk, the patient first moves the
crutches a little further forward, takes
weight down through the crutches and lifts
the foot forward to a position just behind the
line of crutches.
 Once this is mastered the patient may
progress to lifting the foot forward to a
position just in front of the line of the
crutches.

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 Partial weight bearing: The crutches and

the affected leg are taken forward and put

down together. Weight is then taken through

the crutches and the affected leg, while the

unaffected leg is brought through.

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GAIT PATTERN WITH CRUTCHES
 Four point gait
 Three point gait
 Two point gait
 Two point swing through gait
 Two point swing to gait (the feet are
advanced by a much shorter distance and
placed behind the level of crutches)

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WHAT IS GAIT?

• Human locomotion, or gait, may be

described as a translatory progression of the

body as a whole, Produced by coordinated,

rotatory movements of body segments.

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• The alternating movements of the lower

extremities essentially support and carry

along the head, arms, and trunk (HAT).

• HAT constitutes about 75% of total body

weight,

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GAIT
 Phases of the Gait Cycle
 A gait cycle spans two successive events of the
same limb, usually initial contact of the lower
extremity with the supporting surface.
 During one gait cycle, each extremity passes
through two major phases:
 a stance phase, when some part of the foot is
in contact with the floor, which makes up about
60% of the gait cycle, and
 a swing phase, when the foot is not in contact
with the floor, which makes up the remaining
40%
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 There are two periods of double support
occurring between the time one limb
makes initial contact and the other one
leaves the floor at toe off.
 At a normal walking speed, each period of
double support occupies about 11% of the
gait cycle,
 Which makes a total of approximately 22%
for a full cycle.
 The body is thus supported by only one limb
for nearly 80% of the cycle
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GAIT TERMINOLOGY
 Temporal variables include
 Stance time,
 single-limb and double-support time,
 swing time,
 stride and step time,
 cadence, and
 speed.

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 The distance (spatial) variables include
 stride length,
 step length and
 Width and
 degree of toe-out

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 Stance time is the amount of time that elapses
during the stance phase of one extremity in a gait
cycle.
 Single-support time is the amount of time that
elapses during the period when only one extremity
is on the supporting surface in a gait cycle.
 Double-support time is the amount of time spent
with both feet on the ground during one gait cycle.
 The percentage of time spent in double support
may be increased in elderly persons and in those
with balance disorders.
 The percentage of time spent in double support
decreases as the speed of walking increases
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 Stride length is the linear distance
between two successive events that are
accomplished by the same lower extremity
during gait.
 stride length is not always twice the length
of a single step, because right and left steps
may be unequal
 Stride length varies greatly among
individuals, because it is affected by leg
length, height, age, sex, and other variables

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 Stride duration refers to the amount of
time it takes to accomplish one stride.
 Stride duration and gait cycle duration are
synonymous.
 One stride, for a normal adult, lasts
approximately 1 second.

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 Step length is the linear distance between
two successive points of contact of
opposite extremities.
 It is usually measured from the heel strike
of one extremity to the heel strike of the
opposite extremity
 A comparison of right and left step lengths
will provide an indication of gait symmetry.
 The more equal the step lengths, the more
symmetrical is the gait

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 Step duration refers to the amount of time
spent during a single step.
 Measurement usually is expressed as seconds
per step.
 When there is weakness or pain in an
extremity, step duration may be decreased
on the affected side and increased on the
unaffected (stronger) or less painful

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 Cadence is the number of steps taken by a
person per unit of time.
 Cadence may be measured as the number of
steps per second or per minute,
Cadence = number of steps/time
 A shorter step length will result in an
increased cadence at any given velocity.
 when a person walks with a cadence
between 80 and 120 steps per minute,
cadence and stride length had a linear
relationship
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 As a person walks with increased cadence,
the duration of the double-support period
decreases.
 When the cadence of walking approaches 180
steps per minute, the period of double
support disappears, and running commences.
 A step frequency or cadence of about 110
steps per minute can be considered as
“typical” for adult men;
 a typical cadence for women is about 116
steps per minute.
 stride cadence, is exactly half the step
cadence

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 Walking velocity is the rate of linear
forward motion of the body,
 which can be measured in meters or
centimeters per second, meters per minute,
or miles per hour.
 Women tend to walk with shorter and faster
steps than do men at the same velocity.
 Increases in velocity up to 120 steps per
minute are brought about by increases in
both cadence and stride length,

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 But above 120 steps per minute, step length
levels off, and speed increases are achieved
with only cadence increases.
 Speed of gait may be referred to as slow,
free, and fast.
 Free speed of gait refers to a person’s
normal walking speed;
 slow and fast speeds of gait refer to
speeds slower or faster than the person’s
normal comfortable

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 Step width, or width of the walking base,

may be found by measuring the linear distance

between the midpoint of the heel of one foot

and the same point on the other foot

 Step width has been found to increase when

there is an increased demand for side-to-side

stability, such as occurs in elderly persons and

in small children.
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 In toddlers and young children, the center

of gravity is higher than in adults, and a

wide base of support is necessary for

stability.

 In the normal population, the mean width

of the base of support is about 3.5 inches

and varies within a range of 1 to 5 inches.

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 Degree of toe-out represents the angle of
foot placement (FP) and may be found by
measuring the angle formed by each foot’s
line of progression and a line intersecting
the center of the heel and the second toe.
 The angle for men normally is about 7 from
the line of progression of each foot at free
speed walking
 The degree of toe-out decreases as the
speed of walking increases in normal men.
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 Power generation is accomplished when muscles
shorten (concentric contraction). They do positive
work and add to the total energy of the body.
 Power absorption is accomplished when muscles
perform a lengthening (eccentric) contraction.
They do negative work and reduce the energy of
the body.
 If joint motion and moment are in opposite
directions, negative work is being performed
through energy absorption.

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STICK
 They are wooden / metal sticks, which have
to be cut to the correct length for the
patient or there are adjustable metal sticks.
 Tripod or quadrapod sticks are available and
can be used if more stability is required.
 Two sticks can be used for partial weight
bearing as a progression from crutches.

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FRAMES
 Made of metal and adjustable.
 Light in weight
 Have ferrules attached to four struts. some have
wheels attached but should be carefully used.
 There are reciprocal frames which are hinged

So that one side can be moved forward than the

other.

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 Uses:
 Used for partial weight bearing.
 In elderly patients with unsteady gait.
 In patients with cerebral palsy or spina bifida.
 The patient lifts the frame forward, then
leans on it and takes two steps. The patient
should take even steps, keeping the frame
well forward. A bag can be attached to the
front of the frame to carry small items.

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 Safety:

• The physiotherapist must check the safety of all

walking aids not only when giving them to a

patient, but regularly throughout a treatment

programme.

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THANK YOU….

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