Assistive Devices for Mobility

Intro to Mobility Aids - First Steps

• Assistive Devices for Mobility (ADMs): External devices enhancing movement for individuals with mobility impairments.
• Primary Goals: 📌 S.A.F.E.R.
  • Stability & balance improvement
  • Assist ambulation, promote independence
  • Functional ability ↑ (e.g., ADLs)
  • Energy conservation during movement
  • Reduce weight-bearing on limbs, alleviate pain
• Broad Classification:
  • By Support: Canes, crutches, walkers
  • By Mobility: Wheeled (e.g., wheelchairs) vs. Non-wheeled
• Prescription Principles: Patient assessment (strength, balance, cognition, environment, goals).

⭐ Proper patient education and training are crucial for safe and effective ADM use.

Canes & Crutches - Lean On Me

• Canes: Mild balance/stability, unilateral weakness.

  • Types: Single-point, quad cane, hemi-walker.

  • Height: Greater trochanter/ulnar styloid, 20-30° elbow flexion.

  • Usage: Use contralateral (📌 COAL: Cane Opposite Affected Leg).

• Crutches: ↓ Weight-bearing, ↑ stability.

  • Types: Axillary, Forearm (Lofstrand/Canadian).
  • Axillary:
    • Fit: 2-3 fingers below axilla; handpiece for 20-30° elbow flexion.
    • ⚠️ Complication: Crutch palsy (Radial nerve).
  • Forearm: Cuff: proximal 1/3 forearm, 1-1.5 in. below elbow.
  • Stairs: 📌 "Up with the Good, Down with the Bad".

⭐ Radial nerve palsy: most common neuro complication from ill-fitted axillary crutches.

• Crutch Gaits:

  • 2-point: Mild bilateral weakness.

  • 3-point: NWB one limb.

  • 4-point: Severe bilateral weakness/incoordination (stable).

  • Swing-to/Swing-through: Bilateral LL weakness (paraplegia), needs good upper body strength.

• Gait Selection Flowchart:

Walkers & Frames - Steady Go

• Types & Indications:
  • Standard (Pick-up): Max stability; for severe balance/weakness.
  • Wheeled (2-wheel front): Balance support, less energy than standard.
  • Rollator (4-wheel): Balance, ↑gait speed; not for significant weight-bearing. Has brakes, seat, basket.
  • Hemi-walker: For hemiplegia, more stable than quad cane.
• Height: Handgrip at greater trochanter/ulnar styloid; 20-30° elbow flexion.
• Gait: Walker → Affected leg → Unaffected leg (WWAL).
• Pros: Wide base, high stability.
• Cons: Slow, bulky, stairs/uneven terrain difficult.

⭐ Standard walkers provide the most stability but require more energy expenditure than wheeled walkers.

Wheelchairs & Orthoses - Mobile Support

• Wheelchairs: Aid non-ambulatory patients, conserve energy, enable long-distance mobility, provide pressure relief.
  • Types:
    • Manual: Self-propelled or attendant-propelled.
    • Powered (Electric): For users unable to self-propel or for long distances.
  • Prescription: Correct fit (seat width/depth/height, back height, armrests, footrests) prevents pressure sores, postural issues.
  • Specialized: Sports, standing, reclining.
• Lower Limb Orthoses: Goal: Stabilize joints, assist movement, prevent deformity, protect, reduce pain.
  • AFO (Ankle-Foot Orthosis):
    • Indications: Foot drop, ankle instability, mediolateral control.
    • Types: Solid, Hinged, Posterior Leaf Spring (PLS), Ground Reaction.

    ⭐ A Posterior Leaf Spring (PLS) AFO is for isolated foot drop with good mediolateral ankle stability, aiding dorsiflexion in swing phase.

  • KAFO (Knee-Ankle-Foot Orthosis):
    • Indications: Significant knee weakness/instability (e.g., quadriceps paralysis post-polio, SCI, muscular dystrophy).

High‑Yield Points - ⚡ Biggest Takeaways

• Axillary crutches: Risk of radial nerve palsy; fit 2-3 fingerbreadths below axilla, elbow 20-30° flexion.
• Canes: Held contralateral to affected limb; handle at greater trochanter height.
• Walkers: Offer maximum stability among ambulatory aids; standard type requires lifting.
• Three-point gait: For non-weight bearing on one leg, used with crutches or a walker.
• AFO (Ankle-Foot Orthosis): Primary orthotic intervention for foot drop.
• PTB (Patellar Tendon Bearing) socket: Standard design for Below-Knee Amputation (BKA) prostheses.
• Energy expenditure: Significantly ↑ with more proximal amputation levels and greater device support (Walker > Crutches > Cane).