BY-

Dr Amit kumar mallik

Dptt. Of PMR

RIMS, IMPHAL

INDIA

“Devices used to increase the mobility of a patient”

2830 BC- Carvings at tomb of Herkuf

Before 18th century

Canes- First made from cuttings of tree

branches

Crutch- Single piece of wood with a crossbar

18th century- introduction of different designs

20th century- Aluminium and steel tubes, plastic,

foam, rubber as accessories

Improve balance

Give proprioception

Decrease pain

Reduce weight bearing on injured or inflamed structures

Compensate for weak muscles

Scan the immediate environment

Stability of the patient

Strength of upper and lower limbs

Co-ordination of upper and lower limbs

Required degree of relief from weight-bearing

Parallel bars

Walking frames

Canes

Tripods

Quadrupeds

Crutches

Scooting boards

Wheelchairs

Parallel Bars

Rigid Support through

the length of bars Enables patients to

concentrate onlower limbs

A full length mirrorplaced at one end

Adjustment: height of the bar should be at the level of greater trochanter

More stable

For debilitated/elderly people confined to home

Patients with fear of falling

Front of the walker at 12 inches in front of the patient

Patient’s elbow at 20-30° flexion

Advantage:- Stability Sense of security Light and adjustable

Disadvantage:- Difficult to use on

stairs Difficult through a

doorstep or entrance

1. Standard 2. Reciprocal 3. Rollator

Types:-

Consist four almost vertical aluminiumtubes joined on three sides by upper andlower horizontal tubes

One side is left openHandgrips on upper horizontal tube Rubber tips at lower ends of vertical tubes

Identical with standard frame Each side of the frame can be

moved forward Swivel joints between horizontal

and vertical tubes

Two small wheels at front and two legs without wheels at backor one wheel at each leg

No need for lifting the whole device

Care to be taken forelderly patients

Best suited for children

Other Variants of Walking Frame

Gutter frame Pulpit frame

Gutter frame Pulpit frame

Most common mobility aid

Commonly made of wood or aluminium

Transmits 20-25% of body weight

Held in hand opposite the involved side

Increase stability

Compensates for muscle weakness

Relieves pain

Elbow at 30° flexion

Measurement:Upside downHandle at shoe heel and Lower end at greater

trochanter or radial styloid in standing

Adjustible canes Non Adjustible canes

Made of aluminium alloy or steel

Three rubber tipped legs at

corner of an equilateral triangle

Handgrip in same plane as a line

joining two legs nearest and parallel

to patient’s foot

Elbow at 30° flexion

More stable

Has four rubber tipped legs

Handgrip vertically above two

inner legs

More stable

Adjustable hand grip height

Can be used singly or in pairs

Sense of balance Correct selection and

adjustment of crutches Strengths of the muscles

Good vision Correct crutch stance Pattern of gait envisaged

The patient’s ability to use crutches depends on

Consists of double upright joined at top by crutch pad, a handgrip and a rubber tip at lower end

Axillary/crutch pad rest against chest wall and 5cm from axillary apex

Hand grip adjusted to make 30° elbow flexion

Weight transmitted down arm to hand grip

Support upto 80% of body weight

Used when crutch walking is commenced

When non weight bearing on one lower

limb is indicated

More stable though cumbersome to use

Patient can release a handgrip and use that

hand for other purpose

A. AdjustableB. PermanentC. Ortho crutch

A B

c

Finger flexors and thumb Wrist Dorsiflexors Elbow extensors Shoulder flexors Shoulder depressors Shoulder adductors

Measurement:

1. Height minus 16 inches2. From apex of axilla to lower margin of

medial malleolus3. From anterior axillary fold to 6 inch

in front and lateral to 5th toe4. From anterior axillary fold to bottom

edge of shoe heel in supine position5. From tip of middle finger to olecranon

of opposite

Position Patient in standing and wearing shoes Crutch under each arm Palm of hand on handgrip Tip of the crutches 6 inches in front and lateral to tip

of toesChecking overall length 3 fingers between anterior axillary fold and axillary

crutch Slide crutch extension to correct length

Checking handgrip position

Palm on top of the handgrip and wrist in 90° dorsiflexion

Elbow in 30° flexion with shoulder depressed

Move the handgrip to the correct position after removing

uppermost wing nut and bolt

Check elbow is in 30° flexion

Tighten nut and bolt

Made of aluminium alloy

U shaped cuff at upper end to

accommodate forearm

Rubber or plastic covered handgrip

Rubber tip at lower end

Adjustable length

Transmit 40 to 50% of body weight

Less cumbersome

More stable than walking stick

For patients who can take some

weight on both feet

Paraplegic patients

Position Standing with shoes Armband around the arm with hand on the handgrip Crutch tip at 6 inches front and lateral to tip 5th little toeChecking overall length Elbow at 30° flexion Slide lower part after pressing the spring loaded double

ball catchPosition of armband 2 inches gap between armband and flexor crease of

elbow

Single adjustable aluminium alloy tube

Short horizontal metal gutter at upper end

Vertical handgrip projecting forward from

gutter

Lower end protected with rubber tip

Fixed flexion deformity

Weakness of muscle controlling elbow

joint or hand

Deformity of hand

Pain in hand or wrist

Elbow lies at or just behind the posterior

edge of gutter

Elbow at 90° flexion

Palm on the handgrip

Tip of the crutch 6 inches anterior and

lateral to tip of toes

Adjustable height with spring loaded

double catch ball

Crutch tip

Hand grip

Axillary pad

Tricep band

Wrist strap

Attached to the foot of crutch

Crutch tip diameter of at least 1.5 inches

Prevent slippage Act as shock absorberTypes1. Suction crutch tip2. Snow boot crutch tip3. Rain guard crutch tip4. Small crutch tip

1

2 3 4

Sponge pad to relieve pressure

Can be modified to accommodate a

stiff or deformed hand

Can increase the girth with rubber

sponge

Axillary pad Made of sponge rubber Prevent undue pressure over nerve and vesselsTricep band Metal or stiff leather and attached to upper part of crutch Helpful for those with tricep weaknessWrist strap Leather or plastic For weak wrist extensors Assist in holding the hand grip

Basically a wooden board with wheels below

Patient sitting on it and pushing forward with hands

Popular among Indian housewives with residual

polio