Ambulation Aids
Function
Ambulation aides are designed to increase the base of support for standing and walking activities. Torque and other joint stresses can be minimized with an effective use of an ambulation aid. Selection of the most appropriate device is dependent on stability and mobility needs. Overall, ambulation aids can
- decrease pain
- decrease WB on involved limbs
- allow for compensation when there are decreases in
- coordination
- endurance
- balance
- strength
The term "assistive device" can be substituted for ambulation aid, however, it is less specific and needs to be supported by language and instruction specific to its use in gait training.
Factors Influencing Selection of Ambulation Aid
- patient status (medical history, WB, cognition)
- prognosis for rehabilitation/mobility
- home/work environment
- community activities/demands
- patient/client/family goals
Pre-Ambulation Aids
Tilt tables may be indicated when the patient has experience extended bed rest, or if there are contraindications for joint motion(s). Gravity can be incrementally applied, resulting in increased demand to the cardiopulmonary system and postural muscles. Ankle plantar flexors and foot instrinsics are passively stretched and proprioception increases through WB in the feet.
Parallel bars can be fixed or folding are are most often found used in rehabilitation settings. Patients who have low endurance or need a significant amount of assistant to rise to sitting. The fixed nature of the bars can allow the patient to pull with the upper extremities when transitioning to standing.
Summary of Ambulation Aids
Ambulation aids are organized on the table based on progressively increasing patient mobility/safety levels. In the clinical setting, patients may be progressed through all of these devices. PTAs can select/modify the assistive device to meet the needs of the patient. Abrupt changes in mobility status (e.g., declines) must be communicated to the PT for reassessment and treatment planning
|
Ambulation Aid |
Types |
Advantages |
Disadvantages |
|
Tilt-table |
-- |
Allows for progressive transition to upright position; can adapt for NWB situations |
Dependent; tilt is functional up to ~70 degrees |
|
Parallel Bars |
Folding Floor Mounted
|
Allows for maximum stability, support and safety in a functional position |
Some challenge with body mechanics by PT/PTA Stability may be challenged with larger/weaker patients |
|
Walkers
|
Front-Wheel Standard or Pick-up Four-Wheel Hemi |
Allows for maximal stability for ambulation/gait training; Potential to increase mobility in community Adjustable Some fold |
Some environmental limitations
Walking speed is slower Challenging to use with stairs
|
|
Axillary Crutches |
Wood Aluminum |
Allows for increased variability in gait patterns Provides support with increasing mobility adjustable Can be used on stairs |
Less stable Requires relatively good trunk and UE strength Risk for nerve/vessel damage with improper fit/use |
|
Forearm Crutches |
Lofstrand Canadian |
Allows for increased mobility in patients who are unable to use a cane adjustable Functional on stairs and in narrow areas |
Forearm cuff can make it difficult to remove crutch Dynamic qualities may make some patients feel insecure (e.g., elderly) |
|
Quad Cane |
Crab Large Base (LBQC) Small Base (SBQC) |
Provide a broad base with four points of contact on floor Height adjustable |
Can feel unstable with transitioning weight through the device; Results in a slower gait pattern |
|
Cane |
Wood (standard) Aluminum Offset handle Pistol grip
|
Allows for progressive increased mobility Used for added stability during upright activities Aluminum varieties are easily adjusted Offset handle allows for weight distribution through shaft of cane Less environmental constraints; easily stored Inexpensive |
Standard variety is not adjustable; must be cut to fit patient Function is to widen BOS and improve balance Relatively small BOS compared to other AD Unable to use with 3-point gait pattern |
