Mobility aids

MOBILITY aids very important for those who are disable
and these aids make them independent in many aspect of life
to live a honourable life.

1. Mobility Aids BY- Dr Amit kumar mallik Dptt . Of PMR RIMS, IMPHAL INDIA

2. Introduction “Devices used to increase the mobility of a patient”

3. Brief History 2830 BC- Carvings at tomb of Herkuf Before 18 th century Canes- First made from cuttings of tree branches Crutch- Single piece of wood with a crossbar 18 th century- introduction of different designs 20 th century- Aluminium and steel tubes, plastic, foam, rubber as accessories

4. Functions Improve balance Give proprioception Decrease pain Reduce weight bearing on injured or inflamed structures Compensate for weak muscles Scan the immediate environment

5. S election Stability of the patient Strength of upper and lower limbs Co-ordination of upper and lower limbs R equired degree of relief from weight-bearing

6. Types Parallel bars Walking frames Canes Tripods Quadrupeds Crutches Scooting boards Wheelchairs

7. Parallel Bars Rigid Support through the length of bars Enables patients to concentrate on lower limbs A full length mirror placed at one end Adjustment: height of the bar should be at the level of greater trochanter

8. Walking Frames 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

9. 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:-

10. Standard walking frame Consist four almost vertical aluminium tubes joined on three sides by upper and lower horizontal tubes One side is left open Handgrips on upper horizontal tube Rubber tips at lower ends of vertical tubes

11. Reciprocal Walking Frame Identical with standard frame Each side of the frame can be moved forward Swivel joints between horizontal and vertical tubes

12. Rollator Two small wheels at front and two legs without wheels at back or one wheel at each leg N o need for lifting the whole device Care to be taken for elderly patients B est suited for children

13. Other Variants of Walking Frame Gutter frame Pulpit frame Gutter frame Pulpit frame

14. Canes 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

15. Measurement: Upside down Handle at shoe heel and Lower end at greater trochanter or radial styloid in standing Adjustible canes Non Adjustible canes

16. Tripods 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

17. Quadrupeds Has four rubber tipped legs Handgrip vertically above two inner legs More stable Adjustable hand grip height Can be used singly or in pairs

18. Crutches 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

19. Axillary Crutches 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

20. Support upto 80% of body weight Used when crutch walking is commenced W hen 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

21. Types of axillary crutches Adjustable Permanent Ortho crutch A B c

22. Crutch Muscles Finger flexors and thumb Wrist Dorsiflexors Elbow extensors Shoulder flexors Shoulder depressors Shoulder adductors

23. Measurement: Height minus 16 inches From apex of axilla to lower margin of medial malleolus From anterior axillary fold to 6 inch in front and lateral to 5 th toe From anterior axillary fold to bottom edge of shoe heel in supine position From tip of middle finger to olecranon of opposite

24. Adjustment 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 toes Checking overall length 3 fingers between anterior axillary fold and axillary crutch Slide crutch extension to correct length

25. 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

26. Elbow Crutches 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

27. Transmit 40 to 50% of body weight L ess cumbersome More stable than walking stick For patients who can take some weight on both feet Paraplegic patients

28. Adjustment Position Standing with shoes Armband around the arm with hand on the handgrip Crutch tip at 6 inches front and lateral to tip 5 th little toe Checking overall length Elbow at 30° flexion Slide lower part after pressing the spring loaded double ball catch Position of armband 2 inches gap between armband and flexor crease of elbow

29. Gutter Crutches Single adjustable aluminium alloy tube Short horizontal metal gutter at upper end Vertical handgrip projecting forward from gutter Lower end protected with rubber tip

30. Indications Fixed flexion deformity Weakness of muscle controlling elbow joint or hand Deformity of hand Pain in hand or wrist

31. Adjustment 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

32. Crutch Accessories Crutch tip Hand grip Axillary pad Tricep band Wrist strap

33. Crutch Tip Attached to the foot of crutch Crutch tip diameter of at least 1.5 inches Prevent slippage Act as shock absorber Types Suction crutch tip Snow boot crutch tip Rain guard crutch tip Small crutch tip 1 2 3 4

34. Handgrip Sponge pad to relieve pressure Can be modified to accommodate a stiff or deformed hand Can increase the girth with rubber sponge

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

36. Scooting board Basically a wooden board with wheels below Patient sitting on it and pushing forward with hands Popular among Indian housewives with residual polio