Indication for Assistive Devices

• Structural deformity,
• amputation,
• injury, or disease resulting in decreased ability to weight bear through lower extremities
• Muscle weakness or paralysis of the trunk or lower extremities
• Inadequate balance

anes are assistive devices, useful for patients who can bear weight but need support for
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balance and stability. They are also useful for patients who have decreased strength in one
leg. Canes provide an additional point of support during ambulation and promotes greater
independence.

Types of Cane

Canes are made of wood or metal and often have a rubberized cap on the tip to prevent
slipping. Canes come in three variations: standard straight or single-ended canes with half-circle
handles (A), recommended for patients requiring minimal support and for those who will be
using stairs frequently; standard straight or single-ended canes with L-shape handles (B),
recommended for patients with hand weakness because the handgrip is easier to hold, but not
recommended for patients with poor balance; canes with three (tripod) (E) or four legs/tips
(quad cane) (F) provide a wide base of support, recommended for patients with poor balance.

The basic cane has four parts

• Handle. The handle of a cane is extremely important to the user. Many different styles
exist, the most common traditional designs are the Tourist, or crook handle, the Fritz
Handle and the Derby Handle. Ergonomically shaped handles have become
increasingly common for canes intended for medical use, both increasing the comfort of
the grip for the user (particularly important for users with disabilities which also affect
their hands or wrists), and better transmitting the load from the user's hand and arm into
the shaft.
• Collar. The collar of a cane may be only a decorative addition made for stylistic
reasons, or may form the structural interface between shaft and handle.
• Shaft. The shaft of the cane transmits the load from the handle to the ferrule and may
be constructed from carbon fiber polymer, metal, composites, or traditional wood.
• Ferrule. The tip of a cane provides traction and added support when the cane is used at
an angle. Many kinds of ferrules exist, but most common is a simple, ridged rubber
stopper. Users can easily replace a ferrule with one that better suits their individual
needs.

Fitting the Cane

Many canes are adjustable, but some are not. To make sure your cane fits the
patient properly:
• Check your elbow bend. With the cane in your hand, your elbow should bend
at a comfortable angle, about 15- 30 degrees. You might bend your elbow
slightly more if you're primarily using the cane for balance.
• Check your wrist height. With your arm hanging straight down at your side,
the top of your cane should line up with the crease in your wrist or level of the
greater trochanter.
• cane tip about 3-4” from the foot and at a 450 angle
• The patient holds the cane in the hand opposite the weak or injured leg.

If the cane is too long, makes it harder to pick it up and move it.
If the cane is too short, you might lean to one side — which can throw you off
balance.

Crutch is a mobility aid that transfers weight from the legs to the upper body. It is often used by people who
cannot use their legs to support their weight, for reasons ranging from short-term injuries to lifelong
disabilities.

Types of Crutches
1. Underarm or axilla crutches

Underarm crutches are used by placing the pad against the ribcage beneath the armpit and holding
the grip, which is
below and parallel to the pad. They are usually used for
short term injuries to provide support for patients who have temporary restriction on ambulation-
as in recovering from
ankle or knee injuries.
Advantages:
• Underarm crutches are adjustable to a person’s
• height and come with arm pads and handgrips for comfort.
• the easiest to use.

Disadvantages
• This type of crutch people tends to slouch while using them.
 • May cause armpit injury. A condition known as crutch paralysis, or crutch palsy can arise
from pressure on nerves in the armpit, or axilla. Specifically, "the brachial plexus in the
axilla is often damaged from the pressure of a crutch...In these cases the radial is the nerve
most frequently implicated; the ulnar nerve suffers next in frequency.

2. Forearm or Lofstrand Crutches

A forearm crutch (also commonly known as an elbow crutch, Canadian crutch or "Lofstrand"
crutch has a cuff at the top that goes around the forearm It is used by inserting the arm into a cuff
and holding the grip. The hinged cuff, most frequently made of plastic or metal, can be a half-
circle or a full circle with a V-type opening in the front allowing the forearm to slip out in case of
a fall. Used by users with long term disabilities.
Advantages:
• Encourage the user to use good posture, and experience less back and neck problems.
• Increase your upper body strength over time.
• Reduce strain and keep pressure off your wrist while moving.
Disadvantages:
• Hard to use for beginners.

3. Platform or Gutter Crutches

These are less common and used by those with poor hand or grip strength. The forearm rests on a
horizontal platform and is usually strapped in place with Velcro-type straps that allow the
platform or trough to release in case of a fall. The hand holds an angled grip which, in addition,
should allow adjustment of length from trough to grip and side-to-side sway depending on the
user's disability.

4. Leg Support
These non-traditional crutches are useful for users with an injury or disability affecting one lower
leg only. They function by strapping the affected leg into a support frame that simultaneously
holds the lower leg clear of the ground while transferring the load from the ground to the user's
knee or thigh. This style of crutch has the advantage of not using the hands or arms while
walking. A claim
Gait Patterns
1. two-point gait: the client is partially weight-bearing on both legs. (A crutch and the
opposite leg are considered one “point.” The other crutch and leg are the second “point.”)
Gait speed is faster than 4 point, but less stable as only two points are in contact with
floor and good balance is needed to walk with 2 points crutch gait. Low energy required
by patient.
Pattern: advance right crutch & left foot together, then advance the left crutch & right foot
together.
2. three-point gait, each crutch and only one leg support weight. (Each is considered a
“point.”) The other leg is non-weight-bearing. Used when patient has one leg can fully bear
weight and one leg can’t bear weight. Most rapid gait speed, provides the least amount of
stability for the patient. High energy required by patient.
Pattern: advance crutches & injured leg first, followed by unaffected leg in a step through
or step to pattern.
• Partial Weight Bearing
o Step to: Progress the involved extremity to the uninvolved extremity.
o Step through: Progress the involved extremity past the uninvolved extremity.
• None Weight Bearing
o Swing-to gait: A person with a non-weight bearing injury generally performs a
"swing-to" gait: lifting the affected leg, the user places both crutches in front of
himself, and then swings his uninjured leg to meet the crutches.
o Swing-through or tripod gait, the client stands on the strong leg, moves both
crutches forward the same distance, rests his or her weight on the palms, and
swings forward slightly ahead of the crutches. Because this gait is fast, the client
should learn to balance before attempting it. The client who is allowed to put
weight on only one leg must hold up the other leg, bending the knee (not bending
at the hip).
3. In four-point gait, each crutch and each leg move separately. (Each of the four “points”
supports weight.) this gait pattern is used when there's lack of coordination, poor
balance and muscle weakness in both LE, as it provides slow and stable gait pattern
with three points support. Provides maximum stability for patient and low energy
required by patient.
Pattern: advance right crutch, then left foot, left crutch, right foot.
Steps in Climbing Up and Going Down the stairs
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