1. Machakos Campus
Department of Orthopaedic
Trauma Medicine
Subject – Biomechanics
Topic – Positioning and mobility
aids
BY
Mr. Oduor Wafulah
30th November, 2022.

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Walking
• Walking is the manner or way in which you move
from place to place with your feet.
• It is a Movement at a regular and fairly slow pace by
lifting and setting down each foot in turn, never
having both feet off the ground at once.
• It is the highest level of motor control skill.

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• The major requirements for successful walking
include:
• Support of body mass, by the lower
extremities
• Production of locomotors rhythm
• Dynamic balance control of the moving body
• Propulsion of the body in the intended
direction

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Basic terms
• Ambulation: To walk from place to place or move about.
• It is a technique of post operative care in which a patient gets
out of bed and engages in light activity (as sitting, standing, or
walking) as soon as possible after an operation.
• Some time this term is also use in the place of walking .
• Gait: Gait is a term to describe human
locomotion, it is pattern of walking or a
sequence of foot movements.

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Gait cycle or walking cycle
• A cycle of walking is the period from the heel-strike of one
foot to the next heel-strike of the same foot
• When a subject is walking on level ground, than the
movements of the lower limbs may be divided into “swing”
and “stance” phases.
• The swing phase occurs when the limb is off the ground, and
the stance phase when it is in contact with the ground and is
bearing weight.

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 Walking aid is a device designed to assist walking and improve the
mobility of people who have difficulty in walking or people
who cannot walk independently.
 Walking aids are sometimes also referred to as Ambulatory
Assistive Devices.
 A walking aid is one of several devices a patient may be issued in
order to improve their walking pattern balance or safety while
mobilizing independently.
 They can also be a means of transferring weight from the upper
limb to the ground, in cases where reducing weight bearing
through the lower limb is desired.
WALKING AIDS

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Purpose of walking aids
 Increase area of support or base of support
 Maintain center of gravity over supported area
 Redistribute weight-bearing area by decreasing
force on injured or inflamed part or limb
 Compensate for weak muscles
 Decrease pain
 Improve balance
 Improves proprioception

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Different Types of Walking Aids
Walke
r
Cane/Stic
k
Crutche
s

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Selection
 Stability of the patient
 Strength of upper and lower limbs
 Co-ordination of upper and lower limbs
 Required degree of relief from weight-bearing

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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

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Canes
 Most common mobility aid
 Commonly made of wood or
aluminium
 Transmits 20-25% of body weight
 Held in hand opposite the involved
side
 Compensates for muscle weakness
 Relieves pain
 Elbow at 30° flexion

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Advantages -
 Improves balance & postural stability
 Reduce biomechanical load on lower extremity (LE) joints
 Widens base of support (BOS)
 Reduces forces on hip while walking
 Reduces knee pain in osteoarthritis (OA) knee patients
 Restricted in Non weight bearing (NWB) NWB & Partial weight
bearing (PWB)

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TYPES OF CANE

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Standard cane
• Single point or straight cane
• Made of wood or acrylic
• Has half circle or t-shaped
handle
• Less expensive & fits anywhere
• Not adjustable

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Standard adjustable aluminum
cane
• Same as standard, made of aluminum &
handle with a molded plastic covering
• Adjustable height with a push button
mechanism
• Approximate height is 27-38.5 inches (68-
98cm)
• Light weight & fits easily anywhere
• Costly than standard

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Adjustable aluminum offset
cane
• Proximal component of shaft of cane is
offset anteriorly – straight offset
handle.
• Plastic or rubber molded grip
• Pressure can be given on center of the
cane for greater stability
• Adjustable height, lightweight & fits
anywhere.
• Costly

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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

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Quadrupeds
 Has four rubber tipped legs
 More stable
 Adjustable hand grip height
 Provides broad base
 Each point is covered with a rubber
tip
Disadvantage – pressure exerted on
handle may not be centered, causes
instability; may not be used on stairs;
slower gait pattern

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Hemi cane
• Provides a very broad base
• Legs are angled to maintain floor contact to
improve stability farther from body
• Handgrip is molded with plastic
• Fold flat & adjustable in height
• Easy for travel & storage
• May not allow pressure to be centered
• Can not be used on stairs
• Require slow forward progression
• Costly

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Rolling cane
Provides wide, wheeled base allowing
uninterrupted forward progression
• Includes contoured handgrip, height adjustments &
pressure sensitive break in the handle
• Wheeled base allows continuous weight on cane;
no need to lift & lace it forward
• Provides faster forward progression
• Require sufficient UE & grip strength for breaking
mechanism
• Not suitable for patients with propulsive gait
pattern (parkinson’s)
• Costly

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Laser cane
• Incorporates bright red lase line
projected along the floor to assist
freezing episodes while walking

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Gait pattern with cane

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Walker (Walking
Frame)

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Walking Frames
 Used to improve balance & relieve weight bearing
 Provides greatest stability
 Suitable for patients with poor balance
 Provide wide BOS, improve anterior & lateral stability,
allows upper extremity (UE) to transfer body weight to
floor.
 Typically made of aluminium with moulded vinyl handgrip
& rubber tips
 Adjustable adult size- 32-37inches (81-92cms)

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Features
• Glides
• Folding mechanism
• Handgrips
• Platform attachment
• Wheel attachment
• Braking mechanism
• Tripod rolling walker
• Storage attachment
• Seating surface

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1. Standard
2. Reciprocal
3. Rollator
Types:-

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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

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

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Advantages :-
• Allows unilateral forward progression
• Useful for patients incapable of lifting the walker to move it
forward
• Relatively light weight & easily adjustable
Disadvantages :-
• Less inherent stability
• Awkward in confined area
• Eliminate arm swing
• Can not be used on stairs

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Rollator
 Two small wheels at front and two legs without wheels
at back or one wheel at each leg
 No need for lifting the whole device
 Care to be taken for elderly patients
 Bestsuited for children
 Have decreased stability due to wheels

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Other Variants of Walking
Frame
Gutter
frame
Pulpit
frame

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CRUTCHES

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• Used most frequently to improve
balance & to relieve weight bearing
(fully/partially)
• Typically used bilaterally – to increase
BOS, improve lateral stability, allows UE
to transfer body weight to the floor.
• 2 basic designs of crutches in clinical
use are :-
• Axillary crutches
• Forearm crutches

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Prerequisites for crutches
• Good strength of upper limb muscles is
required.
• Range of motion of upper limb should be good.
• Muscle group which should be strong are –
• Shoulder flexor, extensors and depressor
• Shoulder adductors
• Elbow and wrist extensors
• Finger flexors

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Axillary crutches /under arm
crutches
• Referred as standard crutches.
• They are made of lightweight wood or metal with an Axillary bar, a hand
piece and double uprights joined distally by single leg covered with
rubber suction tip.
• Single leg allows height variations.
• Both the overall height of the crutch & height of the handgrip can be
adjusted.
• Adjustable adult crutch size is 48-60 inch.

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• Advantages –
• Improve balance & lateral stability
• Provide functional ambulation with restricted weight bearing
• Easily adjustable
• Inexpensive
• Can be used for stair climbing easily
• Disadvantages –
• Awkward in small areas –
may compromise safety when using in crowded place
• Limited upper body freedom
• Axillary crutches require good standing balance by the patient.
• Tendency to lean forward on axillary bar (pressure on radial groove -
potential damage to vascular structures)

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Precautions
Have someone nearby for assistance until accustomed to the
crutches.
• Frequently check that all pads are securely in place
• Check screws at least once per week.
• Clean out crutch tips to ensure they are free of dirt and
stones.
• Remove small, loose rugs from walking paths.
• Beware of ice, snow, wet or waxed floors
• Avoid crowds.
• Never carry anything in hands ,use a backpack.

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Gutter Crutches
 Also referred as Forearm Rest, Platform attachment or Troughs.
 Also used with walkers.
 Function – to allow transfer of body weight from forearm to assistive
device.
 Used when weight bearing is contraindicated through wrist or hand.
 Forearm piece is usually padded, has a dowel or handgrip, has hook or
loop strap to maintain position of forearm.
 These are used for patient’s with Rheumatoid Disease, who require some
form of support but cannot take weight through hands, wrists and elbows
because of deformity and/or pain.

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Platform attachment
 They are made of metal with a padded forearm support
Platform, Velcro strap, an adjustable hand piece and a rubber
ferrule.
 These are used for patients with Painful wrist and hand
condition or elbow contractures, or weak hand grip
 Elbow flexed 90 degrees
 The hand rests on a grip which can be angled appropriately,
depending on the user's disability.

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Measurement of axillary crutch

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Forearm crutches
• Also known as Lofstrand / Elbow / Canadian Crutches.
• They are made of aluminum.
• Design includes a single upright, a forearm cuff & a handgrip.
• It adjusts both proximally (position of forearm cuff) & distally (height of crutch); using
push button mechanism.
• Generally adult sizes are 29-35inches (74-89cms).
• Distal end of crutch is covered with rubber suction tip.
• Forearm cuffs are available with either medial or anterior opening.

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• Advantages –
• Forearm cuff allows use of hands
• Easily adjusted & allows functional stair climbing
• Most functional for patients with bilateral KAFO’s.
• Using forearm crutches requires no more energy, increased oxygen
consumption or heart rate than axillary crutches.
• There is no risk of injury to the neurovascular structures in the
axillary region when using this type of crutches.
• Disadvantages –
• Less lateral support
• Cuffs ay be difficult to remove
• They require good standing balance and upper-body strength.
• Geriatric patient sometimes feel insecure.

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Preparation For Crutch Walking
• Arms: shoulder extensors, adductors and elbow extensors
even all muscles of arms must be assessed and strengthened
before the patient starts walking. The hand grip must also be
tested to see that the patient has sufficient power to grasp
hand piece.
• Legs: Strength and mobility of both legs should be assessed
and strengthened if necessary. Main attention to the hip
abductors and extensor, the knee extensors and the plantar
flexors of the ankle should be given.
• Balance: sitting and standing balance must be tested.
• Demonstration: demonstrate appropriate crutch walking to
the patient.

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Crutch walking
• During first time, when the patient is to stand and walk, the
physiotherapist should have an assistant for supporting the
patient.
• Non-weight bearing: patient should always stand with a
triangular base i.e. crutches either in front or behind the
weight bearing leg
• Partial weight bearing: The crutches and the affected leg are
taken forward and put down together. Weight is then taken
through the crutches and the affected leg, while the
unaffected leg is brought through.

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STAIR
CLIMBING

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GUIDELINES
• If railing is available – use it (For axillary
crutches, put both in one hand)
• Stronger LE always leads going up & weaker
or involved limb leads coming down. (up
with good; down with bad)

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Ascending stairs :-
• Therapist – postero-lateral on affected side
• Maintain wide BOS
• Take step only when patient is not moving
• Hold guarding belt posteriorly by one hand & other
anteriorly but not touching the shoulder of affected
side
• Leave crutches on the same level where standing.
• Support weight evenly on the crutch hand and railing.
• Raise the uninjured foot to the higher step, letting the
injured foot trail behind.
• Straighten the uninjured leg and advance the crutches.

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To Descend
• Therapist – anterolateral to affected side
• Maintain wide BOS
• Take step only when patient is not moving
• Hold guarding belt anteriorly by one hand & other
anteriorly but not touching o the shoulder o affected
side
• Place the crutches on the lower step, while extending the
injured foot forward. Place the crutches on both sides of
the body if no railing is present.
• Support weight evenly on the crutch hand and railing.
• Move the uninjured foot to the lower step.
• Narrow steps without a railing might require sitting on
each step.

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Stair Climbing
Up With GOOD, Down With BAD

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If balance is lost .
. .
1. Make contact of the hand guarding the shoulder.
2. Therapist should move towards the patient. (don’t pull patient
towards therapist)
3. If needed, make the patient sit down on the staircase.

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Wheelchair
 A wheelchair is an assistive device used by people who have difficulty walking on
their feet, either due to illness, injury, or disability.
 This tool can be driven by being pushed by another party, driven by hand, or driven
by using an automatic machine.
 It is estimated that the first concept of a wheelchair was invented more than 6,000
years ago.
How To Use (How It Works)
 The client is seated in a wheelchair.
 Open the foot support then place the client's foot on the support so that it is
comfortable.
 To move it the client needs to hold a special place for the handrails to walk and then
run the wheelchair.
 It could as well be moved by being pushed by other people.

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Wheelchair

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Don’t Give Up

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Questions

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