By:Dr.Hassan Hussien Mohammad Elsharkawy

1. AMBULATION By:Dr.HassanHussien Mohammad Elsharkawy

2. AMBULATION • Act of walking or being able to walk

3. AMBULATION AIDS • A piece of equipment used to provide support or stability for a person as he/she walks (Pierson, 1999)

4. AMBULATION AIDS • Appliance to aid ambulation • Provide an extension of the UE to help transmit BW & provide support for the patient

5. Functions of the Ambulation Aids Increase area of support Increase patient’s stability Redistribute & unload a weightbearing limb Improve balance Provide sensory feedback

6. Selection of the proper ambulation devices & gait pattern is most important to provide optimal security, safety, & function with the least energy expenditure.

7. What is my role as a physiotherapist? Know WHEN to indicate Know the RIGHT ambulation aid to use Provide PRE-Ambulation Exercises Stages: Strengthening Exe Coordination Exe Trunk Balance Exe Use of Ambulation Aids (END GOAL)

8. What are the factors that influence ambulation training program?

9. FACTORS THAT INFLUENCE AMBULATION TRAINING • Joint ROM & Muscle Strength of Upper Extremity • Joint ROM & Muscle Strength of Lower Extremity • Coordination • Trunk Balance • Impairment in Sensory Perception

10. What are the factors that help determine ambulatory needs?

11. FACTORS THAT HELP DETERMINE AMBULATORY NEEDS • Nature of Disability • Age of the Patient • Mental Status • Physical Endurance • Energy Expenditure

12. AMBULATION AIDS

13. CRUTCHES

14. CANES

15. WALKERS

16. PARALLEL BARS

17. Types of crutches

18. 1.Axillary crutch • This is the most common type. Wooden or aluminum models can be adjusted easily to your overall height and hand height. In the stationary position, the top of the crutch should extend from a point the width of two to three fingers below the armpit (axilla) to a point on the floor 15 cm-20 cm (6 in-8 in) outside your foot. Your hand should rest at a level that allows you to flex your elbow about 30°. If you are unable to stand, simply subtract 16 inches from your height to determinethe crutch length you need.

19. Axillary crutch

20. 2.Forearm crutch Forearm crutch (also known as the Lofstrand crutch, or elbow crutch): This crutch should allow you to flex your elbow 15°-30°. The increased flexion allows your arm to bear greater weight. The crutch should contact the floor 5 cm-10 cm (2 in-4 in) outside and 15 cm (6 in) in front of your foot. The cuff on the crutch should sit 2.5 cm-4 cm (1 in-1.5 in) below the back of the elbow. This type of crutch is common in Europe, however in the U.S. generally only people with lifelong disabilities such as polio use this type of crutch

21. Forearm crutch

22. 3.Platform crutch • Also known as a triceps crutch, this crutch should contact roughly 5 cm (2 in) below the skinfold of the armpit. The lower cuff should lie 1 cm-4 cm (0.5 in-1.5 in) below the back of the elbow to avoid bony contact on the arm yet provide stability. • Strutter crutch: This crutch is a type of underarm crutch that has larger crutch tips that remain flat on the floor. This allows for improved weight distribution and more even walking gait.

23. Platform crutch

24. 4-Leg support crutches These are like a knee scooter where the affected leg is strapped into a support frame on wheels. Leg support crutches are particularly useful for below the knee injuries or postoperatively after below-the-knee surgery that affect one leg only.

25. Leg support crutch

26. 5-sTrutter crutch • This crutch is a type of underarm crutch that has larger crutch tips that remain flat on the floor. This allows for improved weight distribution and more even walking gait.

27. Strutter crutch

28. Strtutter Crutch

29. Strtutter Crutch

30. Function of crutches 1-A crutch must do two things: reduce weight load on one of your legs and broaden your support base to improve your balance and stability. The support also should assist upright movement and transmit sensory cues through the hands. A crutch allows people with paralysis or other disabilities the benefits of upright posture and lets them maneuver in places they cannot go with a wheelchair.

31. 2-A crutch becomes necessary when a person cannot walk or walks with extreme difficulty. Any person with leg or foot pain or injury, weak muscles, or an unstable gait may benefit from using a crutch or crutches. Regaining upright body movement aids circulation, assists kidney and lung functions, and helps prevent calcium loss from your bones. 3-Crutches shift the force of upright movement from your legs to your upper body. You must have sufficient arm strength, balance, and coordination to use them effectively.

32. Adjustment of crutches

33. Adjustment of crutches

34. To begin walking with crutches, gradually shift your weight to your healthy leg. Move the crutches in front of you to a point at which you can maintain stability. For the swing movement, shift your weight from your healthy leg to your arms, swinging your body through the crutches as the crutches take up the weight. Plant your healthy leg at a point ahead, again maintaining stability, and shift your weight back to the leg. Then move the crutches forward to repeat the movement.

35. Studies have shown that your wrist receives from one to more than three times your body weight during the swing phase of walking with crutches -- a load the upper body was not designed to sustain. • Never support yourself on your armpits. Hold the handgrips for support. • While standing, place the crutches 8 in-10 in in front of you. • While walking, do not try to move too quickly or to cover too long a distance with each step. Keep the crutches close to your body.

36. Generally, people use a swinging gait, where the crutches are advanced and stabilized then the feet swung through after stabilization of the crutches has occurred. • While navigating on stairs, have someone assist you.

37. While going down stairs, place the crutches on the next step below, then step down with the good leg. • While going up stairs, step up with the good leg first, then bring the crutches up.

38. Types of gait crutches 1-Four-Point Gait: Indication:Weakness in both legs or poor coordination. Pattern Sequence:Left crutch, right foot, right crutch, left foot. Then repeat. Advantages: Provides excellent stabilty as there are always three points in contact with the ground Disadvantages:Slow walking speed

40. 2-Partial Weight-Bearing Three-Point Gait Indication:Inability to bear weight on one leg. (fractures, pain, amputations) Pattern Sequence:First move both crutches and the weaker lower limb forward. Then bear all your weight down through the cruthes, and move the stronger or unaffected lower limb forward. Repeat. Advantages:Eliminates all weight bearing on the affected leg. Disadvantages:Good balance is required

42. 3-Two point crutch gait Indication:Inability to bear weight on one leg. (fractures, pain, amputations) Pattern Sequence:First move both crutches and the weaker lower limb forward. Then bear all your weight down through the cruthes, and move the stronger or unaffected lower limb forward. Repeat. Advantages:Eliminates all weight bearing on the affected leg. Disadvantages:Good balance is required.

44. 4-Three-Point Swing-Through Gait indications:Inability to fully bear weight on both legs. (fractures, pain, amputations) Pattern Sequence:Advance both crutches forward then, while bearing all weight down through both crutches, swing both legs forward at the same time past the crutches. Advantage:Fastest gait pattern of all six. Disadvantage:Energy consuming and requires good upper extremity strength.

46. 5-Swing-To Crutch Gait Indications:Patients with weakness of both lower extremities. Pattern Sequence:Advance both crutches forward then, while bearing all weight down through both crutches, swing both legs forward at the same time to (not past) the crutches. Advantage:Easy to learn. Disadvantage:Requires good upper extremity strength.