WALKING AID PRESCRIPTION Calvary Health Care Sydney WALKING AID PRESCRIPTION Updated May 2013

Why Use Walking Aids? Provide support Reducing or totally relieving weight and therefore pain E.g. Recent fractures/surgery of lower extremity Provide stability E.g. For decreased balance, an amputee, paraplegic, or weakness Relieve Pain E.g. Severe OA In many cases it will be a combination of the above May be temporary while recovering from surgery, or permanent Aim is to provide the support required but allow as normal a gait pattern as possible. Pain management/falls prevention!

Considerations in Selecting a Walking Aid Age and functional needs of the person Nature and pathology of the disease E.g. fractures, sprains, rheumatoid arthritis, medications causing dizziness The extent of disability Joint range, pain, coordination, balance, sensation, comprehension, communication and sight. Mental and Physical capacity (muscle strength) E.g. If NWB on right (R), then need adequate strength in (L) to support total body weight, UL need sufficient power to use the aid Short or long term basis Requires assessment of the patient, careful fitting and measuring, instructions and training of its use, and monitoring for safety and progression. ONLY RECOMMEND WHAT HAS BEEN TESTED BY THE PATIENT

Types of Walking Aids

People

People Advantages: Stable and safe May be only option for people with UL issues and unable to use walking aid Disadvantages: Not realistic for independence Large carer burden

Parallel Bars

Parallel Bars Advantages: Stable for practicing walking/balance in the gym provides maximal support Useful for initial training prior to walking stick, crutches Disadvantages: Not readily available Cannot mimic normal gait Difficult to wean off if on them too long Does not train balance, obviously very restrictive

Forearm Support Frame (FASF)

Forearm Support Frame (FASF) May have 2 wheels or 4 wheels: 2 wheels have increased stability, 4 wheels allow increased mobility Advantages: Provides +++ support so able to take weight through arms for initially post op # NOF, hip replacement etc Very supportive to compensate for very poor balance Used in patients who are Non Weight Bearing (NWB) or Touch Weight Bearing (TWB) in one lower limb (LL) Suitable for patients with Rheumatoid Arthritis in hands as unable to grasp handles of other frames Disadvantages: Large and may not be compatible with peoples homes especially bathrooms not really community accessible FITTING Shoulders should be relaxed although the patient should be able to push through their forearms to allow some lift, as well as clearance for the leg to swing forward. Can adjust the rotation of the forearm for patient comfort. Elbows are at 90 degrees.

Pick Up Frame (PUF)

Pick Up Frame (PUF) Advantages: Usually light weight aluminium May fold up to go in car Progression from FASF Disadvantages: Only allows step to gait Slow due to need to pick up frame which is inefficient and provides a period of instability during which there is no support from the assistive device Cannot be used on steps Provides maximal support Difficult to negotiate small spaces

2 Wheel Rollator (2WRF)

2 Wheel Rollator (2WRF) Advantages: Light weight and transportable Normal gait can develop Increased stability due to skis/stoppers on back and rigid front wheels Good progression from FASF Disadvantages: Difficult to maintain contact with ground and turn Cannot be used on steps Difficult to negotiate small spaces. FITTING: Patient erect, arms at comfortable angle

4 Wheel Rollator (4WRF)

4 Wheel Rollator (4WRF) Advantages: Light weight and transportable Normal gait can develop, step through with increased speed Has accessories such as seats, brakes, (pull up or push down), and baskets enabling them to carry things increasing independence Disadvantages: Decreased stability due to 4 wheels, some have 2 wheels and skids which have increased stability FITTING: Patient erect, arms at comfortable angle Important to teach the patient use of the brakes which should be suited to their hand function, as well as stationary positioning for use of the seat , and in preventing the rollator from running away down slopes .

Crutches

Auxiliary Crutches Advantages: Cheap Adjustable Readily available Disadvantages: They are difficult to stow Temptation to weight bear under axilla leading to potential danger to axillary vessels and nerves Both hands are occupied so difficult to perform manual tasks or transport objects in hands. FITTING: Patient erect, shoes on, 3cm space between top of the crutch and the axilla when the shoulders are relaxed. Hand piece adjusted so that there is approximately 30 degrees elbow flexion when in use, and at level of ulnar styloid process or proximal wrist crease when arm relaxed. When measuring the ferrule of the crutch should be approximately 14 cm out from the side of the lateral side of the foot, to allow space for the patient’s body.

Elbow or Canadian Crutches Advantages: Shorter and easier to store, possible to free hands. Cheap and adjustable Disadvantages: Need more control of shoulder and elbows. FITTING: As per Auxiliary crutches

Single Prong Stick (SPS)

Single Prong Stick (SPS) Advantages: Light and cheap Easily managed Readily available one hand available for tasks Community accessible For patients requiring minimal support Decreases the load on the hip contralateral to the hand it is held Disadvantages: Provide little stability Cannot NWB/TWB Need good wrist strength and rhythm FITTING: Elbow flexion is at 15-30 degrees

Four Prong Stick (FPS)

Four Prong Stick (FPS) Advantages: Provides stability in standing Most supportive device if 1 UL not functional Disadvantages: Normal gait impossible because it promotes uneven weight bearing towards side of stick Difficult outdoors on uneven terrain to get four prongs flat on ground Heavy for some patients to hold FITTING: As per single prong stick

Wheelchair (W/C)

Wheelchair (W/C) Advantages: Allows more dependent patients to mobilise Allows patients with poor exercise tolerance to mobilise longer distances/outdoors Disadvantages: Large and may not be home accessible Need good shoulder function Speak to OT if needing to prescribe

Provision of Other Devices Ankle Foot Orthosis (AFO) For patients with a foot drop, as a result of CVA or peripheral neuropathy. Zimmer splints for example for distal femoral # to restrict knee ROM, useful for patients with knee flexion contractures to provide prolonged stretch, useful for patients with poor knee control to mobilise with splint holding knee in extension. Other Pre and post spirometry Incentive spirometers Slings, Collar and cuffs Hoists Etac turner Slide transfer board

NWB Ankle