Assistive Devices Advantages and Disadvantages

Four Wheel/Rollator Walker Disadvantages

-All walkers are challenging to use on stairs -Can be cumbersome to store/transport -Typically not the first choice due to how heavy they are and how expensive they are -Mainly used for long-term not temporarily

Wheeled Walker Disadvantages

-All walkers are challenging to use on stairs -Some patients are unsafe and the walker gets to far ahead of them -Can be cumbersome to store/transport

Crutches Types

-Axillary Crutches -Forearm Crutches (Forearm CR) (Loftstrand, Canadian)

Platform Supports/Attachments: Disadvantages

-Can be time-consuming to adjust properly -The patient/caregiver needs to strap the patient's arm to the platform after standing and unstrap it when getting ready to sit down (time consuming)

Parallel Bar Disadvantages

-Can lead to some challenges with body mechanics by PT -The parallel bars limit mobility. So once the patient becomes proficient with the appropriate gait pattern, the patient must be progressed to another assistive gait device to be mobile -Care must be taken so that the patient does not become dependent on the parallel bars

Crutches (Wood/Aluminum)

-Can use 2 crutches (typically with NWB, TTWB, PWB, or WBAT) or 1 crutch (FWB or WBAT); typically used with younger (not elderly) patients -Easier to use on stairs than a walker; offers more support than canes -Provides less stability and require more coordination than a WR -For patients with one- or two-sided involvement -Must have grip strength in both UEs or use platform on crutch -In general, for young to middle-age population

Forearm/Candadian/Loftstrand CR Disadvantages

-Forearm cuff can make it difficult to remove the crutch -Dynamic qualities may make some elderly patients feel insecure

Standard Walker Disadvantages

-It doesn't facilitate a "normal gait pattern" (foot after foot); some patients lose their balance backward when they have to lift the WR as they place it in front of them. -All walkers are challenging to use on stairs -Can be cumbersome to store/transport

Crutches Disadvantages

-Less stable -Requires generally good UE and trunk strength -Can risk damage to nerves/vascular supply in the arms if the patients leans for prolonged periods on the axillary pads (Don't hang on the crutch)

Forearm/Candadian/Loftstrand CR

-More commonly used for patients with pain or balance impairments; Can use 1 or 2 forearm crutches; NOT typically used when someone has a WB restriction (NWB, TTWB, PWB); used when the patient need crutches permanently, or for long periods of time (use for the long haul, typically for a health condition) -Allows more support and mobility than when using canes -Easier to use on stairs or in narrow spaces -No risk of injury to the neurovascular structures in the axillary region

Parallel Bars Advantages

-Primarily used in inpatient settings that have therapy gym -Provides the greatest amount of stability -Will use in patients who did very poorly in the screen and need a lot of support -Adjusting the height is the same as other devices; also need to adjust width of bars

Cane Disadvantages

-Provide the least amount of support -Require more coordination/thought related to sequencing

Four Wheeled/Rollator Walker

-Same as front wheeled; wheels swivel, making turning easier; has handbrakes to stop the walker/improve control; has a seat to sit on if sore/fatigued; can use the seat/basket to transport objects

Cane Types from Least to Most Support

-Single point straight cane (SC, SPC) -Small based quad cane (SBQC) -Large based quad cane (LBQC) -Hemi-walker or Hemi-cane

Walker Types

-Standard WR -Rolling, Wheeled (RW; WWR) -Platform attachment -Rollator WR Swivel wheels, hand brake, seat (long term walker) -Walkers in general provide a high level of stability; not easy to use on multiple stairs; good for patients with limited WB status who are unsafe with crutches or canes

Standard Walker

-Use if you're worried a WWR will "get away" from the patient -Use for patients who are safer when they move slowly

Canes

-Usually used for patients with unilateral involvement (unless using 2 st. canes) -DO NOT use for someone with a limitation in WB status (NWB, PWT, or TTWB), as it would not sufficiently offload an affected extremity -Can use for ortho. patient who has pain, neurologic patient with unilateral involvement who can't effectively use their arm to hold a walker, or other neuro dx/balance impairments -Must have grip to hold the device or use platform -For neurologic conditions, the choice between use of SPC, SBQC, LBQC, or hemi-WR will be dependent on stability in standing. -Hemi-cane (hemi-walker) - typically use with patients following stroke who require a high degree of support -Easiest to use on stairs

Platform Supports/Attachment Use/Advantages

1. Patient who are restricted or unable to bear weight distal to the elbow. Weight is distributed throughout forearm; check that ulnar nerve is not being compressed. 2. Patients with an inability to grip a device.

Wheeled Walkers

When to use: -Patient is too weak to life/advance the walker -If the patient has lifting restrictions (eg. Sternal precautions after open heart surgery) -If they lose their balance or have pain when they lift a standard walker -Great for faster, "normal" walking pattern