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progression of devices - most stabile to least stabile

II bars > walker > rolling walker > crutches > cane > none


always guard at side or behind pt. (weak side), lelow pt. on stairs or curb, hands on gait belt until SBA


no weight on LE - requires assistive device


pt allowed to touch toe for balance NWB assistive devise required


orders will usually tell how much weight in %, use scale for accuracy assistive device required


amount of wt. pt can tolerate, minimal to full, assistive devise may or maynot be needed


full wt. on LE, assistive devise may be used for balance

gait patterns

4 point, 2 point, 3 point, swing to

4 point gait

pt. moves each crutch and each step seperately (crutch-steo-crutch-step), requires bilateral ambulation devices

4 point advantage

most stable gait pattern, similar to normal gait pattern

4point disadvantage

difficult to learn, slow, pt must be FWB

4 point indicated for

independent w/bilateral weakness, poor balance, decreased coordiantion

2 point gait

move opposite crutch and LE together, requires bilateral amb. devise

2 point advantage

stable gait pattern, faster than 4 point, relieves some wt on LE

2 point disadvantage

relatively slow, pt. must be FWB

2 point indicated for

individual with bilateral weakness, poor balance

3 point gait

advance both crutches/walker, then step legs to or through crutches (affected LE leads), requires bilateral ambulation devices or walker, cannot use two canes

3 point advantage

faster, used when pt. is NWB on one LE

3 point disadvantage

requires good balance and coordination, sufficient UE strangth needed, requires a good amount of energy

3 point indicated for

LE fracture, amputations, NWB on one LE, indiv. PWB > FWB, decreased balance

swing to/ swing through gait

advance both crutches simultaneously, then bring both legs through crutches, used with patients who have bilateral LE involvement and unable to adv legs. rely on UE momentum

swing to advantage

fast gait pattern

swing to disadvantage

requires good balance, UE and trunk strength, high energy use

swing to indicated for

individual with parapelegia, LE weakness

walker types

standard walker, roller walker, hemi-walker, platform walker, stair climber walker

standard walker

most stable walker

roller walker

likelihood for more reciprocal gait pattern, good for pt. unable to lift walker


handle comes out of center of front bar, use with only one UE, used for pt. with unilateral UE use (stroke)

platform walker

unilateral or bilateral available, forearm rest on platform, good for pt with arthritis, wt. bearing restrictions of wrist

stair climber walker

splin in middle to allow use on stairs

walker adjustment

20 - 30 elbow flexion, walker handles approx. at greater trochanter level, ulnar styloid

walker gait patterns level surface

affected leg first, pt should not hop

walker gait patterns stairs and curbs

place walker sideways with 2 legs where you are and 2 legs where you are going, middle bar closest to pt, use walker as hand rail, bad leg first when coming down stairs

crutch types

axillary, lofstand/forearm, platform

axillary crutches

orthopedic problems, short term use

lofstrand crutches

neurological problems, SCI, CP, long term use

platform crutches

arm rest on platform, wrist or hand wt. bearing problems

fitting axillary crutches

6" infront and to the side of feet, 20 - 30 elbow flexion, 2 -3 fingers between axilla and crutch, handrest at greater trochanter

fitting lofstrand crutches

20 - 30 elbow flexion, 2 - 3 fingers between cuff and elecranon fossa, hand hold at greater trochanter

platform crutches

set to pt comfort

one crutch

use cane guidelines

cane type

straight, quad

cane adjustment

place cane 6" infront of pt., 20 - 30 elbow flexion, top of can at greater trochanter

cane patterns and procedures

pt. must be FWB, 2pt. or 3pt. gait, cane held opposite injured LE

ascending stairs

good leg first, bad leg, device, therapist guard below pt.

descending stairs

device, bad leg, good leg

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