T13 - Walking Aids

• Rollator frames are not in the exam
• • gutter frames and gutter crutches allow people who have wrist conditions such as RA to put weight through the forearm instead
  • this allows for weight to be forced forward without aggravating symptoms of the wrist
• • people taller than 5"11 require longer frames/crutches that are indicated with an L sticker
  • maximum load is usually 120 kg
• walking stick wont feature in the exam
• Fischer sticks can be used for people with reduced grip strength e.g. due to RA or have reduced range of motion
• • check the shaft of crutches and frames to see theyre straight and not dented
  • the poppers need to be visible on both sides of the shafts
• Before getting the pts up:

  • need pts to understand their weightbearing status
  • need to ask pts if theyre in pain and if theyre nauseas/dizzy
  • check if pts have taken their medication - make sure theyve taken their pain relief so theyre not in pain doing the rehab
  • check what the pts are in for
  • check their situation last night
  • check observation chart
  • check history of presenting condition
  • check relevant past medical history - e.g. RA will need gutter crutches
• • tubes attached to pts need to be either removed or mobilised
  • ask nurses if theyre actively measuring urine content, if theyre not, drain it and attach it to their leg under gown
• in exam teh pts will sit up themselves
• • after the pts have sat up ask again about their nauseousness/dizziness and pain to see if its changed since
  • MUST ALWAYS HAVE A SECOND PERSON NEXT TO PTS AT ALL TIMES - MUST SAY THAT IN THE EXAM
  • check pts footwear
• • have 2 sets of crutches (one to demonstrate and one for the pts)
  • have 1 zimmer frame for the pts
  • pts can only touch zimmer frame once theyve fully stood up
  • guide pts on the way up with your hands
• Height of zimmer frame doesnt need to be measured, just get a good estimate
• • top of crutches must be in line with radial styloid process
  • poppers must be visible - crutches and frame
  • the holes should not be worn out - crutches and frame
  • the handles and ferrules should be firm - crutches and frame
  • elbow cuff must be just below the elbow
  • make sure height of the crutches are the same
  • front of the crutches should act as headlights and always be facing forwards
• when demonstrating how to stand up with crutches, you can try facing away from the pts so the pts mimics the movement instead of it being mirrored
• • 3 point gait is better than 2 point gait during early stage
  • 3 point gait = crutches forward first, then injured leg, then good leg
  • when walking backwards pts should walk in 2 point gait
  • 2 point gait = good leg back first, then injured leg along with crutches
• • to sit down, step back with good leg until you feel the edge of the chair
  • then make the H shape with crutches
  • then reach down with the good side
• • to measure gutter crutches you need to measure the gutter frames first - PRACTICE CHANGING HEIGHT OF GUTTER FRAME
  • there should be around 90 degrees of elbow flexion, without there being too much lumbar flexion on the gutter frame
  • for the gutter crutches get the pts to stand up right, holding onto gutter frame, with weight forward and with the elbow flexed to measure the height
• • to transfer onto gutter crutch, have pts holding gutter frame and then transfer one arm onto one crutch, whilst holing onto the frame with the other arm, then transfer the other arm
  • to get off the gutter crutch, stand by the plinth, move one arm onto the gutter frame, then the other, then reach down to plinth with the good side, then the injured side
• NWB stairs - good leg to heaven, bad leg to hell:

  • hop onto first stair with good leg
  • then bring the injured leg along with the crutches up (injured leg doesnt get placed down)
  • must stay behind the pts on the way up
  • on the way down tell the examiner someone would stay behind and you move in front of the patients
  • put the crutches and injured leg down first (injured leg doesnt get placed)
  • then bring good leg down
• PWB stairs - good leg to heaven, bad leg to hell:

  • stand behind the pts
  • good leg steps up first
  • then injured leg and crutches move up onto the same level
  • stand in front of the pts on the way down - tell examiner someone will stand behind
  • injured leg and crutches go down first
  • then good leg goes down
• always do a demonstration first in the exam
• • in a stairs scenario you dont need to teach pts how to get up onto crutches or how to walk