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Case

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Simon

Simon is 78 years old and has recently developed some left hip pain. He had been reluctant to use a cane, despite urgings from family members, but eventually agreed to use the carved wooden cane that had belonged to his father. Simon’s son has brought him to your clinic because his father’s hip pain has persisted even with the use of the cane.

In addition to examining Simon’s hip, what concerns might you have about his assistive device?

If there are changes you need to make regarding Simon’s use of the cane, what personal factors might you consider in the process?

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Introduction

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Although the fundamental principles of gait and gait training apply across devices, each device has its own unique characteristics. In this chapter, indications, advantages and disadvantages, fit, and use are specified for each ambulatory assistive device.

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Parallel Bars

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Indications

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Walking in parallel bars provides the greatest amount of stability of any assistive ambulation device and can be an appropriate choice for a patient who requires stability and security during the training period. It is not, of course, a functional choice in the long run because it is fixed in one place. Ambulation in the parallel bars must, therefore, always be carried out with an eye toward establishing good gait habits that will serve patients as they progress to less restrictive devices (AMAP/ANAP).

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  • Advantages: Parallel bars provide the greatest amount of stability and serve as a transition toward greater ambulatory mobility. The focus can be on practicing isolated components of gait, such as weight—shifting or lower-extremity (LE) advancement, or on achieving supported gait for short distances.

  • Disadvantages: The stability of the parallel bars comes at the cost of portability. Parallel bars are usually available only in facility-based settings, such as rehabilitation facilities and some acute care facilities, and are not accessible to patients at home or in some outpatient settings.

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Fit

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The height of the parallel bars should be at approximately the level of the standing patient’s greater trochanter, wrist crease, or ulnar styloid process. When the patient’s hands are placed on the bars about 6 in. (15 cm) anterior to the hips, the elbows should be flexed to approximately 20° to 30° (see Fig. 15-1). A horizontal clearance of about 2 in. (5 cm) between the bars and the greater trochanters is desirable. The method of height adjustment for the bars is usually a pin, push button, or hydraulic mechanism. Be sure that the bars are secure before beginning patient ambulation.

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FIGURE 15-1

The clinician maintains contact with the patient while adjusting the electric parallel bars to the correct height.

Graphic Jump Location
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Guarding

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Guarding while the patient is in ...

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