Simon is 78 years old and recently developed 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?
Although the fundamental principles of gait training apply across devices, each device has its own unique characteristics. Any gait assistive device that relies on the use of the upper extremities (UEs) will increase forces transmitted through the UE joints, increase energy expenditure, and alter the overall pattern of gait.1 In addition, any increase in stability comes at the cost of mobility, and vice versa. Correct selection, fit, and use of assistive devices can help minimize potential negative effects. In this chapter, indications, advantages and disadvantages, fit, and use are specified for several ambulatory assistive devices.
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 generally recommended to begin novel activities or devices in the parallel bars. For example, if patients are prescribed lower-extremity (LE) prostheses, they may benefit from ambulating with the prostheses first in the secure environment of the parallel bars.
Parallel bars are not, of course, a functional choice in the long term because they are 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
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 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.
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° ...