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Chapter 8: Non-Systems

Chris Childers; Ellen Lowe

SECTION A: EQUIPMENT, DEVICES AND TECHNOLOGY

The physical therapist has an extensive barrage of equipment devices and technology available. Definitions are as follows:

Adaptive devices: A variety of implements or equipment used to aid patients/clients in performing movements, tasks, or activities. Adaptive devices include:

  • Environmental controls

  • Hospital beds

  • Raised toilet seats

  • Seating systems

Assistive devices: A variety of implements or equipment used to aid patients/clients in performing movements, tasks, or activities. Assistive devices include:

  • Canes

  • Crutches

  • Long-handled reachers

  • Percussors and vibrators

  • Power devices

  • Static and dynamic splints

  • Walkers

  • Wheelchairs

The role of the physical therapist with respect to assistive devices is to choose the one that is most appropriate, and then teach the patient to use the device correctly. Table 8A–1 provides information on assistive devices for gait, including appropriate measurement of the device, and gait pattern most frequently used with the device. Tables 8A–2 and 8A–3 provide stair protocols and frequently used gait patterns.

TABLE 8A–1Gait devices.
View Table||Download (.pdf)
TABLE 8A–1Gait devices.
Device Unilateral/Bilateral Gait Patterns Measurement Typical Patient
Axillary crutches Bilateral

Four point

Two point

Three point

Modified three point

 2 inches below axilla when correctly on the floor (2−4 inches lateral and 4–6 inches anterior to toes) and wrist crease at handle

Recent fracture

Recent surgery

Usually younger (under 65)

Using three point or three-point modified when WB restrictions
  Unilateral

Modified four point

Modified two point

 As above As above, progressing to a unilateral device with no WB restrictions
Forearm or Loftstrand crutches Bilateral

Four point

Two point

Not recommended for three point or modified three point

 Cuff distal to olecranon wrist crease at handle Longer-term users such as chronic neurological patients but generally under 65
  Unilateral

Modified four point

Modified two point

 As above As above requiring less support

Walkers

Standard, front-wheeled, four-wheeled

 Bilateral Three point or modified three point gait just requiring support of bilateral device with no WB restrictions; is unnamed when using a walker Wrist crease at handle Generally over 65, may have WB restrictions or just instability
Single-point cane Unilateral

Modified two point

Modified four point

 Wrist crease at handle

Adds some balance stability; least stable of all AD, used in opposite hand to affected leg if there is one leg affected

Also used as a progression from a bilateral device when no WB restrictions apply
Wide- and short-based quad canes Unilateral

Modified two point

Modified four point

 Wrist crease at handle

As above, but the wider base adds greater stability when there are balance deficits

Often used with higher-functioning patients post CVA
Hemi walker Unilateral

Modified four point

Modified two point

 Wrist crease at handle

Often used with patient post CVA for initial gait training

Also used with patients post arm or shoulder injury or surgery who need increased stability using only one UE

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