Augmented Mobility Intervention

Editor’s note: This text-based course is a transcript of the webinar, Augmented Mobility Intervention, presented by Michelle Lange, OTR, ABDA, ATP/SMS.Learning OutcomesAfter this course, participants will be able to:identify clinical indicators for canes and crutches to increase functional balance and functional mobility for ADLs/IADLs.identify clinical indicators for walkers to increase functional balance and functional mobility for ADLs/IADLs.identify clinical indicators for gait trainers to increase functional balance and functional mobility for ADLs/IADLs.What We Are CoveringMobility SeriesAugmented MobilityDependent MobilityManual MobilityPower MobilityThis is part of a series on mobility. Mobility devices are on a spectrum. We start with augmented mobility devices like canes, crutches, walkers, and gait trainers. From there, we move into dependent mobility devices such as adaptive strollers, transport chairs, and tilt-in-space manual wheelchairs. Manual mobility and power mobility devices round out the series. We have courses on each of these topics. If you are interested, I encourage you to check out each of these.Augmented mobility uses devices that augment or assist ambulation. These are used with someone who has some ability to ambulate. A device augments mobility to either improve efficiency, safety, or both. This includes walking aids such as canes and crutches, walkers, and gait trainers. These are each used for different reasons with different ages, populations, and diagnoses. We will touch on this as we move through this information.Why Does Someone Need These Devices?Decreased strengthDecreased balanceDecreased stabilityWhy does someone need these devices? It could be for a host of reasons. Many of us have used a pair of crutches or maybe even a cane. You may have sprained your ankle or broken your leg. These are fairly familiar pieces of equipment to us and are often used temporarily. People who may need to use these on a longer-term basis may have decreased strength, decreased balance, or decreased stability.Goals of Augmented MobilityFall preventionIncreased mobilityStrengtheningDynamic weight-bearingOne big goal with using augmented devices is to prevent falls by compensating for lack of strength or balance. We also want to increase their mobility, so this person can go a little further or ambulate in other environments than their home. Many people "furniture walk" in their home, which we know is not very safe and certainly limits where they can move. Sometimes, this equipment is used for strengthening to improve functional abilities. Again, it depends on the item and the person using it. Some of this equipment, particularly gait trainers, provides dynamic weight-bearing, rather than static weight-bearing, like in a stationary stander. The person moves while bearing weight through their legs.Who Uses This Technology?Varies with deviceWho uses these devices varies by device. We will talk about people who use these in each of these categories of augmented mobility as we go. CanesDefinitionTypesClinical indicatorsContra-indicatorsPopulationClinician roleWe are going to start with canes. You may be thinking, "I know what a cane is. How hard can this be?" There are times when it is appropriate for a client to use a cane and times where we should be recommending something else. And, there is a surprising amount of variety of features on canes that can make a significant functional difference to the client. DefinitionA cane is generally a vertical pole with a handle grasped by one hand to assist in ambulation.TypesStandard canesTypically, height adjustableQuad canesSeat canesWalking sticks (1-2)We have all seen those standard canes. These are typically height-adjustable, designed to be rather generic, and are typically accessible at local drugstores. They are designed to meet many people's needs. These are height-adjustable to find the correct height for an individual. This is based not just on their own height but also on whether there is some fixed kyphosis happening or other factors to best support the individual. There are quad canes like the one pictured in Figure 1.Figure 1. Quad cane from ProBasics.The idea is to provide more stability under the cane than one single point of standard cane. There are seat canes. These are a little clunky to use as a cane, but the idea is that if someone gets tired, they can stop and sit down.Some people benefit from using walking sticks. I use a walking stick when I am hiking. These are also height-adjustable, and a person might have better control with a walking stick, particularly if they need that height to be much higher than a standard cane.AccessoriesFlex tipSelf-standing tipIce cane attachmentThere are also a variety of accessories for canes. In Figure 2, there is a flexible tip that is available from many manufacturers. This means that when I put my cane down, even if the cane is not absolutely perpendicular to the ground, the tip of that cane will be firmly in contact with the ground because it flexes. This can really help someone be safer as it improves stability. Figure 2 shows a self-standing tip.Figure 2. Flexible cane tip by FlexSTICK company.It depends on the cane's surface, but this helps someone be less likely to drop their cane. For example, a person can put their cane down to unlock their front door. They do not have to worry about leaning it up against something and it slipping. This can be a common concern. There is even an ice cane attachment that you see pictured in Figure 3.Figure 3. Ice cane tip by Vive Health.I would be a little leery of recommending that my clients go out with their cane in an ice storm. However, if the conditions are such that this type of tip is required to improve safety, it is available.FeaturesFoldingVarious style handlesThere are folding style canes. If someone does not need their cane all the time and wants to fold it up to stash it in their purse or bag, it gives them that option. This is also a convenient option when traveling, especially on airplanes. There are different handles too. Some of these handles are designed to look a little more interesting, while others are designed for specific ergonomic purposes. Depending on your client's grip or range limitations, different styles can be used to best match the person's abilities.Clinical IndicatorsTo provide walking assistanceTo assist sit to standTemporary use: post-injury or surgeryLong term use: decreased mobilityCanes provide walking assistance as someone is moving along....