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The right support

Tuesday, July 03, 2018

Mobility aids can make life easier for those who need them but they must be used correctly, says Dr Naresh Shivdasani

There are many patients who cannot move around independently. There may be an injury which necessitates the use of crutches or walking sticks, or there may be a permanent condition such as arthritis or other disability. Most patients are advised the use of walking aids during a period of temporary disability. They however are not properly  trained in their use. I will give a synopsis of some of the common aids and their proper usage.

Walking sticks are very useful for patients who are unsteady on their feet, especially older patients. Unfortunately, many of our patients tend to hold someone for support, rather than carry a walking stick as they feel ashamed to do so. With today's uneven footpaths, it is better to use a stick, rather than risk a fall. Sticks are available in wood or aluminium. The latter can be adjusted to the patient's height. Ideally the length of the stick should be up to the patient's hip. It should be carried on the opposite side of the game limb, though it may be carried on either side if the patient is prefers. The walking stick is very useful for those who have an arthritic knee and can reduce the dependency on painkillers. A rubber tip prevents the stick from slipping.

Any injury to the lower limbs would mean a period of non-weight bearing, while the limb heals. In younger patients this would mean the use of axilllary crutches. They allow the patient to walk on one leg, or if the condition warrants, to put weight on both feet. The rubber tips at the ends of the crutches should not be worn out. The hand rest should be positioned so that the elbow is slightly bent. The pad in the armpit should not press into it, i.e. there should be no weight put onto the pad. Any pressure in the armpit can cause pressure on the major nerves and cause a paralysis. The complete weight of the body must be taken on the hands, and the good leg. This requires good upper body strength. The length of the crutches should also be measured individually for each patient. Patients who are extremely confident can use a 'swing through' gait, while others will take short steps. Elbow crutches are also available which can be used by patients who can bear weight on both lower limbs. There is a trough on which the forearm rests and the body weight is taken on this.

Walkers are useful for those who cannot handle crutches. They are three- sided and can be adjusted to the patient's height.  Folding ones are also available. However, they require that the patient should be able to use both upper limbs and they are impossible to use on stairs. They are very useful for older patients with hip fractures. The ones with two front wheels do not need to be lifted with each step.

Wheelchairs are used for those patients who cannot walk with either of the above aids. Patients who have had a stroke or have little upper body strength need to use a wheelchair. Unfortunately, most of our buildings do not have a ramp and  are not wheelchair friendly. Folding wheelchairs are convenient for storage, but not as sturdy as solid ones. If a patient is unable to sit in it, a strap may be used for support. While getting down slopes, it is always better to go backwards so that the patient does not fall. Motorised wheelchairs, though expensive, are also available for those who are able to use them. These are more useful in large houses with minimal furniture.

Mobility aids can make life easier for those who need them, but they must be used correctly if they are not to cause damage to the user.

If you need advice, write to Dr Naresh Shivdasani at naresh.shivdasani@gmail.com; he will answer queries in this column.

Dr Naresh Shivdasani (D.Orth, M.S. (Orth) is a Senior Orthopaedic Surgeon, with interest in Acupuncture and Spinal Manipulation. He believes that most disease originates from stress and lifestyle issues.

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