Range of Motion. Walkers, Crutches, and Canes

Range-of-Motion Exercise

Active range-of-motion (ROM) activities are performed independently by the client. During active ROM exercises, the client moves various muscle groups. Passive ROM exercises are done by the nurse to help maintain or restore a client’s mobility by achieving several outcomes; see the accompanying display.

 

 

Musculoskeletal system is the second largest body system; it includes the bones, joints, and skeletal muscles, as well as their supporting structures. Disease, surgery, and trauma often affect one or more parts of this system, yet its as­sessment is often overlooked by nurses. This chapter does not include diagnostic testing related to arthritis or specific tests for osteoporosis. Descriptions of those tests are found in Chapters 21 and 51 under discussions of those diseases.

ANATOMY AND PHYSIOLOGY REVIEW Skeletal System

The skeletal system consists of 206 bones and multiple joints. The growth and development of these structures occur during childhood and adolescence and are not discussed in this text.

i BONES Types

Bones may be classified by their shape. Long bones, such as the femur, are cylindric with rounded ends; they often bear weight. Short bones, such as the phalanges, are small and bear little or no weight. Flat bones, such as the scapula, protect vi­tal organs and often contain blood-forming cells. Bones that have unique shapes are known as irregular bones (e.g., the carpal bones in the wrist). The sesamoid bone is the least common type and develops within a tendon; the patella is a typical example.

I   Structure

As shown in Figure 50-1, the outer layer of bone, or cortex, is composed of dense, compact bone tissue. The inner layer, in the medulla, contains spongy, cancellous tissue. Almost every bone has both tissue types but in varying quantities. The long bone typically has a shaft, or diaphysis, and two knoblike ends, or epiphyses.

The structural unit of the cortical, compact bone is the haversian system, as detailed in Figure 50-1. The haversian system is a complex canal network containing microscopic blood vessels, which supply nutrients and oxygen to bone, and lacunae, which are small cavities that house osteocytes (bone cells). The canals run longitudinally within the hard, cortical bone tissue.

The softer, cancellous tissue contains large spaces, or tra-beculae, which are filled with red and yellow marrow. Hematopoiesis (production of blood cells) occurs in the red marrow. The yellow marrow contains fat cells, which can be dislodged and enter the bloodstream to cause fat embolism syndrome (FES), a life-threatening complication. Volkmann’s canals connect bone marrow vessels with the haversian sys­tem and periosteum, the outermost covering of the bone. Os-teogenic cells, which later differentiate into osteoblasts (bone-forming cells) and osteoclasts (bone-destroying cells), are found in the deepest layer of the periosteum.

Bone also contains a matrix (also called osteoid) consist­ing chiefly of collagen, mucopolysaccharides, and lipids. De­posits of inorganic calcium salts (carbonate and phosphate) in the matrix provide the hardness of bone.

Bone is a very vascular tissue; its estimated total blood flow is between 200 and 400 mL/min. Each bone has a prin­cipal nutrient artery, which enters near the middle of the shaft and branches into ascending and descending vessels. These vessels supply the cortex, the marrow, and the haversian sys­tem. Sympathetic and afferent (sensory) fibers constitute the sparse nerve supply to bone. Dilation of blood vessels is con­trolled by the sympathetic nerves. The afferent fibers transmit the pain experienced by clients who have primary lesions of the bone.

■ Growth and Metabolism

After puberty, bone reaches its maturity and maximal growth. Bone is a dynamic tissue, however, that undergoes a continu­ous process of formation and resorption, or destruction, at equal rates until the age of 35 years. In later years, bone re­sorption accelerates, decreasing bone mass and predisposing clients to injury. (See Chapter 51 for a discussion of the ef­fects of aging on bone metabolism.)

Bone growth and metabolism are affected by numerous minerals and hormones, including the following:

» Calcium

•  Phosphorus

•  Calcitonin

•  Vitamin D

•  Parathyroid hormone (PTH)

•  Growth hormone
Glucocorticoids

•  Estrogens and androgens

•  Thyroxine

•  Insulin

E   CALCIUM AND PHOSPHORUS

Bone accounts for approximately 99% of the calcium in the body and 90% of the phosphorus. The serum concentrations of calcium and phosphorus maintain an inverse relationship; for example, when calcium levels rise, phosphorus levels de­crease. When serum levels of calcium and phosphorus are al­tered, calcitonin and PTH work to maintain equilibrium. If the calcium level of the blood is decreased, for example, the bone (which stores calcium) releases calcium into the vascular sys­tem in response to PTH stimulation.

W,   CALCITONIN

Calcitonin is produced by the thyroid gland and decreases the serum calcium concentration if it is increased above its nor­mal level. Calcitonin inhibits bone resorption and increases renal excretion of calcium and phosphorus as needed.

it  VITAMIN D

Vitamin D and its metabolites are produced in the body and transported in the blood to promote the absorption of calcium and phosphorus from the small intestine. They also seem to en­hance PTH activity in the release of calcium from the bone. A decrease in the body’s vitamin D level can result in osteomala-cia in the adult. An external source of vitamin D may be given to clients at risk for or diagnosed with osteomalacia. Vitamin D metabolism and osteomalacia are detailed in Chapter 51.

 

m   PARATHYROID HORMONE

When serum calcium levels are lowered, parathyroid hor­mone (PTH, or parathormone) secretion increases and stimu­lates bone to promote osteoclastic activity and donate calcium to the blood. PTH reduces the renal excretion of calcium and facilitates its absorption from the intestine. Conversely, when serum calcium levels increase, PTH secretion diminishes to preserve the bone calcium supply; this is an example of the feedback loop system of the endocrine system.

iff   GROWTH HORMONE

Growth hormone secreted by the anterior lobe of the pituitary gland is responsible for increasing bone length and determin­ing the amount of bone matrix formed before puberty. During childhood, an increased secretion results in gigantism, and a decreased secretion results in dwarfism. In the adult, an in­crease causes acromegaly, which is characterized by bone and soft-tissue deformities (see Chapter 63).

m   GLUCOCORTICOIDS

Adrenal glucocorticoids regulate protein metabolism, either increasing or decreasing catabolism to reduce or intensify the organic matrix of bone. They also aid in regulating intestinal calcium and phosphorus absorption.

m ESTROGENS AND ANDROGENS

Estrogens stimulate osteoblastic activity and inhibit PTH. When estrogen levels decline at menopause, women are sus­ceptible to low serum calcium levels with subsequent bone loss (osteoporosis). Androgens, such as testosterone, promote anabolism and increase bone mass. External sources of estrogen and testosterone may be prescribed for clients at risk for or diagnosed with osteoporosis.

m  THYROXINE

Thyroxine is one of the principal hormones secreted by the thyroid gland. Its primary function is to increase the rate of protein synthesis in all types of tissue, including bone.

if  INSULIN

Insulin works together with growth hormone to build and maintain healthy bone tissue.

i Function

The skeletal system:

Provides a framework for the body

• Supports the surrounding tissues (e.g., muscle and
tendons)

• Assists in movement through muscle attachment and joint formation

• Protects vital organs, such as the heart and lungs

• Manufactures blood cells in red bone marrow

• Provides storage for mineral salts (e.g., calcium and phosphorus)

1 JOINTS

I Types

There are three types of joints in the body:

■ Synarthrodial, or completely immovable, joints (e.g., in the cranium)

Amphiarthrodial, or slightly movable, joints (e.g., in the pelvis) • Diarthrodial (synovial), or freely movable, joints (e.g.,

the elbow and knee)

Although any of these joints can be affected by disease or injury, the diarthrodial joints are most commonly involved.

1 Structure and Function

The diarthrodial, or synovial, joint is the most common type of joint in the body. Synovial joints are so named because they are the only type lined with synovium, a membrane that se­cretes synovial fluid for lubrication and shock absorption. As illustrated in Figure 50-2, the synovium lines the internal por­tion of the joint capsule but does notnormally extend onto the surface of the cartilage at the spongy bone ends. Articular car­tilage consists of a collagen fiber matrix impregnated with a complex ground substance. Bursae, small sacs located at joints to prevent friction, are also lined with synovial membrane.

Synovial joints are subtyped by their anatomic structures. Ball-and-socket joints (shoulder, hip) permit movement in any direction. Hinge joints (elbow) allow motion in one plane, flexion, and extension. The knee is often classified as a hinge joint, but it rotates slightly, as well as flexes and extends. It is best described as a condylar type of synovial joint

I Types

There are three types of joints in the body:

■ Synarthrodial, or completely immovable, joints (e.g., in the cranium)

Amphiarthrodial, or slightly movable, joints (e.g., in the pelvis) • Diarthrodial (synovial), or freely movable, joints (e.g.,

the elbow and knee)

Although any of these joints can be affected by disease or injury, the diarthrodial joints are most commonly involved.

1 Structure and Function

The diarthrodial, or synovial, joint is the most common type of joint in the body. Synovial joints are so named because they are the only type lined with synovium, a membrane that se­cretes synovial fluid for lubrication and shock absorption. As illustrated in Figure 50-2, the synovium lines the internal por­tion of the joint capsule but does not normally extend onto the surface of the cartilage at the spongy bone ends. Articular car­tilage consists of a collagen fiber matrix impregnated with a complex ground substance. Bursae, small sacs located at joints to prevent friction, are also lined with synovial membrane.

Synovial joints are subtyped by their anatomic structures. Ball-and-socket joints (shoulder, hip) permit movement in any direction. Hinge joints (elbow) allow motion in one plane, flexion, and extension. The knee is often classified as a hinge joint, but it rotates slightly, as well as flexes and extends. It is best described as a condylar type of synovial joint.

 

Muscular System

There are three types of muscle in the body: smooth muscle, cardiac muscle, and skeletal muscle. Smooth, or nonstriated, involuntary muscle is responsible for contractions of organs and blood vessels and is controlled by the autonomic nervous system. Cardiac muscle, or the myocardium, is also con­trolled by the autonomic nervous system. The smooth and cardiac muscles are discussed with the body systems to which they belong in the assessment chapters.

■ Structure

In contrast to smooth and cardiac muscle, skeletal muscle is voluntarily controlled by the central and peripheral nervous systems. The junction of a peripheral motor nerve and the muscle cells that it supplies is sometimes referred to as a mo­tor end plate. Muscle fibers are held in place by connective tis­sue in bundles, or fasciculi. The entire muscle is surrounded by dense, fibrous tissue (fascia) containing the muscle’s blood, lymph, and nerve supply.

1 Function

The primary function of skeletal muscle is movement of the body and its parts. When bones, joints, and supporting struc­tures are adversely affected by injury or disease, the adjacent muscle tissue is often involved, limiting mobility. During theaging process, muscle fibers decrease in size and number, even in well-conditioned people. This senile atrophy is com­pounded when muscles are not regularly exercised, and they deteriorate from disuse.

I DEMOGRAPHIC DATA

Young men are at the greatest risk for trauma related to motor vehicle crashes. Older adults are at the greatest risk for falls that result in fractures and soft-tissue injury (see Chapter 5).

Supporting Structures

In addition to the articular cartilage of joints, several types of cartilage occur in other areas. Costal cartilage connects the sternum to the rib cage. Hyaline cartilage is in the septum of the nose, larynx, and trachea. The external ear and epiglottis contain yellow cartilage. In all areas, the tissue is flexible and elastic and can withstand enormous tension.

Other important supporting structures that are susceptible to injury include tendons (bands of tough, fibrous tissue that attach muscles to bones) and ligaments, which attach bones to other bones at joints.

Musculoskeletal Changes Associated with Aging

As one ages, bone density often decreases, causing postural changes and predisposing a person to fractures. Synovial joint cartilage degenerates as a result of the repeated use of joints, especially weight-bearing joints such as the hips and knees. The result is often degenerative joint disease. Muscle tissue atrophy occurs, but its rate may be slowed by increased activ­ity and exercise. Collectively, these changes cause decreased coordination, gait changes, and predisposition to falls with in­jury. Chart 50-1 lists the major anatomic and physiologic changes and suggested nursing interventions.

 

 

Physical Fitness

The ultimate outcome of regular physical activity is physical fitness that affects an individual’s functional ability. There are four components of physical fitness: endurance and strength, joint flexibility, cardiorespiratory fitness, and body composition.

Endurance and Strength

Endurance is the ability to withstand movement in terms of duration and absence of fatigue. A physically fitindividual has adequate muscular strength and endurance to accomplish one’s goals.

Muscle strength is the amount of force exerted by the muscles against resistance. Good muscle strength allows an individual to lift more safely.

Joint Flexibility

The ability to use a muscle through its complete range of motion is referred to as flexibility; see Table 34-4 for a complete description of joint movement. People with limited flexibility are likely to experience shortened muscles and  tendons with resultant imbalance in muscle strength and joint injury. Flexibility can be improved by stretching exercises such as yoga, tai chi, and dancing. Performance of ADLs also helps maintain flexibility. Walking, stooping, and lifting activities can promote and maintain flexibility.

Cardiorespiratory Fitness

Exercises that improve cardiorespiratory fitness are discussed in Table 34-3. To improve cardiorespiratory function, physical activity must be maintained for at least 20 minutes in order to raise the heart rate to the target level.

Body Composition

The recommended proportion of fat to lean body tissue is referred to as body composition. Having a body that falls within the normal range of body weight and percentage of body fat depends on balancing caloric intake and expenditure. Any type of physical activity can be useful in developing and maintaining physical fitness; see Table 34-5.

Fitness in Older Adults

Approximately 33% of those ages 65 and older fall each year (Lab & Cummings, 2000). “No one is too old tom enjoy the benefits of regular physical activity. Of special interest to older adults is evidence that muscle-strengthening exercises can reduce the risk of fall and fracturing bones and improve the ability to live independently” (Centers for Disease Control & Prevention, 1999, p. 5). The accompanying display lists benefits of physical

exercise in older adults.

 

Independence is an important part of a client’s recovery process. Being able to move about in the environment can spell the difference between living at home and living in a health care facility. Being able to move independently improves a client’s emotional, mental, and physical well-being.

Client’s who cannot safely walk unassisted can use devices designed to aid them in walking independently. The three most common devices used are crutches, canes, and walkers.

The appropriate device for each client is determined by the client’s physician, qualified provider, physical therapist, or nurse. Often these caregivers work together to determine which device works best for the client.

Determination of which device to use is based on the following:

• Upper arm strength

• Endurance (stamina)

• Presence or absence of one-sided weakness

• Weight-bearing ability; see Table

This decision is based on the client’s ability to bear weight on his legs, his upper arm strength, his stamina, and the presence or absence of weakness on one side.

Crutches can be used by clients who cannot bear any weight on one leg, clients who can only bear partial weight on one leg, and clients who have full weight bearing on both legs. There are several types of crutches available, depending on the length of time the client will require the assistance and the client’s upper body strength.

Crutches

A crutch is a wooden or metal staff used to increase client mobility.

 

There are several types of crutches:

Forearm 

a type of crutch with a cuff at the top to go around the forearm, also known as the Lofstrand crutch. It has been the type most commonly used in Europe. Forearm crutch is used by inserting the arm into a cuff and holding the grip. The cuff, typically made of plastic or metal, can be a half-circle or a full circle with a V-type opening in the front allowing the forearm to slip out in case of a fall.

Underarm 

or axilla crutch. It is used by placing the pad against the ribcage beneath the armpit and holding the grip, which is below and parallel to the pad.

Platform 

These are less common and used by those with poor hand grip due to arthritis, cerebral palsy, or other conditions. The arm rests on a horizontal platform and is strapped in place. The hand rests on a grip which, if properly designed, can be angled appropriately depending on the user’s disability.

Leg Support 

These non-traditional crutches are useful for users with an injury or disability affecting one lower leg only. They function by strapping the affected leg into a support frame that simultaneously holds the lower leg clear of the ground while transferring the load from the ground to the user’s knee or thigh. This style of crutch has the advantage of not using the hands or arms while walking. A claimed benefit is that upper thigh atrophy is also reduced because the affected leg remains in use. Unlike other crutch designs these designs are unusable for pelvic, hip or thigh injuries and in some cases for knee injuries also.

Information on use

Several different gait patterns are possible, and the user chooses which one to use depending on the reason the crutches are needed. For example, a person with a non-weight bearing injury generally performs a “swing-to” gait: lifting the affected leg, the user places both crutches in front of himself, and then swings his uninjured leg to meet the crutches. Other gaits are used when both legs are equally affected by some disability, or when the injured leg is partially weight bearing.^[1]

With underarm crutches, sometimes a towel or some kind of soft cover is needed to prevent or reduce under arm injury. A condition known as crutch paralysis, or crutch palsy can arise from pressure oerves in the armpit, or axilla.^[2][3] Specifically, “the brachial plexus in the axilla is often damaged from the pressure of a crutch…In these cases the radial is the nerve most frequently implicated; the ulnar nerve suffers next in frequency”.

There are two types of crutches: axillary and forearm. The most commonly used type, the axillary crutch, fits under the axilla with the weight being placed on the handgrips. The forearm crutch, which has a handgrip and a metal cuff that fits around the arm, is more convenient but provides less stability than the axillary crutch.

To prevent slipping, crutches have rubber tips, which must be kept dry. If the tips are worn or loose, they must be replaced. The crutch must be regularly inspected; if cracks or bends are present, the person’s weight will not be properly supported.

Crutches can be used by clients who are unable to bear any weight on one leg, clients who can bear partial weight on one leg, as well as clients who have full weight bearing on both legs.

Several gaits are used with crutches: the four-point gait, three-point gait, two-point gait, and swing-through gait.

The four-point gait for weight bearing with both legs follows the pattern of right crutch forward, left foot forward, left crutch forward, then right foot forward. The four-point gait with crutches is very stable but slow. The two-point gait for weight bearing with both legs has the pattern of right crutch and left foot forward together, then left crutch and right foot forward together. The two-point gait requires more balance but is a faster gait. The three-point gait for weight bearing with one leg has the pattern of crutches and weak leg forward together, then weight-bearing leg forward. The swing-through gait has the pattern of crutches forward, then legs swing forward together. The swing-through gait has the advantage of speed; however, it requires good balance. See Procedure 34-11 for a description of crutch-walking techniques.

 

A cane is used by clients who can bear weight on both legs but one leg or hip is weaker or impaired.

There are several types of canes as well. The standard, straight cane is used most often. There are also canes with three or four legs on the end to increase a client’s stability as he walks.

Walkers are used by clients who require more support than a cane provides. Walkers are available with or without wheels.Walkers without wheels provide the most stability but they must be lifted with each step. Walkers with wheels are somewhat less stable but a client who does not have the upper body strength to lift the walker repeatedly can push it along while walking.Mobility is an important part of everyone’s life. The ability to get around can contribute greatly to a client’s well-being.

Walkers

A walker is a waist-high metal tubular device with a handgrip and four legs. Some walkers have rubber tips on all four legs, whereas others have wheels on the two front legs. The advantages of using a walker include provision of extra support, provision of a sense of security, and independence. The client first moves the walker forward and then takes a step while balancing his or her.

A walker is used by clients who need more support than that provided by a cane. Walkers are available with and without wheels. The walker without wheels provides more stability but also requires more client stamina in order to lift the walker. Walkers with wheels are intended for use by clients with limited upper body strength.

 The nurse should determine the following for clients using walkers:

1. Amount of weight bearing allowed on lower limb

2. Appropriateness for client’s height

3. Type of walker (pick-up or rolling)

4. With pick-up walker: client’s ability to grip, lift, and propel the walker forward

5. With rolling walker: client’s ability to grip and propel the walker forward

When educating clients about the use of walkers, inform them when transferring from chair or commode they should back the walker to the toilet seat and use arms of chair or commode to assist in standing. Teach clients to always use both hands when using a walker to transfer from standing to sitting;

ASSESSMENT

1. Assess the reason the client requires anassistive device. Is it a long-term need or a short-term need? This helps determine which device to use.

2. Assess the client’s physical limitations. How much weight is the client able to bear? Can he bear weight on both legs or just one? Is his upper body strength good? Does he tire easily? Safety and comfort assessment.

3. Assess the client’s physical environment. Is he at home or in a medical facility? Is his environment suited to his assistive needs and the assistive device he will be using? Are the hallways wide enough?

Well lit? Are the doorways wide enough? Do the doors swing open far enough? Safety and comfort assessment.

4. Assess the client’s ability to understand and follow directions regarding use of an assistive device. Can he understand the instructions? Can he remember them? Has he used this device in the past? Is there a language barrier that might limit understanding?

Safety, educational, comfort, and effectiveness assessment.

DIAGNOSIS

·        Impaired Physical Mobility

·        Risk for Trauma

·        Knowledge Deficit, related to using assistive devices for mobility

 PLANNING

Expected Outcomes:

1. The client will be able to demonstrate safe and independent ambulation with the assistance of crutches, a cane, or a walker.

2. The client will feel confident and safe while using the assistive device.

Equipment Needed

• Gait belt

• Assistive device: crutches, cane or walker

Tape measure

• Sturdy footwear, properly fitted

 CLIENT EDUCATION NEEDED:

1. Reinforce teaching regarding holding a cane on the “good” side rather than the weak side.

2. Teach the client not to allow the crutch pad to rest in the axilla. This can cause damage to the client’s arm.

3. If the client’s walker has wheels, teach the client not to let the walker get too far ahead of his center of gravity.

Estimated time to complete the skill: 30 minutes

 

EVALUATION

Assess if the client is able to demonstrate safe and independent ambulation with the assistance of crutches, a cane, or a walker. Assess if the client feels confident and safe while using the assistive device.

DOCUMENTATION

 Document the type of device the client is using, the level of understanding regarding the use of the device, how far the client is able to walk using the device, and the client’s response to the activity.

Kardex

•Any information that is pertinent to nurses or therapists regarding type of device or a particular client’s needs should be noted.

 

NURSING TIPS

• Be sure there is about 2 inches or 3 fingers width of distance between the client’s axilla and the top of the crutch.

• Be sure the client is holding his cane on the good side for optimal effect.

• Be sure that the client’s walker is just below waist level. This allows the client’s arms to be slightly bent when standing in the walker. This is a stronger arm position than with the arms totally straight.

• Check the rubber tips on all assistive devices frequently. They can become worn quickly. Worn rubber tips can lead to instability and falls.

• When measuring the height of a cane be sure the client stands erect, not hunched or bent over.

• When teaching a client to stand up prior to using a walker have him use the armrest on the chair not the walker, for support. The walker is less stable and the client could pull it over.

• Provide a robe or other covering and shoes with firm, nonslip soles to provide for modesty and safety.

• Label the client’s equipment so he will not wind up with equipment measured for another person.

 

Some Interesting Facts – iWalker Project

Keywords: Balance, assistive devices, locomotion, community mobility, motor control.

In collaboration with: Centre for Studies in Aging, Toronto Rehabilitation Institute, University of Waterloo

Overview of Research

Assistive mobility devices, such as canes, crutches, or walkers, continue to grow in popularity as an approach to maintain and maximize ‘safe mobility’ among individuals with mobility restrictions. The rollator (or ‘four-wheeled walker’) is a mobility aid commonly used to facilitate balance and mobility for individuals with cardiorespiratory, musculoskeletal, or neurological deficits. Despite its popularity, there are also reports of adverse effects related to walker use linked to increased fall risks.

Studies examining the effectiveness and consequences of rollator use have employed standard laboratory-based measurement methods that rely on performing specific tasks within a short time period and under controlled conditions. These lab-based assessment methods are potentially limited in generalizability to mobility in the everyday context. To address the lack of tools available, an instrumented rolling walker (iWalker) was developed as an ambulatory measurement tool applicable to the assessment of balance outside of the lab or clinic for assistive device users.

System Overview

The iWalker (shown in Figure 1) autonomously collects measurements of the upper and lower limb behaviour related to balance, walker kinematics, and video of the immediate spatial environment. Figure 2 shows the component layout designed to be mounted underneath the seat. Aspects examined by the iWalker are:

Balance Control

• Upper limb forces (e.g., vertical load, centre-of-pressure) are measured through load cells mounted in the legs of the iWalker

• Spatiotemporal parameters of lower limb stepping (e.g., step width, step time) are captured using a video system aimed at the user’s feet

iWalker Kinematics

• Magnetic encoders capture wheel rotations to measure iWalker distance and speed

• Inertial sensors capture the 3-D acceleration of the iWalker

Spatial Environment

• Aimed at the upcoming environment, a video system captures the immediate spatial surroundings (e.g., obstacles, terrain, lighting, pedestrians)

Data Acquisition

• An on-board acquisition system based on mobile electronics (e.g., SmartPhone) captures and stores data

Figure 1. The iWalker

Figure 2. Schematic of specialised iWalker components, located under the iWalker seat

Research Objectives

The initial development and evaluation goals characterized the contribution of the upper limbs in maintaining balance in standard standing and walking tasks in older adults who regularly used rollators. The main findings from these studies were that the upper limbs play an important role in maintaining balance, particularly in the medial-lateral plane, and can compensate for lower limb deficits or constraints.

Pilot studies assessed the feasibility and utility of assessing in-patients recovering from neurological injury (e.g., stroke, traumatic brain injury). In this study, we found that users demonstrated repeated incidents of device collisions with the environment, problems manoeuvring, and stronger walker dependency under specific situations.

Currently, the project has identified the following avenues for continued research:

1.     Extracting features from the iWalker data stream to identify specific environmental challenges to balance

2.     Development of lower limb kinematics measurements

3.     Further characterization of task-specific behaviours (e.g., turning, transitions)

Funding Sources

Canadian Institutes of Health Research (CIHR – NET)

Natural Sciences and Engineering Research Council of Canada ( NSERC)

Toronto Rehab (Mobility team)

Research Team

James Tung, Ph.D. Candidate (University of Waterloo)

William McIlroy, Ph.D. (University of Toronto, TRI)
Karl F Zabjek (University of Toronto)
Brian E Maki (SWCHSC, TRI)

William H Gage (TRI)

Stephen Hill (TRI)

Geoff Fernie (TRI)

Alex Mihailidis, Ph.D. P.Eng. (University of Toronto)

Pascal Poupart (University of Waterloo)

Dina Brooks (University of Toronto, TRI)