Orthoses provide support for damaged joints, ligaments, tendons, muscles, and bones. Most are customized to a patient’s needs and anatomy. Orthoses designed to fit into shoes may shift the patient’s weight to different parts of the foot to compensate for lost function, prevent deformity or injury, help bear weight, or relieve pain, as well as provide support. Orthoses are often very expensive and not covered by insurance.
Walking aids include walkers, crutches, and canes. They help with weight bearing, balance, or both. Each device has advantages and disadvantages, and each is available in many models. After evaluation, a therapist should choose the one that provides the best combination of stability and freedom for the patient (Ambulation Aids). Physicians should know how to fit crutches. Prescriptions for assistive devices should be as specific as possible.
Fitting Crutches
Patients should wear the type of shoes usually worn, stand erect, and look straight ahead with the shoulders relaxed. For a correct fit, the end of each crutch should be placed about 5 cm from the side of the shoe and about 15 cm in front of the toe, and the length of the crutch should be adjusted so that the top of the crutch is about 2 to 3 finger widths (about 5 cm) below the axilla. The hand grip should be adjusted so that the elbow bends 20 to 30°.
Wheelchairs
Wheelchairs provide mobility to patients who cannot walk. Some models are designed to be self-propelled and to provide stability for traveling over uneven ground and up and down curbs. Other models are designed to be pushed by an assistant; they provide less stability and speed. Wheelchairs are available with various features. For athletic patients with impaired lower extremities but good upper body strength, racing wheelchairs are available. A one-arm-drive or hemi-height wheelchair may be suitable for hemiplegic patients with good coordination. If patients have little or no arm function, a motorized wheelchair is prescribed. Wheelchairs for quadriplegics may have chin or mouth (sip and puff) controls and built-in ventilators.
Mobility Scooters
Mobility scooters are battery-powered, wheeled carts with a steering wheel or tiller, speed control, and ability to move forward and in reverse. They are used on firm, level surfaces inside and outside buildings but cannot negotiate curbs or stairs. Scooters are helpful for people who can stand and walk short distances (i.e. to transfer to and from the scooter) but who lack the strength and/or stamina to walk longer distances.
Rollator Walker Assessment
We have physiotherapists who are authorizers of the Assistive Devices Program (ADP) and can perform ADP assessments for rollator (wheeled) walkers. The Ontario Ministry of Health provides an excellent program to assist with funding for wheeled walkers, through their Assistive Devices Program (ADP). This program is “needs-based” rather than being “means-based”. So, your income won’t disqualify you from getting the assistance you need to get a wheeled walker. However, you must be assessed by a health professional trained and authorized by the ADP program and complete the application process.
If you have extended Health Benefits, the cost of the physiotherapy assessment and the client portion of the walker fee may be partially or fully covered. A doctor’s prescription is not necessary to participate in the ADP program or the physiotherapy assessment but may be required for your health claim. Check with your benefit provider prior to having the assessment and purchasing the walker. Contact us for more information on the application process you must complete to get funding assistance.
