OVERVIEW.

Canes are wooden or metal walking devices that are held in one hand and designed to aid in stability and to “take some of the weight off one foot.”¹ Straight and quad canes offer one and four points of support, respectively. Hemi-walkers (walk-canes) offer four points of support with a wider base than that provided by a quad cane.²

SUMMARY: PRECAUTIONS.

Some procedural concerns relate to proper fitting and appropriate use of canes. For example, canes are not designed to unweight a limb of a patient with a protected weight-bearing status. Twenty-six cane-related injuries were reported to the FDA from December 1990 to November 2002; the majority of injuries involved quad canes. Three quad cane-related deaths were reported to the FDA between 1997 and 2003.³

OTHER ISSUES.

Mechanical failure: Two of the FDA-reported deaths have been associated indirectly with use of a quad cane that snapped (also see Crutches). Note: Because users apply upper extremity force downward through the device, upper limb tissues and the device itself need to be sufficiently strong/healthy to withstand these compressive forces.

OVERVIEW.

Crutches are wooden or metal walking devices that extend from the floor to the vicinity of the elbow or the axilla. Axillary crutches terminate proximally with cross bars near the user’s axilla, whereas forearm crutches (Loftstrand) end proximally with hinged open cuffs located just below the elbow.¹

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Crutch concerns tend to be either musculoskeletal (arthritis, weakness), device-related (worn tips), or procedural (improper use of crutches). Cases report poor crutch usage, which has resulted in vascular (thrombosis) or neurological complications (neuropraxia).^2,3

OTHER ISSUES.

Note 1: Mechanical failure: While great emphasis has been placed on monitoring crutch tips for wear, the majority of crutch-related injuries reported to the FDA appear to have been mechanical failure-related (e.g., metal cracking, bolt failure). Only seven of 38 reported incidences involved the patient slipping.⁴

Note 2: Users apply downward force through the device in order to ambulate. Upper limb tissue (i.e., joints, bones, skin) and the device itself should be sufficiently strong/healthy to withstand these compression forces.

OVERVIEW.

A mechanical lift is a hydraulic-, battery-, or mechanically powered device used to lift and transfer or transport a patient in the horizontal or other required position from one place to another. The device includes straps and a sling to support the patient.¹

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Mechanical lift concerns are either device-related (appropriate model for the task) or procedural-related (proper use of the device during transfers; proper maintenance).^2,3 Thirty-two lift-related deaths have been reported to the FDA from 1990 to 2002. In almost 80% of these cases, deaths were sling or strap related.¹

OVERVIEW.

A vibrator is a hand-held device that is powered by AC or battery and used to (1) stimulate muscle contraction in paralyzed muscles, (2) assist in postural drainage (used over the thorax), or (3) modulate pain (over acupuncture points).^1,2

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Vibration-related concerns include (1) dosage settings (excessive amplitude or frequencies) that may irritate skin or (2) vibration use in some neurological populations where stimulation may facilitate unwanted responses (in the latter case, vibration has been used or suggested as an aid in diagnosis).