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Wheelchairs, canes, crutches and walkers
The position of the rear wheel axle sets the balance between ease of propulsion and stability: a more forward axle — easy pushing and good manoeuvring but a tendency to tip backwards; a more rearward axle — stability, so it suits a leg amputee whose centre of gravity shifts back.
Why it matters in the exam
Wheelchair fitting: seat width — hip width plus a little clearance on each side; seat depth — leaves a few fingers' gap behind the knee; seat height — allows clearance between the footrests and the floor; backrest height — by trunk control. A lightweight rigid-frame manual chair suits an active user with paraplegia and reduces shoulder load. A power chair suits high tetraplegia (chin, head or sip-and-puff control). A suitable cushion (air, gel or foam) and regular pressure relief — push-ups or tilting — prevent pressure injuries.
Cane: its length is set with the handle at the greater trochanter or wrist crease, so the elbow is flexed about 20–30 degrees. The cane is held in the hand opposite the affected leg, which reduces load on the affected hip joint and hip abductors. On stairs: "up with the good leg, down with the bad leg" — the cane moves with the affected leg. Axillary crutches: the top about 5 cm below the axilla, with weight on the hands — pressure on the axilla can injure the radial nerve.
Crutch gait patterns: two-point and four-point (partial weight-bearing on both legs), three-point (one leg non-weight-bearing), "swing-to" and "swing-through" (paraplegia with orthoses). Walkers: a standard walker is lifted at each step, stable but slow; a front-wheeled walker allows a more continuous gait; a four-wheeled rollator with brakes and a seat suits someone who needs rests, but is less stable. For walking problems at home — add grab rails, non-slip surfaces and clear obstacles.
Key points
- Forward axle — easy to push, less stable.
- Leg amputee — rearward axle.
- Cane in the opposite hand, elbow 20–30 degrees.
- Crutches — 5 cm below the axilla.
- Up with the good, down with the bad.
Summary table
| Aid | Main rule | Trap |
|---|---|---|
| Forward rear axle | Easy pushing, good manoeuvring | Tends to tip backwards — anti-tippers |
| Rearward rear axle | Stability | Suits leg amputees |
| Cane | In the opposite hand; elbow flexed 20–30 degrees | In the same-side hand — less unloading |
| Axillary crutches | About 5 cm below the axilla, weight on the hands | Axillary pressure — radial nerve injury |
| Rollator | Wheels, brakes and seat | Less stable than a standard walker |
In the full version for subscribers
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Sources
- RESNA Position on the Application of Ultralight Manual Wheelchairs, 2012 — Configuration and axle position
- Braddom's Physical Medicine and Rehabilitation, 6th edition (2021) — Wheelchairs and Seating; Assistive devices for ambulation
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.