AD and Guarding Flashcards
tilt table is used for
when pts need to acclimate to upright position
elevates gradually
measure vitals before, during, after
parallel bars are used when
balance training, teaching, specific gaot patterns, support while measuring an AD
fitting for parallel bars
20-25 degrees albow flexion with 2 in wider than either greater trochanter
top of bar even with greater trochanter or wrist crease in standing with UEs at sides
what are ambulatory ADs
devices that provide external support during gait training in an upright posture
major indications for use of ambulatory ADs
structural deformity, amputation, injury, or disease resulting in inability to bear weight through LEs
muscle weakness/paralysis in trunk or LEs
balance deficits
what do ADs do
increase BOS
provide method for redistributing weight normally borne through LEs and UEs
helps keep pelvis level and not adduct during unilateral stance
a canes force can substitute what force
force for hip abductors
transmits part of BW to ground thus decreasing muscle force required for balance
how do ADs reduce pain
decrease WB
distribute force over larger surface area
imporve joint stability
how do ADs improve weakness
increase BOS
redirection of line of action forces
how do ADs affect limited PROM
redirection of line of forces
stabilization of uninvolved joints
how do ADs affect decreased enduracne
improve movement efficiency
how do ADs affect balance deficits
increase BOS
how do ADs affect impaired motor control
increase BOS
increase WB
how do ADs affect fear of fall
increased BOS
examples of assitive devices
walkers
axillary crutches
forearm crutches
canes
benefit of walkers and what populations often uses thenm
provide large degree of stability
for pts with:
-general weakness
-debilitating conditions
-need to reduce WB in LEs
-poor balance/coordination
-inability to use crutches
types of walkers
standard
wheeled
stair climbing
ring walkers (peds)
knee walkers
reverse walkers (peds)
hemiwalker
reciprocal walkers
benefits of axillary walkers and common pt populations
provide mod stability
require more coordination
take substantial energy
pts with:
-weakness in one or both LEs
-impaired balance
-need for trunk support
-permits 80-100% WB support
characteristics of forearm crutches
provide better ease of movement but less trunk support than axillary
frees hands; dont have to drop crutch
good for same pt population as axillary crutches but dont require trunk stability
canes are chosen for pts with
minimal LE weakness
Require slight WB reduction
impaired balance
characteristics of quad canes
usually for pts with limited or no use of one UE as with hemiparesis
slightly heavier
semi awkward
common conditions that require ADs
pain
limited PROM
decreased sensation
open wounds on weight bearing surfaces
unstable structures
decreased strength
decreased endurance
impaired motor control
balance deficits
fear of falling
rank walkers in most to least stable
standard
rolling/2 wheeled
rollator or 4 wheels
rank ADs from most to least stable
parallel bars
walker
bilateral axillary
bilateral forearms
bilateral canes
hemi walker
quad cane
single point cane
no device
how to fit a walker
wear shoes
can determine in standing or supine
hand grip at level of pts:
-wrist crease
-ulnar styloid process
-greater trochanter
how to choose height for axillary crutches
multiply height by 77% or subtract 16 in
result is theoretical overall crutch length
how to chose height for axillary crutch with pt in supine
use tape measure to measure the distance frim axillary fold to 6-8 in lateral to heel
how to fit axillary crutch in seated
UEs abducted at shoulder level
one elbow extended, one flx to 90
measure distance between middle finger of extended elbow and olecranon process of flexed elbow
how to confirm fit of axillary crutches in standing
tips should be positioned 2 in laterally and 4-6 in anterior to toe of shoes
hand piece height check with pt in supine
from greater trochanter, wrist crease, or ulnar styloid process to heel of shoe; use this number to measure form the rubber tip to the hand piece
alternate method is to measure from anterior axillary fold to greater trochanter or ulnar styloid and use this to measure from the axillary rest to hand piece
how to fit axillary crutches when crutches are in tripod position
pt should have approx 20-30 deg elbow felxion with relaxed shoulders
two finger breadths should be present between the axillary rest and bottom for axilla
how to fit forearm crutches
same as cane measurement for height of hand piece
forearm cuff should be 1-1.5 in distal to olecranon process when pt grasps hand piece with wrist in neutral
confirm tips are positioned 2 in laterally and 2-6 in anterior to toe of shoes
how to guard with crutches
stand slightly to one side; usually weaker sude
stride stance outside foot behnid the assistive device and pts foot; other trails when you walk
underhand grip gait belt
what to do if balance is lost fwd
pull back on gait belt
other hand pulls trunk up and back
may need to push fwd on pelvis and pull back on trunk
what to do if balance is lost bwd
push fwd on pelvis/trunk
what to do if balance is lost to one side away from PT
pull gait belt toward you
what to do if balance is lost toward side of PT
turn body so that you face pts side
widen BOS
use body to support pt
