AD and Guarding

Question 1

tilt table is used for

Answer 1

when pts need to acclimate to upright position

elevates gradually

measure vitals before, during, after

Question 2

parallel bars are used when

Answer 2

balance training, teaching, specific gaot patterns, support while measuring an AD

Question 3

fitting for parallel bars

Answer 3

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

Question 4

what are ambulatory ADs

Answer 4

devices that provide external support during gait training in an upright posture

Question 5

major indications for use of ambulatory ADs

Answer 5

structural deformity, amputation, injury, or disease resulting in inability to bear weight through LEs

muscle weakness/paralysis in trunk or LEs

balance deficits

Question 6

what do ADs do

Answer 6

increase BOS

provide method for redistributing weight normally borne through LEs and UEs

helps keep pelvis level and not adduct during unilateral stance

Question 7

a canes force can substitute what force

Answer 7

force for hip abductors

transmits part of BW to ground thus decreasing muscle force required for balance

Question 8

how do ADs reduce pain

Answer 8

decrease WB

distribute force over larger surface area

imporve joint stability

Question 9

how do ADs improve weakness

Answer 9

increase BOS

redirection of line of action forces

Question 10

how do ADs affect limited PROM

Answer 10

redirection of line of forces

stabilization of uninvolved joints

Question 11

how do ADs affect decreased enduracne

Answer 11

improve movement efficiency

Question 12

how do ADs affect balance deficits

Answer 12

increase BOS

Question 13

how do ADs affect impaired motor control

Answer 13

increase BOS

increase WB

Question 14

how do ADs affect fear of fall

Answer 14

increased BOS

Question 15

examples of assitive devices

Answer 15

walkers

axillary crutches

forearm crutches

canes

Question 16

benefit of walkers and what populations often uses thenm

Answer 16

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

Question 17

types of walkers

Answer 17

standard
wheeled
stair climbing
ring walkers (peds)
knee walkers
reverse walkers (peds)
hemiwalker
reciprocal walkers

Question 18

benefits of axillary walkers and common pt populations

Answer 18

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

Question 19

characteristics of forearm crutches

Answer 19

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

Question 20

canes are chosen for pts with

Answer 20

minimal LE weakness

Require slight WB reduction

impaired balance

Question 21

characteristics of quad canes

Answer 21

usually for pts with limited or no use of one UE as with hemiparesis

slightly heavier

semi awkward

Question 22

common conditions that require ADs

Answer 22

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

Question 23

rank walkers in most to least stable

Answer 23

standard
rolling/2 wheeled
rollator or 4 wheels

Question 24

rank ADs from most to least stable

Answer 24

parallel bars
walker
bilateral axillary
bilateral forearms
bilateral canes
hemi walker
quad cane
single point cane
no device

Question 25

how to fit a walker

Answer 25

wear shoes

can determine in standing or supine

hand grip at level of pts:
-wrist crease
-ulnar styloid process
-greater trochanter

Question 26

how to choose height for axillary crutches

Answer 26

multiply height by 77% or subtract 16 in

result is theoretical overall crutch length

Question 27

how to chose height for axillary crutch with pt in supine

Answer 27

use tape measure to measure the distance frim axillary fold to 6-8 in lateral to heel

Question 28

how to fit axillary crutch in seated

Answer 28

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

Question 29

how to confirm fit of axillary crutches in standing

Answer 29

tips should be positioned 2 in laterally and 4-6 in anterior to toe of shoes

Question 30

hand piece height check with pt in supine

Answer 30

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

Question 31

how to fit axillary crutches when crutches are in tripod position

Answer 31

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

Question 32

how to fit forearm crutches

Answer 32

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

Question 33

how to guard with crutches

Answer 33

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

Question 34

what to do if balance is lost fwd

Answer 34

pull back on gait belt

other hand pulls trunk up and back

may need to push fwd on pelvis and pull back on trunk

Question 35

what to do if balance is lost bwd

Answer 35

push fwd on pelvis/trunk

Question 36

what to do if balance is lost to one side away from PT

Answer 36

pull gait belt toward you

Question 37

what to do if balance is lost toward side of PT

Answer 37

turn body so that you face pts side

widen BOS

use body to support pt