Ambulation Aids, Patterns, Activities Flashcards
Why are the selection of proper ambulation devices and gait patterns important?
Provides:
Optimal Security
Safety
Function with least expenditure of energy
How would you prepare for ambulation?
review med info, determine limitations, determine equipment, obtain consent, explain pattern, clear the area, check safety & fit of equipment, gait belt, check mental/ physical capability of patient, explain/ demonstrate pattern, check points of control and body mechanics
how would you choose best assistive device
based on goals, assessment, medical record
what are the points of control on the patient when ambulating?
the gait belt and patients shoulder (book)
what are the precautions for ambulation activities
footwear, monitor physiological appearance, avoid guarding or grasping clothing/ UE, expect unexpected, guard patient, do not leave patient unattended, practice protect appliances, make sure environment is clear
how should you guard patient
standing behind, slightly to one side and maintain grip on safety belt until patient can ambulate independently and safely
how do ambulation aids improve a person’s stability?
expand base of support, reduce WB on one or both LE, permit mobility OOORRRR
compensate for decreased balance, strength, coordination, decreased ability to bear weight, and relieve pain
list the order of ambulation aids from greatest to least amount of stability
parallel bars, walkers, bilateral crutches(axillary –> forearm), single crutches, bilateral canes, crab canes, and single canes
criteria to consider before changing the ambulation aid
info on refererral, mental/physical capabilities, environment which they will ambulate, expected ambulation activities, prognosis
when would you use a tilt table?
person who needs to physiologically accommodate to an upright position.
what are indicators of intolerance of position on tilt table
increase/ decrease of bp, pulse rate, sweating, edema in LE, decrease in pedal pulse, nausea, numbness, pale face, tingling in LE, dizziness
what degree of tilt table is usually sufficient?
70- 80 degrees, 15-20 minutes– past 80, COG shifts forward, anteroposterior curve negated by table
when would you use parallel bars? for what
requires max support, stability, safety— for balance training and gait pattern initiation, and fit of ambulation aid
how should you adjust parallel bar?
patients hips and trunk pass thru on each side and height is at greater trochanter
when are walkers used?
used for max stability, support, and mobility required
what are disadvantages of the walker?
difficult to store/transport, difficult for stairs, reduce speed of ambulation, difficult to perform normal gait pattern, difficult in crowded areas
what are the types of walkers?
standard: adjustable, nonadjustable
reciprocal, stair climbing, wheeled, folding
and hemiplegic (one handed)
when would you use axillary crutches
need less stability/ support than what is provided by bars/ walker
benefits of axillary crutches?
allow greater gait patterns, increase speed, provide stability and support, easily adjusted, used in narrow environment/ stairs
disadvantages of axillary crutches?
less stable than walked, injure axillary vessels/ nerves, require good balance, elderly may feel insecure, functional strength of trunk/ UE required
what are the types of axillary crutches?
standard (adjustable, nonadjustable), offset, and triceps (elbow extension)
when are forearm crutches used?
“lofstrand/Canadian” when stability and support of axillary crutch is not required, but more stability and support than can is needed
benefits of lofstrand crutches?
eliminate danger of axillary nerve/ vessel damage, used in narrow area and stairs, can reach for something while crutch remains attached to forearm
disadvantages of forearm crutches?
less stability/ support than axillary crutches, walker, parallel bars, require functional balance, upper body, and UE, forearm cuff makes difficult to remove, elderly may feel insecure
when would you use a platform attachment?
unable to bear weight thru wrists/hands
sever deformities of wrists and fingers
below elbow amputation
unable to extend elbows
disadvantages of platform?
loses use of triceps to elevate body during swing phase, another person may need to apply them, less effective on stairs
what muscle is needed to elevate body during swing phase
triceps
if platform is attached to crutch or walker what is it called?
trough, shelf
when is a cane used?
impaired balance or to improve stability, more functional on stairs
disadvantages of cane?
limited support bc small BOS
2 canes do not provide sufficient stability for 3 point
fit of parallel bars
20-25 degree elbow flexion grasp 6 in anterior to hip bar 2 in wider than hip greater trochanters centerd between bars wrist crease/ ulnar styloid process beside bar
fit of cane
handgrip at level of GT or wrist crease/ ulnar styloid
cane parallel to femur, foot of cane on floor or at heel
fit of forearm crutch
hand piece at GT, ulnar styloid/ wrist crease
arm cuff 1-1.5 distal to olecranon process
grasp cuff with wrist in neutral flex/extension
3 ways to fit of axillary crutch
- subtract 16 in from height
- pt supine axillary fold to 6-8 in lateral to heel
- sit, arms abducted, elbow extended and bent, measure from OP of flexed to long finger of hand opposite side
how should axillary crutch fit?
20-25 degrees elbow flexion
hand piece at GT/ wrist crease/ styloid process
2 fingers between axilla rest/ axilla
2-4 in lateral, 4 to 6 in anterior
errors in fitting axillary crutches
pt hunches shoulders, flex trunk, flex/extend wrist, no shoes, no axillary pads, patient is measured not in tripod position
fit of walker
handgrip at wrist/ styloid process, GT
what does improper fit cause
increase energy expenditure
decreased stability
decreased function
decreased safety