Ambulation And Gait Flashcards
How does ambulatory assistive devices help people
Increases BoS
Distributes weight from the lower extremity to the upper extremity
What is weight bearing status (WB)
The amount of weight that can be borne on a lower extremity during standing or ambulation
What is WB status dependent on?
Impairment
Medical management
FWB
Full weight bearing
Puts all the weight on
WBAT
Patient decides how much they can take
PWB
Partial weight bearing
When the PT decides how much weight they can put
How much weight can they put
TTWB or FeWB
Toe touch weight bearing or Feather touch weight bearing
Tapping your toes on the ground, barely touching the ground
NWB
Non weight bearing
Can’t put any weight on it
What benefits do walkers provide for patients ?
Wider BoS
Is able to stand on its own, good for being beside the bed
Provides the most support out of all devices
Easy to use
When would you recommended a walker?
Generalized weakness
A need to reduce WB on one or both lower extremities
Poor balance and coordination
Not able to use crutches
What are challenges with walkers?
Take up a lot of space
Can’t get you up stairs
If your home has carpet it might not move or if your home has smooth floors it might move out of reach and cause a fall
Need two good arms and hand strength to walk with them
Slow
They can be unstable
How to size a walker
Have patient stand up right looking straight ahead, relaxed shoulders, shoes on
Hand grips should be at the scaphoid
Proper sizing: when resting hands on the walker the elbow will be at 20° flexion
Measurement for sizing the walker
Patient standing: measure from the scaphoid to the floor with the tape measure and adjust the walker
Patient standing: measure the walker with the patient standing within the walker
Ring walker
Decreases WB
Wider BoS
Provides trunk support for significant weakness
Reciprocal walker
Used When patients lack strength or balance to lift a normal walker
Knee walkers
Inability to provide weight through tibia or foot
Quicker than crutches or walker
Posterior walker
Mostly used for pediatrics
What are the benefits of auxiliary crutches
BoS
Trunk stability
Can support WB restrictions
What are challenges with auxiliary crutches
Creates moderate fall risk
Requires mod/high coordination and strength
When would we recommend crutches
Weakness of lower extremity
Reduced WB of lower extremity
Balance impairments
A need for increased support in the trunk
What are some safety precautions with crutches
Patient needs good coordination and upper body strength
Slippery surfaces are dangerous
Stairs are dangerous
If the sizing is wrong they can get circulatory damage
Sizing of crutches
Tips of crutches should be 5cm anterior and 5 cm lateral to 5th toe
Axillary bar should be three fingers below the axillae
Hand grips: at the scaphoid
When hands on on grips the elbows should be 20° flexion
Three rules of going up stairs with crutches
Crutches and bad leg are always moving together
Going up: “up with the good”
Going down: “down with the bad”
If there is a railing always use it
Responsibility while teaching a patient stairs on crutches
“Should I get help”
Position yourself below them
3 points of contact at all times
Standing in stride on the stairs (bigger BoS)
Always maintain close/contact guarding with patient
Benefits of Forearm crutches
Greater ease of movement
Cuff around the forearm permits the use of hands without dropping them
More comfortable
Supports all WB restrictions
Requires good upper body strength Slippery surfaces
Benefits of Canes
Small, portable, and cheap
Larger BoS
Can support PWB and WBAT
Should only be used for small to moderate balance deficits
