Ambulation Patterns and Gait Training

Question 1

Considerations for Safe Ambulation

Answer 1

-gait belt
-WB status & pain during WB
-decreased strength, impaired balance, alteration in coordinated movements
-attention to lines and equipment
-type of surface for ambulation
-absence of LE, ability to use UE
-pt cognition and attentiveness
-use of second person
-proper stance, guarding, and hand placement

Question 2

Preparation for Ambulation

Answer 2

-Review of medical chart
-Pt assessment:
1. ROM
2. Muscle Performance
3. Sensation Screen
4. Balance/Coordination
5. Cognition/Attentiveness/Ability to follow commands

Question 3

Pre Ambulation Considerations

Answer 3

-AD
-Amount of assistance required (pt HT, pt WT)
-Safety (1 or 2 person assist)

Question 4

PT Position during level ground ambulation

Answer 4

-posterolateral to pt
-if WB Status: stand opposite to NWB side
-if pain/weakness: stand on same side

Question 5

Progressions in Ambulation

Answer 5

-level of assist decreases
-able to meet modified surface challenges
-improvement in impairments
-increased safety awareness

Question 6

Gait Patterns

Answer 6

Four point
Three point
Two point

Question 7

Four point pattern

Answer 7

4 points touch floor in sequence, 3 points always in contact w/ ground:
Crutch –> Opposite Foot –> Crutch –> Opposite Foot
-used w/ 2 canes or 2 crutches
-for pt w/ very POOR BALANCE (pt unable to lift more than one point off ground safely)
-**cannot be used w/ non WB
-slow and stable pattern

Question 8

Three point pattern

Answer 8

3 points touch ground not in sequence
Walker/both crutches & NWB LE –> FWB LE while pt distributes body wt onto aid
-used w/ bilat ambulation aids or cane
-NWB ALWAYS
-PWB & WBAT
-rapid ambulation possible, requires high energy expenditure

Question 9

Two point pattern

Answer 9

-two points on ground at all times
crutch + opposite leg –> opposite crutch + leg
-approximates normal gait pattern
-**not for NWB
-relatively stable and faster than 4 point

Question 10

Ascending Stairs: PT Guarding

Answer 10

-posterolateral to pt
-PT outside foot on stair where pt standing, inside foot on step below pt
-PT advances foot one step AFTER pt has advanced step

Question 11

Ascending Stairs- pt using handrails

Answer 11

-walker opposite from handrail, closed side of walker next to pt
-front feet of walker placed one step ABOVE where pt standing
-pt steps UP w/ STRONG LE

Question 12

Descending Stairs- PT Guarding

Answer 12

-anterolateral to pt
-PT outside foot on step where pt will step, inside foot one step below
-Alt method: behind pt

Question 13

Descending stairs- pt using handrails

Answer 13

-walker opposite to handrail with closed side of walker next to pt
-front wheels one step below where pt stands, rear wheels on step where pt stands
-pt steps DOWN w/ WEAK LE

Question 14

Ascending Curb- PT Guarding

Answer 14

-posterolateral to pt
-pt steps up then PT steps up

Question 15

Ascending Curb- pt & walker

Answer 15

-place walker onto curb
-UP w/ STRONG LE
-pt elevates body onto curb using UE and LE while raising weak LE onto curb

Question 16

Descending Curb- PT Guarding

Answer 16

-anterolateral to pt
-PT outside foot on curb where pt standing
-PT inside foot on surface where pt will step
-Alt guarding: behind pt

Question 17

Descending Curb- pt & walker

Answer 17

-pt moves to edge of curb and places
-pt moves to edge of curb and places walker down onto lower surface
-WEAKER LE DOWN while controlling lowering with strong LE + UE

Question 18

Descending Curb- pt & cane

Answer 18

-pt steps down simultaneously w/ WEAK LE + Cane
-pt lowers body w/ stronger LE and steps down