assistive devices Flashcards
swing and a stance phase because during the gait cycle a given foot is either in contact with the ground (stance) or is in the air (swing)
normal gait pattern
comprises approximately 60% of the cycle
stance phase
comprises approximately 40% of the cycle
swing phase
time from the initial contact (heel strike) of a given foot to the next initial contact (heel strike) of the same foot
gait cycle
initial contact (heel strike), loading response, midstance (foot flat), terminal stance (heel off), and preswing (toe off)
major gait phase has subphases 1974, Perry
initial swing (acceleration), midswing, and terminal swing (deceleration)
swing subphases
When a lower extremity is in contact with the floor or other surface
stance phase
not in contact with the floor
swing phase
used for support, stability, and movement when ambulation-assistive devices are used
upper extremities
scapular stabilizers; the shoulder depressors, flexors, and extensors; the elbow flexors and extensors; and the finger flexors
primary upper extremity muscles involved in supporting the body’s weight and assisting in propelling the body
weight-bearing phase
hip extensors and abductors, the knee flexors
primary lower extremity muscles involved in supporting the body’s weight
the knee extensors, and the plantar flexors
used to elevate the extremity and, with momentum, move the extremity during the non– weight-bearing (NWB) (swing) phase
hip flexors, knee flexors, and ankle dorsiflexors
necessary to maintain an erect position and proper posture
trunk musculature
meant to provide a brief description of basic information about ambulation and gait patterns
introductory material
- Initial contact to foot flat
- Stabilize limb
Gluteus maximus
- Terminal stance to preswing
- Stabilize the pelvis in the frontal plane
Gluteus medius/minimus
- Preswing to midswing
- Accelerate limb
Hip flexors/adductor
- Loading response
- Absorb shock, eccentric contraction stabilizes the knee
Quadriceps
- Midswing to initial contact
- Decelerate limb
Hamstrings
- Initial contact to midstance and preswing to initial contact
- Absorb shock, elevate foot
Tibialis anterior/ peroneals
- Midstance, terminal stance to preswing
- Knee stability at terminal stance, push off
Gastrocnemius/soleus
- Initial contact to initial contact
- Stabilize trunk
Erector spinae
Major Muscle Groups Used for Non– Weight-Bearing Ambulation
- Upper trunk: scapular depressors, scapular stabilizers
- Lower trunk: trunk extensors, trunk flexors
- Upper extremity: shoulder depressors, shoulder
extensors and flexors, elbow extensors, finger flexors - Weight-bearing lower extremity: hip abductors, hip
extensors, knee flexors (which function as hip extensors), knee extensors, ankle dorsiflexors, and plantar flexors
Preparation for Ambulation Activities
- Review the patient’s medical record for information to assist in planning the ambulation activities. What information will be particularly important to you?
- Assess, examine, and evaluate the patient to determine limitations and capabilities to plan the preambulation activities and gait pattern.
- Determine the appropriate equipment and gait pattern based on the medical record, your assessment, and the goals of intervention.
- Prepare the patient for ambulation (e.g., obtain consent) and explain the gait pattern.
- Remove items in the area that may interfere with ambulation to maintain a safe environment.
- Confirm the initial measurement of the equipment to ensure a proper fit and determine that the equipment is safe (e.g., tighten loose nuts and bolts, be certain spring adjustment buttons are secure, and examine rubber tips for dirt or cracks in the rubber).
- Apply a gait belt to the patient.
- Be certain the patient is mentally and physically
capable of performing the selected gait pattern. - Explain and demonstrate the gait pattern for the
patient; require that the patient describe the pattern, how it is to be performed, and what is expected of him or her. - Use the gait belt and the patient’s shoulder or trunk as points of control when guarding the patient.
- Maintain proper body mechanics for yourself and the patient.
provide safe and stable practice sessions, improve the patient’s ability to use assistive devices safely and effectively, determine the type of assistive aids and functional skills the patient will require, and allow the patient to develop confidence in the use of the assistive aids
preambulation procedures and activities
Precautions for Ambulation Activities
- Ensure that the patient wears appropriate footwear; do not allow the patient to ambulate while wearing loose-fitting shoes or slippers or when barefoot. These conditions can lead to patient insecurity and injury.
- Monitor the patient’s physiological responses to ambulation frequently and evaluate vital signs, general appearance, and mental alertness during the activity. Compare your findings with normal values to determine the patient’s reaction to the activity.
- Avoid guarding or controlling the patient by grasping his or her clothing or an upper extremity.
- Anticipate the unexpected and be alert for unusual patient actions or equipment problems; anticipate that the patient may slip or lose stability or balance at any time.
- Guard the patient by standing behind him or her and slightly to one side, and maintain a grip on the gait belt until the patient is safe to ambulate independently.
- Do not leave the patient unattended while he or she is standing.
- Protect patient appliances (e.g., a cast, drainage tubes, intravenous tubes, and dressings) during ambulation.
- Be certain that the area used for ambulation is free of hazards, such as equipment or furniture, and that the floor or surface is dry. Maintain safe conditions to reduce the risk of injury to the patient.
help accommodate the patient to an erect position
tilt table
safety and security when practicing a gait pattern or to improve balance
parallel bars
acclimate patients who are wheelchair bound
standing frames
- designed to improve a person’s stability by expanding the base of support (BOS), reduce weight bearing on one or both lower extremities, and permit mobility
- help the patient compensate for decreased balance, strength, coordination, or a decreased ability to bear weight on one or both lower extremities, and they help relieve pain during ambulation
assistive devices
used for patients who must physiologically acclimate to an erect position before they can initiate ambulation
tilt table
balance training, to teach specific gait patterns, and to provide support while measuring an assistive device
parallel bars
- benefit persons who need to physiologically acclimate to an upright position as a result of a variety of conditions, such as prolonged recumbence, disturbance in balance, decreased proprioception, kinesthesia, lower extremity circulation, or generalized weakness
- elevated gradually and maintained at any position between horizontal and completely vertical
tilt table
Used when maximal patient stability and support are required
walkers
Used for persons who need less stability or support than is provided by parallel bars or a walker; they allow greater selection of gait patterns and ambulation speed and provide stability and support
axillary crutches
Used when the stability and support of an axillary crutch are not required, but when more stability and support than can be provided by a cane are needed; they eliminate the danger of injury to axillary vessels and nerves and are more functional on stairs and in narrow, confined areas
forearm crutches (Lofstrand or Canadian crutches)
Used for persons who are unable to bear weight through their wrists and hands, have severe deformities of the wrists or fingers that make it difficult to grasp the handpiece of a regular crutch, have a below- elbow amputation, or are unable to extend one or both elbows
platform attachment
Used to compensate for impaired balance or to improve stability and are more functional on stairs and in narrow, confined areas
canes
used for patients who need to be partially “unweighted” during gait training
supported suspension device
Common Errors in Fitting Assistive Devices
- If the patient elevates or depresses the shoulders, the device will be too long when the shoulders are relaxed.
- If the patient depresses or drops his or her shoulders or flexes the trunk at the hips, the device will be too short when the patient stands erect.
- If the patient flexes or extends the wrist, the handpiece will be improperly positioned.
- If the measurements are made without the patient wearing shoes or without the crutch/cane tips or crutch axillary pads in place, the device will be too long when those items are added.
- If the evaluation of the fit of the crutches is made without the crutches in the tripod position, the crutches may be too short or too long depending on the crutch position.
- NWB
- Walker, if indicated; progress to bilateral crutches
three point
- WBAT to FWB
- Reciprocal walker, bilateral crutches, bilateral canes
four point, two point
- PWB as ordered by MD
- Walker, bilateral crutches
Three-one–point (modified three-point)
- FWB
- One crutch or one cane
Modified four-point, modified two-point
- WBAT
- Axillary crutches, if indicated, to bilateral canes
Four-point, two-point, three-one–point
- WBAT
- One crutch or one cane
Modified four-point, modified two-point
