Assistive Devices Flashcards
NWB
foot doesn’t touch the ground
TTWB
foot contacts ground for balance only
up to 20% of body weight through limb
PWB
20-50% of body weight
WBAT
limited only by patient tolerance
usually 50-100%
FWB
no restrictions
100% WB
monitoring weight-bearing
bathroom scales
limb load monitor
occasionally the PT will put their hand under the patient’s foot to feel WB
AD typically used to…
increase support of load
increase stability through enlarged BOS
stability-mobility trade offs
more stable-less mobile
- walker
more mobile-less stable
- single point cane
ADs: most to least supportive
parallel bars
walker
bilateral axillary crutches
bilateral forearm crutches
hemi walker (good for no shoulder WB)
quad cane (more parallel side toward pt)
single point cane
energy cost of ADs
gait deviations tend to increase energy expenditure-more energy to get where they need to go.
which requires more energy: rolling or standard walker?
standard walker
fitting an AD
good posture
wear typical footwear
device handle at level of ulnar styloid process or greater trochanter of hip
estimate seated and confirm standing in functional position
estimating axillary crutches
patient’s height minus 16 inches
77% of patient’s height
ATNR position: one arm extended out the other bent and measure from elbow to finger tips
3 fingers b/w axilla and crutch
6 inches diagonally from foot and 20-30 degrees of elbow flexion
guarding during gait
behind and slightly toward weaker side
control points: pelvis and shoulder girdle
for gait requiring hands-on guarding, one hand is typically grasping the gait belt and the other hand hovers at the contralateral shoulder.
supinated grip on gait belt
patient instruction
demonstrate first
mental rehearsal time
start simple and build to complex
cueing as needed
feedback
instruction on AD maintainance and care
sit to stand with AD
edge of seat w/nose over toes
feet back as far as possible
extend trunk and LE into standing
use armrests to help stand
DONT PULL ON WALKER TO STAND
feel for chair with legs and arms b4 sitting
sit to stand compensatory techniques
UE use
push legs against chair
press legs together
rocking
sit to stand with axillary crutches
both crutches on one side
push down on armrest and crutch grips
stand and balance and transfer on me crutch over to other side
sit to stand with a cane
ready position
lay cane to side and hold same handle with armrest
push to standing and place cane upright
if cane can stand on its own, place it to the side and push on both armrest then grab cane
when turning, go towards ___ side
the stronger
collapsing fall
move closer and lift slightly on the gait belt to help the patient regain support.
angular fall
move in close and attempt to bring center of mass (CoM) back over BoS.
falling
if regaining position is not possible and a chair is not immediately available, deepen your stride and rest the patient on your forward thigh
if resting on your thigh is not an option, carefully lower the patient to the floor
falling with crutches
drop crutches out to the side
slightly flex elbows of extended arms
turn head to the side
getting up from a fall without KAFOs
Gather crutches.
Move into kneeling with both crutches on one side.
Move into half-kneeling (on stronger LE).
Move into full standing and place a crutch on each side.
getting up from a fall with KAFOs
Stand one crutch up and use it to push up from the floor, with balls of feet in contact with the floor.
Quickly pick up the other crutch and stand it erect.
Reposition crutches for ambulation.
2 point gait pattern
AD and opposite LE advance together (one or two canes or crutches, or one hemi walker).
3 point gait pattern
NWB—two ADs are advanced followed by the WB LE
WB—two ADs and weaker LE, followed by stronger LE.
4 point gait pattern
(deliberate two-point gait): four contact points: AD #1, opposite LE, AD #2, opposite LE.
step to gait pattern
LE in swing phase is advanced only to the level of the ADs.
step-through gait pattern
LE in swing phase is advanced beyond level of ADs
swing to gait pattern
both crutches advance simultaneously followed by simultaneous advancement of LEs to level of ADs
swing through gait pattern
both crutches advance simultaneously followed by simultaneous advancement of LEs beyond the level of ADs
tripod alternating gait pattern
AD #1 is advanced, followed by AD #2, then both LEs simultaneously. (often with neurological issues)
tripod simulaneous gait pattern
both ADs are advanced together, followed by both LEs. (both crutches followed by both legs)
types of walkers
Standard Walker-more stable, more energy required
Rolling Walker- less energy required, less stable than no wheels.
Rollator Walker- 4 wheels with seat
Reciprocal Walker-pivots so that the arm rail on one side pivots around the other one.
Posterior Walker/Reverse walker-often used with children
progressing from a walker
“rocks” a standard walker-likely to be able to use a lower support AD.
is able to walk with minimal pressure through the hand grips
typical gait progression with axillary crutches
crutches
involved
uninvolved
progress from step-to to step-through gait pattern
forearm crutches
more mobility, less stability than axillary crutches
often used with bilateral knee-ankle-foot orthoses (KAFOs)-keeps them in extended position so they can bear weight through the legs
arm cuffs about 2 inches below elbow crease
progressing from crutches
weight-bearing (WB) restrictions are decreased to weight-bearing as tolerated (WBAT) or full weight-bearing (FWB)
functional balance improves
knee walker
more stable than crutches
require less upper body strength and energy expenditure than crutches
not suitable for limited WB at or above knee or on stairs
hemi walker
more stability than a cane
FWB or WBAT
consider progressing when patient’s stability increases or when gait speed causes patient to “rock” the hemi walker
which side should the cane go on if one side is weaker?
on the stronger side
if no weakness-ask patient preference (often their dominant hand)
stair with an AD
“up with the good, down with the bad.”
the AD generally moves with the involved LE.
guarding:
- going up, guarding from behind
- going down, guarding in front
stairs with axillary crutches
“up with the good, down with the bad.”
move crutches with the involved or weaker LE.
AD moves with the weaker limb.
2 crutches held in one hand as a T.
one crutch parallel to the rail.
stairs with forearm crutches
Can perform as with axillary crutches
Can also perform reciprocal pattern
Up and down stairs with locking knee braces and forearm crutches is an advanced mobility skill.
Typically ascending backwards, descending facing forward
Use of handrail advised
Want all points of the cane on the step at a time.
ramps
Lean forward when ascending.
Take slightly longer steps when ascending.
Take slightly shorter steps when descending.
Follow zigzag path if necessary to reduce steepness of path.
curbs with a walker
Ascending a curb, the walker must be advanced first, followed by stronger LE.
The patient must lean forward for effective push through UEs before lifting weaker LEs.
Descending follows typical pattern for descending steps.
special considerations for Alzheimers disease
Rely more on automatic responses.
Approach from the front & make eye contact.
Use more visual, and fewer verbal, cues.-train by doing, not telling.
Use positive instructions; avoid “don’t”.
Use hand-under-hand handhold if AD is not practical.- you will be their support until they can use an AD
special considerations for muscular dystrophy
Neurological disorder that can affect UE and LE strength and motor control.
Progressive condition; AD may change over time. (get worse over time)
Locking knee braces may be used to allow secure WB on LEs; swing-to and swing-through gait in which forward movement is powered by upper body momentum.
