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DPT 508 > Assistive Devices > Flashcards

Assistive Devices Flashcards

1
Q

NWB

A

foot doesn’t touch the ground

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2
Q

TTWB

A

foot contacts ground for balance only

up to 20% of body weight through limb

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3
Q

PWB

A

20-50% of body weight

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4
Q

WBAT

A

limited only by patient tolerance

usually 50-100%

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5
Q

FWB

A

no restrictions

100% WB

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6
Q

monitoring weight-bearing

A

bathroom scales

limb load monitor

occasionally the PT will put their hand under the patient’s foot to feel WB

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7
Q

AD typically used to…

A

increase support of load

increase stability through enlarged BOS

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8
Q

stability-mobility trade offs

A

more stable-less mobile
- walker

more mobile-less stable
- single point cane

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9
Q

ADs: most to least supportive

A

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

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10
Q

energy cost of ADs

A

gait deviations tend to increase energy expenditure-more energy to get where they need to go.

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11
Q

which requires more energy: rolling or standard walker?

A

standard walker

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12
Q

fitting an AD

A

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

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13
Q

estimating axillary crutches

A

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

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14
Q

guarding during gait

A

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

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15
Q

patient instruction

A

demonstrate first

mental rehearsal time

start simple and build to complex

cueing as needed

feedback

instruction on AD maintainance and care

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16
Q

sit to stand with AD

A

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

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17
Q

sit to stand compensatory techniques

A

UE use

push legs against chair

press legs together

rocking

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18
Q

sit to stand with axillary crutches

A

both crutches on one side

push down on armrest and crutch grips

stand and balance and transfer on me crutch over to other side

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19
Q

sit to stand with a cane

A

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

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20
Q

when turning, go towards ___ side

A

the stronger

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21
Q

collapsing fall

A

move closer and lift slightly on the gait belt to help the patient regain support.

22
Q

angular fall

A

move in close and attempt to bring center of mass (CoM) back over BoS.

23
Q

falling

A

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

24
Q

falling with crutches

A

drop crutches out to the side

slightly flex elbows of extended arms

turn head to the side

25
Q

getting up from a fall without KAFOs

A

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.

26
Q

getting up from a fall with KAFOs

A

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.

26
Q

2 point gait pattern

A

AD and opposite LE advance together (one or two canes or crutches, or one hemi walker).

27
Q

3 point gait pattern

A

NWB—two ADs are advanced followed by the WB LE

WB—two ADs and weaker LE, followed by stronger LE.

28
Q

4 point gait pattern

A

(deliberate two-point gait): four contact points: AD #1, opposite LE, AD #2, opposite LE.

29
Q

step to gait pattern

A

LE in swing phase is advanced only to the level of the ADs.

30
Q

step-through gait pattern

A

LE in swing phase is advanced beyond level of ADs

31
Q

swing to gait pattern

A

both crutches advance simultaneously followed by simultaneous advancement of LEs to level of ADs

32
Q

swing through gait pattern

A

both crutches advance simultaneously followed by simultaneous advancement of LEs beyond the level of ADs

33
Q

tripod alternating gait pattern

A

AD #1 is advanced, followed by AD #2, then both LEs simultaneously. (often with neurological issues)

34
Q

tripod simulaneous gait pattern

A

both ADs are advanced together, followed by both LEs. (both crutches followed by both legs)

35
Q

types of walkers

A

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

36
Q

progressing from a walker

A

“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

37
Q

typical gait progression with axillary crutches

A

crutches

involved

uninvolved

progress from step-to to step-through gait pattern

38
Q

forearm crutches

A

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

39
Q

progressing from crutches

A

weight-bearing (WB) restrictions are decreased to weight-bearing as tolerated (WBAT) or full weight-bearing (FWB)

functional balance improves

40
Q

knee walker

A

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

41
Q

hemi walker

A

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

42
Q

which side should the cane go on if one side is weaker?

A

on the stronger side

if no weakness-ask patient preference (often their dominant hand)

43
Q

stair with an AD

A

“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

44
Q

stairs with axillary crutches

A

“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.

45
Q

stairs with forearm crutches

A

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.

46
Q

ramps

A

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.

47
Q

curbs with a walker

A

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.

48
Q

special considerations for Alzheimers disease

A

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

49
Q

special considerations for muscular dystrophy

A

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.

DPT 508 (19 decks)

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