Assistive Devices Flashcards
1
Q
What is a FWB device?
A
- Full Weight Bearing
- Used only for balance
2
Q
What is a WBAT device?
A
- Weight Bearing as Tolerated
- Determined by the patient-ranging from full to minimal WB
3
Q
What is a PWB device?
A
- Partial Weight Bearing
- Minimal WB permitted if specific amount not indicated (5 lbs)
4
Q
What is a TTWB device?
A
- Toe Touch Weight Bearing
- Toe rested on ground for BALANCE ONLY
5
Q
What is a NWB device?
A
- Non Weight Bearing
- Not Touching Ground at all
6
Q
What can help determine the amount of weight being borne through an extremity?
A
Bathroom scales.
7
Q
What is a dependent level of assistance?
A
100 % of work done by someone or something else. No patient work done.
8
Q
What is a maximal assist assistance level?
A
More than 60 % of work done by something or something else.
Patient does less than 1/2 of work
9
Q
.What is a moderate asst level of assistance?
A
- 25 - 50 % of work done by something or someone else.
10
Q
What is a minimal assist level of assistance?
A
- 25 % of work done by someone or something else.
11
Q
What is contact guard level of assistance?
A
- Hands on assist by someone for balance and/or safety.
- Pt. does 100 % of work
12
Q
What is a supervision/ stand-by guard level of assistance?
A
- Close or distant supervision
Close: close enough for verbal cues or visual assist.
Distant: Within visual range
13
Q
What is independent level of assistance?
A
Pt 100 % independent.
14
Q
What needs to be considered at all levels of assistance?
A
- Assistive device and amount of verbal and tactile cues.
15
Q
How is the gait belt positioned and gripped during ambulation of a patient?
A
- Supinated grip at forearm level with grip at level of pelvis near Pt.’s COM
- Other arm near shoulder to control movement and direction of patient’s trunk..
16
Q
How is the therapist directed during ambulation when guarding with gait belt?
A
- Close to patient
- Generally on affected side; may change depending on which way patient may fall.
- Wide base of support
- Posteriorly and to side of Pt.
- CoM in line with patient’s CoM
17
Q
What are 5 indications for use of an assistive device?
A
- Decreased ability WB on LE
- Muscular weakness/ trunk paralysis
- Poor balance in upright posture
- Pain/ antalgic gait
- Safety
18
Q
What environmental factors must be considered when using assistive devices?
A
- Avoiding wet or slippery floors/ sidewalks
- Be aware of walking from one surface type to another
- Remove throw rugs and other obstacles
- Avoid revolving doors and escalators
19
Q
How can the Pt. take precautions for interaction with their environment?
A
- Be slow, and take time to survey
- Look straight ahead, not at feet
- Wear proper footwear (non-skid soles)
- Monitor AD for signs of wear
20
Q
Where does gait training always first begin?
A
At parallel bars
21
Q
How soon should the patient progress to ambulation outside of parallel bars?
A
As soon as safely possible.
22
Q
What are 3 indications for use of a walker?
A
- Need for increased lateral and anterior stability
- Need to reduce WB through one or both LEs
- Patients with debilitating conditions or poor balance with LE injury that cannot use crutches
23
Q
What are 2 negative features of the use of walkers?
A
- No reciprocal arm swing
- Increased kyphosis/ trunk flexion
24
Q
How are walkers fitted to the patient?
A
- 20 - 30 degrees of elbow flexion
- Measure from greater trochanter to point 6 inches lateral to toes (height)
25
What features distinguish a rolling walker?
- 2 to 4 wheels
- Often have auto-braking features
- May have seat
- May have hand brakes
26
What are 2 benefits of rolling walkers?
- Encourages continuous gait movement
| - Increased speed
27
What posture does a posterior walker promote?
- Upright posture
28
What patients are typically prescribed posterior walkers?
- Pediatric patients
| - Patients with CP
29
What patients are typically prescribed hemi walkers?
- Pt's post CVA
30
What features distinguish a stair climber walker?
- 2 posterior extensions
| - Additional hand grips off rear legs for use on stairs
31
What movement does a hinged reciprocal walker facilitate?
- Advancement of one side of walker at a time
| - Reciprocal gait patterns/ orthroses
32
What are 3 indications for the use of crutches?
- Decrease WB on LEs
- Need for moderate stability
- Need for increased BOS
33
What are benefits of axillary crutches?
- Increased UE WB in comparison to forearm crutches
34
What are negative aspects of the use of axillary crutches?
- Difficult to use in small areas
| - Prolonged use can result in axillary artery/ brachial plexus (radial nerve) damage.
35
What diameter are rubber crutch tips, and how do they minimize slippage?
- 1.5" in diameter
- Provide suction
- Rubber --> increased grip
36
What are advantages of the use of forearm crutches?
- Frees hands for use while still having access to crutch
| - Light and easy to maneuver
37
What is a disadvantage of forearm crutches?
- Slightly less stable than axillary crutches
38
To what type of patients are forearm crutches typically prescribed?
- Long term use patients
39
What re 2 other names for forearm crutches?
- Loftstrand
| - Canadian
40
What is the advantage of forearm platform crutches, and to whom are they typically prescribed?
- Allow WB through forearms
| - Prescribed for pt's who cannot WB through hands.
41
What are 3 methods of crutch measurement?
- 20 - 30 degrees elbow flexion; wrist neutral
- Subtract 16" from Pt.'s height
- Measure from a point 6" anterior and 2" lateral to the foot
42
How can a Pt's crutch measurements be estimated from supine?
- Axilla to a point 6 - 8" lateral to heel
43
How much of the forearm should a loftstrand crutch cuff cover?
Proximal 1/3rd of forearm. 1 - 1.5 " below elbow.
44
What are 3 indications for the use of a cane?
- Widened BOS to improve balance
- Limited stability and unweighting (unloads involved extremity 30%)
- Relief of pain; antalgic gait
45
What cane approximate normal gait the closest?
Standard cane.
46
How many points of support are provided by a standard cane?
One.
47
What advantage and disadvantage are their when using a quad cane in comparison to a standard cane?
- Increased stability
| - Slows gait
48
What type of quad canes are useful for stairs?
Small based quad-canes.
49
What type of canes do not fit on stairs?
Large based quad-canes.
50
In what hand is the Cane held?
Contralateral to involved LE.
51
What LE advances with the cane?
The involved LE.
52
What 2 measurements fit a cane to a Pt.?
- 20 - 30 degrees elbow flexion
| - Great trochanter to point 6 inches to side of toes.
53
What 6 non-biomechanical factors must be considered when choosing ADs?
- Device with least amount of assistance
- Lowest cost
- Determine if extra energy expenditure to device is worth WB relief
- Determine if patient will be distracted by device
- Determine if patient's self-esteem will be affected
- Determine if device is practical in a public setting
54
What are general hand grip principles for all ADs?
- Stand upright; shoulders relaxed
- Grip height at level of ulnar styloid/ wrist
- Grip at level of greater trochanter
- 20 - 30 degrees elbow flexion
55
How are the fit of axillary crutches determined?
- 6"/ 2-3 finger breadths below axilla
| - 45 degree angle from 5th metatarsal
56
How are platform crutches fitted?
- Directly in line with shoulder; 3" from midfoot
- Shoulder in neutral
- Elbow flexed 90 degrees
57
Which side of a quad can should face the Pt.?
- The flat side.
58
What are the 5 basic AD gait patterns?
- Swing-to
- Swing-through
- Four-point
- Three-point
- Two-point
59
What devices may utilize a 4-point gait pattern?
- 2 canes
| - 2 crutches
60
What 4 impairments may indicate a 4-point gait pattern?
- Bilateral LE Ms weakness
- BL LE pain
- Poor balance
- BL PWB
61
What is the main use of a 4-point gait pattern?
Learning tool towards 2-point gait pattern.
62
What is the slowest AD gait pattern?
4-point
63
What ADs may utilize 2-point gait pattern?
- 2 canes
| - 2 crutches
64
What 4 patients may utilize 2-point gait pattern?
- Ms weakness
- Pain
- Decreased balance
- BL PWB
65
What is the action of 2-point gait?
AD and contralateral LE advance at the same time allowing for natural arm and leg motion.
66
What ADs may utilize 3-point gait?
- 2 crutches
- 2 canes
- Walker
67
What impairment indicates 3-point gait pattern?
- Unilateral LE impairment (fx, ms weakness, NWB, etc...)
68
What is the action of 3-point gait?
- Both crutches, or canes moved forward simultaneously.
- Unaffected leg forward
- WB onto AD
- Swing uninvolved leg past (or to) crutches/canes
- WB onto uninvolved LE
- Repeat cycle
69
What ADs utilize swing-to gait?
- 2 crutches
| - Walker
70
What impairment indicates swing-to gait?
- BL LE impairment
71
What is the action of swing-to gait with crutches?
- Both crutches/ walker advance simultaneously
- WB onto crutches
- Swing both LEs foward to crutches.
- WB onto one or both LEs
- Repeat
72
What is the action of swing-to gait with walker?
- Walker and affect leg advance
- WB onto walker
- Swing uninvolved leg to walker
- WB on uninvolved
- Repeat
73
What ADs may utilize swing-through gait?
- 2 crutches
74
What is the action of swing-through gait?
- Crutches advance simultaneously
- WB onto crutches
- Swing both LEs beyond crutches to floor
- Repeat
75
What is an advantage and disadvantage of swing-through gait?
- Faster
| - Not as safe
76
What 5 factors should be considered when choosing a gait-pattern?
- WBing status
- Uni or Bilateral
- Strength/ ROM
- Balance impairment
- Cognition
77
Which LE leads ascending and descending stairs?
- Good leg leads going up
| - Bad leads going down
78
Which side is guarded when a patient is ascending or descending stairs?
Always the downward facing side.
79
What are 6 steps that should be followed if a patient falls?
- Try to lower the patient slowly to the floor
- Check for serious injury
- Move to prone or quadruped
- Crawl to stable furniture or support
- Pt. climbs onto surface
- File accident report
80
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