Assistive Devices and Gait, ADLs Flashcards
a disturbance in motion that increases the chance of a breakdown in the [human movement system]
perturbation
patient is positioned in supine with bilateral knees flexed and feet flat on the floor or bed
hook lying
patient is allowed to put as much weight as possible through the extremity and is only limited by his or her pain tolerance
weight bearing as tolerated
patient is not allowed (generally due to physician order) to bear any weight on the extremity
nonweightbearing
patient is allowed to place full weight through the extremity and is not limited by pain
full weightbearing
patient is allowed to bear some weight on the extremity, but the amount is often dictated by the physician
partial weight bearing
manner or style of walking, stepping or running
gait
patient is allowed to only put weight through the tippy toes, sometimes limited to 10% of weight or less, to maintain balance only (not a functional WB status)
toe-touch or touch-down weightbearing
devices patients cannot use when NWB
canes, hemi-walkers, Lofstrands
only restrictions for weight bearing as tolerated
pain, mobility
devices patients cannot use when PWB
canes, hemi-walkers, Lofstrands
patient can use any device that meets his/her mobility needs
FWB status
biofeedback device used to alert patient of placing too much weight on extremity
weight-bearing monitor
safety maintenance
brakes locked, gait belt, hand on gait belt at all times if contact guard or more assistance required
sit to stand from chair with crutches
place both crutches in one hand, push up from armrest with other hand
stand to sit in chair with cruthces
back all the way until patient feels chair behind knees, place both crutches in one hand, reach back for armrest with other hand, lower slowly into chair
position of hands for sit to stand when using walker for gait
both hands push up from chair
position of hands for stand to sit when using walker
reach back for chair armrests to lower into chair
injury or poor posture leads to more or less efficient gait
less efficient gait
quadruped
on all fours; less stable than prone or hook lying; requires more strength and balance to maintain
exercise that involves contraction of muscles without any movement in the surrounding joints
isometric hold
position in which patient is fully upright without upper extremity support
plantigrade
position in which patient is on 2 feet with upper extremities supported on table top or parallel bars
modified plantigrade
postures that offer a chance to strengthen certain muscle groups while challenging balance to prepare for fully upright gait training
developmental postures
very stable developmental position in which patient can strengthen muscles of shoulders, neck, arms and neck
prone on elbows
stable position in which patient can have lower extremity strength or balance challenged
hook lying/bridging
table that starts in horizontal position, then can slowly raise patient to 90 degree angle (would stop by 80 though!)
tilt table
patient responses on a tilt table that require patient to be returned to more horizontal position
significant heart rate increase or blood pressure drop
devices that may be used to help keep blood flow up toward brain when attempting to tolerate upright position
abdominal binders, compression stockings
patient signs and symptoms of intolerance to upright position
significant heart rate increase or blood pressure drop, dizziness, nausea, loss of consciousness, vision changes, pallor, lower extremity edema, excessive perspiration
parallel bar activities
weight shifts (gait), lifting one hand then both (balance), push-ups (strength), lift 1 lower extremity, gait patterns, sidestepping/backward walking/turning
position of PT/PTA when working with patient in parallel bars
inside the bars, hand on gait belt
harness system to suspend patient from upright so patient can practice gait on treadmill without fear of falling
body weight support treadmill
considerations when assigning a patient an assistive device
strength, balance, endurance, home setup, caregiver assistance required, WB status, cognition
progression from most restrictive device to least restrictive device
parallel bars>walker>cane
walker>hemi walker>quad cane>single point cane
walker>crutches>single point cane
most appropriate use for single point cane (SPC)
incidental balance needs
cane with 4 points in contact with the ground
quad cane
fit for a cane or walker
standing if possible, handle should reach wrist crease or greater trochanter
placement of cane
opposite of affected or weaker limb
device for patients who weigh over 200-250 pounds
bariatric AD
used when patient lacks good hand grip strength or has WB restrictions/pain on 1 or both forearms/wrists/hands
platform attachments
amount of elbow flexion patient should have when assessing fit of walkers/canes/ crutch handgrips
20-30 degrees
assessing fit of axillary crutches
crutch tips 2 inches lateral and 4-6 inches anterior to toes; 2-3 fingers between axilla and top of axillary rest; 20-30 degrees elbow flexion; hand grip at wrist crease
assessing fit of Lofstrand crutches
crutch tips 2 inches lateral and 4-6 inches anterior to toes; cuff 1-1.5 inches below olecranon process;20-30 degrees elbow flexion; hand grip at wrist crease
moment of initial contact of one lower extremity to initial contact of same lower extremity
gait cycle or stride
when 1 lower extremity is in contact with the floor
stance
when the lower extremity is not in contact with the floor
swing
60% of gait cycle
stance
40% of gait cycle
swing
period when both lower extremities are in contact with the ground
double support
distance of the gait cycle
stride length
distance between the initial contact of one lower extremity and initial contact of other lower extremity
step length
walking faster
less double support
subphases of stance
initial contact (heel strike)
loading response
midstance
terminal stance (heel off)
preswing (toe off)
subphases of swing
initial swing (acceleration)
midswing
terminal swing (deceleration)
average stride lengths
men=62 inches
women=52 inches
normal step width
2-4 inches
gait problem seen with weak dorsiflexors
unable to clear foot from floor during swing
gait problem seen with weak hamstrings
knee hyperextension during stance
gait patterns used with walkers
3 point, 3 point modified
gait patterns used with bilateral axillary crutches
3 point, 3 point modified, four point, 2 point
gait patterns used with unilateral crutch or cane
modified 2 point, modified 4 point
gait patterns used with bilateral forearm (lofstrand) crutches
four point, 2 point
device choices for NWB status
walker, bilateral axillary crutches
device choices for PWB or TTWB (TDWB)
walker, bilateral axillary crutches
lower extremity to move first when ascending stairs
unaffected (intact)
therapist position when guarding patient during gait training
on affected side and slightly behind patient
patient swings lower extremity to point where crutches or walker tips are located on ground
step to
patient advances intact lower extremity a bit beyond the tips of the AD
step through
first move when patient is alone and begins to fall is
move assistive device(s) out of the way
patient education on falling backwards includes
flex trunk, bring chin to chest
patient education on falling forward
release AD, use upper extremities to break fall
directions to patient when educating on descending stairs
crutches down first, followed by affected lower extremity (or simultaneously) followed by unaffected lower extremity
directions to patient when ascending stairs
advance unaffected lower extremity, followed by AD, then affected lower extremity (or last 2 simultaneously)
items to include in documentation of ADs and gait
type of AD
if you fit for device
pt education on gait pattern and which one
WB status
level of assist
cues required
distance (on level ground) or number of stairs/rails
other barriers navigated
gait deviations noted-abnormal ROM/ms weakness/spasticity
pain
caregiver ed if applicable
loss of balance
any progressions-either attempted or planned
therapist position when patient is descending stairs
in front of patient with hand on gait belt/other hand at patient’s shoulder or on rail, straddling 2 steps for increased stability
goal when patient is losing balance during gait training( more than minor LOB)
slow down patient’s descent to floor
extremity circles around to accommodate for lack of clearance during swing phase
circumduction
hyperextension of knee during stance phase
genu recurvatum
shuffling gait, festination, forward head, rounded shoulders, decreased arm swing, decreased or no heel strike, decreased trunk rotation
Parkinsonian gait
hip drop on side opposite of weak muscle during swing
Trendelenburg gait
wide BOS, abducted lower extremities, jerky/uncoordinated movements, staggering
ataxic gait
shortened stance phase on affected limb; shortened step length on uninvolved side, decreased arm swing
antalgic gait
series of tests that are used to determine a person’s ability for work, ADL, and other recreational activities
Functional Capacity Evaluation (FCE)
basic activities of daily living (BADLs)
bed mobility
transfers
gait training
wheelchair training
toileting
grooming
feeding
bathing
dressing
rest/sleep
MRADL
mobility-related ADLs
IADLs
cooking, completing household chores, driving, manageing medications, managing finances, taking care of pets, caring for children, skills generally considered a part of person’s role in the community
MRADLS of grooming, dressing, feeding, toileting, bathing and IADLs often are addressed by
occupational therapists/certified occupational therapy assistants
Provide examples of collaborations btwn OT/PT
See slides 5-9 of Erin’s PPT for examples
Special considerations for both OT and PT when working with patients that have certain conditions
Assessment of vital signs at rest and with activity
Post-op precautions-total hip, cervical, lumbar
weight bearing restrictions
home assessment benefits
allows therapy staff to see pt’s home and observe any challenges or obstacles pt may encounter when pt goes home and make recommendations about modifications prior to patient returning home (accessibility, safety, fall prevention)
PTA’s focus when documenting ADLs
functional nature of interventions performed
areas to look at/for when performing home assessment
accessibility of home
stairs–number? rails?
door widths
rugs, pets
items within reach
bathroom-tub/shower-grab bars? toilet-height, grab bars
–does walker fit into bathroom? around bed?
flooring type
adequate lighting-also at night
furniture-walk between? sit to stand from furniture?
gait assessment tools
Timed Up and Go
Tinetti Test (Performance Oriented Mobility Assessment)
Berg Balance Scale
Dynamic Gait Index
footwear patient should wear when gait training
shoes or socks with non-slip tread on soles
position of PTA when assisting patient from sit to stand
on weaker side and slightly behind
factors to consider for guarding patients
pt weight, height, abilities (also your own), cognition
–do you need a second person?
is patient connected to catheter, IV, chest tube, oxygen?
WB limitations-can patient maintain WB?
clear path for gait training
patient footwear
vital sign monitoring
correct fit of device
gait belt, loss of balance potential
NWB; AD advances simultaneously with NWB lower extremity and then unaffected lower extremity advances
Three point
PWB; AD advances, followed by PWB lower extremity (or can be done simultaneously); unaffected lower extremity advances next
Three-one point (modified three point
FWB or WBAT; AD and opposite lower extremity alternately advance
Four point
FWB or WBAT; utilizes 1 AD; AD and opposite (affected) lower extremity alternately advance
Modified four point
FWB or WBAT; AD and opposite lower extremity advance simultaneously
Two point
FWB or WBAT; utilizes one AD; AD and opposite (affected) lower extremity advance simultaneously
Modified two point
cane types
single point cane, small-based quad cane, large (wide)-based quad cane, Hurrycane (3-point cane)
walker types
standard, front-wheel (FWW), four-wheeled (rollator), three-wheeled (rollator), hemi-walker
crutch types
axillary, forearm (Lofstrand)
key components of motor learning
practice, feedback
