Assistive Devices and Gait Training Flashcards
What things should you consider when choosing an assistive device?
- Diagnosis and/or Surgical procedure performed
- Cognitive status
- Weight bearing status
- Need for stability and support
- Patient assessment (General condition, strength, range of motion, balance, stability, coordination)
Which assistive device provides the greatest support and stability?
Parallel bars
Which assistive device is appropriate for the least impaired gait?
One cane
What should the pateint’s posture look like when being fitted with an assistive device?
the patient will be standing with his/her head erect, shoulders relaxed and level, trunk erect, pelvis level, knees flexed slightly, and feet (foot) flat
When fitting a cane or a walker what 2 landmarks are typically used?
Greater trochanter or ulnar styloid (wrist crease)
When fitting a cane or a walker why is the angle at the elbow important?
Offers a biomechanical advantage for pushing
How do you fit crutches with the patient standing?
2 inches below armpits
Hand position should allow 20-30 degrees of elbow flexion
Crutches should be fit in the “tripod” position what does this mean
2 inches lateral and 6 inches anterior to foot
How do you fit crutches with the patient is supine?
Anterior axillary fold to a surface point 6-8 from the lateral border of the heel
What are the 2 equations you can use to determine crutch height?
- Height of patient x 77%
- Subtract 16 inches from the height of the patient
How do you fit forearm or lofstrand crutches?
- Cuff placement should be in the proximal third of the forearm, approximately 1-1.5 inches below the elbow
- Hand position should allow 20-30 degrees of elbow flexion
4 Common Errors in Fitting Assistive Devices
1) Patient is fit while demonstrating poor posture
2) If patient has flexed or extended arm and/or wrist
3) Assistive device is fit without consideration of shoe wear
4) Crutches are fit without being in the tripod position
What 4 things should you do to prepare for ambulation?
1) Review the patient’s medical record
2) Assess/evaluate the patient to determine their limitations or capabilities
3) Determine the patient’s goals for ambulation
4) Determine the appropriate equipment
When assisting with ambulation what must the patient always be wearing?
A gait belt
What is the best position when ascending stairs?
- Behind and slightly to the side of the patient
- Feet staggered on stairs (one up/one down)
What is the best position when descending stairs?
- Optimally, behind the patient, although patients are typically more comfortable with therapist in front of them.
- Feet Staggered
What are important points of control?
One Hand on the gait belt, the other hand at ‘ready position’ for postural correction slightly anterior to their shoulder
What do you do if a patient loses their balance?
- Use your points of control to help them regain balance
- Have them drop the assistive devices if necessary
- If balance cannot be regained with you offering physical assist; help lower patient to seated position using gait belt.
5 Types of Weight Bearing
1) Non-weight bearing
2) Toe touch weight bearing
3) Partial weight bearing
4) Weight bearing as tolerated
5) Full weight bearing
What are the 6 Gait Patterns?
1) Two-Point Gait
2) Four-Point Gait
3) Modified Two-Point Gait
4) Modified Four-Point Gait
5) Three-Point Gait
6) Three-One-Point Gait
Describe Two-Point Gait Pattern
- Requires bilateral ADs
- 2 points are in contact with the ground at all times (one foot and one AD)
Example: Right foot moves with left AD, Left foot then moves with the right cane
Describe Four-Point Gait Pattern
- Requires bilateral ADs
- 4 points are in contact with the ground throughout the cycle
Example: Right AD moves, left foot moves, left AD moves, right foot moves
Describe Three-Point Gait Pattern
- Requires bilateral crutches or walker…NOT canes
- Involved extremity is NWB
- Requires good UE strength
- High energy expenditure
- The AD advances simultaneously with the NWB LE; then the FWB LE steps through the aides
Describe Three-One-Point Gait Pattern
- Bilateral ambulation aids or walker
- 3 points (if walker 1 point on each side) of contact then 1 point of contact
- Requires a FWB extremity and partial weight bearing extremity
- Move walker or crutches and PWB extremity together, then FWB extremity
Describe Modified Two-Point Gait Pattern
- Only one AD is used (can crutch, or hemi-walker)
- The assistive device and the opposite LE advance simultaneously
Describe Modified Four-Point Gait Pattern
- Only one AD is used
- The assistive aid and the opposite LE advance alternatively
In which hand do you hold the AD in a modified gait?
The assistive aid is held in the hand opposite the affected lower extremity
Describe “Step-to” Gait
Both crutches are advanced forward together; weight is shifted onto hands for support and both legs are then swung forward to meet the crutches; requires the use of two crutches or a walker
Describe “Step-through” Gait
Both crutches are advanced forward together; weight is shifted onto the hands for support and both legs which are swung forward beyond the point of crutch placement
When should you use step-to rather than step-trhough?
When your pt las limited use of both lower extremities and trunk instability.
What types of functional activites should you test?
- Sitting into and standing from different types and heights of chairs
- Ascending and descending stairs
- Ambulation on uneven surfaces
- Curbs and doorways
- Sitting on the ground and returning to standing
Where should inital instruction of a gait pattern take place?
Parallel Bars
They provide maximum stability, security, and safety
When should you use a tilt table?
When you want to reacclimate your patient to upright posture
What are some symptoms of intolerance for the tilt table?
loss of consciousness tachycardia hypotension excessive perspiration c/o nausea sensory changes in lower extremities
What is an ideal starting duration goal?
15-20 minutes
What is an ideal starting degree goal?
30, 60, then 90
Making sure to measure Physiological responses at each increment
