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610: Concepts in Physical Therapy > Assistive Devices and Gait Training > Flashcards

Assistive Devices and Gait Training Flashcards

1
Q

What things should you consider when choosing an assistive device?

A
  • 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)
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2
Q

Which assistive device provides the greatest support and stability?

A

Parallel bars

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3
Q

Which assistive device is appropriate for the least impaired gait?

A

One cane

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4
Q

What should the pateint’s posture look like when being fitted with an assistive device?

A

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

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5
Q

When fitting a cane or a walker what 2 landmarks are typically used?

A

Greater trochanter or ulnar styloid (wrist crease)

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6
Q

When fitting a cane or a walker why is the angle at the elbow important?

A

Offers a biomechanical advantage for pushing

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7
Q

How do you fit crutches with the patient standing?

A

2 inches below armpits

Hand position should allow 20-30 degrees of elbow flexion

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8
Q

Crutches should be fit in the “tripod” position what does this mean

A

2 inches lateral and 6 inches anterior to foot

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9
Q

How do you fit crutches with the patient is supine?

A

Anterior axillary fold to a surface point 6-8 from the lateral border of the heel

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10
Q

What are the 2 equations you can use to determine crutch height?

A
  • Height of patient x 77%

- Subtract 16 inches from the height of the patient

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11
Q

How do you fit forearm or lofstrand crutches?

A
  • 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
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12
Q

4 Common Errors in Fitting Assistive Devices

A

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

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13
Q

What 4 things should you do to prepare for ambulation?

A

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

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14
Q

When assisting with ambulation what must the patient always be wearing?

A

A gait belt

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15
Q

What is the best position when ascending stairs?

A
  • Behind and slightly to the side of the patient

- Feet staggered on stairs (one up/one down)

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16
Q

What is the best position when descending stairs?

A
  • Optimally, behind the patient, although patients are typically more comfortable with therapist in front of them.
  • Feet Staggered
17
Q

What are important points of control?

A

One Hand on the gait belt, the other hand at ‘ready position’ for postural correction slightly anterior to their shoulder

18
Q

What do you do if a patient loses their balance?

A
  • 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.
19
Q

5 Types of Weight Bearing

A

1) Non-weight bearing
2) Toe touch weight bearing
3) Partial weight bearing
4) Weight bearing as tolerated
5) Full weight bearing

20
Q

What are the 6 Gait Patterns?

A

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

21
Q

Describe Two-Point Gait Pattern

A
  • 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
22
Q

Describe Four-Point Gait Pattern

A
  • 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
23
Q

Describe Three-Point Gait Pattern

A
  • 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
24
Q

Describe Three-One-Point Gait Pattern

A
  • 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
25
Q

Describe Modified Two-Point Gait Pattern

A
  • Only one AD is used (can crutch, or hemi-walker)

- The assistive device and the opposite LE advance simultaneously

26
Q

Describe Modified Four-Point Gait Pattern

A
  • Only one AD is used

- The assistive aid and the opposite LE advance alternatively

27
Q

In which hand do you hold the AD in a modified gait?

A

The assistive aid is held in the hand opposite the affected lower extremity

28
Q

Describe “Step-to” Gait

A

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

29
Q

Describe “Step-through” Gait

A

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

30
Q

When should you use step-to rather than step-trhough?

A

When your pt las limited use of both lower extremities and trunk instability.

31
Q

What types of functional activites should you test?

A
  • 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
32
Q

Where should inital instruction of a gait pattern take place?

A

Parallel Bars

They provide maximum stability, security, and safety

33
Q

When should you use a tilt table?

A

When you want to reacclimate your patient to upright posture

34
Q

What are some symptoms of intolerance for the tilt table?

A 
loss of consciousness
tachycardia
hypotension
excessive perspiration
c/o nausea
sensory changes in lower extremities
35
Q

What is an ideal starting duration goal?

A

15-20 minutes

36
Q

What is an ideal starting degree goal?

A

30, 60, then 90

Making sure to measure Physiological responses at each increment

610: Concepts in Physical Therapy (14 decks)

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