assistive devices - exam 1

Question 1

when are tilt tables used?

Answer 1

when patients need to acclimate to upright position
elevated gradually
vital signs measured before, during and after

Question 2

what are parallel bars used for?

Answer 2

balance training
teaching specific gait patterns
support while measuring an AD

Question 3

what is the proper way to use parallel bars?

Answer 3

20-25 deg elbow flexion with 2 inches wider than either greater trochanter
top of bar even w greater trochanter or wrist crease in standing w UE at sides

Question 4

what are ambulatory ADs?

Answer 4

devices that provide external support during gait training in an upright posture

Question 5

what are major indications for use of an AD?

Answer 5

structural deformity, amputation, injury or disease resulting in inability to bear weight through LEs
muscle weakness or paralysis in trunk or LEs
balance deficits

Question 6

what do ADs do?

Answer 6

increase BOS
provide a method for redistributing weight normally borne through LEs to UEs
creates an additional force that keeps the pelvis level in the face of gravity’s tendency to adduct the hip during unilateral stance

Question 7

what causes trendelenberg gait?

Answer 7

large adductor moment due to the natural placement of the COM

Weak abductors

Question 8

how do pts w trendelenberg gait compensate?

Answer 8

lean over the weaker side
decreases the adductor moment

Question 9

a cane’s force substitutes for _____ ________
how?

Answer 9

hip abductors
transmits part of the body weight to the ground –> decreasing the muscular force required for balancing

Question 10

walkers provide ??

Answer 10

large degree of stability

Question 11

walkers are chose for patients with ?

Answer 11

generalized weakness
debilitating conditions
need to reduce WB on one or both LEs
poor balance/coordination
inability to use crutches

Question 12

what are the 8 types of walkers?

Answer 12

standard
wheeled (2 or 4)
stair climbing walkers
ring walkers (peds)
knee walkers
reverse walkers (peds)
hemiwalkers
reciprocal walkers

Question 13

axillary crutches
provide _____
require ______
takes ______

Answer 13

moderate stability
more coordination than walkers
substantial amount of energy

Question 14

axillary crutches are chosen for patients with ?

Answer 14

weakness in one or both LEs
impaired balance
need for trunk support
permits 80-100% WB support

Question 15

what are forearm crutches good for?

Answer 15

providing more ease of movement but less trunk support than axillary crutches
frees hands without having to drop the crutch

Question 16

who are forearm crutches recommended for?

Answer 16

same patients that require axillary crutches but do not require trunk stability

Question 17

canes chosen for patients with?

Answer 17

minimal LE weakness
require slight WB reduction
impaired balance

Question 18

quad canes are used by patients with?

Answer 18

limited or no use of one UE as with hemiparesis
similar impairments as pts who require SPCs but usually greater deficits

Question 19

what are drawbacks of quad canes?

Answer 19

slightly heavier
somewhat awkward with all 4 points on the ground

Question 20

what is NWB?

Answer 20

involved LE not to be WB or touching floor

Question 21

what is toe touch weight bearing (TTWB)?

Answer 21

pt can rest toes on the floor for balance but cannot WB

Question 22

what is PWB?

Answer 22

limited about of WB tolerated

Question 23

what is weight bearing as tolerated?

Answer 23

pt allowed to place as much or as little weight through the involved LE depending on tolerance

Question 24

what are some ways you can monitor the amount of weight being placed in the LE?

Answer 24

scale
weight shifting
put hand on floor and have them step on it (for PWB mostly)

Question 25

how do you choose the proper AD?

Answer 25

match the needs and abilities of the pt with the qualities of the device

Question 26

list ADs in order from providing mostly stability to providing mostly mobility

Answer 26

parallel bars walker bilateral axillary crutches bilateral canes hemi walker quad cane single point cane no device

Question 27

what AD are good choices for increasing the BOS?

Answer 27

parallel bars walkers

Question 28

what AD are good choices for PWB?

Answer 28

parallel bars walkers bilateral crutches

Question 29

what AD are good choices for NWB and TTWB?

Answer 29

parallel bars walkers bilateral crutches

Question 30

what AD are good choices for WBAT?

Answer 30

parallel bars hemiwalkers single point cane or crutch

Question 31

improper fit or use of an AD will lead to:

Answer 31

decreased stability decreased function decreased safety increased energy expenditure

Question 32

how do you fit someone for a walker?

Answer 32

pt in standing or supine shoes should be worn hand grip at level of pts: - wrist - ulnar styloid process - greater trochanter

Question 33

how do you fit axillary crutch height if you know the patients height?

Answer 33

multiply by 77% or subtract 16 inches from height

Question 34

how do you fit axillary crutch height with patient in supine?

Answer 34

use a tape measure to measure the distance from axillary fold to 6-8 inches lateral to heel

Question 35

how do you fit axillary crutch height with patient in seated?

Answer 35

UEs abducted at shoulder level one elbow extended, one flexed to 90 deg measure distance between middle finger of extended elbow and olecranon process of flexed elbow

Question 36

how can you confirm the axillary crutch height?

Answer 36

with patient in standing tips should be 2 inches laterally and 4-6 inches anterior to toe of shoes

Question 37

how do you fit the hand piece height of axillary crutches with pt in supine?

Answer 37

greater trochanter, wrist crease, or ulnar styloid process to heel of shoe use this number to measure from rubber tip to hand piece

Question 38

what is an alternate method of measuring the hand piece height of axillary crutches

Answer 38

from ant axillary fold to greater trochanter or ulnar styloid process use this to measure from the axillary rest to the hand piece

Question 39

how should the crutches properly fit when in a tripod position?

Answer 39

should have approx 20-30 deg elbow flexion w relaxed shoulders two fingerbreadths should be present between axillary rest and bottom for the axilla

Question 40

how do you fit canes in standing?

Answer 40

place cane parallel to femur and tibia with foot of cane on the floor or at the bottom of the heel of shoe hand piece should reach wrist crease, greater trochanter, or ulnar styloid process

Question 41

how do you fit canes in supine?

Answer 41

use a tape measure to measure from greater trochanter to heel w hip and knee straight

Question 42

how do you confirm the fit of a cane? (same from fitting forearm crutches for height of hand piece)

Answer 42

in standing tips should be positioned 2 inches laterally and 4-6 inches anterior to toe of shoes

Question 43

how do you fit the forearm cuff when fitting forearm crutches?

Answer 43

top of the cuff should be 1-1.5 inches distal to olecranon process when the pt grasps the hand piece with wrist in neutral

Question 44

where should you stand when guarding?

Answer 44

slightly to one side and behind pt (where pt is most likely to fall) stand in stride stance - outside foot behind AD & the pt's foot; other foot trails when you walk underhand grip w gait belt. other hand on pts shoulder or chest

Question 45

how should you guard a pt on level surfaces?

Answer 45

stand behind pt and slightly to the weaker side one hand on gait belt w supinated grip other hand lightly resting on pt's shoulder staggered stance advance front foot w AD, trailing foot moves when pt moves

Question 46

true or false. if a pt is falling, stop the fall!

Answer 46

false slow it down to give time for important structures to be protected

Question 47

what do you do when guarding a pt and they lose their balance forward?

Answer 47

pull back on gait belt other hand pulls trunk upward and back may need to push forward on pelvis as pull back on trunk

Question 48

what do you do when guarding a pt and they lose their balance backward?

Answer 48

push forward on pelvis and trunk

Question 49

what do you do when guarding a pt and they lose their balance to one side away from PT?

Answer 49

pull gait belt towards you

Question 50

what do you do when guarding a pt and they lose their balance to one side toward PT?

Answer 50

turn body so that you face the pt's side widen BOS use body to support pt

Question 51

what do you do when guarding a pt and they lose their balance forward WITH AD?

Answer 51

instruct pt to let go of AD and reach for floor firmly, but slowly pull back on gait belt step forward w outside foot to help control descent if possible, instruct pt to cushion fall by bending their elbows and rolling to one side instruct pt to turn head to one side to avoid injury to face