Body Weight Support Flashcards
clinical impairments treated with body weight support:
− Balance deficits
− Strength deficits
− Motor control deficits
− Postural control deficits
− Endurance deficits
contraindications for harness
- When loading of the hip, pelvic, abdominal or chest regions is prohibited by physician orders- harness will compress these regions
− Patients with orders for NWBing or decreased Wbing through legs - Acute fractured rib (until new bone formation begins)
- Over wound vacuum assisted closures in harness region
- Pregnancy
strong precautions
- DVT
- Spondylolisthesis
- Large disc bulge/rupture with acute or worsening neurological signs
- Abdominal aortic aneurysm
- Known metastasis in harness region
- Wounds under the area of harness contact
harness precautions
- Gastrointestinal tube
- Colostomy
- Baclofen pump
- Catheter
- Compromised skin integrity
- Absent sensation
- Acute post hip surgery
- Acute abdominal surgery
rationale for use
- Motor learning paradigm
- Musculoskeletal
- Psychological
- Locomotor Central Pattern Generator
- Safety
rationale for use - motor learning
- Use of partial body weight support system can provide task specific, whole practice for locomotor training
- Lower metabolic demand of partial body weight support system for locomotor training may allow client to:
− practice for longer time period
− at a faster pace
− thus affording more opportunity for practice
− longer time x faster pace = more steps
rationale for use - musculoskeletal
- Provides unweighting through joints during gait reduce pain and allowing
for earlier mobilization - Provide unweighting through joints during gait allows for greater range of
motion at joints - Similar concept to use of buoyancy of water in therapeutic pool
rationale for use - psychological
- Reduction of fear of falling during ambulation
- Impression of “high-tech” equipment
rationale for use - central pattern generator
- Locomotor Central Pattern Generator relies on specific sensory information for trigger, modification of pattern in response to environment
- Use of partial body weight system may be more optimal environment to provide required sensory information to Central Pattern Generator
rationale for use - safety
- Allow to safely ambulate patient that may be at high risk to fall for variety of factors
− Size
− Ataxia
− Apraxia
− Impulsivity - Reduce number of staff required to provide safe environment for ambulation
parameters
percent body weight supported
speed
duration
frequency
% body weight supported
upper limit of 30% body weight support
speed
- Greatest improvement in self selected walking velocity noted with fast training speeds (>2 mph)
duration
- no consensus
- 15-45 mins
- CPG recommends dosing in aerobic zones
frequency
no consensus
3-5x/week for 3 weeks up to 12 months
progression
- Increase treadmill speed
- Increase duration of treatment
- Decrease amount of body weight support (keep harness on to eliminate fear of falling)
- Progress to over ground ambulation
benefits of utilization on treadmill
− Able to emphasize walking speed and objectively record
− Easier utilization with one clinician
− Ability to use properties of treadmill to emphasize portions of gait cycle via extension
benefits of use overground
− Differences in gait kinematics, muscle activation on treadmill (moving
surface)
− Easier utilization with bariatric patient
− Variation of surface
cons of using overground
will likely need one person just to move device, harder for therapist assisting patient to be in correct position
cons of treadmill
Treadmill may be difficult due to handrails, spacing, size of patient/wheelchair fitting on treadmill, no adaptability to environment/less
similar to demands of walking without device as compared to overground
when you should use overground
unweighted walking, turns, adaptability
when to use treadmill
speed of mechanics of gait
open freedome
allows for rotational component; could also completely rotate and attempt backwards ambulation
open flexible yolk
allows for vertical displacement
progression for lite gait with pushers
- Decrease assistance to single person
- Decrease amount of physical assistance
- Decrease amount of unweighting
- Increase speed
- As pushing behavior decreases consider overground options
progression for like gait with low tone
- Decrease amount of manual assistance (try to get to 1 person assist first, then decrease amount of assistance from therapist)
- Decrease amount of body weight support
- Increase speed (may go before body weight support depending on amount of support)
- Transition to overground
therapist position for high tone
- Start sitting and managing leg- considerations knee flexion ability to flex limb for swing, foot position when landing- patient may adduct leg and may not land on flat
foot position - Once patient is able to achieve flexion for swing and foot landing in appropriate
location may transition to standing behind patient working on hip rotation or weight
shifting
