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Intro to Interventions > Chapter 9 - Assistive Devices, Patterns, and Activities > Flashcards

Chapter 9 - Assistive Devices, Patterns, and Activities Flashcards

1
Q

Sitting to Standing with a Walker

A

i. Position the walker directly in front of your chair with the open side facing you, make sure walker is close enough to you so you are able to reach it
ii. Move your hips toward the front of the chair to the best of your ability
iii. Place your feet so your stronger leg is slightly behind your weaker leg
iv. Place feet flat on floor and arms on the front portion of armrests, in front of hips if possible for the most stability
v. Lean forward in the chair and push down with your hands and strong leg to rise to standing
vi. Once in a standing position reach with one hand at a time to grab the handpieces of the walker, establish your balance before attempting to walk

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2
Q

Standing to Sitting with a Walker

A

i. Approach the chair facing it until you are close enough to the chair, use stronger leg to pivot until you are facing away from chair
ii. Step back until the front edge of the chair is touching the back of your stronger leg
iii. Reach back for armrests one hand at a time
iv. Lower yourself into the chair slowly, once seated scoot back into chair into comfortable position

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3
Q

Sitting to Standing with Crutches

A

i. Move forward to the front of the chair and place stronger leg slightly forward
1. If knee of the affected leg cannot be bent this heel should be slid forward before attempting to stand
ii. Grasp the hand pieces of both crutches in one hand on the same side as the affected leg
1. Position crutches slightly in front and to the side of the chair vertically
2. Place the opposite hand on the armrest of the chair
iii. Lean forward in chair and push up with hands and the unaffected leg
1. Axillary Crutches: Establish balance and position crutches underarms before attempting to walk
2. Forearm Crutches: Establish balance and grasp the handpieces, and place crutches in positions and apply the armcuff

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4
Q

Standing to Sitting with crutches

A

i. Approach the chair forward and pivot until you are facing away from the chair, slowly step back until leg is in contact with the chair
ii. Remove the crutches from under the arms and hold the handpieces in the arm on the side of the affected leg
iii. Use the hand of the unaffected side to grabe the armrest and lower your hips into your chair using your arms and legs
iv. Places crutches on a chair and readjust your hips to a comfortable position

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5
Q

Sitting to standing with a cane

A

i. Position cane on side of chair of unaffected extremities - Standard cane can be hooked onto armrest, footed cane should place slightly in front of and to the side of the chair
ii. Move hips toward edge of chair and position your stronger leg slightly behind your weaker leg
iii. Place your hands on the armrests in front of hips
iv. Gently lean trunk forward, and use arms and legs to the best of your ability to push up and rise to stand
v. Grasp cane with hand of unaffected side and establish balance before walking

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6
Q

Standing to sitting with a cane

A

i. Approach the chair and pivot until the unaffected side is closest to chair
ii. Place cane next to, or hooked onto arm rest
iii. Reach for the near armrest with your unaffected hand and if you are able to, grasp the far armrest with affected hand and pivot until back is near chair
iv. Lower yourself into chair and readjust hips so you are comfortable in the chair

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7
Q

Muscle/Group involved in:

phase: initial contact to foot flat
purpose: stabilize limb

A

gluteus maximus

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8
Q

Muscle/Group involved in:

phase: terminal stance to preswing
purpose: stabilize pelvis in frontal plane

A

gluteus medius

gluteus minimus

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9
Q

Muscle/Group involved in:

phase: preswing to midswing
purpose: accelerate limb

A

hip flexors/adductors

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10
Q

Muscle/Group involved in:

phase: loading response
purpose: absorb shock, eccentric contraction stabilizes the knee

A

quadriceps

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11
Q

Muscle/Group involved in:

phase: midswing to initial contact
purpose: decelerate limb

A

hamstrings

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12
Q

Muscle/Group involved in:

phase: initial contact to midstance and preswing to initial contact
purpose: absorb shock, elevate foot

A

tibialis anterior
fibularis longus
fibularis brevis

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13
Q

Muscle/Group involved in:

phase: midstance, terminal stance to preswing
purpose: knee stability at terminal stance, push off

A

gastrocnemius

soleus

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14
Q

Muscle/Group involved in:

phase: initial contact to initial contact
purpose: stabilize trunk

A

erector spinae group

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15
Q

major muscle groups used for non-weight-bearing ambulation: lower trunk

A

trunk extensors

trunk flexors

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16
Q

major muscle groups used for non-weight-bearing ambulation: upper extremity and upper trunk

A 
shoulder depressors
shoulder extensors
finger flexors
scapular depressors 
scapular stabilizers
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17
Q

major muscle groups used for non-weight-bearing ambulation: weight-bearing lower extremity

A 
hip abductors
hip extensors
knee flexors (functioning as hip extensors)
knee extensors
ankle dorsiflexors and plantar flexors
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18
Q

phases of gait

A

Stance: leg in contact with floor or supporting surface (weight bearing)
Swing: leg not in contact with floor or supporting surface (NWB)

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19
Q

Prep for ambulation activities

A

Review medical record
PT exam and evaluation to determine limitations and capabilities
Determine equipment and pattern
Explain process to patient
Prep the patient, prep the surface, clear the path
Confirm initial measurement of equipment
Gait belt
Be certain patient is mentally and physically capable
Explain and demonstrate pattern
Maintain proper body mechanics

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20
Q

Purpose of preambulation activities

A

Provide safe and stable practice sessions
Improve patient’s ability to use assistive ambulation aids
Determine type of assistive aids and functional skills
Allow patient to develop confidence
Increase strength
Improve cardiopulmonary function and endurance
Improve sitting and standing balance
Teach ambulation patterns and functional skills

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21
Q

precautions for ambulation activities

A

Use appropriate footwear
Monitor physiologic responses
Avoid controlling patient by grasping clothing or arm
Anticipate the unexpected
Guard by standing behind or slightly to one side
Maintain grip on safety belt
Do not leave patient unattended while standing
Be certain area is hazard free and dry

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22
Q

Sitting to standing in parallel bars

A

-Prepare wheelchair (position, lock wheels, remove front rigging)
-Scoot body to front edge of chair
-Place stronger leg back and injured leg forward
-Place both hands on armrests of chair and lean forward
-At the same time, push down with arms and legs
-One at a time, move hands from wheelchair to parallel bars
o DO NOT pull yourself up using the bars

23
Q

Standing to sitting in parallel bars

A
  • Make sure your wheelchair is ready (wheels locked, etc)
  • Turn so your back is toward the chair
  • While using the bars for support, back up until you feel the chair with the back of your stronger leg
  • Take one hand off the bars and reach back for the armrest as you begin to sit (it may be easier to start with the hand on your strong side)
  • Take your other hand off the bars and reach back to the armrest
  • Lower yourself down slowly until you are sitting
  • Scoot back and reposition front rigging
24
Q

Measurement and fit for cane

A

Height of the cane should be in line with the crease of the wrist or slightly below hips

25
Q

Ambulation with cane

A

Cane should be placed 2 inches lateral to foot and 4-6 inches from the center of the foot
Cane should be opposite of injured side
Cane and injured leg should move at the same time, followed by the strong leg following through

26
Q

Measurement and fit for parallel bars

A

Height of the parallel bars should be measured while the person is relaxed. The handle should be in line with the crease of the wrist or slightly below hips
Always wear a gait belt

27
Q

Pre-ambulation for parallel bars

A

Sway slightly to the left, right, front,
and back in order to get used to the movement of the body while walking
Alternate lifting hands off of the rails in order to decrease the sense of stability needed while walking
Alternate lifting opposite leg and hand at the same time to simulate walking

28
Q

Ambulation will parallel bars

A

Lift one leg forward, followed by the opposite hand, followed by the other foot, followed by the opposite hand. Continue until walking becomes comfortable

29
Q

Measurement and fit for walker

A

The hand grip of the walker should be level with the patient’s wrist crease or greater trochanter (projection on the side of the hip) while the walker is in front of the patient with the patient’s arm along their sides.
The feet of the walker should be on the floor, the hips and knees should be straight, and shoes should be worn.
If the person being measured is not able to stand by the walker for measurement, the distance between their greater trochanter and heel can be measured with shoes on and knees straight.
*The walker should be readjusted if it does not provide proper function to avoid the development of unsafe gait patterns or bad gait habits.

30
Q

Measurement for crutches

A
  1. ) CRUTCH LENGTH: Multiply your height in inches by 77% or subtract 16 inches from your height.
  2. ) HANDPIECE HEIGHT: With your arms at your side, have someone measure from the crease of your wrist to the heel of your shoe - this should be the length from the rubber tip of the crutch to the hand piece.
31
Q

Fit for crutches

A

While standing straight, shoulders relaxed, knees slightly flexed, and feet flat, the following should be observed:

  1. ) The top of the crutch should be positioned in the armpit. The rubber tips at the bottom should be two inches outside of the shoe and 4-6 inches in front of the shoe.
  2. ) Grasp the hand pieces with wrists straight - they should not be bent in either direction.
  3. ) There should be about 2 inches between the top of the crutch and the armpit (to protect important nerves!)
  4. ) Your elbows should be bent at about 20-25°.
32
Q

Preparations for tilt table

A
  • Wash hands and equipment
  • Introduce yourself, verify and orient the patient
  • Explain the procedure and get informed consent
  • Review patient’s medical record
  • Measure baseline vitals (blood pressure and pulse)
33
Q

Procedure for tilt table

A

• Position the patient lying on his or her back on a sheet-covered tilt table
• Place a rolled towel beneath the patient’s knees, a pillow behind the patient’s head, patient’s arms at rest on either side, and feet flat on the footboard shoulder width apart
• Apply the strap restraints, one across the lower thighs just above the knees, and one across the upper chest
• Elevate the table to a position tolerated by the patient and remain here for several minutes (reassess vital signs, document the length of time spent in this position, and ask the patient how he or she is feeling)
• When the patient is stable, raise him or her to a new elevation and remain here for several minutes (reassess vital signs, document the length of time spent in this position, and ask the patient how he or she is feeling)
• Repeat this procedure as the patient becomes more acclimated to the upright position (continue to reassess vital signs, document the length of time spent in the position, and ask the patient how he or she is feeling)
***always look for signs of nausea, dizziness, sensory or color changes, and changes in vital signs that may indicate an issue. Decrease the elevation of the table if the patient is not tolerating the position or reports feeling any of these symptoms
• Conclude treatment by gradually returning the patient to a horizontal position (reassess vital signs, ask the patient how he or she is feeling, and observe the patient for any signs or symptoms of discomfort or distress)

34
Q

Weight-bearing status types

A 
Non–weight bearing (NWB)
Toe Touch weight bearing (TTWB)
Partial weight bearing (PWB)
Full weight bearing (FWB)
Weight bearing as tolerated (WBAT)
35
Q

4 point ambulation pattern

A
  • Requires use of bilateral assistive devices; ex: two crutches
  • This pattern is very stable, performed slowly, and is the safest pattern to use in crowds
  • Requires low energy expenditure
  • Used when patient requires maximal stability or balance
  • Patient leads with one crutch, then follows with the opposite foot; then the other crutch followed by the second foot (ie. Right crutch -> left foot-> left crutch-> right foot)
36
Q

2 point ambulation pattern

A
  • Requires use of bilateral assistive devices; ex: two crutches
  • Requires more coordination than the four point pattern, but is still relatively stable and can be performed more rapidly
  • Uses simultaneous forward placement of a crutch and the opposite foot (ie. Right crutch and left foot -> left crutch and right foot)
37
Q

Modified 2 point ambulation pattern

A
  • Requires only one assistive device (one crutch)
  • Can be used for patients with function of only one upper extremity or those with a lower extremity that requires less stress to be applied (in this case, the assistive device would be used on the opposite side of that leg)
  • Not appropriate for patients who need a true partially weight bearing gait
  • Performed in the same sequence as the four point or two point pattern, but with the use of one less
38
Q

Measurement and fit for forearm crutches

A

have patient grasp handpieces with forearms inserted into forearm cuffs
position the crutch tips approximately 2 in lateral and 4-6 in anterior to toes
shelbow flexion angle: 20-25 deg
upper edge of cuff: 1-1.5 in below olecranon process

39
Q

3 point ambulation pattern

A

Requires: Bilateral assistive devices (crutches and a walker) EX-CLUDING CANES and a gait belt
During this movement, the assistive aid moves simultaneously with the non-weight bearing limb then the full-weight bearing limb/foot steps through the aids.
When assisting a patient re-member to:
Don’t describe the pattern as a “swing to” or “swing through” - these are used for patients with spinal cord in-juries who are unable to ac-tively use muscles of their lower extremity.
This gait is less stable than the modified 3 point and has higher energy expenditure but produces faster ambulation.

40
Q

Modified 3 point ambulation pattern

A

Requires: Bilateral assistive devices that will support a significant amount of body weight or a walker (NOT CANES) and a gait belt.
During this movement, the assistive aid and partial-weight bearing limb advance simultaneously then the full-weight bearing limb steps through the aid while the patient distributes weight onto the aid and partially bears weight on the protected lower extremity.
This gait Is more stable than the 3 point, requires less strength and less energy but is slower.
It allows the affected limb to function actively while maintaining some weight bearing on it.

41
Q

patient guarding in ascending curb or stairs

A

-position yourself behind and to the side of the patient where they have the least support
+opposite of the handrail
+on the weaker side of patient
-hold gait belt with one hand; other hand on patient’s trunk
+if no handrail, place opposite hand on shoulder
-Place your outside foot on the step the patient is standing on and your inside foot on a step below
the step the patient is standing on
-move your feet after the patient has moved up the steps/curb

42
Q

patient guarding in descending curb or stairs - from the front

A

-position yourself in front of and to the side of the patient where they have the least support
+opposite of the handrail
+on the weaker side of patient
-hold gait belt with one hand; opposite hand on handrail
+if no handrail, place hand on shoulder
-Place your outside foot on the step the patient will step onto and your other foot on a step below
-move your feet after the patient has moved up the steps/curb

43
Q

Guarding when balance is lost forward

A
  • gently pull on the gait belt and the trunk

- move close to the patient and maintain a wide stance

44
Q

Guarding when balance is lost backward

A
  • pivot yourself sideways towards the patient and maintain a wide stance
  • one hand presses the trunk or pelvis
  • other hand grasps gait belt
45
Q

Guarding when balance is lost to one side: towards you

A
  • grasp the gait belt with one hand

- grasp the patient’s trunk with the other hand

46
Q

Guarding when balance is lost to one side: away from you

A
  • grasp the gait belt with one hand
  • grasp the patient’s trunk with the other hand
  • pull the patient towards you
47
Q

Guarding on level ground

A

Stand behind and slightly toward involved side
Grasp safety belt with hand closer to patient’s back
Place other hand lightly on the closer shoulder
Place your feet in anteroposterior stance
Move forward in step with patient
Avoid cross steps

48
Q

Components of gait

A

Moving forward, backward, and sideways
Turning left or right
180 degree arc

49
Q

Moving forward, backwards, sideways

A

sequencing

180 degree arc = “pieces of the pie”

50
Q

Ambulation at home

A

Floor Surface - practice on different surfaces, level and unlevel ground
Trip hazards - assess for these in home
Safety equipment - bathroom, kitchen, etc.

51
Q

Gait goals: safety vs. independence

A

safety: a way
- use cane/walker in the long run
- a step back from complete independence
independence: the way
- may not be the safest way

52
Q

Gait goals: independence vs. functional gait

A

independence: the way

functional gait: the shortcut / modified version

53
Q

Reasons for Assistive Devices

A

NWB on 1 side, post surgery
balance/equilibrium/coordination issues
pt has altered gait
weakness due to stroke, CVA, TBI
progress from walker to cane or independent
facilitate mobility of pt - get from point A to point B
help pt compensate, increase BOS

Intro to Interventions (3 decks)

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