foundations final Flashcards
seating/mobility goals
maximize function/independence
normalize tone/decrease spasticity
minimize orthopedic deformity
manage/prevent pressure sores
enhance QOL
improve self image
increase comfort
standard wheelchair dimensions for adults
18in in width
16 in seat depth
20 in seat height
types of wheelchairs
semi-reclining - 30 degrees extension
reclining - fully horizontal may be achieved
- tilt-in-space chair
externally powered chair (electric)
sports chair
lightweight/ultralight wheelchair
standard wheelchair
outdoor chairs
adaptive controls
seat height measurement
heel of shoe to popliteal fold
add 2 inches unless using a seat cushion
leg length
minimum clearance between floor and footplate is 2 inches
measured from lowest part on bottom of footplate
seat depth
posterior buttock to posterior aspect of lower leg on popliteal fossa
subtract 2 inches
seat width
hip width at widest part
add 2 inches
back height
measure from seat of chair to axilla
subtract 4 inches
measure with seat cushion if applicable
arm rest height
from seat of chair to olecranon process with elbow flexed 90 degrees
add 1 inch
measure with seat cushion if applicable
purpose cushions
improves pelvic position
relieves pressure
types: contoured foam, custom molded, air cushion
common diagnoses for adults
spinal cord injury
TBI
neurodegenerative diseases
ALS
muscular dystrophy
multiple sclerosis
CVA
CP
common diagnoses for children
CP
developmental delay
spina bifida/myelomeningocele
muscular dystrophy/SMA
hydrocephalus/microcephalus
stance
leg in contact with floor or supporting surface
60% in walking
40% in running
swing
leg not in contact with floor
40% in walking
60% in running
NWB
non weight bearing
TTWB
toe touch weight bearing
PWB
partial weight bearing (% or lbs)
WBAT
weight bearing as tolerated
four point gait
bilateral ambulation aid
RA, LF, LA, RF
three point
one leg NWB
walker or bilateral amb aid
R&LA, F
two point
bilateral amb aid
RA&LF, LA&RF
TWO MOVNG TOGETHER
three point one
PWB
bilateral amb aid
injured foot moves with AD, strong foot
modified four point
one amb aid
hemi
LF, RF, RA
modified two point
one amb aid
hemi
RF, LF&RA
gait sequencing
move device first
then weaker leg
then strong leg
if unilateral, device on side of strong leg
pre for ambulation
review medical chart
assess, examine, evaluate limitations and capabilities
what are ambulation goals
determine proper equipment
determine appropriate pattern
explain process to patient
obtain consent
prepare pt and environment
ensure proper footwear
apply gait belt
confirm proper fit of device
explain and demo pattern to pt
guard using gait belt and pt’s shoulder and trunk
which leg do questions refernece?
right leg unless left is specified
how many periods of double support
2 10% periods
step length
right to left foot
stride legnth
right to left to right
step width
right heel to left heel
what happens when demands increase?
keep foot under COG
narrower step width
foot angle
from heel to 2nd toe
length of track to test gait speed
3m acceleration
5m test
2m deceleration
max, preferred, both
normative values
step length - 28in
stride length - 56 in
foot angle - 5-7 degrees
step width - 3.5in
gait speed - 2.7-3.1 mph
initial contact
weight acceptance
stance phase
(heel strike)
moment in time
loading response
weight acceptance
stance phase
(foot flat)
ends: opposite toe off
midstance
single limb support
stance phase
ends: opposite heel off
terminal stance
SLS
stance
(heel off)
ends: opposite heel strike
pre swing
limb advancement
stance
ends: toe off
initial swing
LA
swing phase
ends: feet adjacent
mid swing
LA
swing
ends: tibia vertical (malleoli equal)
terminal swing
LA
swing
ends: next initial contact
plan of care
what you will do to address problem
plan for entire treatment in your setting
POC includes
ST goals
LT goals
intervention plan
discharge plan
factors influencing POC and prognosis
comorbidities
medical complexities
complicating factors
cognitive status / psychological issues
social and economic factors
pt care goals must be …
… functional
measureable
patient specific
why write goals
justify therapy
helps to determine treatments
set priorities
assist with monitoring cost and effectiveness
communicate
motivate
intervention plan may include
modalities
amb
transfer and bed mobility training
exercises
neuromuscular re-education
home program
pt education
include amount, frequency, and duration of services
discharge plan
what pt will do to continue progress one PT is done
directed from STG and LTG
may include
- exercises
- ADs if needed
- referral to other services if needed
origins of professional behaviors
educators in med, law, pharm, vet med
clinical decorum
pt safety
clothing/shoes
hair
jewelry
hygiene
potential errors in clinical decorum
medication error
surgery/procedure on wrong part
errors in performance of hazardous activities
misdiagnosis
selection of inappropriate treatment
nosocomial infection
production pressures
fatigue and sleep deprivation
stress
human factors
accidents occur when
careless
inadequately trained
inattentive
excessively busy
nagi model
active pathology
impairment
functional limitation
disability
WHO
disease
impairment
disability
handicap
ICF model
impairment
activity limitation
participation restrictions
disability
difference about ICF
illustrates the person in his or her world
language places emphasis on function rather than condition
body functions
physiological functions of body systems
body structures
anatomical body parts
activity
execution of task
participation
involvement in life situation
environmental factors
environment where person conducts life
personal factors
demographics
ABCD’s of goal writing
Audience - who exhibits skill
Behavior
Condition - what circumstances
Degree - how well done
SMART goals
specific
measurable
attainable
realistic
timely
who what how much why
who - focus
what - unit of measure
how much - degree of improvement you hope for
why - how does this change relate to pt function
short term goal
most common is ~1 week
my be as long as 2-3 weeks
long term goal
total duration of plan of care
describes final product
tips for writing goals
pt problem list
pt functional deficits
start with LTG and make STG to reach LTG
list in order of priority
how does an AD help?
expand BOS
decrease WB if needed
permit/increase mobility and independence
potentially decrease pain
greatest to least stability
parallel bars
standard walker - bilateral connected
FWW
4WW
axillary crutches - bilateral disconnected
forearm crutches
2 canes
single crutch - unilateral
hemiwalker
quad cane
single point cane
considerations when choosing an AD
diagnosis
prognosis
WB
cognitive status
need for stability/support vs mobility
pt assessment - general condition, strength, ROM, balance, stability, coordination, sensation
how to fit a device
ideally, pt standing straight up with feet flat on floor in proper footwear
fitting a cane or walker
ulnar styloid at hand grip
elbow angle 20-25 degrees
fitting axillary crutches
2 inches below axilla
2 inches out, 4 forward
elbow angle 20-25 degrees
fitting forearm crutches
2 inches out, 4 forward
elbow angle 20-25 degrees
cuff 1-1.5 inches below elbow
common errors when fitting a device
if pt wrist/arm is flexed or extended
footwear not considered
crutches fitted without tripod position
verbal communication
vocal or written
7%
nonverbal communication
body language, gestures, ect
55%
paralinguistics
pitch, pace
38%
sympathy
agreement in feeling
try to move on
pity
empathy
better
relate
vicarious participation
support emotions
understand their perspective
why communicate with physician
enhance pt care
enhance pt as profession
when communicate with physician
no news is good news
before pt returns to physician
per protocol
eval and treat
use professional judgement in treatment
peer communication
understand each profession
teritorial dispute
dominance issue
barriers in communicating with children
ego
rigidity
semi logical
literal
concerned about peer opinions
barriers to communicating with pt families
high emotions
multiple sources of info
opinions differ from pt
barriers to communicating with elderly
reluctant to ask questions
don’t fully report complaints
doesn’t feel responsible for own health
thinks HCP too young or inexperienced
hearing/vision loss
dementia communication
simple commands
yes/no
repetition
short sentences
touch cues
call by name
move on if frustrated
say goodbye to end
decrease extraneous conversation
stressors to alzheimers
fatigue
change in routine
change in caregiver
stimuli
demands exceeding functional capacity
physical stressors
- pain
- discomfort
- infection
- illness
- depression
communicating with alzheimers
environment orderly
clear, concise
repetition
regular schedule
same therapist
similar exercise program
support group for family
communicating with parkinsons
give time to respond
clear, concise
don’t repeat quickly
demonstrate
instruct with functional activities
when ascending stairs
up with the good
strong side next to railing
strong > weak > device
how to guard ascending
posteriolateral
stagger step
hand on gait belt
static when pt is moving
when descending stairs
down with bad
strong side next to railing
device > weak > strong
how to guard descending
in front of pt
stagger
gait belt
static
