Gait Flashcards

Question

How to do part practice for gait re-education

Answer 1

1. In standing with table support practice assisted stepping with affected leg – encouraging DF and knee flexion 2. In standing with table support practice stepping with unaffected leg – transferring weight 3. Progress along the table with w/c behind 4. Backward stepping 5. Sideways stepping 6. Onto step

Answer 2

1. Treadmill training with or without PBWS provides an opportunity to practice repetitively the components of gait. 2. A harness can be used for individuals with significant functional limitations – provides security & earlier mobility

Answer 3

1. Gait training may commence early 2. Enables practice of complete gait cycle 3. Task specific practice 4. Improves walking 5. Improves strength & fitness 6. Opportunities for speed & endurance training 7. Workload input and output is measurable 8. Minimises manual handling risk

Answer 4

* **Short term -** To enable mobility and facilitate increased independence, social interaction, weight-bearing, return to function * **Long term -** To reduce risk of falls, to enable continued mobility and independence, for fatigue management (e.g 4 wheeled walker in MS) * As a last resort think about walking aids as it will take away their own balance reactions thus aim to get off walking aid ASAP

Answer 5

1. Compensations 2. Reliance on walking aid 3. Changes to gait cycle 4. Cognition, require carryover to learn how to use 5. Falls risk/ trip hazard if used incorrectly / inappropriately issued

Answer 6

1. Sticks 2. Crutches 3. Frames

Answer 7

**Types:** 1. Wooden/metal sticks 2. Quadripods - stroke pts 3. Tripods - stroke pts 4. Fischer sticks - for hand arthritis **Uses:** 1. Only when absolutely necessary 2. First choice of walking aid 3. For high level balance (CVA, MS, TBI, PD) 4. For relief of pain (RA,OA) - fischer 5. Can use two if it helps 6. Can use a high stick or pole to prevent too much leaning - more for balance than WB 7. Always use in the opposite hand to the leg affected - encourage more normal gait pattern 8. *Gait patterns:*** 1. Sit to stand 2. FWB/PWB 3. 2pt gait/3pt gait/4pt gait (with 2 sticks) 4. Steps and stairs

Answer 8

* Often measured in standing with elbows slightly flexed (15-20 degrees), the ulnar styloid to floor. A metal stick may be adjusted or, if using wooden stick, this is ‘cut’ to appropriate size * In lying with shoes off: the elbow should be in slight flexion (15°-20°), measure from the ulnar styloid to the bottom of the foot, allowing for footwear, * If you are giving a stick to a neurological patient you might consider a higher stick to prevent them leaning too much on the stick

Answer 9

**Types:** 1. Elbow crutches 2. Fischer crutches 3. Axillary crutches - not used now **Uses:** 1. Only when absolutely necessary 2. Second choice of walking aid 3. For high level balance (CVA, MS, TBI) 4. For relief of pain (RA,OA) 5. Post-op THR, TKR, knee arthroscopies, foot surgery 6. Can use one if it helps - always use in the opposite hand to the leg affected 7. *Gait patterns* 1. **Sit to stand** 2. FWB/PWB/NWB 3. 2pt gait (with 1 EC)/3pt gait/4pt gait (with 2 EC) 4. Steps and stairs

Answer 10

* Often measures in standing with elbows slightly flexed (15-20o), the ulnar styloid to floor. Some elbow crutches also have adjustment for forearm length – the cups should be at least 3 fingers width below fold of elbow * In lying with shoes off: the elbow should be in slight flexion (15°-20°), measure from the ulnar styloid to the bottom of the foot, allowing for footwear

Answer 11

**Types:** 1. Zimmer frame 2. Wheeled Zimmer frame 3. Delta frame (PDs) 4. Stroller 5. Pulpit frame 6. Gutter frame **Uses:** 1. 3rd choice walking aid 2. Outdoor use - Delta frames (PDs), Strollers 3. Stable - all except delta frame 4. Speed - slowest is ZF/pulpit/gutter frame, medium speed is wheeled zimmer frame, fastest is delta frame and stroller 5. Manouverability - WZF, delta frame and strollers 6. Disadvantages - ZF/pulpit/gutter frame (have to lift it), delta frame (unstable, have to use brakes), stroller (have to use brakes) 7. *Pulpit and gutter frames:* * Early mobilisation after: surgery; neurological event eg. TBI; recovering from hospitalisation * Usually start with pulpit frame as provides more support * Progress to gutter frames, these can be provided for home use * Good for people who: 1. can’t lift a frame 2. need to lean on their arms 3. have poor trunk 4. have poor cardiorespiratory function 8. *Gait patterns:* 1. **Sit to stand 2. FWB/PWB/NWB 3. 2pt gait (NWB)/3pt gait

Answer 12

1. If a patient requires a frame to stand or mobilise this will require two people. 2. Ensure that the frame is accessible before the patient stands up and that it is at the approximate height - visual estimation initially, then accurately measured - and adjusted on all four legs. 3. When standing upright with hands on the frame handles, the patient should have 15°-20° of elbow flexion 4. For patients with PD measure higher so they are not flexed over

Answer 13

* Sticks/crutches can be used to climb steps/stairs, either by using both or by using a rail and using one stick/crutch and carrying the other in the same hand. * Steps and kerbs are only possible with a walking frame if the second level is wide enough to accommodate the frame and the patient balanced enough to place it. * Ascending or descending stairs the aid stays with the affected limb to relieve weight on that limb **PWB:** 1. *Ascending –* lead up with unaffected leg. **Crutches/sticks remain with the affected leg** and follow with that limb to the same stair or level 2. *Descending* – lead down with crutches/sticks and the affected leg, unaffected leg then follows to the same stair or level **NWB:** 1. *Ascending* – crutches/sticks stay down taking the weight while the unaffected leg goes to the stair above, standing on the unaffected leg balance is gained and the crutches drawn up to the same level as the affected leg 2. *Descending* – the crutches/sticks are placed down first, the weight transferred to them via the arms and the unaffected limb is then gently lowered to that stair

Answer 14

**sit to stand, stand to sit with:** 1. Zimmer frame 2. Elbow crutches 3. 2 sticks 4. 1 stick *Assume NWB, PWB, FWB as appropriate* **Sticks/Crutches:** 1. Generally both sticks/crutches are placed in one hand, elbow crutches are disengaged with the elbow and one hand is used to push up from the chair into standing. 2. Sticks/crutches then positioned suitably for walking. 3. The procedure is reversed to sit down, elbow crutches are disengaged first, both are placed in one hand before lowering into sitting, the other hand is used to safely locate the chair. **Frames:** 1. For walking frames, push up from chair with both arms or, if difficult to initiate angle of rise to standing, one hand can be placed on the frame (never two, unsafe as frame may tip) the other hand pushes from the chair. 2. Reverse the procedure for sitting, always turning completely for safe sitting! Patients tend to launch themselves at the chair!

Answer 15

* 2 point gait (NWB or FWB) * FWB usually follows 4 point gait, the opposing arm and leg moving simultaneously as confidence and skill is built by practice. * NWB - Non-wheeled zimmer frame or crutches used. **Intructions:** 1. Affected leg and opposite/both crutch(es)/stick(s) are advanced together, followed by the other leg (with/out oppositr crutch)

Answer 16

3 point gait (PWB) – requires a zimmer frame or 2 crutches/sticks. The amount of PWB can be gradually progressed through to FWB when appropriate **Instructions:** 1. Take both crutches/sticks or frame forward followed by taking the affected leg forward, then sharing weight with arms, step-to or step-through with the unaffected leg. 2. In a step-through gait (not with zimmer frame) the affected leg is taken a full step length past the stance leg

Answer 17

* Requires 2 sticks/crutches. * Very stable as at no time are both feet or walking aids off the ground at the same time. However, this means it is a relatively slow pattern. * Only appropriate where near FWB is allowed. It is ideal for balance and as a step to re-learning a normal reciprocal gait pattern. **Instructions:** 1. Take one crutch/stick forward, followed by the opposite leg. 2. Then take the other crutch/stick forward followed by the alternate leg. The opposing arm and leg movement is as for a normal gait pattern

Answer 18

1. Environment safe? Remove trip hazards (presence of rugs, threshold strips, steps, worn floor coverings, adequate lighting) 2. Stairs – ensure have one for upstairs and downstairs 3. Steps indoors/outdoors – teach technique with walking aid 4. Correct technique when using on stairs (if stick/ elbow crutch) 5. Ensure able to carry other objects as necessary - require kitchen trolley or suggest a backpack 6. Can the aid fit through doorways - access to bathroom and bedroom

Answer 19

**Types:** 1. Rigid 2. Dynamic and semi-dynamic 3. Foot-up splint **Uses:** 1. Orthoses are external devices that support or enhance an impaired limb 2. In neurological rehab orthoses are most frequently used to improve function and to prevent or correct deformity 3. If correctly applied AFO’s have been shown to increase speed and efficiency of gait (Tyson & Rogerson 2009) 4. Disadvantages - May make some activities more difficult e.g. sit – stand & stairs as the orthosis may prevent the lower leg moving over the foot

Answer 20

1. Sit to stand 2. FWB/PWB 3. 2pt gait/3pt gait/4pt gait (with 2 sticks) 4. Steps and stairs

Answer 21

1. Sit to stand 2. FWB/PWB/NWB 3. 2pt gait (with 1 EC)/3pt gait/4pt gait (with 2 EC) 4. Steps and stairs

Answer 22

1. Sit to stand 2. FWB/PWB/NWB 3. 2pt gait (NWB)/3pt gait

Answer 23

1. Ferrules - bottom of aids; replace immediately if not worn smoothy or unevenly 2. Handles 3. Check structure of mobility aid - wood = splinters, cracks; adjustable = poppers effective; metal = not bending; elbow crutches = check plastic; brakes working 4. Adjustable equipment – measured correctly for patients height 5. Appropriate footwear 6. Environment – check no trip hazards/ busy environment/ wet floors etc 7. Ensure adequate instructions for use - does the patient understand and remember? Has the patient had clear and concise training with appropriate practice and supervision? Have written instructions been given if necessary?