Gait and Ambulation Flashcards

1
Q

Gait Training vs Ambulation

A

Gait Therapy
* Requires assessment by PT (rhythm, cadence, step, stride and speed)AND
* Skilled intervention designed to create a change in gait / function / skill.

Ambulation
* Nonskilled – can be done by rehab aide, family, other caregivers
* “Maintenance” therapy
* “Pt walked 100 ft with walker. No balance problems”

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2
Q

Qualitative - Gait analysis

A

Observational Gait Analysis
Lab Based Gait

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3
Q

Quantitative - Gait Analysis

A

Walking distance
Walking speed
Walking endurance
Standardized Assessments
How far can they walk without sitting down?

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4
Q

Observational Gait Analysis Terms

A

Phases of Gait
- Stance and swing
Gait Cycles Terminology
- Stride length
- Step length
- Cadence
- Velocity
- Width of base of support

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5
Q

Objective Outcomes Measures: Acute and Beyond

A
  • Physiologic Indicators: Pre and Post
    – BP, HR, Respiration, Pulse O2
  • Perceived exertion or VAS rating of fatigue
  • Gait speed (with age related norms)
  • Functional Reach (full WB)
  • Performance-Oriented Mobility Assessment (POMA)
    how do they tolerate activity?
    Ex: BP went way up
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6
Q

Objective Outcome Measures: Sub-acute care

A

Activities-Specific Balance Confidence (ABC); Must be full weight bearing to get accurate reading
Dynamic Gait Index (Full WB)
Functional Gait Assessment (Full WB)

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7
Q

Name 2 gait speed / velocity standardized assessments

A

TUG, 6 minute walk test, 10 meter walk test

Allows you to be able to test to see if they can be a community ambulator.

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8
Q

WB Restrictions and Gait

A
  • Restrictions can affect gait if UE or LE are compensating
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9
Q

Monitoring WB

A

Bathroom Scales
– Having patient shift weight from one scale to the other provides feedback about static WB equality
Limb-Load Monitor (LLM)
Audible feedback to patient and clinician regarding WB during gait is provided.
– Sensitivity can be adjusted according to patient’s WB restrictions.

  • NEVER PLACE FINGER UNDER SHOE
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10
Q

Explain step-to vs step-through gait pattern.

A
  • Step to: B crutches go forward; feet step to be in line w crutches
  • Step through: B crutchrs go forward; feet step beyond/thru the crutches, most similar to regular gate
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11
Q

Explain swing-to vs swing-through gait pattern.

A

Swing to: swing to the crutches; NOT BEYOND
Swing through: swing beyond the crutches.

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12
Q

Which of these 4 gait patterns most closely represents a normal gait pattern?

A

Step through

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13
Q

Mobility Distances

A
  • Ability to ambulate 0 to 50 feet = single direction household ambulator (needs rest breaks between trips)
  • Ability to ambulate 50 to 150 feet = full household ambulator (can easily walk between rooms for tasks without rest)
  • Ability to ambulate > 150 feet = able to leave the home (out to the car or from car into clinic / store)

These also apply for wheelchair mobility

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14
Q

Community Ambulation Requirements

A
  • Walk >330 meters continuously (1088 feet)
    – Based on mean distance measured:
    — eg, supermarket, drugstore, bank, MD office, post office, department store.
  • Negotiate curbs (up to 7 inches in height)
  • Use gait speed > 1.3 m/s
    – eg, cross street

This applies to someone who is very independent.

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15
Q

Preparation for Gait

A
  1. Assess transfers
  2. Assess standing tolerance
  3. Assess standing mobility in place
    * Note swing limb clearance
    * Note stance limbstability
    * Determine best device
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16
Q

Patient Instruction on devices

A

Demonstrate technique before attempt.
Encourage mental rehearsal, have them repeat it back to you.
Begin with simple tasks and progress in complexity and challenge.
Provide feedback regarding quality of the process.
Instruct in care and maintenance of AD. (Tips of the walker, how to close the walker)

17
Q

Guarding during Gait

A
  • Typically behind and slightly to the weaker side
  • Control points: pelvic and shoulder girdles
  • For gait requiring hands-on guarding, one hand is typically grasping the gait belt and the other hand hovers at the contralateral shoulder.
  • Clinician should walk on the weaker side to better be able to guard.
18
Q

Forward Gait

A
  • Begin with gait on level, clear surfaces and progress to more challenging contexts.
  • Encourage relaxed, upright posture and forward gaze.
  • Begin turns with multiple smaller steps (increased time in double stance for more stability).
  • Turning toward the stronger side is generally easier; progress to more difficult turns.
19
Q

Guarding and Observing Gait

A
  • A common fault in early practice is to be so focused on guarding the patient that you lose sight of how they are walking!
  • Be aware that they are still maintaining anyWBing restrictions
  • Monitor that they are following your instruction for gait pattern / safety
  • Analyze their gait as you guard
20
Q

Documentation of gait

A
  • Type of device utilized
  • Side device is held on
  • Gait pattern utilized
  • Amount of assist provided
  • Indicate distance covered
  • Note ability to maintain WBing restrictions
  • Include gait analysis
21
Q

Gait Patterns

Won’t be tested but good to know for documentation

A