Gait and Assistive Devices Flashcards
Locomotion
Getting around
Gait
Walking and running
Ambulation
Walking
Walking
Has period of double support
Running
Period of no support
What are some body structure and function changes that affect locomotion?
- Neuromusculoskeletal changes
- Cardiopulmonary changes
- Integumentary changes
What are the Rancho Los Amigos gait terminology used for?
Used in research and labs etc.
What are traditional gait terms used for?
Traditional is more like slang. Clinicians use both Rancho Los Amigos and traditional.
How many periods of double support are always in the gait cycle?
There are always two periods of double support in the gait cycle.
What happens when someone walks slowly?
When someone walks slowly, the period of double limb support is longer, and the period of single limb support is shorter.
Initial contact…
Also called heel strike. Consists of the first 3% of the gait cycle. The heel strikes the ground and begins the rotation over the heel.
Loading response…
Also called foot flat. Loading response goes from 3-12% of gait cycle. The knee flexes slightly to absorb shock as the foot falls flat on the ground, stabilizing in advance of single limb support.
Midstance…
Phase of gait where the foot assumes more of a support and overall stability role.
Terminal stance…
Also called heel off. Begins when the center of gravity is over the supporting foot and ends when the contralateral foot contacts the ground.
Preswing…
Also called toe off. The transition phase between stance and swing, in which the foot is pushed and lifted off of the ground.
Initial swing…
During initial swing, the hip, knee, and ankle are flexed to begin advancement of the limb forward and create clearance of the foot over the ground.
Mid-swing…
During mid-swing, limb advancement continues and the thigh reaches its peak advancement.
Terminal swing…
During terminal swing, the final advancement of the shank takes place and the foot is positioned for initial foot contact to start the next gait cycle.
What is measured from the initial contact of one heel to the initial contact of the other heel?
Step length
How is stride length defined?
From the contact of one heel to the next contact of the same heel.
What is a normal step width?
8-10 centimeters. It widens when someone loses stability.
Gait requires…
Controlled mobility, built upon the capacity for mobility and static stability skills.
Describe an antalgic gait
It is a painful gait, limping, and not spending time on a limb.
Describe an ataxic gait
An ataxic gait is without order. It is hesitated, uncoordinated, and usually a cerebellar issue. The cerebellum isn’t correcting movements quickly enough, so movement is not smooth. It doesn’t have to be cerebellar though.
Describe a slap and steppage gait
Slap gait: foot drop, usually due to weak dorsiflexors. They can achieve dorsiflexion, but can’t control it so their foot slaps
Steppage: they can’t dorsiflex, so they have to lift their foot higher to get it through
Describe a trendelenberg gait
Usually a weakness issue not a pain issue. Caused by glute medius weakness. The opposite hip will drop.
Describe a lurch gait
When someone has glute medius pain, they have a lurch gait. It is like a trendelenberg with compensation. They shift their weight over the joint, so they don’t have to contract the glute medius.
Describe circumduction
Circumduction is when they bring their around and out because they don’t have enough knee flexion or ankle flexion to get their leg through. Leg is rotated away from the body then back towards it in a semicircle.
Describe a hip hike
Pt will hike their hip up to get the leg through
Why does WB need to be specified?
WB restrictions can be either UE or LE, so that needs to be specified. It is also incredibly important that they are followed. Healing could be disrupted if they are not.
What are WB restrictions based on?
Typically based on a percentage of the patient’s body weight that should be transmitted through the LE (assuming an average body size).
Why would UE WB restrictions be good to know?
Upper extremity (UE) WB restrictions can affect gait if UEs are being used to compensate for LE difficulty. If they are using an AD, you will need to adjust.
What percentage is TTWB?
foot contacts ground for balance only, or 10 to 15 kg or up to 20% of body weight
What is the limit for PWB?
usually 20% to 50% of body weight
What is WBAT limited by?
limited only by patient tolerance (usually 50% to 100%)
What are ways you can monitor weight bearing restrictions?
Bathroom scales - Having patient shift weight from one scale to the other provides feedback about static WB.
Limb Load Monitor - Audible feedback to patient and clinician regarding WB during gait is provided.
Sensitivity can be adjusted according to patient’s WB restrictions
What should you NOT do to test WB?
Do not place your fingers under a Pt’s foot. It could be painful and doesn’t provide useful data.
What are ADs typically used to do?
- Increase support of load
- Increase stability through enlarged base of support (BoS)
What are things you should consider when choosing an AD? (4)
- Patient Goals
- Restrictions and Impairments
- Activity Limitations
- Stability-mobility trade-offs
List the most common ADs from most to least stable
- Parallel bars
- Walker
- Bilateral axillary crutches
- Bilateral forearm crutches
- Hemi walker
- Quad cane
- Single-point cane
Who would expend the most energy? A) A young person without an Ad B) An older adult without an AD C) A young adult with an AD D) An older adult with an AD
D) Gait deviations tend to increase energy expenditure. Older adults also tend to expend more energy walking long distances.
Which requires more energy expenditure?
A) Standard walkers
B) Rolling walkers
C) Canes
A) Using standard walkers requires significantly more energy expenditure than using rolling walkers or canes
What is a rollator useful for?
It has a lot of mobility, but not a lot of stability. If someone needs mobility, but not as much stability as a rolling walker, a rollator would be good. It is also great for endurance.
Which is more stable?
A) axillary crutches
B) forearm crutches
A) axillary crutches
How much elbow flexion should someone have an AD?
20-30 degrees
What level should the device handle typically be?
Device handle is typically at the level of the greater trochanter or ulnar styloid process.
What is important in how the patient stands while you are fitting them?
- Have the patient in good posture and wearing typical footwear
- Patient should have as close to “normal” posture as possible
Where should the AD be in relation to the Pt?
AD should be slightly forward (about to the pt’s toes) and 2-3” lateral to the feet
How do you test axillary crutch fit?
Should be 2 fingers between the pads and the armpit
What should you always put first when fitting an AD?
SAFETY! Always guard appropriately during fitting and check the fit before moving.
How do you begin teaching gait?
- Begin with gait on level, clear surfaces and progress to more challenging contexts.
- Encourage relaxed, upright posture and forward gaze
How do you begin teaching someone to turn?
- Begin turns with multiple smaller steps (increased time in double stance).
- Turning toward the stronger side is generally easier; progress to more difficult turns.
What all counts as a “point” in gait patterns?
- Each upper extremity device counts as a “point”
- Lower extremity that advances with device does not count
- Lower extremity that advances independently counts as a “point”
What is a gait where the AD and opposite LE advance together? (one or two canes or crutches, or one hemi walker)
Two-point gait
What is a three-point gait?
NWB - two ADs are advanced followed by the WB LE
WB - two ADs and weaker LE, followed by stronger LE
What is a four-point gait?
It is a deliberate two-point gait. Four contact points: AD 1, opposite LE, AD 2, opposite LE
If LE in swing phase is advanced only to the level of the ADs, what gait pattern is it?
Step-to
What is a step-through gait?
LE in swing phase is advanced beyond level of ADs.
What is this gait:
Both crutches advance simultaneously followed by simultaneous advancement of LEs to level of ADs.
Swing-to
Explain a swing-through gait.
Both crutches advance simultaneously followed by simultaneous advancement of LEs beyond the level of ADs.
What is tripod alternating gait?
AD #1 is advanced, followed by AD #2, then both LEs simultaneously.
Name this gait:
Both ADs are advanced together, followed by both LEs. More of a dragging motion.
Tripod simultaneous
What should you do when instructing patients on gait with an AD?
- Demonstrate technique before attempt.
- Encourage mental rehearsal.
- Begin with simple tasks and progress in complexity and challenge.
- Cue patient to internal experience of the process.
- Provide feedback regarding quality of the process.
- Instruct in care and maintenance of AD.
What should you always do before the Pt attempts the technique?
Always demonstrate for the patient
How do you perform sit to stand with an AD?
- Scoot forward on seat.
- Position feet as far back as possible while maintaining full contact with floor (FWB); extend LE out in front if WB is restricted.
- Hands pushing down on armrests; no pulling up on AD.
- Lean trunk forward (“nose over toes”).
- Extend trunk and LE into standing.
How do patients compensate for weak quads or reluctance to flex the trunk?
- Relying heavily on UE strength to push up (on armrests or on knees)
- Rocking to gain momentum
- Bracing lower legs against chair to create leverage
- Pressing knees together to create leverage
How do you perform a stand to sit with an AD?
- Back up all the way to the chair using AD.
- Feel chair at the back of the legs.
- If WB is restricted, extend restricted LE before sitting.
- Reach back for chair, one hand at a time.
- Forward trunk flexion.
- Control descent.
What is unique about a sit to stand with crutches and NWB or TTWB LE?
make sure it is extended upon standing and sitting AND consider what side the crutches are moved to
What are the principles of guarding with an AD?
- 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
What grip should you use on the gait belt?
Supinated grip
What is the goal with a collapsing fall and an angular fall?
Try and help the patient regain support. Bring them in close and attempt to bring their center of mass back over BoS.
How do you navigate inclines and declines?
Instruct: Lean forward going up, stand upright going down
Guard – going up (stand behind), going down (consider ramp/patient)
Lean forward when ascending.
Take slightly longer steps when ascending.
Take slightly shorter steps when descending.
Follow zigzag path if necessary to reduce steepness of path.
How do you navigate curbs and stairs?
Instruct: Use railing, Up with stronger and down with weaker
Guard: PT always down the steps, feet staggered
“Up with the good, down with the bad.” Normally AD advances with LE its supporting Guarding: Going up, guarding from behind Going down, guarding in front
How do you navigate curb/stairs with a cane?
Up Up with “good” first Then “bad” & cane Down Down with “bad” and cane first Then “good” If there is a railing…use it (can switch cane to other side)
How do you navigate curb/stairs with a walker?
Same stepping pattern on stairs as cane
On stairs turn walker sideways and use railing
Brace walker on step and check stability before stepping
Curb:
Up – Walker, good, bad
Down – Walker, bad, good
How do you navigate curb/stairs with a crutches?
Same pattern – up with good, down with bad
Use railing when able and move both crutches to the opposite side (either together or cross)
Crutches need to be on the down side upon moving…
SO going up – foot goes first
So going down – crutches go first (or with “bad”)
Guarding – on down side, don’t pull them or block them
