Gait and Elevation

Question 1

Stair Mobility ROM Requirements

Answer 1

Hips: 10 to 80 degrees Flexion
Knees: 10 to 120 degrees Flexion
Ankles: 10 to 35 degrees DF; 20 to 40 degrees PF

Effected LE needs minimum, Strong needs high number

This is the minimum for a STEP TO, high number is for a STEP OVER

Question 2

General Rules for Stairs With AD

Answer 2

• Use the railing if it is available
• The railing is the most stable and usually safest support
• “Up with the good, down with the bad.”
• The AD generally moves with the involved LE.
• Guard (Down Step from patient)
• Be very close to patient when guarding

Question 3

Up and Down Steps With Walker

Answer 3

• Depends on support or moving between levels
• For Support (walker must NOT have wheels)
  – Turned walker: rail on one side, walker turned sideways on other
  – Folded walker: rail on one side, folded walker on other
• For Moving between levels
• With railing(s), can keep open and move straight ahead or turned OR fold and hold to side

Question 4

Up and Down Curbs With Walker

Answer 4

When ascending a curb:
* The full walker must be advanced first, followed by stronger LE.
* The patient must lean forward for effective push through UEs before lifting weaker LEs.
* Descending follows typical pattern for descending steps.
* Full walker first, then step down with weaker LE, followed by stronger LE

Question 5

Stairs With Axillary Crutches

Answer 5

“Up with the good, down with the bad.”

Ascending:
- Pushing down through the hands, the patient advances the stronger extremity up the step, then brings the crutches and weaker extremity up to the same step; repeat (Front leg does all of the work)

Descending:
- The patient lowers the crutches to the next step, then moves the weaker extremity to the same step, followed by pushing down through the hands, lifting the stronger extremity, and advancing it to the same step

Question 6

Walker vs Crutches Ascending Steps

Answer 6

Walker: goes up first then leg
Crutches: leg goes first then cutches

Question 7

Stairs With Axillary Crutches and 1 Rail

Answer 7

• Two crutches braced under one arm
• Similar gait pattern to using 1 crutch under each arm
• Encourage movement of hand on rail
• Other crutch placement: T position or with hand and rail

Question 8

Acending/Descending Stairs WB

Answer 8

A: Push through crutches, affected leg, good leg, then crutches
D: Crutches, affected leg, good leg

DC

Question 9

Ascending and Descending Stairs NWB

Answer 9

• A: Push through foot first and crutches
• D: Crutch first, then push through and step to

Question 10

Stairs with forearm crutches

Answer 10

• Can perform as with axillary crutches
• Can also perform reciprocal pattern
• Up and down stairs with locking knee braces and forearm crutches is an advanced mobility skill.
  – Typically ascending backwards, descending facing forward; though each individual is different
  – Use of handrail advised

Try both ways

Question 11

Stairs with Cane

Answer 11

“Up with the good, down with the bad.”

Ascending
* Cane and strong leg up, followed by weak leg

Descending
* Cane and weak leg down, followed by strong leg

• May move cane to other hand to use handrail.
• May need to turn quad cane sideways for secure placement.
• Consider Step-to-step or Step-over-step pattern

Question 12

Walking on Inclines With AD: Ascending vs Descending

Answer 12

When ascending
* Lean forward
* Take slightly longer steps

When descending
* Take slightly shorter steps
* If using a 4ww, may need to do some controlled braking

Follow zigzag path (to slowly go down path), if necessary, to reduce steepness of path.

Question 13

What do you need to consider for documentation of the stairs?

Answer 13

Document seperately for EACH direction

• Type of device utilized
• Side device is held on
• Side railing(s) is/are on
• Number of Steps or Distance of Ramp
• Ability to maintain WB restricitons
• Indicate Step to Step or Step over Step