gait and mobility Flashcards
gait cycle- 2 phases
stance phase- 60%, swing phase- 40%, initial contact- heel hit ground, loading response- foot hits floor, mid stance- weight is going through, terminal stance- heel starts to come through
what does rehabilitation of gait involves
knowledge of gait cycle, assessment of the gait cycle to identify any deficits. the re-education of a safe walking pattern promoting efficient gait
what can deficits in gait be
muscle weakness/ tightness, high/low tone, ataxia, sensory deficit, apraxia, pain, initiation problems, speed of movement, quality of movement, efficiency of movement cardio fitness, joint stiffness, confidence
how to address each deficit- muscle problems
weakness- strengthening work/electrical stimulation, tightness- stretches/ positioning/ splinting/ soft tissue work, high tone- medication/ soft tissue mobs/ stretches/ splinting/ positioning
low tone- strengthening work/ weight beating/ electrical stimulation
how to address each deficit- sensory problems
sensory deficits- sensory stimulation, ataxia- coordination and core stability
how to address each deficit- other
pain- hot/cold/TENS/ mobs/ soft tissue mobs/ medication, CV fitness- cardiovascular training, joint stiffness- joint mobs, confidence/anxiety- repetition and reassurance
how to address each deficit- movement
initiation problems- cuening, speed of movement- repetition of movement/ progressing speed/ treadmills
quality of movement- repetition of specific movement/ facilitation of movement, efficiency of movement- analysis of movement
types of walking aid
sticks, quadripods, tripods, fischer sticks, elbow crutches, zimmer frame, wheeled zimmer frame, stroller, delta frame, trolley, gutter frame, pulpit frame
why are walking aids a last resort
taking away ability to use arms to balance, to use own body weight and reactions- get lost
rationale for using walking aid
to reduce amount of weight taken through LL in standing and walking- post op, or too greater pain
to re-educate gait, to improve balance and reduce risk of falling, to assist the confidence and level of independence, may be required short and long term
safety considerations
check ferrules, check structures of mobility aid, check the mobilirt and measurements (crutch with ulna styloid), when measuring check the patient has correct footwear, check the patient is standing upright or lying in a straight position for measuring, check the mobility aid is the most appropriate, ensure adequate instruction for use
what are you looking for on structure of mobility aid
wood not going to cause splinter- no fractures,no cracks in handles, check frame is working effectively, make sure adjustable catch is right, check no bent metal, check the breaks, check wheels run smoothly, check weight limit
walking sticks
need to measure before use, used more post stroke and neurological patients (tripods). uses- only when abdosulet necessary- confidence/ balance issues, fisher choice of walking aid, for high level balance, for pain relief, can use 2 if it helps, can use a high stick or pole to prevent to much leaning, always use in the opposite hand the leg affected
measuring for a stick
usually measured in standing with elbows in 15-20° flex, measure ulna styloid to floor, a metal stick may be adjusted or cut wooden stick, if you are giving stick to neurological patient- consider a higher stick to prevent them leaning too much on stick
using a walking stick
sit to stand, FWB/PWB, 2pt gait/ 3pt gait/ 4pt gait, steps and stairs
elbow crutches
closed and open cuff crutches. uses- only when absolutely necessary- confidence/balance issues, second choice of walking aid, for high level balance, for relief of pain, post op- THR, TKR, knee athrosocpiesm foot surgery- start with zummer frame first, can use 1- use on opposite leg
measuring elbow crutches
often measured in standing with elbows slight flexed (15-20*), the ulna styloid to floor, some elbow crutch have adjustments for forearm length- the cuffss should be at least 3 fingers width below the fold of elbow
using elbow crutches
sit to stand, FWB/PWB/NWB, 2pt gait, 3pt gait, 4pt gait, steps and stairs
Outside use, stable, maneuverable, speeed, disadvantages- zimmer frame
no, yes, no, slow, have to lift it
Outside use, stable, maneuverable, speeed, disadvantages- wheeled zimmer frame
no, yes, yes, medium
Outside use, stable, maneuverable, speeed, disadvantages-delta frame
yes, no, yes, fast, have to be able to use brakes and less stable because only 1 wheel at the front
Outside use, stable, maneuverable, speeed, disadvantages- stroller
yes, yes, yes, fast, have to able to use the brakes
measuring for frames
if a patient requires a frame to stand or mobilize this will require 2 people, ensure that the frame is acceptable before the patient stand up and that it is at the approx height- visual estimation, then accurately measured and adjusted on all 4 legs, when standing with hands on frame handles, the patient should have 15-20° elbow flex, for patients with PD measure higher so they are not flexed
gutter frame and pulpit frame uses
early mobilisation after surgery, neurological event (e.g. TBI), usually start with pulpit frame as provide more support, progress to gutter frame these can be provided for home use.
good for people who- cant lift a frame, need to lean on there arms, have poor trunk stability, have poor cardiorespiratory function
provide a walking aid for home- consider the home environment
home visit if possible/ door frame widths/ presence of carpet and rugs, threshold strips/ steps/ worn floor coverings/ access to bathroom, toilet, bedroom/adequate lighting
provide a walking aid for home- duplicate
consider the need for duplicate mobility aids
provide a walking aid for home- advice on
shoes- flat closed/avoid slippers flip-flops, sandals etc., using on wet and slippery surfaces, take extra care in icy conditions/ uneven surfaces/ high winds/ in crowds/ avoid wet leaves on pavements, use of a back pack/bag on walking aid
