gait and mobility

Question 1

gait cycle- 2 phases

Answer 1

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

Question 2

what does rehabilitation of gait involves

Answer 2

knowledge of gait cycle, assessment of the gait cycle to identify any deficits. the re-education of a safe walking pattern promoting efficient gait

Question 3

what can deficits in gait be

Answer 3

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

Question 4

how to address each deficit- muscle problems

Answer 4

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

Question 5

how to address each deficit- sensory problems

Answer 5

sensory deficits- sensory stimulation, ataxia- coordination and core stability

Question 6

how to address each deficit- other

Answer 6

pain- hot/cold/TENS/ mobs/ soft tissue mobs/ medication, CV fitness- cardiovascular training, joint stiffness- joint mobs, confidence/anxiety- repetition and reassurance

Question 7

how to address each deficit- movement

Answer 7

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

Question 8

types of walking aid

Answer 8

sticks, quadripods, tripods, fischer sticks, elbow crutches, zimmer frame, wheeled zimmer frame, stroller, delta frame, trolley, gutter frame, pulpit frame

Question 9

why are walking aids a last resort

Answer 9

taking away ability to use arms to balance, to use own body weight and reactions- get lost

Question 10

rationale for using walking aid

Answer 10

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

Question 11

safety considerations

Answer 11

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

Question 12

what are you looking for on structure of mobility aid

Answer 12

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

Question 13

walking sticks

Answer 13

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

Question 14

measuring for a stick

Answer 14

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

Question 15

using a walking stick

Answer 15

sit to stand, FWB/PWB, 2pt gait/ 3pt gait/ 4pt gait, steps and stairs

Question 16

elbow crutches

Answer 16

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

Question 17

measuring elbow crutches

Answer 17

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

Question 18

using elbow crutches

Answer 18

sit to stand, FWB/PWB/NWB, 2pt gait, 3pt gait, 4pt gait, steps and stairs

Question 19

Outside use, stable, maneuverable, speeed, disadvantages- zimmer frame

Answer 19

no, yes, no, slow, have to lift it

Question 20

Outside use, stable, maneuverable, speeed, disadvantages- wheeled zimmer frame

Answer 20

no, yes, yes, medium

Question 21

Outside use, stable, maneuverable, speeed, disadvantages-delta frame

Answer 21

yes, no, yes, fast, have to be able to use brakes and less stable because only 1 wheel at the front

Question 22

Outside use, stable, maneuverable, speeed, disadvantages- stroller

Answer 22

yes, yes, yes, fast, have to able to use the brakes

Question 23

measuring for frames

Answer 23

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

Question 24

gutter frame and pulpit frame uses

Answer 24

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

Question 25

provide a walking aid for home- consider the home environment

Answer 25

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

Question 26

provide a walking aid for home- duplicate

Answer 26

consider the need for duplicate mobility aids

Question 27

provide a walking aid for home- advice on

Answer 27

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