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Physiotherapy 2 > Gait and Mobility Aids > Flashcards

Gait and Mobility Aids Flashcards

1
Q

List some reasons why patients use walking aids. 5

WBMCE

A
  1. Weight bearing
  2. Balance
  3. Motor pattern
  4. Confidence
  5. Endurance
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2
Q

What are the factors influencing selection of mobility aids? 5

ASBCP

A
  1. Age – elderly need more stability
  2. Strength – of upper limbs, more needed for crutches
  3. Balance – more for crutches than frame
  4. Complications – upper limb fractures
  5. Patient’s needs – stairs, space
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3
Q

What does BOS refer to? 1

A

BOS refers to the area beneath an object or person that includes every point of contact that the object or person makes with the supporting surface e.g. feet or hands or crutches.

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4
Q

What is COG? 1

A

COG is a point at which the entire weight of a body may be considered a concentrated so that if supported at this point the body would remain in equilibrium in any position.

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5
Q

Describe BOS and COG in the context of erect standing.

A

In erect standing the BOS is small with high COG, requiring greater support.

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6
Q

How are standing activities most often initiated? 1

A

Standing activities are most often initiated in the parallel bars

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7
Q

Describe the base of support of a walking frame versus a walking stick. 1

A

Walking frame will have a wide base of support compared to a walking stick

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8
Q

Explain perambulation. 10

A
  1. Before a walking activity, patient may require a perambulation rehabilitation programme.
  2. Before you can walk, you need a good balance in standing
  3. Before you can stand, you need to be independent and have good balance in sitting
  4. Before you sit, you need to be independent in bed activities.
  5. Patients need to overcome the orthostatic (postural) hypotension before they can walk.
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9
Q

Explain the use of parallel bars. 10

A
  1. Upright position can be initiated as soon as adequate motor control is achieved.
  2. Pre-standing exercises needs to be done
  3. Adjust parallel bars to allow 20-30 degrees of elbow flexion and come to about the level of greater trochanter.
  4. Wheelchair or chair should be positioned at the end of the parallel bars.
  5. Wheelchair breaks should be locked, footrests placed in an upright position and patient’s feet should be flat on the floor.
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10
Q

List the sequence of activities in terms of parallel bar activitiy: 4

A
  1. Initial instructions/demonstration
  2. Assuming the standing position
  3. Initial parallel bar activities:
  4. Advanced parallel bar activities
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11
Q

List the initial parallel bar activities. 8

A
  1. .Standing balance
  2. Limits of stability
  3. .Hip hiking
  4. .Standing push-ups
  5. Stepping forward and backward
  6. Forward progression
  7. Turning
  8. .Returning to the seated position
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12
Q

What are the limits to stabilty?` 4

A
  1. -lateral weight shift
  2. -anterior-posterior weight shift
  3. -anterior-posterior band placement and weight shift
  4. -single-band support
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13
Q

Describe how to walk a patient with a walking aid. 8

G P S C E W P O

A
  1. General interaction with patient
  2. Prepare the area- put chair halfway and check safety of walking aid
  3. Screen for safety aspects/contraindications
  4. Check for balance in sitting and standing
  5. Explanation and demonstration of technique to patient (including sit to stand and turning)
  6. Walk the patient
  7. PT stand posterior and lateral to the patient’s weaker side
  8. One of the therapist’s hand is placed posteriorly on the patients back and the other anterior to, but not touching the patient’s shoulder on the weaker side.
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14
Q

List some saftey precautions: 8

M S D C B D C W

A
  1. Medically stable
  2. Socks off, proper shoes
  3. Drips, catheters taken care of
  4. Circulatory preparation
  5. Check balance
  6. Check for dizziness
  7. Have a chair ready
  8. Know weight bearing status
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15
Q

What is the function of a cane? 1

A

Function is to widen the BOS and to improve balance.

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16
Q

When using a cane, which hand should one use? 1

A

Patients are instructed to hold the cane in the hand opposite the affected extremity.

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17
Q

What are the advantages of a standard cane? 2

A

-Advantage is that it is inexpensive and fits easily on stairs and other surfaces where space is limited.

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18
Q

What are the disadvantages of the standard cane? 2

A

-Disadvantage is that its not adjustable and must be cut to fit the patient. The point of support is anterior to the hand and not directly beneath it.

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19
Q

What are the advantages of the adjustable aluminium offset cane? 4

A

-Advantage:

  1. is that it allows pressure to be borne over the center of the cane for greater stability.
  2. Its is quickly adjustable,
  3. lightweight
  4. and fits easily on stairs.
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20
Q

What are the disadvantages of the adjustable aluminium offset cane? 1

A

-Disadvantage is that its more costly than standard canes.

21
Q

What are the advantages of the quad cane? 3

A

-Advantage:

  1. provide broad-based support.
  2. Available in several different sizes.
  3. Its easily adjustable.
22
Q

What are the disadvantages of the quad cane? 3

A

-Disadvantage:

  1. pressure exerted by patient may not be centered over the cane and may result into complaints of instability.
  2. Not practical to use on stairs
  3. and warrant slower gait pattern.
23
Q

What are the advantages of the walking cane? 3

A

-Advantage:

  1. provide a broad base of support
  2. and is s more table than quad canes.
  3. They also fold flat for travel or storage.
24
Q

What are the disadvantages of the walking cane? 4

A

Disadvantage:

  1. design and handgrip may not allow pressure to be centered over the cane.
  2. Cannot be used on most stairs,
  3. allow slower gait
  4. and are more costly than quad canes.
25
Q

How does one measure a cane? 3

A
  1. 6in (15.24cm) lateral border of the toes
  2. Top of the cane should come to approximately the level of the greater trochanter
  3. Elbows should be flexed to about 20-30 degrees.
26
Q

Describe gait pattern for use of canes: 4

A
  1. -Hold it on the opposite side of the affected side.
  2. -On level surface, cane and affected limb advance simultaneously.
  3. -Cane should be close to the body
  4. -When bilateral involvement exist, a decision must be made as to which side of the body the cane will be held.
27
Q

When are crutches used? 5

A

•Crutches are used most frequently:

  1. -To improve balance
  2. -Relieve weight bearing fully or partially on a lower extremity.
  3. -Increase BOS
  4. -Improve lateral stability
  5. -Allow the transfer of body weight to the floor while maintaining restricted weight bearing status.
28
Q

What are the advantages of axililary crutches? 2

A

•Axillary crutches

  • Made out of light weight wood or aluminum
  • Advantage:
  1. Improve balance and lateral stability
  2. and provide for functional ambulation with restricted weight bearing.
29
Q

What are the disadvantages of axiliary crutches? 2

A

-Disadvantage:

  1. Awkward in small and crowded areas, therefore safety becomes compromised.
  2. Damages the nervous and vascular structures in the axilla to some patients.
30
Q

What are the advantages of Gutter/Platform crutches (Lofstrand and Canadian crutches) 3

A

-Advantage:

  1. the forearm cuff allows use of hands without the crutches becoming disengaged
  2. . Easily adjusted and
  3. allow functional stair climbing activities.
31
Q

What are the disadvantages of Gutter/Platform crutches (Lofstrand and Canadian crutches) 3

A

Disadvantages:

  1. provide less lateral support.
  2. Difficult to remove
  3. and more costly than wooden axillary crutches.
32
Q

Describe the measuring of an axiliary crutch. 4

A
  1. In standing in parallel bars: 2in (5.08cm) below axilla (width of three fingers), distal end should come to a point of 2in (5.08cm) lateral and 6in (15.24 cm) anterior to the foot.
  2. A general estimate is that you subtract 16 in (40.64cm) from patient’s height.
  3. Shoulder relaxed and hand piece should be adjusted to provide 20 to 30 degree elbow flexion.
  4. -In supine: take measurement from the anterior axillary fold to a surface point 6-8ins (15.24-20.32cm) from the lateral boarder of the heel.
33
Q

Describe the measuring of forearm crutches: in supine 5

A
  1. -Supine:
  2. -Relax shoulders, flex elbow 15-30 degrees, place the tip of the crutch to the end of the shoes
  3. -The ring of the elbow crutch should be placed about 2.5-3 cm distal to the elbow joint
  4. -The handgrip should be at the level of the greater trochanter/ at the level of the patient’s wrist with the elbow straight
  5. -Check posture in standing with tip of the crutch about 15 cm in front an lateral to foot and confirm above measurements in standing
34
Q

Describe the measuring of forearm crutches: in standing 4

A

Standing:

  1. point 2 in (5.08cm) lateral and 6in (15.24cm) anterior to the foot.
  2. Shoulder relaxed and hand piece should be adjusted to provide 20 to 30 degree elbow flexion.
  3. Cuff is adjusted separately.
  4. It is placed on the proximal 3rd of forearm, approximately 1-1.5in below the elbow.
35
Q

Describe the procedure prior to gait: 5

A
  1. -Body weight should be borne on hands
  2. -Maintain wide BOS
  3. -When using axillary crutches, crutches should be held close to the chest wall to provide improved lateral stability
  4. -Patient should hold the head up and maintain good posture alignment during ambulation.
  5. -Turning should be accompanied by stepping in a small circle rather than pivoting.
36
Q

Describe the four-point gait. 4

A

•Four-point gait

    • Indication: Weakness in both legs or poor coordination.
    • Pattern Sequence: Left crutch, right foot, right crutch, left foot. Then repeat.
    • Advantages: Provides excellent stability as there are always three points in contact with the ground
    • Disadvantages: Slow walking speed
37
Q

Describe the three-point gait 4

A

•Three-point gait

    • Indication: Inability to bear weight on one leg (fractures, pain, amputations)
    • Pattern Sequence: First move both crutches and the weaker lower limb forward. Then bear all your weight down through the crutches, and move the stronger or unaffected lower limb forward. Repeat.
    • Advantages: Eliminates all weight bearing on the affected leg.
    • Disadvantages: Good balance is required.
38
Q

Describe the two point gait. 4

A

•Two-point gait

    • Indication: Weakness in both legs or poor coordination.
    • Pattern Sequence: Left crutch and right foot together, then the right crutch and left foot together. Repeat.
    • Advantages: Faster than the four point gait pattern.
  4. -Disadvantages: Can be difficult to learn the pattern.
39
Q

Describe the swing through crutch gait.4

A

Swing-Through Crutch Gait:

    • Indications: Inability to fully bear weight on both legs (fractures, pain, amputations)
    • Pattern Sequence: Advance both crutches forward then, while bearing all weight down through both crutches, swing both legs forward at the same time past the crutches.
    • Advantage: Fastest gait pattern of all six.
  4. -Disadvantage: Energy consumption high and requires good upper extremity strength.
40
Q

Describe the swing-to-crutch gait 4

A

Swing-To Crutch Gait:

    • Indications: Patients with weakness of both lower extremities.
    • Pattern Sequence: Advance both crutches forward then, while bearing all weight down through both crutches, swing both legs forward at the same time to (not past) the crutches.
    • Advantage: Easy to learn.
    • Disadvantage: Requires good upper extremity strength.
41
Q

What are the advantages of walkers? 3

A

•Advantage:

  1. provide 4 points on floor contact with a wide BOS and high level of stability.
  2. Provide a sense of security.
  3. They are lighter and easily adjustable.
42
Q

What are the disadvantages of walkers? 4

A

Disadvantage:

  1. cumbersome,
  2. awkward doorways and into cars.
  3. Eliminate normal arm swing and
  4. cannot be used safely on stairs.
43
Q

How are walkers measured?

A

•Measuring walkers

  1. -Same way as a cane
  2. -They should come to approximately the greater trochanter and allow 20-30 degrees of elbow flexion.
44
Q

With regards to walkers prior to gate: 3

A

Prior to gait:

  1. -Walker should be picked up and placed down on all four legs simultaneously.
  2. -Hold head up and maintain good balance
  3. -Cautious not to step too close to the front crossbar
45
Q

What are the Types of weight bearing with using walker:? 3

A

Types of weight bearing with using walker:

  1. -Full-weight-bearing
  2. -Partial weight-bearing
  3. -Non-weight-bearing
46
Q

With regards to stair climbing with a walker, describe ascending: 4

A

Ascending:

  1. -PT is posterior and lateral on the affected side behind the patients
  2. -A wide BOS is maintained with each foot on a different stair
  3. -A step should be taken only when patient is not moving.
  4. -One hand is placed posteriorly on the guarding belt and one is anterior to, but not touching, the shoulder on the weaker side.
47
Q

With regards to stair climbing with a walker describe descending: 4

A

Descending:

  1. -PT is anterior and lateral on the affected side in front of the patients
  2. -A wide BOS is maintained with each foot on a different stair
  3. -A step should be taken only when patient is not moving
  4. -One hand is placed anteriorly on the guarding belt and one is anterior to, but not touching, the shoulder on the weaker side.
48
Q
A

Physiotherapy 2 (13 decks)

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