Gait & Stair Training Flashcards
Define gait cycle
- the period that begins with the initial contact of an extremity & lasts until that extremity strikes the ground again
- contains a stance & swing phase for each extremity
Define step length
- the forward linear distance between the occurrence of one point in the gait cycle of one foot & the recurrence of that point by the same extremity
- example:
Define stride length
- the linear distance between the occurrence of one point in the gait cycle of one foot & the recurrence of that point by the same extremity
- example: one heel strike of the left foot to the next heel strike of the left foot
Define stance time
- the period that an extremity is in contact with the ground in stance phase
Define single limb support time
- the period when only one extremity is in contact with the ground
Define double limb support time
- the period when both feet are in contact with the ground in a supportive manner
Define swing time
- the period that an extremity is off the ground during the swing phase of that extremity
Define cadence
- the number of steps taken in a given unit of time usually measured in steps per second or steps per minute
Define speed
- the rate at which an individual’s locomotion covers a specified distance
- everyone has a natural, comfortable walking speed that tends to be efficient for that person
What swing & stance phases are coupled together
- Heel strike coupled with pre-swing
- Loading response coupled with toe-off
- Mid-stance coupled with mid-swing
- Terminal stance coupled with terminal swing
What body structure/function changes effect locomotion
- musculoskeletal changes
- neuromuscular changes
- cardiopulmonary changes
- integumentary changes
How does an assistive device help with pain
- decreased weight bearing on the painful side
- distribution of force over a larger surface area
- improved joint stability
How does an assistive device help with weakness
- increased base of support
- redirection or manipulation of the line of action of forces, especially external forces
How does an assistive device help with limited PROM
- redirection of line of forces
- stabilization of uninvolved joints
How does an assistive device help with decreased endurance
- improved efficiency of movement
How does an assistive device help with impaired balance
- increased base of support
How does an assistive device help with impaired motor control
- increased base of support
- increased weight bearing
How does an assistive device help with fear of falling
- increased base of support
What are the goals of assistive devices
- maximize level of functional independence
- enhance body functions
- assist with fracture healing
- provide security & safety
- enhance function with the least expenditure of energy
Define NWB (non-weight bearing)
- foot does not touch ground
Define TTWB (toe-touch or touch down weight bearing)
- foot contacts ground for balance only or up to 20% of body weight
Define PWB (partial weight bearing)
- usually 20% to 50% of body weight
Define WBAT (weight bearing as tolerated)
- limited only by patient tolerance (> 50%)
Define FWB (full weight bearing)
- no restriction (100%)
Ways to monitor weight bearing status
- bathroom scale
- limb load monitors
- clinician foot/hand (not recommended as it puts the pt & therapist at risk)
List the assistive devices from most stable to most mobile
- parallel bars
- walker
- bilateral axillary crutches
- bilateral forearm crutches
- bilateral canes
- hemi walker
- quad cane
- single point cane
- no device
Fitting the patient with an assistive device
- goal is to have a 20-30 degree bend in the elbow
- device should be on the floor (back legs of walker even with pt’s mid foot; crutches 2 inches lateral & 4-6 inches anterior to the toes & 3 fingers below the axilla)
Advantages of parallel bars
- maximal stability, support, & safety to build skills
- great place to initiate gait training, balance training, & to evaluate fit of other AD’s
- allows for multiple staff to assist
- guarding within bars provides greater protection against falls
Disadvantages of parallel bars
- severely limits mobility
- bars must be wide enough for patient to ambulate through
- not practical
Advantages of walkers
- used when maximal stability, support, & mobility are required
- rolling walker = faster continuous gait pattern when compared to a standard walker
Disadvantages of walkers
- facilitates flexion of the trunk
- patient may try to pull & alter sit to stand
- patient loses arm swing
Advantages of trough/platform attachments
- used for patients who are unable to bear weight through their wrists & hands or have severe deformities of the UE
- may help those with UE amputation or are unable to extend elbow
- provides additional stability
Disadvantages of trough/platform attachments
- unable to use triceps
- may require additional assist
- not as effective on stairs
- difficulty to manage in home environment or around obstacles
Advantages of canes
- used to compensate for impaired balance or to improve stability/confidence
- more functional on stairs & in narrow confined areas/community areas
- easily transported
Disadvantages of canes
- very limited base of support
- not ideal for a 3 point gait pattern or anyone with a weight bearing limitation due to lack of stability
Guarding during gait
- typically behind & slightly tot he weaker side
- control points at the pelvic area & shoulder girdle
- one hand is typically grasping the gait belt & the other hand hovers at the contralateral shoulder
- anticipate the patient’s actions & responses to the environment & prevent or control any major losses of balance
Describe four point gait pattern
- requires use of bilateral ambulation aids
- very slow & stable pattern
- low energy demand
- sequence = AD, opposite LE, AD, opposite LE
Describe 3 point gait pattern
- requires bilateral ambulation aides or a walker, but cannot be performed with bilateral canes
- stable gait pattern, requires less strength & stability, but slow
- sequence for NWB & PWB = AD(s), PWB extremity, WBAT or FWB extremity
Describe two point gait pattern
- used with two or one assistive device
- stable gait pattern & faster than four point gait
- low energy, similar to normal gait
- requires more coordination
- sequence = AD & one LE, other LE & device follow
Describe step to or swing to gait pattern
- the trail LE will only advance as far as the lead LE
- more stable
- good for cognitive stage of learning
- slower speed, more taxing
Describe step through or swing through gait pattern
- the trail LE will advance past the lead LE
- simulates more typical gait pattern
- increased speed & improved energy conservation
- progression of gait
- decreased stability, requires increased control/balance
Describe stairs with crutches
- guard posterior to the patient as they ascend/climb the steps
- guard anterior to the patient as they descend
- crutches go first in descending the stairs and go last in climbing the stairs
Describe stairs for different assistive devices
Quad cane: not advised to have cane and both feet on the same step
Single point cane: stays back with affected leg
Walker: can place on flat platform and walk into walker, go up the stairs backwards, fold walker and place opposite of railing, or turn the walker and place opposite of the railing
Describe stairs with a cane
Sequence to ascend: intact LE, involved & cane at same time follow
Sequence to descend: cane first, involved LE follows, then intact LE
ow many stairs is considered a full flight of stairs
- 12 to 13 steps
Describe curbs with a rolling walker
- have patient place rolling walker on curb first if curb is < 4 inches
- have patient turn around & use a retro technique if curb is > 6 inches
How to go through a door that opens toward you
- stand close to the door, turned slightly toward the hinges
- pull door open, then push it fully open with same hand
- block door with crutch tip if needed
- walk through doorway
How to go through a door that opens away from you
- stand close to the door, facing door handle
- push door wide open
- block with crutch tip if needed
- walk through
Prevention of falling with crutches by addressing
- person: balance, strength, appropriate device
- task: effective gait training
- environment: good lighting, removing obstacles
How to decrease risk of injury in a fall with crutches
- dropping crutches out to the side
- slightly flexing elbows of extended arms
- turning head to the side
How to get up after a fall with crutches
- gather crutches
- move into kneeling with both crutches on one side
- move into half-kneeling on stronger LE
- move into full standing & place a crutch on each side
