Gait Training and Physical Therapy Flashcards
General Rules for Choosing a Gait Device
- Single-hand device (CANNOT have WB restriction; Watch for compensations that require a two hand device)
- Consider Transfer, Gait, and stair/ramp needs
- Consider Mobility Distances
Pt’s get one device covered by Medicare; After 5 years can get a new one.
Parallel Bars
- Use bars to build gait skills with maximum support
- Consider progressing when patient is able to walk the length of the bars with good form
Parallel Bar Exercises
- Walking forwards and backwards
- Walking sideways
- Cross steps (front and rear cross)
- Braiding (AKA karaoke) – combines front and rear cross steps in alternating pattern
- Stepping over objects
- Step up/down
- Backwards walking
Full WB
What is the most often prescribed AD?
2 Wheeled Walker
Why would you want to use a platform walker?
- Adds weight and stability
- Supports compensatory use of UE
- Promotes balance and WBing
EVA Walker
- Promotes upright posture
U Step Walker
- Used often in Parkinson’s population
- Ultra-stable base
- Reverse braking system
- Visual laser line cue (red dot line to have them step)
- Audible stepping cue (metranome)
STEVE
Very hard to get in and out of the car.
Forward Gait With Walker
- Most stability
- Keep them inside the box
Progressing From a Walker
Consider progressing to a less restrictive device if the patient:
- “Rocks” a standard walker
- Is able to walk with minimal pressure through the handgrips
Knee Walker
- Less stable than a walker, but more stable than crutches
- Requires less upper body strength and energy expenditure than crutches
- Not accessible to stairs! Not stable on uneven ground. Very awkward to get on and off. Must take into consideration of the bathroom.
Estimating Axillary Crutch Fit
- Adjust overall height before grip height.
- Height markings on crutch are not always accurate
Estimate fit: - Patient’s height minus 16 inches
- 77% of patient’s height
- Technique in picture
Confirming Axillary Crutch Fitting
- Recheck axillary crutch fit in functional stance with crutches positioned 4-6 inches forward and 2 inches to the side.
- Two fingers should fit between axilla and axillary pad.
Do not allow for compensations; Can damage nerves and vessels in axillary region.
Forward Gait With Axillary Crutches
Typical gait progression:
* Crutches
* Involved extremity
* Uninvolved extremity
- Progress from step-to to step-through gait.
- Turn in small steps.
Estimating Forearm Crutch Fit
- Adjust overall height before cuff height / position
Estimate fit:
* Measure the distance from the patient’s heel to the greater trochanter and adjust the crutch so that the handgrip is that distance from the tip
* Recheck forearm crutch fit in functional stance with crutches positioned 4-6 inches forward and 2 inches to the side.
* Hand grip at wrist crease
* Top of forearm cuff 1-1.5 inches distal to olecranon process
Forward Gait With Forearm Crutches
- Erect posture
- Two-point, modified three-point, or four-point gait pattern
- Step-through or swing-through gaits
- Often used with bilateral knee-ankle-foot orthoses (KAFOs) or hip-knee-ankle-foot orthoses (HKAFOs)
- Bilateral KAFOs / HKAFOs typically require swing-to or swing-through gait
- Rely on UE highly to progress in movement for HKAFOs
