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
Moving Through Doorways With Crutches - Door Open Towards 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 / device if needed.
- Walk through doorway.
Moving Through Doorways With Crutches - Door Opens Away
- Stand close to the door, facing door handle.
- Push door wide open.
- Block with crutch tip / device if needed.
- Walk through.
How do you know you are able to progress from bilateral to single hand device?
- Weight-bearing (WB) restrictions are decreased to weight-bearing as tolerated (WBAT) or full weight-bearing (FWB)
- Functional balance improves
If someone with a hemiwalker starts rocking it, what should you consider?
They have likely progressed out of it! They rock because they are too fast!
Canes are typically held in the hand on the ____ as the involved LE
opposite
Forward Gait with Single Hand Device
- Typically, the patient holds the gait device in the handcontralateral to the involved (weak or painful limb)
- Modified 2-point advance involved limb with deviceand step-to or through with uninvolved limb
- Modified 4-point advance device, then involvedlimb, then uninvolved limb
Other Ambulation Challenges
- Obstacles (objects in path, pets near feet, etc.)
- Carrying objects (occupies hand, increasing load, shifting CoM)
- Walking on yielding or unstable surfaces
- Walking over slick or wet surfaces
- Inadequate lighting
- Interrupted gait rhythm (being bumped in a crowd)
- Give small pertibations (helps to prepare them to stop fast)
Tolerance
Good
Poor
Fair
Why?
- Drop in O2 stat, felt SOB, etc
