Gait Training & Final Review Flashcards
What is the correct name for the “hurt” side?
Affected
What is the definition of ambulation?
Act of walking or being able to walk
What is an example of an ambulation aid?
Piece of equpitment ex: crutch, cane, walker that is used to provide support or stability
This is an endangerment site and can be injured if crutches are not used properly.
Axilla
Bilateral means?
pertaining to TWO sides (both sides)
Name this gait pattern: repetitive, alternative, reciprocal forward movement of an ambulation aid and a person’s opposite LE
four point gait pattern
What is gait?
The manner or style of walking
What is an example of an immobilizer?
object or apparatus that prevents movement ex: cast or bace
This can platform can be added to a walker or crutches and stabilizes a person’s forearm to rest and aid in weight bearing
platform attachment
Name this gait pattern: 1 LE is full weight bearing, & the opposite LE is PWB; bilateral canes, crutches, or a walker is used to partially support the body weight as the person bears weight on the PWB LE; the FWB LE advances independently, & the amubulation aids & PWB LE advance simutaneously
three-one-point gait (PWB)
Name this gait: the repetitive, simultaneous, reciprocal forward movement of an ambulation aid & the persons opposite LE
Two-point gait
Unilateral
pertaining to ONE side
Name this amubulation aid: four contacts are placed on the floor & a farm to supports the pts body weight & provide stability during ambulation
walker
Why might someone need an ambulation aid?
Compensate for impaired balance, decreased strength, alteration in coordinated movements, pain during wb in 1 or both LE, absence of LE , improve functional mobility, enhance body functions & assist with fracture healing
What % does the swing & stance phase make up in the gait cycle?
Stance (60%) Swing (40%)
What is double support?
When both feet are on the ground
How does a person’s walking speed affect double support?
faster they walk less time in double support
The gait cycle is defined as?
The time from initial contact (heel strike) of a given foot to the next initial contact (heel strike) of the same foot
Describe the gait cycle
1) Initial contact (heel strike) 2) loading response 3)mid stance (foot flat) 4) terminal stance (heel off) 5) preswing (toe off)
Name the swing sub-phases
1) initial swing (acceleration) 2) mid swing 3) terminal swing (deceleration)
Sanders et al. explains the way the body functions to reduce energy expenditure over the center of gravity of the body during ambulation. The 6 items are…?
Transverse pelvic rotation, pelvic tilt, knee flexion during midstance, foot & ankle motion, knee motion, lateral pelvic rotation
Name the muscle in which its purpose is to stabilize the limb during heel strike to mid stance?
Gluteus Maximus
Name the muscle in which its purpose is to stabilize the limb during heel strike to toe off?
Gluteus Medius/minimus
Name the muscle in which its purpose is to accelerate the limb during toe off to mid swing?
Hip flexors/ adductor
Name the muscle in which its purpose is to absorb shock, decelerate the limb during heel strike to foot flat & toe off to mid swing?
Quadriceps
Name the muscle in which its purpose is to decelerate the limb during heel strike to foot flat and toe off to heel strike?
Tibialis anterior/peroneals
Name the muscle in which its purpose is to push of the limb during mid stance to heel off?
Gastrocnemius/soleus
Name the muscle in which its purpose is to stabilize the trunk during heel strike to heel strike?
Erector Spinae
Preparation for ambulation activities include?
review pt’s medical h/o, determine appropriate equipment & gait pattern based on medical record assessment of pt and goals of intervention, obtain consent, confirm proper fit & security of device, apply safety belt, be certain the patient is mentally & physically capable, explain & demonstrate gait pattern, maintain proper body mechanics.
Precautions for ambulation activities ?
appropriate foot wear, monitor patients physiological responses (vital signs, alertness), anticipate the unexpected, guard pt by standing behind & slightly to one side, don’t leave the pt unattended, make sure area is safe (no hazards)
Preparation and training for a pt is essential. Name a few conditions in which this is especially true.
persons who have been immobile, condition has affected their balance,coordination, strength, flexibility, or ability to tolerate an erect position, elderly, decreased physical capacity to learn or perform ADLs.
What is the purpose of perambulation procedures?
Provide safe & stable practice sessions; improve the patient’s ability to use assistive ambulation aids safely, determine the type of active aids & functional skill the pt requires, develop confidence in the use of assistive aids
Give examples of why a tilt table maybe needed for a pt?
Assist the patient to accommodate to an erect position. Possible prolonged recumbence (hypo BP), kinesthesia, decreased proprioception, generalized weakness
Why must the caregiver be aware of the pt’s environment outside of pt?
Must be aware of home, workplace, social environments to make sure the optimal assistive device is used, practice gait training based on that environment (steps, ramps etc.) Be able to perform ADLs
What is the purpose of ambulation?
To strengthen muscles, to improve cardiopulmonary function & endurance, assist to alleviate pain,to improve sitting & standing balance, teach & practice ambulation patters & functional skills for ADLs
Ambulation aids are designed to improve a person’s stability by expanding…?
The base of support (BOS)
Name the ambulation aids in order from greatest support to least
parallel bars, walkers, bilateral crutches, single crutches, bilateral canes, quad canes (4pt cane), hemi canes and single canes
What criteria should the caregiver consider when changing the aid device, gait pattern and what device it should be ?
WB status, diagnosis, person’s mental & physical abilities, environment which the pt will ambulate, expected or desired ambulation activities, prognosis for improvement or regression of the pt’s conditions & abilities
What conditions indicate a persons intolerance to a tilt table?
excessive increases or decreases in BP & PR, change in consciousness, excessive perspiration, edema formation in the LE, loss of pedal pulses, complaints of nausea or numbness, change in facial or limb color(flushed or pale), tingling in LE
What psychological effects does a tilt table have?
Increases mental outlook b/c you can do activities like eating, reading or writing that are uncomfortable or redundant while in bed. Allows the pt to strengthen, ROM & passive stretching
When are parallel bars used?
Maximal stability, support & safety needed.
When is a walker used?
Maximal stability, support & mobility required
What are some disadvantages to using a walker?
Difficult to store, transfer, use on stairs, reduces speed of ambulation, use in narrow or crowded areas
Name a few examples of walkers?
standard, reciprocal, stair-climbing, wheeled, folding and one-handed (hemiplegic)
Why might someone choose axillary crutches?
pt who needs less stability or support and allows for a greater amount of gait patterns & ambulation speeds
What are some disadvantages of using axillary crutches?
less stable than a walker, can cause injury to axillary vessels & nerves if used or measured improperly, need good balance, trunk & UE must be strong, elderly pt’s may feel insecure
Name a few examples of axillary crutches
standard (adjustable non adjustable) offset, & triceps
Forearm crutches are AKA?
lofstrand or Canadian crutches
When are forearm crutches used?
when the stability & support of axillary crutches are not required but more stability than a cane is needed.
Name some advantages of Lofstrand crutches.
eliminates the danger of injuring the axilla, more functional on stairs & narrow confined areas, easy to store & transport allows the pt to use their wrist/hand to reach for an object
Name some disadvantages of Canadian crutches.
require functional standing balance & functional upper body & LE strength, cuff makes it difficult to remove the crutch, elderly pts feel insecure, less stable and supportive than axillary crutches a walker or parallel bars.
What are some disadvantages of a platform attachment?
pt loses triceps to elevate & maintain body during swing phase, may need assistance putting them on, less effective on stairs
What are some types of platform attachments?
Can be attached to an axillary, forearm crutch, walker
What are some advantages in using a cane?
more functional on stairs, in narrow confined areas and it can be stored & transported more easily than crutches or a walker
What are some disadvantages to using a cane?
Provides limited support b/c it has a small BOS, 2 canes do not provide sufficient stability & support to perform a 3pt gait pattern
Name the bony landmarks that are used to measure parallel bars correctly for a pt
20-25 elbow flex, 2 inches wider than the pt’s greater trochanters, bar top even with greater trochanter or ulnar styloid process with hands to their sides
How do you fit a cane correctly for a pt?
standing or supine, handgrip @ greater trochanter, wrist crease or ulnar styloid process. Place cane parallel to the femur & tibia w/ the foot (tip) of the cane on the floor by the heel of their foot
What is the proper measurement techniques for a forearm crutch?
top of the crutch should be approx. 1-1.5inch distal to the olecranon process and when the pt grasps the hand piece with the cuff applied the forearm & wrist should be neutral. (height-greater trochanter)
How to correctly measure hand piece height for a forearm crutch?
pt supine= measure from the greater trochanter from the wrist crease to the heel of the shoe. tape measure and adjust hand piece. Also measure anterior axillary fold to the pt’s trochanter or ulnar styloid with the arm along the side, elbow extended
How do you fit a pt for axillary crutches?
position the crutch in the axilla, crutch is 2 inches lateral & 4-6 inches anterior on the floor, crutch should be 2 inches or 2 finger space underneath axilla, elbow flexion 20-25 degrees, wrist straight
How do you properly fit a walker for a pt?
handgrip of the walker level @ pt’s wrist crease, ulnar styloid process or greater trochanter, walker should be resting on the floor even with the pt’s heels/hips, elbow flexion 20-25 degrees, walker is positioned in front of the pt so the rear feet are apprx. opposite to the mid portion of the shoes
Improper fit of ambulation aids will likely cause?
decreased stability, increased energy expenditure, decreased function & decreased safety for the patient
What are some common errors in fitting axillary crutches?
pt hunches their shoulders- crutches are too long when the shoulders are relaxed, pt flexes hips/wrist messes up the measurement of the crutches, pt isn’t wearing shoes when the measurements are made, crutch fit not made in tripod position
What should the patient’s posture be when fitting for ambulation aids in the standing position?
Trunk erect, hips straight, pelvis level, knees slightly flexed, feet flat on the ground
Having a pt use improper fitted crutches can lead to?
Development of bad gait habits or unsafe gait pattern
What are the weight bearing statuses?
NWB-non weight bearing PWB- partial weight bearing WBAT- weight bearing as tolerated FWB- full weight bearing
How do explain to a pt what PWB means and how could initially teach them?
Pt must learn to judge the amount of weight placed on the restricted lower extremity, could use a scale for a predetermined weight, imagine an egg you don’t want to crush underneath your shoe etc.
What type of gait pattern should be used when a “touch down” or toe touch” gait is desired?
heel-strike gait or place foot flat w/ PWB rather than toe-touch gait b/c “toe touch” is an abnormal gait pattern & causes the foot to be in plantar flexion rather than dorsiflexion
Name the major muscles used in non-weight bearing ambulation for the upper trunk
scapular depressors, scapular stabilizers
Name the major muscles used in non-weight bearing ambulation for the lower trunk
trunk extensors, trunk flexors
Name the major muscles used in non-weight bearing ambulation for the upper extremity
shoulder depressors, shoulders extensors & flexors, elbow extensors, finger flexors
Name the major muscles used in weight bearing ambulation for the LE
hip abductors, hip extensors, knee flexors, knee extensors, ankle dorsiflexors, ankle plantar flexors
In NWB what is the appropriate ambulation pattern & walking aid that should be used?
Three-point pattern with a walker- progress to bilateral crutches
In WBAT to FWB what is the appropriate ambulation pattern & walking aid that should be used?
4 pt, 2 pt gait pattern- reciprocal walker, bilateral crutches or bilateral canes
In PWB what is the appropriate ambulation pattern & walking aid that should be used?
3-1 point (modified 1pt) gait pattern- walker, bilateral crutches
In FWB what is the appropriate ambulation pattern & walking aid that should be used?
modified 4 pt or modified 2 gait pattern. 1 crutch or 1 cane
In WBAT what is the appropriate ambulation pattern & walking aid that should be used?
4pt, 2pt & modified 3pt (3- 1pt), axillary crutches to bilateral canes
In WBAT what is the appropriate ambulation pattern & walking aid that should be used?
modified 4 pt & modified 2 pt, 1 crutch or 1 cane
Gait patterns may change either progress or degress based on?
the patient’s abilities
What walking aids might one must use if the pt is FWB in order from
walker to axillary crutches to forearm crutches to bilateral crutches to single cane to independent of walking aids
What gait is described: requires the use of bilateral assistive devices, used in an alternate & reciprocal forward movement of the ambulation aid & the pt’s opposite LE. Very slow & stable, requires low energy expenditure & requires max stability or balance. Approximates a normal gait pattern.
Four-point gait pattern
What gait is described: requires the use of bilateral ambulation aids, simultaneous reciprocal forward placement of the assistive device & pt’s opposite lower extremity. Requires low energy expenditure & similar to normal gait pattern, requires pt coordination UE & opposite LE forward at the same time.
Two-point gait pattern
What gait is described: only require 1 assistive device & can be used for pt’s who have only 1 functional UE or who have a LE medical condition(less stress is required). Also referred as a hemi-gait pattern
Modified four point or two point
What gait is described: bilateral assistive device or a walker but can’t be used with bilateral canes (can’t support weight). “step to “ or “step-through” pt able to bear weight on 1 LE but is NWB on the opposite LE. Step up to the front of the rail of the crutches or walker. Less stable but rapid ambulation, need good UE strength, trunk & 1 LE . Energy expenditure high. Teach pt to step through not “swing through”
Three point- non weight bearing pattern
What type of patients are commonly associated with the three point -non weight bearing pattern that requires the pt to use the UE to support & provide force to lift & move body forward?
Spinal cord injury, developmental disability, Unilateral amputation
What gait pattern is described: requires use of assisitive devices that can support significant amount of body weight or a walker. Bear FW on 1 LE & PWB on other LE. Walker or crutches advance simultaneously with PWB then FWB LE advances. More stable then 3pt pattern & requires less strength & energy but is slower
Modified 3 point pattern
True or False: You should never use a pt’s clothing, UE or personal belt for control when gait training?
True. ALWAYS PUT A GAIT BELT ON!
How should the PT stand when guarding a pt?
Initial stand to the side of the pt’s affected or weakest side. Stand behind & slightly to the side of the pt.
How should you place your feet when guarding a pt?
anteroposterior stance w/ most forward LE btw the pt’s LE & ambulation device. Step with the pt, allow 1 foot to trail the other
What must the PT be prepared todo (alert) to in case of a forward/backward/side loss of balance?
control shoulder & upper trunk quickly, move forearm across pt chest to maintain optimal control of movement. May need to assist pt to a secure position (on the floor, ground, furniture or stair step)
How should the PT train the pt to ascend stairs?
Lead with the unaffected LE, stopping at each step to gain balance b4 progressing forward, use railing if available, no railing use 2 ppl to help guard pt
How should the PT train the pt to descend stairs?
Lead with the affected LE, PT may need to widen their stride (spanning 2 steps-wide anteropostieror stance)
What are some general guarding techniques for stairs, curbs & ramps?
Maintain wide stance w/ feet, use 2 steps, 1 hand 2 grasp the gait belt, anticipate the actions to be performed in case balance is lost
What might you want to consider when analyzing your pt for gait training?
pt size, statue, weight, strength, psyhological state (cognitive ability)
When guarding the pt from the back while acceding a curb stair or ramp, what techniques should the therapist use?
Position yourself behind & slightly to the side of the pt in the area were there is the least protection (opposite side of the railing), no hand rail position yourself on the affective side, grasp gait belt w/ 1 hand use the other to hold the railing or have it available to control the pt’s trunk. Anteroposterior stance (1 foot on the step the pt is on the other on the step behind them) Move w/ the patient 1 step at a time
What should the pt do with the affected NWB LE when descending a curb?
Place the effected LE in front so it does not drag or make contact with the curb or ground. Have the hip & knee flexed keeping the LE elevated in front clearing the pt’s heel.
How should a pt ascent stairs or a curb with a full-length cast or knee immobilizer on?
pt should extend & externally rotate the hip so the toes are clear of the stair lip or riser. Effected extremity will trail the body as the pt steps up.
How should a pt descend stairs or a curb with a full-length cast or knee immobilizer on?
partially flexes the hip so the heel clears the stair tread or curb, immobilized LE remains in from tot the pt & leads the body when they step down.
Describe techniques on how the pt should control doors with an assistive device?
approach the door with back facing the hinges, ( pt remains close to the door knob)push open door with one hand, shifts body to opposite crutch & LE, pt returns hand to crutch, crutch nearest to the door is used to stop the dr from closing. Make sure the door has fully stopped moving before. Guide the crutch against the door as you maneuver out. (you can move sideways if needed)
Which LE do you use when ascending stairs, What LE do you use when defending stairs?
Ascending- non-effected LE
Descending- effected LE
Ability to function or perform without assistance from another person
Independent
The ability to move from one place to another
Locomotion
Pertaining to the foot or feet
Pedal
The act of propelling; movement of a wheelchair by the person in the chair or by another person
Propulsion
List the factors associated with the selection of a wheelchair type and components
1) Patient’s impairments, activity limitations, and participation restrictions, 2) Patient’s age, size, stature, and weight, 3) User’s functional skills or preference, 4) Portability / accessibility, 5) reliability / durability, 6) Expected use or patient needs of the wheelchair (indoors v. outdoors, recreation, transfer needs, etc.), 7) Temp. vs. Permanent use, 8) potential for change in pt’s condition, 9) Mental / physical condition of pt, 10) cosmetic features, 11) Options available, 12) Service, and 13) Cost
Name the basic components of a wheelchair
armrest, footplate, wheel, hand rim, wheel lock, seat, seat back
Name the various types of wheelchairs
Standard adult; Heavy-duty adult; ultralight wheelchair; Intermediate or junior; growing; child or youth; indoor; hemiplegic; amputee; one-hand drive; externally powered; sports; and reclining
Name the measurements involved for proper fit of a standard wheelchair
Seat height / leg length = measure from user’s heel to popliteal fold, add two inches for clearance of footrest
Seat depth = measure from user’s posterior buttock, along the lateral thigh, to popliteal fold then subtract two inches to avoid pressure on the popliteal space
Seat width = measure the widest aspect of the user’s buttocks, hips, or thighs and add approximately 1.5 inches for clearance of clothing, orthoses, & trochanters
Back height = measure from seat of chair to the floor of the axilla with the user’s shoulder flexed to 90 degrees, and then subtract approximately 4 inches
Armrest height = measure from the seat of the chair to the olecranon process with the user’s elbow flexed to 90 degrees, and then add approximately 1 inch
The characteristics of a confirmation of a proper fit of a wheelchair are:
allows two to three fingers to be placed under the thigh from the front edge of seat; the footrest must be at least two inches from the floor; hands can fit between the patient’s hips and the armrests (sides of seat); back height below the inferior angle of the scapula; user able to sit with trunk erect, the back against the upholstery, and the shoulders level when bearing weight on forearms on the armrests
Name the parameters that should be measured in confirming a wheelchair fit?
Seat height, leg length, seat depth, seat width, back height, and armrest height
Various components of wheelchairs are:
Armrests: fixed, removable/reversible, desk/cutout, & adjustable
Wheels & Tires: caster, drive/rear wheels, & one-arm drive
Wheel Locks: toggle, “z” or scissors lock, auxiliary lock for reclining chair, & caster lock
Leg Rests: fixed footrests, swing-away/removable leg rests, elevating leg rest, footrest/footplate
Name the two types of body restraints associated with wheelchairs
Lap belt or chest belt
Type of wheelchair that allows the back of the chair to be adjusted to various positions from fully upright to 30 degrees of extension; usually the chair back is higher than that of a standard chair; a removable head component is necessary to support the user’s head; has elevating leg rests is called
a semireclining wheelchair
Type of wheelchair that allows the back to be adjusted to various positions from vertical to horizontal is called
a full reclining wheelchair
Type of wheelchair that can be adjusted to position the user at various angles and can be wheeled with the user positioned at any angle is called
a tilt-in-space wheelchair
Type of wheelchair that is powered by one or more deep-cycled batteries that provide stored electrical energy to one or more belts that drive or propel the chair is called
an externally powered wheelchair
Wheelchairs that have specific features such as low backrests, solid, lightweight frames, canted (angled) rear wheels, low narrow seats, and an overall low profile to make the chair more functional for the user are called
Sport or recreational wheelchair
Each wheelchair user should be taught to perform the following maneuvers:
1) operate the wheel locks & tighten them when necessary, 2) remove /replace the armrests, 3) swing away, remove, and replace the front rigging, and 4) elevate / lower the footplates before performing other activities
What device can be added to wheelchairs in order to prevent the chair from tipping backward
Anti-tipping extensions
When folding a wheelchair, the following must be done:
1) raise footrests after moving heel loops forward
2) pull up on the seat rails or on hand loops attached to the seat rails, or, grasp the midline of the front & back of the seat upholstery & lift upward
3) release back support bar (if reclining chair)
Ascending a curb with a wheelchair while facing forward, the PT / PTA should:
1) Position the chair facing the curb
2) stand on the street surface
3) tip the wheelchair back using the push handles & tipping lever
4) wheel the chair forward until the rear wheels contact the curb; lower the caster wheels to the sidewalk surface
5) lift up using the push handles & wheel the chair forward over the curb
Ascending a curb with a wheelchair while facing backward, the PT / PTA should:
1) Position the chair so the rear wheels contact the curb
2) stand on the sidewalk surface
3) tip the wheelchair back using the push handles; maintain this position
4) pull the chair over the curb on its rear wheels
5) back up or turn the chair to one side until the caster wheels are above the sidewalk surface
5) lower the caster wheels using the push handles & tipping lever
Descending a curb with a wheelchair while facing backward, the PT / PTA should:
1) position the chair with the rear wheels at the edge of the curb; caster wheels should remain in contact with the sidewalk surface
2) stand on the street surface
3) allow the rear wheels to roll over the edge of the curb until they contact the street; control the movement with one hip against the back of chair
4) elevate the caster wheels until they cleared the curb; back up or turn the chair to one side
5) lower the caster wheels onto the street surface using the push handles & tipping lever
Descending a curb with a wheelchair while facing forward, the PT / PTA should:
1) position the chair with the caster wheels at the edge of the curb; the pt should be should be seated back in the chair
2) stand on the sidewalk surface
3) tip the chair onto its rear wheels using the push handles & tipping lever
4) wheel the chair forward & allow it to roll over the edge of the curb as you pull back on the push handles
5) after the rear wheels are on the street, gently lower the caster wheels using the push handles & tipping lever
While ascending a slope with a wheelchair, the PT / PTA should:
On two wheels:
1) elevate the caster wheels & push the chair forward, or backward, with only the drive wheels in contact with the ground
2) propel the chair forward or backward on the rear wheels
on four wheels: push the chair forward with all 4 wheels in contact with the ground
While descending a slope with a wheelchair, the PT / PTA should:
On two wheels:
1) elevate the caster wheels & retard the motion of the chair by holding the push handles as the chair descends forward
on four wheels:
1) allow the chair to descend backward with all 4 wheels in contact with the ground
2) as the chair descends, retard the motion of the chair with the side of your body against the back of the chair & your feet in a widened base of support
