Gait Training Lecture 1

Question 1

T/F physical therapist determine weight bearing status

Answer 1

False

Question 2

what is NWB?

Answer 2

non weight bearing: foot does not touch the ground

Question 3

what is TTWB?

Answer 3

toe touch weight bearing: foot contacts the ground for balance only

Question 4

what is PWB?

Answer 4

partial weight bearing: usually 20-50% of body weight

Question 5

what is WBAT?

Answer 5

weight bearing as tolerated: limited only by patient tolerance usually 50-100%

Question 6

what is FWB?

Answer 6

full weight bearing: no restrictions 100% WB

Question 7

in which classifications of weight bearing do the patients need 2 hands on an assisted device?

Answer 7

NWB, TTWB, and PWB

Question 8

How can weight bearing be monitored?

Answer 8

bathroom scales and limb load monitor

Question 9

how are bathroom scales used to monitor weight bearing?

Answer 9

having the patient shift weight from one scale to the other provides feedback about static WB

Question 10

how are limb load monitors used to monitor weight bearing?

Answer 10

audible feedback to patient and clinician regarding WB during gait is provided. sensitivity can be adjusted according to patient’s WB restrictions

Question 11

T/F Physical therapists should never place their fingers under a patient’s foot to assess WB

Answer 11

true- it can be very dangerous and minimally useful data

Question 12

What is a good thing to say to patients as to why you are placing the gait belt on them?

Answer 12

“I’m going to be placing this gait belt around you so that I have something to hold in case you need some help”
Or “I am placing this gait belt on you so I have an extra point of contact incase you need any assistance”

Question 13

How is a gait belt placed on patients?

Answer 13

place around the waist with buckle in front and slightly lateral. Metal tipped end through the TEETH if buckle FIRST, then pull belt snug, then bring tip of belt past the front of belt and slip it through the metal ring. tuck excess length

Question 14

Where does the physical therapist stand while guarding during gait?

Answer 14

slightly behind and to the weaker side

Question 15

Where are the control points for guarding during gait?

Answer 15

pelvic and shoulder girdles

Question 16

what is the physical therapist’s grip on the gait belt?

Answer 16

underhanded SUPINATED grip

Question 17

what should the instructions be to the patient during a sit to stand

Answer 17

scoot forward on seat
position feet as far back as possible while maintaining contact with floor for FWB for partial extend leg out in front
hands pushing down on armrests; no pulling up on assistive device
lean trunk forward (“nose over toes”)
extend trunk and LE into standing

Question 18

How do patients often compensate for weak quads?

Answer 18

relying heavily on UE strength to push up, rocking to gain momentum, bracing lower legs against chair to create leverage, pressing knees together to create leverage

Question 19

how should patients complete a stand to sit?

Answer 19

back up all the way to the chair using the AD
feel chair at the back of the legs
if WB is restricted, extend restricted LE before sitting
reach back for the chair one hand at a time
forward trunk flexion
control descent

Question 20

what should patient instructions and steps be when preparing to teach?

Answer 20

demonstrate the technique first. then encourage mental rehearsal, begin with simple tasks and progress in complexity and challenge. cue patient to internal experience of the process. provide feedback regarding quality of the process. instruct in care and maintenance of AD

Question 21

what are some energy costs of ADs?

Answer 21

gait deviations tend to increase energy expenditure. older adults tend to expend more energy walking long distances than younger adults

Question 22

what are ADs typically used to?

Answer 22

increase support of limb and increase stability by widening base of support

Question 23

How can ADs help with impaired body structure/function?

Answer 23

structural loss, injury or disease that decreases ability to WB on a LE
muscle weakness or paralysis
ROM limitations
inadequate balance
compressive load intolerance

Question 24

list ADs most to least supportive

Answer 24

parallel bars, walker, bilateral axillary crutches, bilateral forearm crutches, hemi walker, quad cane, single point cane

Question 25

list ADs most to least coordination required

Answer 25

bilateral forearm crutches, bilateral axillary crutches, hemi walker, quad cane, single point cane, walker, parallel bars

Question 26

describe parallel bars

Answer 26

very stable; usually used to prepare for ambulation with less restrictive ADs. guarding within bars provides greater protection against falls. use bars to build gait skills with maximum support. turning requires additional guarding.

Question 27

when should therapist consider progressing patients from parallel bars?

Answer 27

when the patient is able to walk the length of the bars with good form

Question 28

describe walkers

Answer 28

provides stability and unloading of one LE. UE platforms can be attached

Question 29

what are some differences between rolling walkers and “pick up” walkers?

Answer 29

“pick up” walkers require more energy to use than rolling walkers. rolling walkers are less stable but allow faster, continuous gait

Question 30

when performing a sit to stand with a walker, what should the patient push off of: the walker or the wheelchair?

Answer 30

pushing off the wheel chair is more secure. Once the patient is standing then they can grab the walker

Question 31

T/F: patients walk outside the walker to get places more efficiently.

Answer 31

False patients should always walk inside the walker

Question 32

What are some signs it maybe time to progress from a walker?

Answer 32

if the patient “rocks” a standard walker or is able to walk with minimal pressure through the handgrips

Question 33

describe axillary crutches

Answer 33

allow greater mobility, provide less stability. Allow unloading of one LE

Question 34

how should PT’s fit an AD?

Answer 34

have the patient in good posture and wearing typical footwear.
guard appropriately during fitting
device handle is typically at the level of the greater trochanter or ulnar styloid process
estimate with patient seated and always confirm fit in functional walking position

Question 35

how should pt’s elbow position be while holding ADs?

Answer 35

with pt’s arm at their side, match handle of AD to level of ulnar styloid process. confirm 20-30º elbow flexion when holding the hand grip

Question 36

What are two great ways to estimate axillary crutch fit?

Answer 36

adjust the overall height before the grip height.
There are height markings on the crutch you can use as a guide. there also is the asymmetric tonic neck reflex pose (patient arm out from their elbow all the way to the tip of their middle finger)

Question 37

how should the PT confirm the crutch fit?

Answer 37

recheck with crutches in the functional state, two fingers should fit between axilla and axillary pad

Question 38

how should pt’s complete a sit to stand with axillary crutches?

Answer 38

both crutches to uninvolved side (up with good)
push down on armrest and crutch grips
stand and balance
transfer a crutch under each arm

Question 39

what is the typical gait progression with crutches?

Answer 39

crutches, involved extremity, uninvolved extremity

Question 40

what are some steps for progressing with gait training with crutches?

Answer 40

begin with gait on level, clear surfaces and progress to more challenging contexts. encourage relaxed, upright posture and forward gaze. begin turns with multiple smaller steps. turning toward the stronger side is generally easier; progress to more difficult turns

Question 41

describe forearm crutches

Answer 41

provide less stability, more mobility than axillary crutches. two-point, three-point, or four-point gait. often used with bilateral knee-ankle-foot orthoses. bilateral KAFOs typically require swing to swing through gait

Question 42

when is it time to consider progressing to a different AD?

Answer 42

if WB restrictions are decreased to WBAT or FWB or if functional balance improves

Question 43

describe knee walkers

Answer 43

more stable than crutches. require less upper body strength and energy expenditure than crutches. not suitable for limited WB at or above knee or on stairs

Question 44

describe hemi walkers

Answer 44

one sided support with more stability than a cane. FWB or WBAT. consider progressing when patient’s stability increases or when gait speed causes patient to “rock” the hemi walker

Question 45

describe canes

Answer 45

can be used singly (opposite of involved LE) progress from wide-based and small-based quad canes to single-point cane

Question 46

how should a patient perform a sit to stand with a single point cane?

Answer 46

move into ready position
lay cane to the side still holding the handle in the same hand with the armrest
push to standing and place cane upright

Question 47

how should a patient perform a sit to stand with a stand alone cane?

Answer 47

place cane next to to chair
push to standing on both armrests
grasp cane

Question 48

What should you say to a patient if they are WBAT and say ouch this is still hurting?

Answer 48

“Try using your upper body more and pushing through the assistive device to take some of the pressure off your weakened extremity”

Question 49

What percent of body weight can one assistive device (like a crutch or cane) aid with?

Answer 49

10-20%