Gait Training Lecture 1 Flashcards
T/F physical therapist determine weight bearing status
False
what is NWB?
non weight bearing: foot does not touch the ground
what is TTWB?
toe touch weight bearing: foot contacts the ground for balance only
what is PWB?
partial weight bearing: usually 20-50% of body weight
what is WBAT?
weight bearing as tolerated: limited only by patient tolerance usually 50-100%
what is FWB?
full weight bearing: no restrictions 100% WB
in which classifications of weight bearing do the patients need 2 hands on an assisted device?
NWB, TTWB, and PWB
How can weight bearing be monitored?
bathroom scales and limb load monitor
how are bathroom scales used to monitor weight bearing?
having the patient shift weight from one scale to the other provides feedback about static WB
how are limb load monitors used to monitor weight bearing?
audible feedback to patient and clinician regarding WB during gait is provided. sensitivity can be adjusted according to patient’s WB restrictions
T/F Physical therapists should never place their fingers under a patient’s foot to assess WB
true- it can be very dangerous and minimally useful data
What is a good thing to say to patients as to why you are placing the gait belt on them?
“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”
How is a gait belt placed on patients?
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
Where does the physical therapist stand while guarding during gait?
slightly behind and to the weaker side
Where are the control points for guarding during gait?
pelvic and shoulder girdles
what is the physical therapist’s grip on the gait belt?
underhanded SUPINATED grip
what should the instructions be to the patient during a sit to stand
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
How do patients often compensate for weak quads?
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
how should patients complete a stand to sit?
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
what should patient instructions and steps be when preparing to teach?
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
what are some energy costs of ADs?
gait deviations tend to increase energy expenditure. older adults tend to expend more energy walking long distances than younger adults
what are ADs typically used to?
increase support of limb and increase stability by widening base of support
How can ADs help with impaired body structure/function?
structural loss, injury or disease that decreases ability to WB on a LE
muscle weakness or paralysis
ROM limitations
inadequate balance
compressive load intolerance
list ADs most to least supportive
parallel bars, walker, bilateral axillary crutches, bilateral forearm crutches, hemi walker, quad cane, single point cane
list ADs most to least coordination required
bilateral forearm crutches, bilateral axillary crutches, hemi walker, quad cane, single point cane, walker, parallel bars
describe parallel bars
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.
when should therapist consider progressing patients from parallel bars?
when the patient is able to walk the length of the bars with good form
describe walkers
provides stability and unloading of one LE. UE platforms can be attached
what are some differences between rolling walkers and “pick up” walkers?
“pick up” walkers require more energy to use than rolling walkers. rolling walkers are less stable but allow faster, continuous gait
when performing a sit to stand with a walker, what should the patient push off of: the walker or the wheelchair?
pushing off the wheel chair is more secure. Once the patient is standing then they can grab the walker
T/F: patients walk outside the walker to get places more efficiently.
False patients should always walk inside the walker
What are some signs it maybe time to progress from a walker?
if the patient “rocks” a standard walker or is able to walk with minimal pressure through the handgrips
describe axillary crutches
allow greater mobility, provide less stability. Allow unloading of one LE
how should PT’s fit an AD?
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
how should pt’s elbow position be while holding ADs?
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
What are two great ways to estimate axillary crutch fit?
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)
how should the PT confirm the crutch fit?
recheck with crutches in the functional state, two fingers should fit between axilla and axillary pad
how should pt’s complete a sit to stand with axillary crutches?
both crutches to uninvolved side (up with good)
push down on armrest and crutch grips
stand and balance
transfer a crutch under each arm
what is the typical gait progression with crutches?
crutches, involved extremity, uninvolved extremity
what are some steps for progressing with gait training with crutches?
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
describe forearm crutches
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
when is it time to consider progressing to a different AD?
if WB restrictions are decreased to WBAT or FWB or if functional balance improves
describe knee walkers
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
describe hemi walkers
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
describe canes
can be used singly (opposite of involved LE) progress from wide-based and small-based quad canes to single-point cane
how should a patient perform a sit to stand with a single point cane?
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
how should a patient perform a sit to stand with a stand alone cane?
place cane next to to chair
push to standing on both armrests
grasp cane
What should you say to a patient if they are WBAT and say ouch this is still hurting?
“Try using your upper body more and pushing through the assistive device to take some of the pressure off your weakened extremity”
What percent of body weight can one assistive device (like a crutch or cane) aid with?
10-20%
