GRFC - functional training Flashcards by Ralph Kevin Genoguin

Ambulation aids from most coordination needed to least coordination needed

Non-axillary crutches
Axillary crutches
Cane
Walker
Parallel bars

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Parallel bars measurement

Height: level of greater trochanter, 20 degrees to 30 degrees of elbow flexion

Width: +1 inch from each greater trochanter (+2 total)

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Ambulation aids from least stable to most stable

Cane
Non-axillary crutches
Axillary crutches
Walker
Parallel bars

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Assistive device weight transmission

Cane: 20% to 25% (up to 30%, NPTE)
Non-axillary crutches: 40% to 50%
Axillary crutches: 80% to 90%
Walker: 85%

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Walker dimension measurement

Height: 20 degrees to 30 degrees elbow flexion, height of greater trochanter

Distance: 10” to 12” anteriorly (12” ideally)

Rubber tip height: 2” to 3”

Rubber tip diameter: 1” to 1.5”

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Different types of walker (with indications and features)

Standard (collapsible) walker: For easy storage, for those who travel frequently, for those with PD with stereotypic (festinating) gait

Hemi-walker: For persons with CVA, 1 UE and 1 LE amputation; has centrally located handgrip; contraindicated for those with (R) CVA with (left) unilateral neglect

Stair-climbing walker: Has additional 2 posterior uprights

Reciprocal (reciprocating) walker: For those with RGO using reciprocal gait pattern, for those with SCI and spina bifida (at T12 - L1)

Rollating walker (rollator): with wheels, for those with PD with akinesia

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Anterior rollating walker

For those with stooped posture, PD, CP, osteoporosis, for the elderly; anterior tips replaced with wheels

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Posterior rollating walker

For those with CP and increased flexor tone; posterior rubber tips are replaced with wheels

NOTE: For energy efficiency and increased velocity, use posterior rollating walker with 4 wheels

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Types of crutches

Axillary

Non-axillary

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Axillary crutch dimension measurement (standing)

Axillary pad: 2” (2 to 3 finger) below axilla

Handgrip: 20 degrees to 30 degrees elbow flexion, level of greater trochanter

Rubber tips: 6” anterior, 2” lateral from 5th toe

NOTE: Can also be measured using patient’s height -16”

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Axillary crutch dimension measurement (sitting)

(R) shoulder abducted with elbow flexed
(L) shoulder abducted with elbow extended
Axillary pad on tip of olecranon process
Rubber tip on tip of 3rd digit (2nd finger or middle finger)

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Axillary crutch dimension measurement (supine)

Axillary pad over anterior axillary fold

Rubber tip 6” to 8” from lateral heel OR at side of lateral heel +2” without shoes

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Non-axillary crutch dimension measurement

Forearm cuff orientation: Facing medially and anteriorly

Forearm cuff location: Proximal 1/3 of forearm (1” to 1.5” below elbow)

Handgrip: 20 degrees to 30 degrees elbow flexion, level of greater trochanter

Rubber tip: 6” anterior, 2” lateral to 5th toe

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Platform attachment details

For those with arthritic hand, elbow flexion contracture, distal forearm and wrist fracture

NOTE:
Platform crutch - if attached to crutch
Platform walker - if attached to walker

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Triceps (Canadian) crutch details

For those with triceps weakness

Has two cuffs:
Triceps cuff (locks elbow in extension)
Forearm cuff

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Types of gait patterns

Point gait:
Four-point (most difficult to teach/ instruct)
Three-point
Two-point

Swing gait:
Swing-to
Swing-through (most advanced, most difficult to learn)

Drag gait:
Drag-to (for those with severe spasticity)
Drag-through

Simultaneous gait (for those with coordination problems)

NOTE: Always teach 2 gait patterns (1 for stability, 1 for speed)

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Therapist position/ assistance

Level surface: Posterolateral, near weaker/more affected/ affected side

Stair ascent: Posterolateral, near weaker/ more affected/ affected side

Stair descent: Anterolateral, near weaker/ more affected/ affected side

NOTE:
If with handrail, use handrail (place (B) crutches, canes on one side)

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Scapular depressors (crutch walking muscles)

Latissimus dorsi
Lower trapezius
Pectoralis minor

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Shoulder adductors (crutch walking muscles)

Latissimus dorsi

Pectoralis major

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Shoulder flexors, extensors, abductors (crutch walking muscles)

Deltoids

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Elbow extensors (crutch walking muscles)

Triceps brachii

Anconeus

Wrist extensors (crutch walking muscles)

Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris

Finger flexors (crutch walking muscles)

Flexor digitorum superficialis

Flexor digitorum profundus

Thumb flexors (crutch walking muscles)

Flexor pollicis longus

Flexor pollicis brevis

Cane dimension measurement and indication

Handgrip: Beside straight leg, at level of ulnar styloid Rubber tip: 6" lateral to tip of 5th toe

Different types of canes

Standard aluminum adjustable cane Standard aluminum offset cane - point of support is directly beneath hand Quad cane (large-base: more stable, small-base: intended for stair ambulation) - best for antalgic gait

Wheelchair back rest height measurement

From seat to base of axilla -4" From seat to inferior angle of scapula -2" NOTE: For those with high level SCI: high back rest For those wit paraplegia: low back rest

Wheelchair back rest width measurement

Normal: 16" to 18"

Wheelchair seat depth measurement

Normal: 16" From back of seat to popliteal fossa -2" NOTE: If too long: Sacral sitting If too short: Decreased stability, uneven weight bearing on buttocks and thighs

Wheelchair seat width measurement

Normal: 18" Widest portion of buttocks +1" each side (each greater trochanter) (total of +2") NOTE: Too wide: Difficulty with propulsion Too narrow: Pressure on greater trochanter

Wheelchair seat height measurement

Normal: 20" From popliteal fossa to heel +2" NOTE: Too low: Person will reach for foot rest, sacral sitting Too high: Weight bearing on ischial tuberosities only

Wheelchair arm rest height measurement and types

From seat to elbow, with elbow flexed 90 degrees According to "removability" Fixed Removable: For sliding board transfer According to width Full: well-supported forearm [and length] Desk: Can fit under a desk

Wheelchair leg/calf rest length measurement and types

From popliteal fossa to heel +2" Fixed Removable/ detachable/ swing-away: For pivot transfer Elevating: For LE edema

Wheelchair foot plate measurement

Clearance of 2" from the floor

Wheelchair wheel/tire diameter and types

Diameter: 22" to 24" [22" OR 24"] (ideally 24") Width: 1" Pneumatic wheel Solid rubber wheel (ideal)

Wheelchair hand/ push rims diameter and projections

Diameter: 18" to 20" (ideally 20") ``` Oblique (C5) Vertical (C6) Horizontal (C7) Friction (C7) Standard (C8) ```

Wheelchair caster diameter and indications

Diameter: 5" to 8" (ideally 8", for better propulsion) 3" for easy turning 12" for rough surfaces

Wheelchair types, features, and indications

Standard (collapsible) wheelchair: For easy storage, for those who travel frequently Hemi-wheelchair: For those with CVA; has one-arm drive (bigger for same side, smaller for opposite side), has low seat height (17.5") Sports wheelchair: Has solid/ rigid frame, low seat height, low back rest, increased camber (3 degrees to 9 degrees), and is lightweight Reclining wheelchair: For those who have postural instability, for pressure relief; backrest can be reclined to 180 degrees with the horizontal, has elevating leg rests, anti-tippers Tilt-in-space wheelchair: For those with extensor spasticity or spasm, for pressure relief; can be tilted maintaining hips and knee flexion at 90 degrees Motorized/ electric/ power wheelchair: For those with SCI levels C1 - C4; joystick, push button, sip and puff controls ``` NOTE: Outdoor wheelchair (for power) - wheels posterior, casters anterior Indoor wheelchair (for mobility) - caster posterior, wheels anterior ```

Ramp dimensions

1:12 1" rise 12" run

Stair measurement

7:11 7" rise/ height 11" run/ length

Handrail height

32"

Toilet seat height

17" - 19" (ideally 19")

Door width

Minimum: 32" Ideal: 36"

Hallway/ corridor width

Minimum: 36" Ideal: 42"

Ramp width

Minimum: 36" Ideal: 48"

Grab bars dimensions

Height: Bathroom/ toilet - 33" to 36" Diameter: 30mm (3cm OR 1.25" to 1.5") NOTE Height - Ramp (handrail): 32"

Sink height

17" to 24"

Reaching forward distance

High: 48" Side: 24" Low: 15"

Dimension needed for wheelchair turning

90 degrees: 36" 180 degrees: 60" 360 degrees: 60" x 60"

Cross-brace

Push on seat rail to open seat | Can be used to suspend urinary catheter bladder

Tripod stance

Crutch position 4" anterior 4" lateral