GRFC - functional training Flashcards
Ambulation aids from most coordination needed to least coordination needed
- Non-axillary crutches
- Axillary crutches
- Cane
- Walker
- Parallel bars
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)
Ambulation aids from least stable to most stable
Cane Non-axillary crutches Axillary crutches Walker Parallel bars
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%
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”
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
Anterior rollating walker
For those with stooped posture, PD, CP, osteoporosis, for the elderly; anterior tips replaced with wheels
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
Types of crutches
Axillary
Non-axillary
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”
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)
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
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
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
Triceps (Canadian) crutch details
For those with triceps weakness
Has two cuffs:
Triceps cuff (locks elbow in extension)
Forearm cuff
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)
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)
Scapular depressors (crutch walking muscles)
Latissimus dorsi
Lower trapezius
Pectoralis minor
Shoulder adductors (crutch walking muscles)
Latissimus dorsi
Pectoralis major
Shoulder flexors, extensors, abductors (crutch walking muscles)
Deltoids
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
