intro to assistive devices

Question 1

discuss the use of parallel bars

Answer 1

most table assistive device

for initial amb training to make pt aware of good standing posture

Question 2

parameters of use of parallel bars

Answer 2

pt should have standing and amb balance and tolerance

elbows at 20-30° flexion and height of bar at greater troch

bar should be 2 inches lateral to greater troch and 6 in anterior

instruct pt to push down no to pull on the bars

Question 3

discuss the use of walkers

Answer 3

progression of parallel bars and is used to widen BOS

gives lateral and anterior stab = 75% walker and 25% pt effort

Question 4

parameters of use of walkers

Answer 4

pt is able to maneuver in parallel bars and has good standing balance and tolerance

elbows at 20-30° flexion and height of bar at greater troch

Question 5

discuss wheeled walkers

Answer 5

allows cont walking since wheels on ant part - mob > stab

for pt c difficulty initiating movement - brady, apraxia

not for pts with postural instab and parkinsons

Question 5

discuss folding or collapsible walkers

Answer 5

easily stored but sacrifices stab - mob > stab

pt must have good standing balance, tolerance and stab

Question 6

discuss stair climbing walkers

Answer 6

descent: anterior leg longer

ascent: ant leg shorter

Question 7

discuss reciprocal walkers

Answer 7

allows advancement of one side - mimics reciprocal gait pattern

requires 3/5 iliopsoas

however it eliminates arm swing and not good on stairs

Question 8

discuss hemi walkers

Answer 8

use of one UE only - for stroke pts

more stable than quad cane however weight of pt may not be centered over walker

Question 9

discuss walker gait pattern in NWB

Answer 9

walker moved forward - moved bad leg forward but do not step - step with good leg - repeat

Question 10

discuss walker gait pattern in PWB

Answer 10

walker moved forward - moved bad leg forward but step partially only and use walker for most of weight - step with good leg - repeat

Question 11

discuss walker gait pattern in FWB

Answer 11

walker moved forward - moved 1st or weaker leg forward - step with 2nd or stronger leg - repeat

Question 12

discuss the use of axillary crutches

Answer 12

progression form walker - good to normal balance and tolerance and can accept challenge when standing

50% from crutches and 50% from pt

Question 13

parameters for axillary crutches

Answer 13

20-30° elbow flexion

pt height - 16 in or pt height x 77%

base of axilla to 2 in lateral of foot or axilla then lateral to heel 6-8 in while supine

L method

should be 2 in lateral and 6 in ant from foot

Question 14

discuss the use of forearm crutches

Answer 14

for pts with considerable mob and mod stab - faster to amb than axillary

SCI pts with no UE weakness

Question 15

parameters for forearm crutches

Answer 15

1-1.5 in below olecranon

should be 2 in lateral and 6 in ant from foot

Question 16

disadvantage of axillary crutches

Answer 16

prolonged leaning on axillary bar = damage to axillary artery or radial nerve

WB should be on grab bar not axillary

Question 17

importance of proper crutch length

Answer 17

too low → too much trunk flexion

too high - trunk ext and compression in axillary space

Question 18

discuss use of forearm platform crutch

Answer 18

for pt unable to WB through hands - RA, wounds, burns of hand

Question 19

crutch tips measurement

Answer 19

rubber - 1.5 in in diameter

Question 20

discuss use of canes

Answer 20

for pts c much improved balance - highest progression

25% cane and 75% from pt

usually used to relieve pain lng

Question 21

parameters for cane

Answer 21

20-30° elbow flexion and 2 in lateral to greater troch and 6 in anterior

Question 22

discuss wood or aluminum cane

Answer 22

adjustable with push pin lock

Question 23

discuss standard cane

Answer 23

J-point or C-chaped handle

J - more stable than C d/t angulation of J that balanced GRF

Question 24

discuss quad cane

Answer 24

4 contact points - more stab but slows gait

quad to single cane

SBQC or WBQC

Question 25

discuss 4 point gait pattern

Answer 25

(B) canes or crutches, reciprocal walker

(R) AD - (L) LE - (L) AD - (R) LE

Question 26

discuss 2 point gait pattern

Answer 26

(B) canes or crutches, reciprocal walker

(R) AD and (L) LE - (L) AD and (R) LE

Question 27

discuss 3 point gait pattern (NWB)

Answer 27

(B) crutches or walker

(B) AD and NWB LE - FWB LE

Question 28

discuss 3-1 point gait pattern (PWB)

Answer 28

(B) cane or crutches, walker

(B) AD and PWB LE - FWB LE

Question 29

discuss modified 4 point gait pattern

Answer 29

one cane or crutch on contra of bad leg

bad leg - good leg - AD -

Question 30

discuss modified 2 point gait pattern

Answer 30

one cane or crutch on contra of bad leg

AD and bad leg - good leg

Question 31

discuss gait in stair climbing

Answer 31

ascent: good LE - AD - bad LE

descent: AD - bad LE - good LE

Question 32

discuss guarding in stair climbing

Answer 32

ascent: PT is posterolat of involved

descent: PT is anterolat of involved

Question 33

discuss guarding in level surface

Answer 33

posterolat of involved