intro to assistive devices Flashcards
discuss the use of parallel bars
most table assistive device
for initial amb training to make pt aware of good standing posture
parameters of use of parallel bars
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
discuss the use of walkers
progression of parallel bars and is used to widen BOS
gives lateral and anterior stab = 75% walker and 25% pt effort
parameters of use of walkers
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
discuss wheeled walkers
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
discuss folding or collapsible walkers
easily stored but sacrifices stab - mob > stab
pt must have good standing balance, tolerance and stab
discuss stair climbing walkers
descent: anterior leg longer
ascent: ant leg shorter
discuss reciprocal walkers
allows advancement of one side - mimics reciprocal gait pattern
requires 3/5 iliopsoas
however it eliminates arm swing and not good on stairs
discuss hemi walkers
use of one UE only - for stroke pts
more stable than quad cane however weight of pt may not be centered over walker
discuss walker gait pattern in NWB
walker moved forward - moved bad leg forward but do not step - step with good leg - repeat
discuss walker gait pattern in PWB
walker moved forward - moved bad leg forward but step partially only and use walker for most of weight - step with good leg - repeat
discuss walker gait pattern in FWB
walker moved forward - moved 1st or weaker leg forward - step with 2nd or stronger leg - repeat
discuss the use of axillary crutches
progression form walker - good to normal balance and tolerance and can accept challenge when standing
50% from crutches and 50% from pt
parameters for axillary crutches
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
discuss the use of forearm crutches
for pts with considerable mob and mod stab - faster to amb than axillary
SCI pts with no UE weakness
parameters for forearm crutches
1-1.5 in below olecranon
should be 2 in lateral and 6 in ant from foot
disadvantage of axillary crutches
prolonged leaning on axillary bar = damage to axillary artery or radial nerve
WB should be on grab bar not axillary
importance of proper crutch length
too low → too much trunk flexion
too high - trunk ext and compression in axillary space
discuss use of forearm platform crutch
for pt unable to WB through hands - RA, wounds, burns of hand
crutch tips measurement
rubber - 1.5 in in diameter
discuss use of canes
for pts c much improved balance - highest progression
25% cane and 75% from pt
usually used to relieve pain lng
parameters for cane
20-30° elbow flexion and 2 in lateral to greater troch and 6 in anterior
discuss wood or aluminum cane
adjustable with push pin lock
discuss standard cane
J-point or C-chaped handle
J - more stable than C d/t angulation of J that balanced GRF
discuss quad cane
4 contact points - more stab but slows gait
quad to single cane
SBQC or WBQC
discuss 4 point gait pattern
(B) canes or crutches, reciprocal walker
(R) AD - (L) LE - (L) AD - (R) LE
discuss 2 point gait pattern
(B) canes or crutches, reciprocal walker
(R) AD and (L) LE - (L) AD and (R) LE
discuss 3 point gait pattern (NWB)
(B) crutches or walker
(B) AD and NWB LE - FWB LE
discuss 3-1 point gait pattern (PWB)
(B) cane or crutches, walker
(B) AD and PWB LE - FWB LE
discuss modified 4 point gait pattern
one cane or crutch on contra of bad leg
bad leg - good leg - AD -
discuss modified 2 point gait pattern
one cane or crutch on contra of bad leg
AD and bad leg - good leg
discuss gait in stair climbing
ascent: good LE - AD - bad LE
descent: AD - bad LE - good LE
discuss guarding in stair climbing
ascent: PT is posterolat of involved
descent: PT is anterolat of involved
discuss guarding in level surface
posterolat of involved
