Lecture 4 - Assistive Devices and Guarding Flashcards
1
Q
When is a tilt table used?
A
when patients need to acclimate to upright position
2
Q
When are vital signs taken with a tilt table?
A
Before, during and after
3
Q
What is a tilt table?
A
Table that is elevated gradually, starts supine and then goes to a “standing” upright positioning
4
Q
When are parallel bars used?
A
balance training, teaching specific gait patterns, support while measuring an AD
5
Q
How much elbow flexion do we need with parallel bars?
A
20-25 degrees elbow flexion
6
Q
How much space horizontally does a patient need in the parallel bars?
A
2 inches wider than either greater trochanter
7
Q
What should the top of a parallel bar be even to?
A
greater trochanter or wrist crease in standing with the UEs at sides
8
Q
What are ambulatory ADs?
A
devices that provide external support during gait training in an upright posture
9
Q
What are indications for usage of an AD?
A
- structural deformity, amputation, injury, or disease resulting in inability to bear weight through the LEs
- muscle weakness or paralysis in trunk or LEs
- balance deficits
10
Q
What do ADs do?
A
- increase BOS
- provide a method for redistributing weight normally borne through LEs to UEs
11
Q
Wha kind of force do ADs create?
A
- additional force that keeps the pelvis level in the face of gravity’s tendency to adduct the hip during unilateral stance
12
Q
What is trendelenberg gait due to?
A
weakness or pain caused by large adductor moment due to the natural placement of the COM
13
Q
How to pts compensate with trendelenberg gait?
A
- lean over the weaker side
- decreases the adductor moment
14
Q
Why is a cane useful for trendelenberg gait?
A
- cane’s force substitutes for the hip abductors
- transmits part of the body weight to the ground decreasing the muscular force required for balancing (decreased demand)
15
Q
How can ADs help with pain?
A
- decreased WB
- distribution of force over larger surface area
- improved joint stability (instability can cause pain)
16
Q
How can ADs help with weakness?
A
- increased BOS
- redirection of the line of action of forces
17
Q
How can ADs help with limited PROM?
A
- redirection of the line of forces
- stabilization of uninvolved joints
18
Q
How can ADs help decreased endurance?
A
- improved efficiency of movement
19
Q
How can ADs help with balance deficits?
A
- increased BOS
20
Q
How can ADS help with impaired motor control?
A
- increased BOS
- increased WB
21
Q
How can ADs help with fear of falling?
A
- increased BOS
22
Q
What are some examples of ADs?
A
- walkers
- axillary crutches
- forearm crutches
- canes (quad or single point)
23
Q
What do walkers provide?
A
a large degree of stability
24
Q
What type of patients would benefit from a walker?
A
- generalized weakness
- dehabilitating conditions
- need to reduce WB on one or bothLEs
- poor balance/coordination
- inability to use crutches (need balance, coordination)
25
What are the types of walkers?
- standard
- wheeled (2 or 4)
- stair climbing walkers
- ring walkers (peds)
- knee walkers
- reverse walkers (peds)
- hemiwalkers
- reciprocal walkers
26
What kind of stability do axillary crutches provide?
Moderate stability
27
Do axillary crutches require more or less coordination than walkers?
MORE
28
What is a negative for axillary crutches?
Takes substantial amount of energy
29
What kind of patient would benefit from axillary crutches?
- weakness in one or both LEs
- impaired balance
- need for trunk support
- permits 80-100% weight-bearing support
30
What do forearm crutches provide in comparison to axillary crutches?
- more ease of movement but less trunk support
31
What is a pro of forearm crutches?
frees hands without having to drop the crutch
32
What kind of patients are forearm crutches recommended for?
- same patients that may require axillary crutches but do NOT require trunk stability
33
Where should the cuff on forearm crutches fall?
2 inches below elbow (olecranon process)
34
What kind of patient benefits from usage of a cane?
- minimal LE weakness
- require slight WB reduction
- impaired balance
35
What kind of patient benefits from usage of a quad cane?
- limited or no use of one UE as with hemiparesis
- similar impairments as patients who require SPCs but usually greater deficits
36
What are some cons of quad canes?
- slightly heavier
- somewhat awkward with all 4 points on the ground
37
What is non-weight bearing?
- involved LE not to be WB or touching floor (NWB)
38
What is toe touch weight bearing (TTWB)?
- pt can rest toes on the floor for balance but cannot WB
39
What is partial weight bearing? (PWB)
- limited amount of WB tolerated
- usually a percentage is given (i.e. 25% PWB)
40
What is weight bearing as tolerated (WBAT)?
- pt allowed to place as much or as little weight through the involved LE depending on tolerance
41
What should we match when choosing an AD?
- the needs and the abilities of the patient with the qualities of the device
42
What are some common conditions warranting the usage of ADs?
- pain
- Limited PROM
- decreased sensation
- open wounds on WB surfaces
- unstable structure (fractures)
- decreased strength
- decreased endurance
- impaired motor control
- balance deficits
- fear of falling
43
What AD is a good choice for increasing BOS?
- parallel bars
- walkers
44
What AD is a good choice for PWB?
- parallel bars
- walkers
- bilateral crutches
45
What AD is a good choice for NWB and TTWB?
- parallel bars
- walkers
- bilateral crutches
46
What AD is a good choice for WBAT ?
- Parallel bars, hemiwalkers, single point cane or crutch
47
What can an improper fit or use of an AD lead to?
- decreased stability
- decreased function
- decreased safety
- increased energy expenditure
48
How do we fit a walker?
- with pt in standing or supine
- shoes SHOULD be worn (when applicable)
- hand grip at level of pt's: wrist crease, ulnar styloid process and greater trochanter
49
How do we fit axillary crutches if we know the pt's height?
- multiply by 77% or subtract 16 in from height
50
How do we fit axillary crutches in supine?
- use a tape measurer to measure the distance from axillary fold to the 6-8 inches lateral to the heel
51
How can we fit axillary crutches in seated?
- UE abducted at shoulder level
- one elbow extended, one flexed to 90 degrees
- measure distance between middle finger of extended elbow and olecranon process of flexed elbow
52
How do we confirm the fit of axillary crutches in standing?
- tips should be positioned 2 inches laterally and 4-6 inches anterior to toe of shoes
53
How do we measure the hand piece height of axillary crutches in supine?
- from greater trochanter, wrist crease, or ulnar styloid process to the heel of the shoe
- use this number to measure from the rubber tip to the hand piece
OR
- from anterior axillary fold to greater trochanter or ulnar styloid process
- use this to measure form the axillary rest to the hand piece
54
What should the patient elbows be doing with the crutches in tripod position?
- pt should have approx 20-30 degrees elbow flexion with relaxed shoulders
55
How much space should be present between the axillary rest and the bottom of the axilla with axillary crutches?
- two findgerbreadths
56
How do we fit a cane in standing?
- place cane parallel to femur and tibia with foot of the cane on the floor or at the bottom of the heel of the shoe
- hand piece should reach wrist crease, greater trochanter or ulnar styloid process
57
How do we fit a cane in supine?
- use a tape measure to measure from greater trochanter to heel with hip and knee straight
58
How do we confirm the fit of a cane in standing?
- tips should be positioned 2 inches laterally and 4-6 inches anterior to toe of shoes
59
How do we measure the fit of the forearm cuff with forearm crutches?
- top of the cuff should be 1-1.5 inches distal to the olecranon process when the pt grasps the hand piece with wrist in neutral
60
How do we confirm the fit of forearm crutches in standing?
- tips should be positioned 2 inches laterally and 4-6 inches anterior to toe of shoes
61
Where should we guard with ADs?
- should stand slightly to one side and behind the pt
- on the weaker side usually
- stride stance (outside foot behind the AD and the pt's foot; other foot trails when you walk)
- underhand grip with gait belt other hand on pt's shoulder or chest
62
How should we guard on level surfaces with ADs?
- stand behind pt and slightly to the weaker side
- one hand on gait belt with supinated grip
- other hand lightly resting on pt's shoulder (DONT impede motion)
- PT's stance staggered
- advance front foot with AD, trailing foot moves when patient moves
63
How do we guard during LOB?
- not trying to stop the fall, just slow it down to give enough time for important structures to be protected
64
Where do we guard if balance is lost forward?
- pull back on gait belt
- other hand pulls trunk upward and back
- may need to push forward on pelvis as pull back on trunk
65
Where do we guard if balance is lost backwards?
- push forward on pelvis and trunk
66
Where do we guard if balance is lost to one side (away from PT)?
pull gait belt toward you
67
Where do we guard if balance is lost to one side (toward PT)?
- turn body so that you face the pt's side
- widen BOS
- use body to support pt
68
What do we instruct the patient to do if LOB forward?
- let go of AD and reach for the floor
- cushion fall by bending their elbows and rolling to one side
- turn head to one side to avoid injury to the face
69
What does the PT do when balance is lost forward?
- firmly but slowly pull back on gait belt avoiding excessive force
- step forward with outside foot to help control descent
