Lecture 5 - Functional Tasks and Transfers w/ an Assistive Device

Question 1

How do we instruct a patient to do a sit to stand with a walker?

Answer 1

• Hips forward in seat
• Unaffected LE slightly posterior to
  affected
• Both hands on armrest of chair or
  one hand on walker one on
  chair/bed
• Trunk leans forward “nose over
  toes” w/ simultaneous push
  through UEs and the strongest LE

Question 2

How do we instruct a patient to do a stand to sit with a walker?

Answer 2

• Pt approaches the chair and
  pivots on the stronger LE until
  back is to the chair
• Steps back until the strongest LE
  is in contact with the chair
• Reaches with one hand at a time
  for the arm rest and uses UEs to
  control descent

Question 3

How do we do a sit to stand with axillary crutches with NWB LE or forearm crutches with WBAT?

Answer 3

• Hips moved forward in chair
• Instruct pt to place NWB or weaker LE anterior to stronger LE or PT can support
  NWB LE during task
• Hand pieces of both crutches are grasped in hand (initially on weaker side)
  slightly in front of the chair
• Strong side hand is on arm rest or supporting surface
• To stand, “nose over toes” pushing through BUEs and stronger LE
• Switch one crutch to other hand once stable

Question 4

How do we do a sit to stand with axillary crutches WBAT? (ALT METHOD/LESS SAFE)

Answer 4

LESS SAFE! SHOULD NOT BE USED IF POSSIBLE!
* Pt should have normal if not greater strength in BUEs
* Stronger LE is more underneath pt
* Hand pieces of crutches are grasped in each hand (slightly
in front of the chair
* To stand, “nose over toes” pushing through BUEs and stronger LE

Question 5

How do we do a stand to sit with alternative method with axillary crutches WBAT?

Answer 5

Same as w/ NWB
* Need to control descent w/ hand on
the destination surface

Question 6

How do we do a sit to stand with a cane?

Answer 6

Hips moved forward in chair
* Cane is placed either side next to the armrest
* To stand, “nose over toes” pushing through BUEs and LEs
* If chair does not have armrests, pt can use cane in hand opposite weaker LE

Question 7

How can we transfer from crutches to floor?

Answer 7

Shift both crutches to side of weaker LE
* Pt reaches to floor with stronger side UE
using crutches for balance

Question 8

How can we transfer from floor to crutches?

Answer 8

Pt side sits and grasps both crutches on
side of weaker LE
* Pt pushes to stand using stronger LE and
both hands

Question 9

Where do we guard during descent of stairs or ramps?

Answer 9

in front of patient

Question 10

Where do we guard during ascent of stairs or ramps?

Answer 10

Behind patient

Question 11

What is recommended if not handrail is present?

Answer 11

2 people guard patient

Question 12

Where do some PTs place their feet when guarding a pt on stairs?

Answer 12

place one foot on step pt is standing on and one 2 steps down

Question 13

How can we ascend stairs or curbs with HRs with a standard walker?

Answer 13

• If pt uses walker for balance only and is
  relatively strong
• If significant strength deficits are present:
• Can use walker opened for greater stability
• Up w/ good, down w/ bad

Question 14

How do we ascend stairs or curbs with HRs?

Answer 14

“Up with the good, down with
the bad”

Question 15

How do we ascend stairs with HRs with bilateral canes or SPC?

Answer 15

• Hold both canes in one hand w/ other
  on HR OR hold one cane in hand
  holding onto HR parallel and other cane
  in other hand
• Up with stronger LE, weaker LE and
  cane(s) follow

Question 16

How can we ascend stairs with bilateral axillary crutches? (NWB, WBAT, or PWB)

Answer 16

• Hold both crutches in one hand OR
  in one hand in a “T” formation OR
  one in one hand the other parallel
  to the HR in the other hand
• Up w/ strong LE

Question 17

How do we descend stairs or curbs with HRs?

Answer 17

• Back two legs on the same step w/ pt; front two legs on the step below
• Down with the weaker LE

Question 18

How do we descent stairs or curbs with HRs?

Answer 18

• “Up with the good, down with
  the bad”

Question 19

How do we descend stairs with HRs with bilateral canes or SPC?

Answer 19

• Hold both canes in one hand w/
  other on HR OR hold one cane in hand holding onto HR parallel and other cane in
  other hand
• Down w/ weaker LE and
  cane(s) while slightly flexing
  stronger LE hip and knee

Question 20

How do we descend stairs with HRs with bilateral crutches? (NWB, WBAT, or PWB)

Answer 20

• Hold both crutches in one hand OR in one hand in a “T” formation OR one in one hand the other parallel to the HR in the other hand
• Down w/ affected LE

Question 21

How can we ascend stairs or curbs without HRs?

Answer 21

up with the good, down with the bad

Question 22

How do we ascend curbs/stairs without handrails with bilateral canes or SPC?

Answer 22

• up with stronger LE, weaker LE and cane(s) follow

Question 23

How do we ascend curbs/stairs with bilateral crutches? (WBAT or PWB)

Answer 23

• same as cane

Question 24

How do we ascend curbs/stairs with bilateral crutches when NWB?

Answer 24

• NWB LE is held in hip extension and ER with either knee ext or flexed
• UP with strong LE

Question 25

How do we ascend a curb with a standard walker without the HRs?

Answer 25

• Low curb, pt can place walker onto the curb with stronger LE
• Higher curb, pt backs up to the curb and goes up with stronger LE, backs away from edge prior to turning around

Question 26

How do we descend curbs with bilateral canes or SPC without the HRs?

Answer 26

Down w/ weaker LE and cane(s) while slightly flexing stronger LE hip and knee

Question 27

How do we descend with bilateral crutches without HRs when NWB?

Answer 27

Down w/ crutches and affected LE

Question 28

How do we descend a curb with a standard walker without HRs?

Answer 28

• Pt places walker onto the lower surface
• Down with the weaker LE first followed by stronger

Question 29

What is it important to remind the pt to do when lowering down?

Answer 29

• flex stronger LE as AD is being lowered down to increase support and stability and lower COG

Question 30

What do you do if pt is unsteady or you as the therapist do not feel you are in a position that will guard against a fall?

Answer 30

DO NOT PROCEED

Question 31

How can we instruct the pt to move in a sideward movement on a level surface

Answer 31

To move to R
* Position L AD to outside of L foot
* Position R AD 6-8 inches away from R foot
* Pt steps towards the R AD
* Reposition crutches as necessary

Question 32

How can we instruct the patient to turn on level surfaces?

Answer 32

• Suggested pt’s INITIALLY learn to pivot
  on the stronger side, BUT learn BOTH
  directions eventually
• AD should be moved in the direction of
  the turn

Question 33

How can we instruct a patient to go through a door with the door opening towards the patient?

Answer 33

If door opens TOWARDS pt:
* Pt approaches at an angle facing the hinges
* Pt positions body outside of where the door needs to open, but close to it
* Pt shifts weight to opposite LE/crutch and momentarily uses hand close to
the door to quickly pull it open
* Hand returns to crutch and crutch is placed so that it acts as a door stop
* This can be repeated to open the door wider

Question 34

How can we instruct a patient to go through a door if the door opens away from the patient?

Answer 34

If door opens AWAY from pt:
* Pt approaches at an angle w/ back to the hinges almost
* Pt shifts weight to opposite LE/crutch and momentarily uses hand close to the door to quickly push it open
* Hand returns to crutch and crutch is placed so that it acts as a door stop
* This can be repeated to open the door wider
OR
* Pt can use body to keep door open and use side movements to get outside