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1 Patient Management > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Indications for assistive device use

A

wide BOS/increase area in which COG can be shifted
allow for redistribution of body weight within the BOS

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2
Q

Assistive Devices

A

ADs
you choose based on aerobic cost; some will cause more energy depletion. Some ADs are more focused on STABILITY vs MOBILITY

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3
Q

Parallel Bars

A

most table place to measure fit of other devices
often is a starting point for initial standing, pre-gait activities, and gait training

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4
Q

Standard walker

A

no wheels
pick-up
lots of aerobic cost

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5
Q

Front Wheeled walker

A

FWW
wheels in front, most common

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6
Q

Four wheeled or rollator

A

4WW
has only wheels
also has a seat and brakes

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7
Q

Hemiwalker

A

for individuals with one side of body paralyzed (hemiplegia), large BOS

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8
Q

Platform walkers

A

decreases or eliminates weight-bearing on wrists/hands
helpful in situations of broken wrists, arthritis. Eliminates that force going through the wrists

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9
Q

Crutches

A

axillary
forearm, lofstrand, canadian

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10
Q

Straight cane

A

single point
SPC

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11
Q

small based quad cane

A

SBQC

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12
Q

Large base quad cane or wide base quad cane

A

LBQC, WBQC
pay attention to the orientation of the base. wider part goes away from the pt to increase BOS and not trip pt

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13
Q

When to use walkers

A

maximal patient stability and support are required

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14
Q

When to use axillary crutches

A

pt who need less stability or support, allow greater selection of gait patterns and ambulation speed while still providing stability and support

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15
Q

When to use forearm crutches

A

eliminate the danger of injury to axillary vessels and nerves
more functional on stairs and in narrow, confined areas
less stability than normal crutches, more than a cane

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16
Q

When to use a cane

A

used to compensate for impaired balance or to improve stability and are more functional on stairs and in narrow, confined areas

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17
Q

Full-weight bearing

A

FEB

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18
Q

Weight bearing as tolerated

A

WBAT
pain tolerance

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19
Q

Partial weight bearing

A

PWB
some % of body weight, or actual weight allowed is typically specified

20
Q

Toe-touch weight bearing or touch-down

A

TTWB or TDWB
foot is in contact with the floor, but no weight is translated through it

21
Q

Non-weightbearing

A

NWB
foot does not touch the floor

22
Q

Reciprocal gait pattern

A

arm and legs move in alternating pattern

23
Q

Four-point gait pattern

A

bilateral ADs
contralateral AD moves before corresponding LE
naturally evolves into a two-point

R crutch
L foot
L crutch
R foot

24
Q

Two-point gait pattern

A

bilateral AD. AD moves w/contralateral leg

L crutch + R foot
R crutch + L foot

modified two-point = take away 1 AD

25
Q

Three-point gait pattern

A

1 LE is NWB

R Foot
L + R crutch

modified = 1 LE is toe touch

26
Q

Step-to vs step-through

A

Modified gait patterns

Step-to = wedding pattern, AD first, then legs together

Step-through = weaker leg & AD forward, contralateral LE follows

27
Q

Swing-to/swing-through

A

these terms are only used when the person is advancing both LEs at the same time, aka a reciprocating gait is not possible

28
Q

Swing-to

A

swinging both legs TO the same position as the crutches

29
Q

Swing-through

A

swinging both legs PAST the position of the crutches

30
Q

How to choose the best AD

A

greatest quality of life w/least amount of risk

Based off of ICF
Activity limitations, impairments (i.e legs), secondary impairments (i.e. arms), health conditions, contextual factors, personal factors (previous use of AD, ability to learn, pt preference), environmental

31
Q

Adjusting AD to fit pt

A

always ensure pt safety while measuring & adjusting

32
Q

Fitting axillary crutches

A

set HEIGHT first (how tall are you?)
Adjust hand grip LAST

standing: tripod position w/crutches, 2-finger width distance btwn crutch and axilla

in sitting = on arm straight to side, other w/elbow flexed to 90°

15° of elbow flexion when hands are on grips

33
Q

Fitting forearm/lofstrand crutches

A

measure grip height FIRST
adjust cuff height next

cuff should be 1-1.5 in below olecranon process. proximal 1/3 forearm.

34
Q

Fitting walkers, canes, hemiwalkers

A

hand grip = use wrist crease

single point cane should be held on contralateral side of affected LE

35
Q

When to use hemiwalker

A

used for people with hemiplegia
gripped in person’s unaffected hand
provides an extended, large BOS to allow person to shift weight toward unaffected side to help the affected LE to be able to swing forward

36
Q

Quad canes

A

orientation of the base is key
wider base must be away from the person. towards the person interferes with achieving gait pattern

37
Q

Guarding

A

can guard from back; moving from the side to the back
can guard from front; PT opposite leg blocks pt’s affected leg

38
Q

Guarding during ambulation

A

PT’s palm is always UP
other hand is on anterior shoulder
don’t hold so tight that you prevent movement
you should stand slightly to the side of the injured area
hands on at all times unless person is S or I

39
Q

Clinical benefits of ADs

A

increased confidence, increased activity level, increased independence. decreased risk of falls

biomechanics stabilization = increases BOS
reduction of LE loads
propulsion and braking during gait
augmentation of somatosensory cues

40
Q

Stop using AD

A

20-50% of people abandon AD after receiving it

use of unprescribed device
inappropriate device prescription
inadequate user training
difficult or risk to use
repetitive stresses on UEs

41
Q

Problems with ADs

A

destabilizing biomechanic effect
attentional and neuromotor demands
interference with limb movement during balance recovery
upper-limb loading and strength demands
metabolic and physiologic demands`

42
Q

Documentation of Ads

A

Who, what, distance ambulated, assistive device used, weightbearing/gait pattern, level of assistance

Ex: PT ambulated 25 ft with SBQC w/modified 4point gait pattern and MIN A

43
Q

Balance lost forward

A

standing/even surface = pull back on gait belt

ambulating/even surface = pull back on gait belt, widen stance, turn sideways. pull on upper trunk.

ascending = pull back on gait belt and trunk/shoulder. Grasp handrail with other hand.

descending = move directly in front, push on shoulder or chest. pt releases aids and straightens/looks up. or pull back on gait belt if behind

44
Q

Balance lost backwards

A

standing/even surface = push forward on pelvis/trunk

ambulating/even surface = one side towards patient, widen stance, let them come back towards you

ascending = one side towards patient, widen stance, let them come back towards you, grasp guardrail

descending = pull forward and grasp guardrail. or press forward with pelvis and grasp handrail if behind

45
Q

Balance lost to side, away from PT

A

standing.even surface = pull on gait belt towards you

ambulating/even surface = pull on gait belt, push forward against pelvis, pull back on shoulder

ascending = gait belt to pull towards. grasp handrail

descending = pull on gait belt towards you. grasp handrail. same if behind them

46
Q

Balance lost to side, towards PT

A

standing = face pts side, widen stance, support pt with body

ambulating = one side is turned toward pt back, use gait belt for control

ascending = use hand or shoulder to press against trunk. grasp guardrail or gait belt

descending = hand or shoulder to press against side of chest to move pt away from you. or use body to support the pt if standing behind.

1 Patient Management (8 decks)

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