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Patient Care Skills > Mobility / Gait Devices > Flashcards

Mobility / Gait Devices Flashcards

1
Q

how is ambulating a patient different than gait analysis

A

ambulation deals with little concern in a patient’s gait pattern. focus is on the distance and quality of movement

analysis - analyzing what elements of the pattern are normal and which elements deviate from it

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2
Q

what is the #1 predictor of falling

A

having fallen in the last 6 months

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3
Q

what is the fear of falling bad for

A

obviously falling
can make a patient scared to do much which in turn decreases their ability to do anything at a rapid rate.

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4
Q

what can contraidicate weight bearing on one side?

A

fracture healing
amputations
open wounds

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5
Q

what are the main ways gait devices facilitate mobility

A

redirection of body weight from affected to normal limb
increased stability from increased BOS

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6
Q

how does a gait device increase base of support

A

moves it from just under the patient to all around the patient

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7
Q

major muscle groups in the trunk used during ambulation

A

scapular depressors and stabilizers
trunk extensors
trunk flexors

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8
Q

what muscles are used in the UE during ambulation with a device

A

shoulder flexors/extensors
elbow extensors
finger flexors

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9
Q

what LE muscles are used during ambulation w a device

A

hip abductors
hip extensors
knee extensors
ankle dorsiflexors

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10
Q

what is NWB

A

non-weight bearing
no weight allowed to be transmitted
important to keep knee bent if the LE is NWB

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11
Q

what is TTWB or TDWB

A

toe-touch weight bearing
touch-down weight bearing

foot/toes are allowed to touch the ground but no weight can be transmitted through affected LE
mainly just used for balance instead of WB

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12
Q

what happens with prolonged TTWB

A

can have gastrocnemius contracture if kept in position for a long time

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13
Q

what is WBAT

A

weight bearing as tolerated
limited by patient’s tolerance
somewhere between 50-100%

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14
Q

how can a patient better understand their partial weight bearing status

A

allow the patient to push into a scale to better understand how much of their force results in the amount of weight they are allowed to push into

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15
Q

what is a limb-load monitor

A

monitor attached to footwear that gauges and provides feedback
will beep if the patient exceeds weight limit

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16
Q

what are common types of walkers

A

wheeled/rolling
folding
posterior rollator
hemi-walkers

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17
Q

what are the common types of crutches

A

axillary and forearm

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18
Q

what are the common types of canes

A

large/small based quad canes
single point cane

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19
Q

most stable to most mobile

A

parallel
walker
axillary
forearm
cane in both hands
hemi walker
quad cane
single point cane
no device

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20
Q

what type of patient would be introduced to parallel bars

A

PT who was eligible for a tilt table
one who has been immobile for quite some time

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21
Q

what is the set up that makes parallel bars the most stable

A

wheel chair behind patient, bars on each side, therapist in front

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22
Q

what are some balance/preambulation activities

A

weight shifts (side to side/forward and backward)
stepping forward/backward
anterior posterior hand placement
single hand support - high fiving therapist
hip hikes
step ups / marches

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23
Q

what is a standard walker

A

4 legs with rubber tips

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24
Q

what are the cons of standard walkers

A

cumbersome
difficult to store
no stairs
decreases ambulation speed
impedes gait pattern
too wide for narrow spaces

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25
Q

what do walkers do for a patient

A

increase base of support
enhance lateral stability
support patient weight

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26
Q

what/who are front wheeled walkers best for

A

patients with a gait that is too fast for standard walker or difficulty lifting it
wheels allow for a more standard pattern but can decrease stability

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27
Q

what are some walker accessories

A

fixed / swivel wheels
glide / wheel brakes
baskets
skis / tennis balls

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28
Q

where do wheels always have to be on walkers

A

in the front

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29
Q

what do skis and tennis balls do?

A

reduce friction on back to legs
can allow for greater ambulation speeds which in turn can increase a patient’s confidence

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30
Q

when does one implement a walker with a platform attachment

A

when a patient is unable to weight bear in one wrist or hand
can instead put weight through the shoulders and elbows

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31
Q

what is a gaurdian strider

A

pediatric walker with an extra wide base for stability
wheels in the front

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32
Q

what is a reverse postural walker

A

pediatric walker that provides stability by moving the COM posteriorly.
decreases flexion angles of the trunk hip and knee
can decrease the oxygen consumption rate

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33
Q

what is an a frame walker

A

pediatric walker that more resembles a normal walker

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34
Q

what is something important for patients using four wheeled walker

A

can be used for improving endurance and increasing distance that one can walk

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35
Q

can a four wheel walker be given to a patient with a heavy reliance upon upper extremity strength

A

no
device can roll away

36
Q

what qualifies a candidate for four-wheel walkers

A

mild to moderate balance disorder
mild “cautious gait” ataxia or compromise exercise endurance

37
Q

what diseases can the U-step walker be used for?

A

movement disorders
parkinson’s, ALS, MS, TBI

38
Q

what does the U-step walker have

A

laser lights that give a patient a goal to step to

always in brake position, only moves when patient presses the lock

39
Q

how much faster can a patient walk with the U-step

A

3-4x faster

can also turn around easily
can traverse over uneven surfaces as well as avoiding jolts

40
Q

what can the cardiac walker be used for? aka platform walker?

A

support of weight by allowing the patient to shift a lot of weight in the UE and none in LE

41
Q

what is the weight capacity of standard axillary crutches

A

250 lbs

42
Q

disadvantages of axillary crutches

A

less stable
can cause axillary nerve impingement
require good balance
can make patient feel insecure
functional strength of UE and trunk are needed

43
Q

what should the gap between crutch and armpit be?

A

3 fingers

44
Q

what is tripod position

A

crutches positioned in
2 inches laterally
6 inches forward
elbow bent at 20-30°

45
Q

what happens if the elbow is bent too much or not enough during tripod position

A

too much = mechanical disadvantage
too little = active insufficiency in triceps

46
Q

what are forearm crutches good for? what are some characteristics

A

stability as well as independence for long term basis
plastic cuffs that pivot 90°
weight limit is 240

47
Q

advantages of forearm crutches

A

eliminates potential axillary damage
more functional on stairs / tight areas
use of hands
more cosmetic
fits into cars

48
Q

disadvantages of forearm crutches

A

less stable
requires great amounts of UE/Trunk strength
greater standing balance
hard to take off
not for elderly
cost more than axillary

49
Q

what does a hemiwalker give a patient compared to a normal cane

A

more broad base support
better for patients requiring continuous weight bearing only in one arm

50
Q

what is the main advantage of the quad cane

A

can stand upright when not in use allowing for patient to use other hand

51
Q

what is the main disadvantage of the quad cane

A

all legs of the cane need to be in contact with ground

52
Q

how may the main disadvantage of the quad cane affect gait

A

may slow ones gait down because the patient is moving too fast to place all 4 legs down consistentyl

53
Q

what WB status can a cane be used for

A

FWB only

54
Q

advantages of cane

A

functional on stairs and tight areas
inexpensive
stored/transported easily
can mimic normal gait patterns

55
Q

disadvantages of a cane

A

limited support
least stable, most mobile

56
Q

if the device is fit to the patient correctly, it will

A

facilitate upright posture
require less energy to ambulate

57
Q

when fitting a device, what is one clothing item that you want the patient to have on

A

the shoes that they will be wearing when using the device

58
Q

what is the proper fitting of parallel bars for a patient

A

bars are level and at the height where a patient can have a 20-30° bend in the elbows
bars are 2” wider than the hips
height of bars is at the greater trochanter or ulnar styloid

59
Q

proper fitting of a walker

A

elbows able to bend at 20-30°
hand grips at ulnar styloid/greater trochanter

60
Q

proper fitting of forearm crutches

A

handgrip at the greater trochanter
forearm cuffs about 1-1.5 in from olecranon process
20-30° elbow flexion

61
Q

proper fitting for canes

A

tip just lateral to toes
handgrip at greater troch/ulnar styloid
20-30° elbowflexion

62
Q

what are some common errors when fitting a device

A

patient’s shoulders are not relaxed
patient slumps forward
measurement without shoes
not in tripod
wrist not in neutral

63
Q

events in a sit to stand to gait device

A

lock breaks on wheel chair
scoot forward
hold on arm rests
push off to stand up with “nose over knees”

64
Q

where should the therapist stand during a sit to stand

A

on affected side if one leg is substantially weaker

if both legs are equally weak, stand on non dominant side

65
Q

is it ok for the patient to use the walker as a brace to get up?

A

no, they will not be able to get their body up because they will pull the device towards themselves

66
Q

what is the therapists position during ambulation

A

feet staggered to increase BOS
slightly behind and to the affected side
one hand on gait belt and one hand in front

67
Q

why should the therapist be on the affected side?

A

better control of the side/limb
can better predict/control a fall
promotes neurological facilitation

68
Q

contraindications of a gait belt include

A

recent abdominal surgery
severe cardiac/respiratory conditions
phobia regarding belts

69
Q

what hand placement should the therapist have on a gait belt

A

supinated
not pronated and definitely not with it wrapped around the wrist
great way to break your wrist

70
Q

tell me about four point gait

A

requires bilateral ambulation devices (2 crutches/canes)
alternate and reciprocal movement
slow but utilizes maximal stability with lower energy expenditure

71
Q

when to use 4 point gait

A

partial weight bearing on one of the LEs
or
patient is allow WBAT or full WB but not strong enough for two point

72
Q

what is the sequence of four point gait

A

one crutch advanced (unaffected)
contralateral leg advancement (affected)
advancement of other crutch
advancement of other leg

73
Q

when to use two point gait

A

patient is allowed WBAT or full WB
stronger than 4 point

74
Q

what is required for two-point

A

bilateral ambulation devices
simultaneous movement
relatively stable
faster
more coordination

75
Q

pattern of two point gait

A

one crutch and opposite extremity move in sequence
followed by opposite crutch and extremity
allows for natural arm and leg motion

76
Q

when to use 3 point gait

A

patient has NWB on one LE
patient has PWB on one LE
patient has WBAT on one leg but not strong enough, needing a stable assistive devices

77
Q

what is required for 3 point gait

A

bilateral ambulation or a walker
less stable
require good UE, LE and trunk strength
high energy expenditure

78
Q

how is swing to different than swing thru

A

swing to level of device
or
swing thru past the device

79
Q

what muscle involvement can a single cane or crutch decrease

A

gluteus medius

80
Q

gait pattern with one crutch

A

advancement of device on contralateral side (forward and laterally)
advancement of affected LE
advancement of uninvolved LE

81
Q

where would a therapist stand when practicing at steps?

A

toward bottom of the steps on “down” side with a wide BOS
stand on tandem steps not just one

82
Q

when ascending, what is the sequence of actions

A

Good LE
Bad LE
Device

83
Q

when descending what is the sequence of events

A

Device
Bad LE
Good LE

84
Q

ascending with no hand rails

A

Good LE
Shift weight forward onto good LE
Bad LE and device at same time

85
Q

if a patient’s arms are not strong enough to move themselves forward in the wheelchair, what does a therapist do to assist

A

one hand on lower back and one leg on knee
one side at a time

86
Q

quote at the end of the power point

A

all truly great thoughts are conceived while walking
Friedrich Nietzsche

Patient Care Skills (3 decks)

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