Mobility / Gait Devices Flashcards
how is ambulating a patient different than gait analysis
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
what is the #1 predictor of falling
having fallen in the last 6 months
what is the fear of falling bad for
obviously falling
can make a patient scared to do much which in turn decreases their ability to do anything at a rapid rate.
what can contraidicate weight bearing on one side?
fracture healing
amputations
open wounds
what are the main ways gait devices facilitate mobility
redirection of body weight from affected to normal limb
increased stability from increased BOS
how does a gait device increase base of support
moves it from just under the patient to all around the patient
major muscle groups in the trunk used during ambulation
scapular depressors and stabilizers
trunk extensors
trunk flexors
what muscles are used in the UE during ambulation with a device
shoulder flexors/extensors
elbow extensors
finger flexors
what LE muscles are used during ambulation w a device
hip abductors
hip extensors
knee extensors
ankle dorsiflexors
what is NWB
non-weight bearing
no weight allowed to be transmitted
important to keep knee bent if the LE is NWB
what is TTWB or TDWB
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
what happens with prolonged TTWB
can have gastrocnemius contracture if kept in position for a long time
what is WBAT
weight bearing as tolerated
limited by patient’s tolerance
somewhere between 50-100%
how can a patient better understand their partial weight bearing status
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
what is a limb-load monitor
monitor attached to footwear that gauges and provides feedback
will beep if the patient exceeds weight limit
what are common types of walkers
wheeled/rolling
folding
posterior rollator
hemi-walkers
what are the common types of crutches
axillary and forearm
what are the common types of canes
large/small based quad canes
single point cane
most stable to most mobile
parallel
walker
axillary
forearm
cane in both hands
hemi walker
quad cane
single point cane
no device
what type of patient would be introduced to parallel bars
PT who was eligible for a tilt table
one who has been immobile for quite some time
what is the set up that makes parallel bars the most stable
wheel chair behind patient, bars on each side, therapist in front
what are some balance/preambulation activities
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
what is a standard walker
4 legs with rubber tips
what are the cons of standard walkers
cumbersome
difficult to store
no stairs
decreases ambulation speed
impedes gait pattern
too wide for narrow spaces
what do walkers do for a patient
increase base of support
enhance lateral stability
support patient weight
what/who are front wheeled walkers best for
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
what are some walker accessories
fixed / swivel wheels
glide / wheel brakes
baskets
skis / tennis balls
where do wheels always have to be on walkers
in the front
what do skis and tennis balls do?
reduce friction on back to legs
can allow for greater ambulation speeds which in turn can increase a patient’s confidence
when does one implement a walker with a platform attachment
when a patient is unable to weight bear in one wrist or hand
can instead put weight through the shoulders and elbows
what is a gaurdian strider
pediatric walker with an extra wide base for stability
wheels in the front
what is a reverse postural walker
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
what is an a frame walker
pediatric walker that more resembles a normal walker
what is something important for patients using four wheeled walker
can be used for improving endurance and increasing distance that one can walk
can a four wheel walker be given to a patient with a heavy reliance upon upper extremity strength
no
device can roll away
what qualifies a candidate for four-wheel walkers
mild to moderate balance disorder
mild “cautious gait” ataxia or compromise exercise endurance
what diseases can the U-step walker be used for?
movement disorders
parkinson’s, ALS, MS, TBI
what does the U-step walker have
laser lights that give a patient a goal to step to
always in brake position, only moves when patient presses the lock
how much faster can a patient walk with the U-step
3-4x faster
can also turn around easily
can traverse over uneven surfaces as well as avoiding jolts
what can the cardiac walker be used for? aka platform walker?
support of weight by allowing the patient to shift a lot of weight in the UE and none in LE
what is the weight capacity of standard axillary crutches
250 lbs
disadvantages of axillary crutches
less stable
can cause axillary nerve impingement
require good balance
can make patient feel insecure
functional strength of UE and trunk are needed
what should the gap between crutch and armpit be?
3 fingers
what is tripod position
crutches positioned in
2 inches laterally
6 inches forward
elbow bent at 20-30°
what happens if the elbow is bent too much or not enough during tripod position
too much = mechanical disadvantage
too little = active insufficiency in triceps
what are forearm crutches good for? what are some characteristics
stability as well as independence for long term basis
plastic cuffs that pivot 90°
weight limit is 240
advantages of forearm crutches
eliminates potential axillary damage
more functional on stairs / tight areas
use of hands
more cosmetic
fits into cars
disadvantages of forearm crutches
less stable
requires great amounts of UE/Trunk strength
greater standing balance
hard to take off
not for elderly
cost more than axillary
what does a hemiwalker give a patient compared to a normal cane
more broad base support
better for patients requiring continuous weight bearing only in one arm
what is the main advantage of the quad cane
can stand upright when not in use allowing for patient to use other hand
what is the main disadvantage of the quad cane
all legs of the cane need to be in contact with ground
how may the main disadvantage of the quad cane affect gait
may slow ones gait down because the patient is moving too fast to place all 4 legs down consistentyl
what WB status can a cane be used for
FWB only
advantages of cane
functional on stairs and tight areas
inexpensive
stored/transported easily
can mimic normal gait patterns
disadvantages of a cane
limited support
least stable, most mobile
if the device is fit to the patient correctly, it will
facilitate upright posture
require less energy to ambulate
when fitting a device, what is one clothing item that you want the patient to have on
the shoes that they will be wearing when using the device
what is the proper fitting of parallel bars for a patient
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
proper fitting of a walker
elbows able to bend at 20-30°
hand grips at ulnar styloid/greater trochanter
proper fitting of forearm crutches
handgrip at the greater trochanter
forearm cuffs about 1-1.5 in from olecranon process
20-30° elbow flexion
proper fitting for canes
tip just lateral to toes
handgrip at greater troch/ulnar styloid
20-30° elbowflexion
what are some common errors when fitting a device
patient’s shoulders are not relaxed
patient slumps forward
measurement without shoes
not in tripod
wrist not in neutral
events in a sit to stand to gait device
lock breaks on wheel chair
scoot forward
hold on arm rests
push off to stand up with “nose over knees”
where should the therapist stand during a sit to stand
on affected side if one leg is substantially weaker
if both legs are equally weak, stand on non dominant side
is it ok for the patient to use the walker as a brace to get up?
no, they will not be able to get their body up because they will pull the device towards themselves
what is the therapists position during ambulation
feet staggered to increase BOS
slightly behind and to the affected side
one hand on gait belt and one hand in front
why should the therapist be on the affected side?
better control of the side/limb
can better predict/control a fall
promotes neurological facilitation
contraindications of a gait belt include
recent abdominal surgery
severe cardiac/respiratory conditions
phobia regarding belts
what hand placement should the therapist have on a gait belt
supinated
not pronated and definitely not with it wrapped around the wrist
great way to break your wrist
tell me about four point gait
requires bilateral ambulation devices (2 crutches/canes)
alternate and reciprocal movement
slow but utilizes maximal stability with lower energy expenditure
when to use 4 point gait
partial weight bearing on one of the LEs
or
patient is allow WBAT or full WB but not strong enough for two point
what is the sequence of four point gait
one crutch advanced (unaffected)
contralateral leg advancement (affected)
advancement of other crutch
advancement of other leg
when to use two point gait
patient is allowed WBAT or full WB
stronger than 4 point
what is required for two-point
bilateral ambulation devices
simultaneous movement
relatively stable
faster
more coordination
pattern of two point gait
one crutch and opposite extremity move in sequence
followed by opposite crutch and extremity
allows for natural arm and leg motion
when to use 3 point gait
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
what is required for 3 point gait
bilateral ambulation or a walker
less stable
require good UE, LE and trunk strength
high energy expenditure
how is swing to different than swing thru
swing to level of device
or
swing thru past the device
what muscle involvement can a single cane or crutch decrease
gluteus medius
gait pattern with one crutch
advancement of device on contralateral side (forward and laterally)
advancement of affected LE
advancement of uninvolved LE
where would a therapist stand when practicing at steps?
toward bottom of the steps on “down” side with a wide BOS
stand on tandem steps not just one
when ascending, what is the sequence of actions
Good LE
Bad LE
Device
when descending what is the sequence of events
Device
Bad LE
Good LE
ascending with no hand rails
Good LE
Shift weight forward onto good LE
Bad LE and device at same time
if a patient’s arms are not strong enough to move themselves forward in the wheelchair, what does a therapist do to assist
one hand on lower back and one leg on knee
one side at a time
quote at the end of the power point
all truly great thoughts are conceived while walking
Friedrich Nietzsche
