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Mobility with Assistive Devices Flashcards

1
Q

What is the difference between ambulation/gait analysis/gait training?

A

ambulation: goal = distance, not necessarily worried about gait style
analysis: goal = moving safely/normal/how they are moving, not worried about distance
training: goal = teaching how to ambulate safely (with/without ambulation device)

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2
Q

What are some of the indications of needing to use a gait device?

A

pain
weakness/balance impairment
decreased endurance/exercises tolerance
fear of falling
WB on one side is contraindicated/not possible/has restriction

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3
Q

What is the #1 predictor of falling?

A

patient has had a fall in the last 6 months

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4
Q

What is the #2 predictor of falling?

A

fear of falling (whether from inactivity/shrinking of lifestyle creating LE weakness, etc.)

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5
Q

What are the two main mechanisms in which gait devices facilitate mobility?

A

redirect body weight from the affected limb to the normal limb
increase stability by increasing base of support

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6
Q

What is the definition of base of support?

A

all points of contact around patient, including ambulation device

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7
Q

How do we assess or know about a patient’s gait impairments?

A

verbal report from healthcare professional/patient
chart review
knowing about pathology (hip fracture, stroke, etc.)
watching the patient ambulate before your intervention/observation in patient’s room

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8
Q

what are the major muscle groups used for ambulation with assistive devices in the trunk?

A

scap depressors/stabilizers
trunk extensors and trunk flexors (for stability)

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9
Q

what are the major muscle groups used for ambulation with assistive devices in the UE?

A

shoulder flexors/extensors
elbow extensors
finger flexors (grip)

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10
Q

what are the major muscle groups used for ambulation with assistive devices in the WB LE?

A

hip abductors/extensors
knee extensors
ankle dorsiflexors

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11
Q

what is the first thing to determine when evaluating a patient for an assistive device?

A

WB status

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12
Q

are we allowed to change the WB status of a patient?

A

no

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13
Q

what is NWB?

A

non-weight bearing

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14
Q

what is TTWB/TDWB/FeWB?

A

toe-touch weight bearing
touch-down weight bearing
feather weight bearing

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15
Q

what is PWB?

A

partial weight bearing (typically given % of BW)

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16
Q

what is WBAT?

A

weight bearing as tolerated

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17
Q

what is FWB?

A

full weight bearing

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18
Q

is the patient allowed to transmit weight through affected extremity during NWB gait?

A

no

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19
Q

when patient is NWB, what is the best way to ensure the patient does not transmit weight through the leg?

A

have the patient flex the knee (if LE) to keep it off of the ground
if in a straight leg cast, just need to monitor the foot being off of the floor

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20
Q

why is TTWB/TDWB/FeWB safer than NWB?

A

allows the patient to use affected limb for balance, less chances of a fall or accident

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21
Q

how can you enforce the patient using TTWB,TDWB,FeWB?

A

use the reference on a potato chip/egg shell being underneath the foot when stepping

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22
Q

what is a common issue seen when a patient uses TTWB gait pattern for a prolonged period of time?

A

calf tightness

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23
Q

what is the range of typical % used when prescribed PWB?

A

between 20-50% of BW

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24
Q

what is the best and most cost effective way to enforce % of PWB?

A

using a scale and asking patient to put x% of BW force through extremity

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25
how does a limb load monitor work?
footwear with a monitor attached, provides auditory feedback if the patient transfers too much weight into the affected limb
26
in addition to the patient's medical condition, your assessment, and expected prognosis... what else should be considered when choosing a gait device?
patient's needs/abilities/preferences what the patient wants/setting (indoor/outdoor) short and long term goals
27
what is the typical weight capacity of standard gait devices?
up to 300 lbs
28
what is the typical weight standard of bariatric gait devices?
500 lbs
29
list the common types of gait devices in order from most stable to least stable:
parallel bars walker axillary crutches forearm crutches cane in both hands hemiwalker quad cane single point cane no gait device
30
what are some pre-gait exercises that can be performed in the parallel bars?
shifting weight anterior/posterior hand placement single-hand support (claps) hip hikes step ups stepping forward/backward/side-to-side forward progression/turning
31
when the patient is in the parallel bars, where should the therapist/gait device be in relation?
therapist in front, wheelchair behind
32
front-wheel walkers are best for which kinds of patients?
those with a gait that is too fast for a standard walker or have a difficult time lifting a standard walker
33
when would platform walkers be utilized?
patient has a NWB restriction of an UE arm weakness
34
what is the main purpose of a four-wheeled walked/rollator?
increase the patient's endurance/ambulation distance
35
u-step walkers are typically utilized when patients are diagnosed with what conditions?
Parkinson's ALS MS TBI other balance disorders
36
what are the advantages of a walker?
lightweight may/may not fold offers the greatest stability 4 points of contact = wide BOS provides sense of security easily adjustable
37
what are some disadvantages of a walker?
cumbersome difficult to store difficult/impossible to use on stairs decreases speed of ambulation impedes normal gait pattern often too wide for narrow spaces
38
what are some advantages of axillary crutches?
greater selection of gait patterns greater ambulation speed easy to store and transport maneuver in crowded/narrow spaces can be used on stairs
39
what are some disadvantages of axillary crutches?
less stable than a walker can cause injury to axillary nerve require good standing balance patient may feel insecure requires function UE/trunk strength
40
what are some advantages of forearm crutches?
eliminates potential of axillary structural damage even more functional on stairs/tight spots allows use of hands more cosmetic fits into cars easier
41
what are some disadvantages of forearm crutches?
less stable requires even greater UE/trunk strength requires greater standing balance difficult to doff due to forearm balance not for the elderly typically cost more than axillary crutches
42
when would a hemiwalker typically be utilized?
patient requires continuous WB on only one arm patients with hemiparesis with moderate/severe loss of LE function
43
what is the main advantage of a quad cane?
can stand upright on the floor when not in use
44
what is the main disadvantage of using a quad cane?
all legs of the cane need to contact the floor simultaneously
45
what WB status must a patient have in order to use a single point cane?
FWB
46
what are the advantages of a cane?
more functional on stairs/tight areas inexpensive stored/transported easily can mimic normal gait patterns
47
what are the disadvantages of a cane?
limited support two canes do not provide sufficient support for a 3-point gait pattern
48
when fitting a gait device, ensure the patient is wearing _______
typical footwear
49
what is the proper fitting of the parallel bars in reference to the patient?
bars level patient's elbows at 20-30 degrees bars 2" wider than the width of the hips height of bars at greater trochanter or ulnar styloid
50
what is the proper fitting of a walker in regard to the patient?
patient standing within BOS of walker hand grips level with ulnar styloid elbows flexed 20-30 degrees
51
what is the proper fitting of axillary crutches?
tripod position (2in to side, 6in in front) fit 2 fingers under axilla handle at ulnar styloid with arms down
52
what is the proper fitting of forearm crutches?
can be measure standing or supine handgrip height at greater trochanter forearm cuffs 1-1.5" below olecranon elbows flexed 20-30 degrees
53
what is the proper fitting of a cane?
tip just lateral to toes handgrip at ulnar styloid elbows 20-30 degrees of flexion
54
what are some common errors while fitting a device?
elevated/hunched shoulders slump forward measure without shoes not in tripod position too much wrist flexion/extension
55
what are the steps in performing a sit to stand with gait device?
lock breaks of wheelchair scoot forward hold w/c arm rests push off to stand up (nose over knees)
56
what are some ways a patient can compensate a sit-to-stand?
patient getting momentum patient putting legs on the back of a chair to get a force couple patient bringing knees together patient placing hands on the thighs
57
once the patient is standing, what things should you check before moving?
ensure static balance ensure patient is not dizzy/nauseous/extreme pain ensure feet are hip width apart re-check height of walker/crutch/cane pre-gait activities
58
what is the rule of thumb in regard to pain scale?
if >6/10, do not walk
59
what is the therapist's position during ambulation?
standing slightly behind on involved side while holding gait belt and guarding at the shoulder
60
when should you utilize a 4-point gait pattern?
patient is allowed PWB on one LE patient is allowed WBAT or full WB but not strong enough to try two-point gait
61
what is the 4 -point gait sequence?
crutch contralateral to affected limb advance affected limb crutch ipsilateral to affected limb advance strong limb
62
what is the sequence of two-point gait?
contralateral crutch/affected limb simultaneously ipsilateral crutch/strong limb simultaneously
63
when do you utilize 2-point gait pattern?
patient is allowed WBAT or FWB and ready to progress from 4-point
64
when do you utilize 3-point gait pattern?
patient has NWB/PWB in one LE, or WBAT but needs stability
65
what is the sequence of 3-point gait?
both crutches/walker bad leg good leg
66
what is swing-to gait?
extremity swing to the point of the device
67
what is swing-through gait?
extremity swing past the point of the device (requires crutches)
68
what gait pattern should you use to go up the stairs?
GBA
69
what gait pattern should you use to go down the stairs?
ABG
70
quote at the end of the ppt???
all truly great thoughts are conceived while walking. -friedrich nietzsche
71

Patient Care Skills (6 decks)

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