Non-systems: Equipment and Devices Flashcards
A patient who has limited dexterity would benefit from which types of equipment for activities of daily living
Buttonhook. Door knob extender. Handwriting aids. Rocker knife. Socks/Shoe aid Zipper pull - pull a zipper through a loop
When are parallel bars indicated? Why are the indicated?
- Provide maximum stability/security at beginning stages of ambulation/standing.
- Proper fit: elbow flexion 20 - 25° grasp bars 4- 6 inches in front of body.
- Progress out of Parallel bar as quickly as possible to increase overall mobility and decrease parallel bar dependance
When is a walker indicated?
- Used with all levels of weight-bearing.
- Significant base of support and good stability.
- 20 - 25° of elbow flexion for proper fit.
- Types: Rolling, hemi, reciprocal (frame will bend with UE movement), folding and adjustable with breaks.
- Upper extremity attachment for seat platform and UE attachments are available.
what type of gait is used with a walker?
Walker is used with three-point gait
When are axillary crutches indicated?
- all levels of WB
- require higher coordination and use
- proper use: 6 inches in front, 2 inches lateral to patient foot
- proper size: 3 fingers below armpit, ulnar syloid at hand grip for 20-25* of elbow flexion
- ## platform attachment: good for radial N injury, not fractures
what type of gait is used with axillary crutches ?
- 2 point
- 3 point
4 point
swing to
swing through
When are lofstrand crutches indicated?
- all levels of WB
- require highest level of coordination
- proper use: 6 inches in front, 2 inches lateral to patient foot
- 20-25* of elbow flexion
- Hand cuff should be 1 -1 1/2 inches below olecranon process to not interfere with elbow flexion
what type of gait is used with lofstrand crutches ?
- 2 point
- 3 point
4 point
swing to
swing through
When is a cane indicated?
- Provides minimal stability and support for patients
- Mainly assist with balance
- Straight cane should not be used for partial weight bearing
- Small/large base canes provide larger base of support and can assist with limited WB and improve balance on unlevel surfaces
- used on opp side of involved LE
- Proper fit: handle at level of hand crease at ulnar styloid
- -20-25* of elbow flexion
what type of gait is used with stright canes ?
2 point.
4 points.
Modified 2 point.
Modified 4 points
nwb
No weight through involved extremity.
Not permitted to touch ground.
An device is required
TTWB
No weight through involved extremity toes on ground to assist with balance
An device is required
Is an assistive device required for WBAT?
May or may not be required patient determined amount of weight from minimal to full
Is an assistive device required for FWB ?
Not required at this level but may be used to assist with balance
Gaudring considerations
- stand by affected side(usually), a little behind patient
- Grasp safety belt with one hand another hand on the shoulder.
- avoid grasping arm, may be needed
- move is the lead foot forward as patient moves, the back leg should advance as patient ambulates
- Anticipate potential hazards and take appropriate precautions.
- Utilize second therapist when needed
when is a arteriography used?
- Visualize his major vessels in the body.
- Can identify arteriosclerosis, aneurysm, vascular malformation, tumors or blockages.
- X-ray imaging and injected contrast visualizes vessels.
when is a arthrography used?
Contrast dye to visualize joints structures with injected dye into the joint.
- Indirect used through by injecting dye into blood vessel to be absorbed by joint space.
- peripheral joints, Hip knee ankle shoulder elbow and wrist pathology such as ligament damage or capsular tears
when is a bone scan used, how does it work?
radionuclide is injected to show areas of high bone remodeling 2/2 osteoblast take up
- Stress fractures infection bone cancer metastasis can be shown.
- Can identify bone disease or stress fracture with as little as 4- 7% bone loss
- less expensive than PET
When are CT scans used
Noninvasive where multiple angles are taken with circular scanner.
- Many images are combined to produce cross-section images.
- Most commonly used for spinal lesions and diagnostic brain studies.
- Quick results. Used in emergency situations.
- Multiple images and structures at the same time.
- More Detailed images compared to x-ray
- highest dose of radiation than other modes
- not for pregs
electroencephalography
- epilepsy and narcolepsy
- electrodes placed on scalp and record electrical impulses of brain activity
- less effective than MRI for exact location of injury
electromyography
E activity of a selected muscle at rest and voluntary activity
floroscopy
shows motion of the body when dye is injected
- shows motion in joint of GI tract
- barium swallow study
- not for pregs
what can a lumbar puncture diagnose ?
Guillain Barre , encephalitis, meningitis
When is a MRI used?
Image soft tissue STX; muscle menisci, ligs, tumors, and internal organs
- excellent contrast detail
- no use of radiation
- safe for pregs
what is myelography?
- contrast dye used with CT, x-ray, or fluoroscopy to image spinal stxs
- spinal stenosis, herniated disc, spinal cord compression, infection and inflammation of meninges, tumors
- used for those who cant have MRI on spine
- better detail on spine than x-ray
when is a nerve conduction velocity test used
used to determine the exact extent of a nerve damage by measuring speed of E impulse
- often used with electromyography
what is PET scan
radiography and injected nucleotide are inject to ID metabolic activity
- nucleotide is attached to substance that target organ will use (glucose for the brain)
- IDs maligant tumors
Ultrasound
- image converted by sound wave, at speed at which they travel
- can be used to show real time muscle movement
- doppler US can view blood flow
- cant pass lots of adipose, bone or air (air cavity)
what can be used to ID DV, tumors, valve dysfxn or other pathology in venous system
venography
what structures are radio opaque in a xray
white, bright
absorbing X-rays
- bone
what structures are radio lucent in a xray
dark
- air
Spine corset
increases ab compression and decreases pain in low to mid back pathologies
- fabric with metal uprights
halo vest orthosis
- full restriction of cervical motion
- used with SCI
- pt wears halo until spine is stable
- invasive; ring with posts are attached to vest with skull attachment
milwaukee orthosis
realignment of spine with scoliosis
- custom
- extends from pelvis to upper chest
-
Taylor brace
thoacolumbarsacral brace
- limit trunk extension, flexion through 3 point design
(kinda looks like straight jacket w.o arms)
thoacolumbarsacral orthosis TLSO
prevent all trunk motions
- post surgical stabilization
- ridgid shell fabricated from plastic
- bivalve system is secured with velco
AFO
- ankle may be lock or not to have anterior or posterior mobility at ankle
- casted in subtalar neutral
- commonly rx’d to peripheral neuropathy, nerve lesions or hemiplegia
solid AFO
- anterior trim line to malleoli to control Ev/IN
- control DF/PF
Articulating AFO
- allows tibia to advance over foot during mid to late stance phase of gait
posterior leaf spring AFO
trim line posterior to malleoli
- asst with DF and prevent foot drop
- requires adequate medial and lateral control by patient
floor reaction AFO
asst with knee extension during stance phase via band over calf
craig scott knee akle foot orthosis
for pts with paraplegia
- allows for standing with posterior lean of trunk
HKAFO
for those who have weak hip, knee, ankle and feet
- control hip rotation, add/abd.
- heavy restricts swing tho and to pattern
reciprocating gait orthosis
derivative of HKAFO
- cable system to advance LE in gait
- when weight is shifted on to 1 side, system will advance opp LE
- maily for paraplegia
parapodium
standing frame to allow ot to sit
- pre-fab frame
- ambulation made possible by weight shift and rocking base across floor
- used in peds
when is a heel wedge used? when would it be placed on the lateral or medial side?
medial heel: to correct excess hind foot eversion
lateral heel: hindfoot inversion
- can be used for pes cavus (hind foot varus, high arch) or pes planus (flat arch, hindfoot valgus )
when is a heel lift used
- achilles tendon pathologies
- leg length discrepancy
when would a heel cushion be used?
calcaneal spur or plantar fasciitis
- decrease pain
when would a heel cup be used?
stabilize calcaneus in neutral position
- can provide some shock absorption
- calcaneal spur or plantar fasciitis
metatarsal bar or pad
relieve pressure from the MT heads by transferring onto MT shafts
- metatarsalgia
rocker bar
helps patient in terminal stance 2/2 limited foot mobility esp the great toe
relieves pressure in toe area for pain relief in that area
what is an A-line, and what are considerations for a A-line (arterial line)
- can take BP readings and blood sample without multiple needle pricks.
- Very accurate vs other BP measures
- avoid BP cuff over infusion site
- grasp IV line pole so line is a heart level
- avoid activity that places infusion site over heart for prolonged time
- exercise is possible but avoid apparatus disturbance
what is a swanz ganz catheter
pulmonary artery catheter
- inserted thro vein into pulmonary artery
avoid excess movement of head and neck
is exercise possible with a swanz ganz catheter , central venous pressure, or indwelling R cathetar?
yes
mobility may be needed to be restricted at site of insertion
What motion would be limited with intravenous feeding
shoulder flexion and ABD
- disruption in line may lead to air embolus
- when empty or disrupted, line may beep
what should be avoided with intracranial monitoring
isometric and valsalva
- neck/ hip flexion >90*
- lying down in prone
- venous drainage is maximal with head of bed elevated to 30*
- momentary increase is normal, but sustained increase should be reported
when a patient id on mechanical ventilation, what are they at risk for more
contractures, ulcers, deconditioning
what is the difference btwn a NG tube , G tube and J tube?
ng: short term feeding, meds, remove gas from stomach. can irritate throat
G tube: small incision in the stomach via ab for long term feeding for risk of aspiration, neurological or anatomic inability to swallow
J tube: jejunostomy tube inserted thro jejumun bu endoscopy, ong term feeding
where are IV usually places
basilic, cephalic, or antecubital superficial veins
- can also nutrients to be absorbed if GI cant absorb
what is a central venous pressure catheter
measure pressure in R atrium or superior vena cava
- evals R ventricular fxn
- evals R atrial filling pressure
- evals circulating volume
- reduces need for venous puncture
what is a indwelling R atrial (hickman) catheter
inserted via the internal jugular or right cephalic vein and threaded to sup vena cava or right atrium.
- longterm admin of substances into venous system; chemo, nutrients, antibiotics
how much O2 can be delivered via nasal canula
6L/min
what is a oxygen tent
canopy placed over head and shoulders to provide more O2 at higher level than normal
what is a tracheostomy mask
placed over stoma or tracheostomy for supplemental o2
held in place with strap that goes over neck
when would balanced suspension be used
- traction on a femur fx
requires pins, screws, and wires to be surgically inserted in bone for traction with external weight - reqs prolonged immobilization and can lead to skin breakdown
what should be done before removing a foley ?
a balloon attachment at the indwelling end is filled with air or liquid and must be deflated before being taken out
what does a chest tube do
- inserted in chest at side
- provides suction for air, pus or muscus
which is more commonly used for longterm mechanical ventilation support? Volume cycled ventilators OR pressure cycled ventilators
Volume cycled ventilators - predetermined amount of gas is given based off pts needs during inspiratory phase
pressure cycled ventilators are instead used with predetermined level of pressure
What is the correct way to fit/measure a wheel chair for seat height?
measure from heel to popliteal space + ADD 2 inches to allow clearance of foot rest
What is the correct way to fit/measure a wheel chair for seat depth
measure from posterior butt along lateral thigh ot popliteal fold.
SUBTRACT 2 inches to avoid pressure form front edge of seat
What is the correct way to fit/measure a wheel chair for seat width
measure widest part of butt, hips of thighs.
- allows space for bulky clothing, greater trochanters or armrest clearance
What is the correct way to fit/measure a wheel chair for back height
measure from seat of chair to floor of armpit while shoulder is at 90* of flexion and SUBTRACT 4 inches
- should be below inferior angles of scap
- consider seat cushion, have pt sit on cushion or add value to measurement
What is the correct way to fit/measure a wheel chair for armrest height
measure from seat of chair to olecranon process while elbow is flexed to 90* and add 1 inch
- seat cushion will impact measurement
Which patient type would benefit from a ultralight WC frame
Highly active
no need for postural support,
used for sports
what Patient could use a standard or light weight frame
Able to self propel using both UE.
Adequate LE ROM,
sitting ability for comfortable sitting
What is the difference between a one hand drive frame, amputee frame, hemi frame
one hand drive frame- Able to self propel with one UE
amputee frame, -Center of gravity is shifted posteriorly do the amputation, pt is able to self propel
hemi frame- Able to self propel using lower extremities
When would you prescribe a geri chair vs a power WC
Geri: Patient unable to self propel or safely operate power device. Requires assistance for seated mobility
Power:Patient not able to self propel but safely operates power device. May transfer sit or have UE functional limitations
What is the difference between reclining frame and backward tilt in space frame
Reclining frame for patients unable to shift wait or unable to sit upright for extended periods 2/2 moderate to severe trunk involvement
tilt in space for : Unable to sit upright or perform weight shift also has issue sliding or extensor tone
When would you prescribe a planer or curved head rest on a wheelchair
Planer headrest for patients with reclining or tilt in space frame who tend to maintain hyperextended positions in upright sitting.
Curb head rests for support with lateral or backward head/neck positioning
What determines which back inserts are used in wheelchair prescription
- *amount of support needed
- sling : No postural support. Pt has no neuromuscular deficit not intended for long-term use
- planar back insert: mild to moderate trunk support due to tone strength or deformity related to postural concern
- Curved back insert : moderate trunk support due to tone strength or deformity related to postural concern
- custom molded insert: Significant trunk support due to severe postural concern.
- removable insert: If WC needs to fold
- insert goes above or below inferior angle of scap: below; pt has good trunk contro. above; pt requires soem spinal support
What determines which seat inserts are used in wheelchair prescription
need for folding, support and stx deformity
when would you choose a sling, planar, curved or custom molded seat?
sling: no postural support needed, no neuromuscular deficit not intended for long-term use
planar: no seated deformity
curved: mild- aggressive support needed to increase contact btwn seat and lower body
custom molded seat: pelvic obliquity or asymmetrical deformity
when would a bevel front seat be needed for WC Rx?
pt self propels with LE
when would you need planar lateral supports or contours/curved lateral supports in WC rx?
Planar lateral supports: mild- mod support 2/2 scoliosis
Contoured/curved lateral support: totl contact lateral support for significant lateral lean or scoilosis
When would you need chest strap or chest harness in WC rx?
strap: anterior support for anterior sway
harness: trunk and shoulder support for anterior sway
When would you need removable, full, or no armrests in WC rx?
Removable- slide board, 2 person max asst transfers or need access to wheels to propel
Full- sit> stand transfer, additional support, lap board is used
No armrests- no UE or trunk support needed by pt
What is the difference btwn fixed/ non-removable arms or tubular/single post arms
single post: min support of UE, easy access to wheel to propel, easy removal
non-removable: pt requires durable UE support
would a patient with decreased UE strength need small or large diameter wheels
large: for pts with weak UE, suggested for increase of power
pts with adequte strength who need speed can have snall diameter
what type of footrests are there for WC Rx?
standard: full ROM in LE
adjustable: LE deformity
one piece footboard: supportive surface to maximize strength/ stability/ support
custom foot box: pts LE not inline with body midline. windswept deformity
what is a proportional and non-proportional control on a WC?
proportional: allows speed control based on joystick displacement 360* directionality
non-proportional- pre-set speeds regardless of joystick displacement, must relsea in order to change directions
which cushion will produce high shear force? Which is light weight?
solid cushion, typically light weight however .
An liquid/gel cushion can limit shear F, but are heavier. Air filled vary in shear F, but can be lightweight. need to monitor inflation.
what are ramp requirements by the ADA. Length? width? hand rails? landing area?
12 inches of run for every 1inch or rise
% grade = rise/run x 100
36 inches wide
hand rails if rise is > 6 inches or run > 72 inches
landing area 5ftx5ft
how wide should a doorway be?
min 32 width
max 24 depth
hallway clearance by ADA
36 inches
carpet and threshold by ADA
carpet: 1/2 pile or less
threshold 3/4 sliding doors, 1/2 inch other doors
WC turning radius for U turn by ADA
60 in width
78 in length
forward and side reach in WC by ADA
ex: to reach open door button
- low reach: 15 inch
- high reach 48 inch
side: 24 inch
how high should a toilet and bathroom sink be according the the ADA
sink: 29-40 inches
toilet: 17-19 inches from floor to toilet top
how big should a parking space be for handicap for ADA
96 width
240 length
