PCM- AD and Guarding Flashcards by Siva Pye

A tilt table is used when patients need to acclimate to a ________ position

upright

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Tilt tables are elevated _________

Vital signs should be measured ______, ______, and _______

gradually

before, during, after

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Parallel bars are used for _______ training, teaching specific ______ patterns, and support while measuring an ______

balance; gait; AD

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With parallel bars, it is ____-____ degrees of ______ flexion w/ 2 inches wider than either ______ _______

20; 30
elbow
greater trochanter

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With parallel bars, the top of the bar should be even with the ______ _______ or _______ crease in standing with UEs at sides

greater trochanter; wrist

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________ ____s are devices that provide external support during gait training in an upright posture

Ambulatory AD

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Major indications for use with ambulatory ADs:

__________ deformity, _______, injury, or disease resulting in ability to _____ weight through LEs

_______ deficits

structural

amputation

bear

balance

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ADs help to increase a patient’s _______

BOS

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ADs provide a method for ________ weight normally borne through LEs to UEs

redistributing

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ADs help create an additional force that keeps the pelvis level in the face of ________ tendency to ______ the hip during a _______ stance

gravity’s

adduct

unilateral

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With Trendelenburg gait, it is due to _____ or _______

weakness; pain

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Tredelenburg gait is caused by large ______ moment due to natural placement of ______

adductor; COM

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Patients compensate with Trendelenburg gait by leaning over to the _______ side, this _______ the adductor moment

weaker; decreases

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Left to right describe the pictures of using a walker…?

Standard position of walker

Lifting walker

Placing walker out in front

Stepping into walker

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Know this

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More GRF creates what???

stress on the hip joint and can lead to pelvic drop

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With cane’s force substitutes for the hip abductors:

Transmits part of the body _____ to the _____—-> which decreases the _______ force required for balancing

weight
ground
muscular

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Know this

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Impairment or Functional Limitation:
_______

How ADs improve biomechanical function:
- Decreased WB
- Distribution of force over larger surface area
- Improved joint stability

Pain

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Impairment or Functional Limitation:
__________

How ADs improve biomechanical function:
- Increased BOS
- Redirection of the line of action of forces

Weakness

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Impairment or Functional Limitation:
_________ ________

How ADs improve biomechanical function:
- Redirection of line of forces
- Stabilization of uninvolved joints

Limited PROM

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Impairment or Functional Limitation:

_________ ________

How ADs improve biomechanical function:
Improved efficiency of movement

Decreased Endurance

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Impairment or Functional Limitation:

_________ ________

How ADs improve biomechanical function:
Increased BOS

Balance deficits

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Impairment or Functional Limitation:

_____ ______ ______

How ADs improve biomechanical function:
Increased BOS
Increased WB

Impaired Motor Control

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Impairment or Functional Limitation: _____ _____ ______ How ADs improve biomechanical function: Increased BOS

Fear of Falling

Walkers provide a large degree of _______

stability

Walkers are for patients with: Generalized _________ __________ conditions Need to reduce _____ in one or both LEs Poor ________/________ Inability to use ________

weakness Debilitating WB balance; coordination crutches

Axillary crutuches: Provide ________ stability Requires more ________ than walkers Takes substantial amount of ______

moderate coordination energy

Axillary crutches are chosen for patients with: __________ in one or both LEs Impaired _________ Need for _______ support Permits ____-____% WBing support

Weakness balance trunk 80; 100

Foreram (Lofstrand) Crutches provide more ______ of movement but less _____ support than axillary crutches

ease trunk

Foreram (Lofstrand) Crutches Frees ______ without having to drop the crutch

hands

Canes are chosen for pts with: _______ LE weakness Require slight WB _______ Impaired _________

Minimal reduction balance

Quad canes: Used by patients with limited or no use of _______ as with hemiparesis Slightly _______ Has _____ points on the ground

UEs heavier 4

________ is the status of the involved LE not to be WB touching the floor

NWB

_______ is the status of the patient being able to rest toes on the floor for balance, but cannot WB

TTWB

________ is the status for limited amount of WB tolerated; EX: 25% WB

PWB

_______ is the status of the patient being allowed to place as much or as little weight through the involved LE depending on tolerance

WBAT

Which device is the most stable of the unilateral devices?

hemi walker

Most to least stable of walkers?...

Standard Rolling/Front Wheeled/2 Wheeled Rollator or 4 Wheeled Walker

ADs for stability -----> mobility?

parallel bars walker B axillary crutches B FA crutches B canes Hemiwalker Quad Cane Single-point cane

Parallel bars and walkers are good for increased _______

BOS

PWB is good for which ADs? (3)

Parallel bars Walkers B crutches

NWB and TTWB is good for which ADs? (3)

Parallel bars, walkers, and B crutches

WBAT is good for which ADs? (3)

Parallel bars Hemiwalkers Single point cane or crutch

Improper fit of AD will lead to: Decreased _____ Decreased ______ Decreased ______ Increased ________ expenditure

Stability Function Safety energy

Fitting a walker: Determined in _____ or ______ Shoes ______ be worn Hand grip at the level of pt's: ______ crease ______ styloid process greater _________

standing; supine should wrist ulnar trochanter

Fitting Axillary Crutches: If you know the height.... multiply by ____% or subtract _____ inches from height Resulting measurement is theoretically the overall ______ length

77; 16 crutch

Fitting Axillary Crutches: PT in supine- Use a tape measure to measure the distance from the ______ fold to ___-_____ inches lateral to heel

axillary 6; 8

Fitting Axillary Crutches: Pt in seated- UEs _____ at shoulder level One ______ extended, one flexed to _____ degrees Measure distance between ______ finger of extended ______ and ______ process of flexed elbow

abducted elbow 90 middle elbow olecranon

Fitting Axillary Crutches: Fit confirmed with patient in standing- Tips should be positioned ____ inches laterally and ___-____ inches anterior to toes of shoes

2 4; 6

Fitting Axillary Crutches: Hand piece height: Patient in supine- from _____ _________, _____ crease, or ______ styloid process to heel of shoe

greater trochanter wrist ulnar

Fitting Axillary Crutches: Hand piece height: Alternate method- From _____ axillary fold to _____ trochanter or ______ styloid process Use this to measure from axillary _____ to the hand _____

anterior greater ulnar rest piece

Fitting Axillary Crutches: When crutches are in tripod position: Pt. should have approx ___-____ degrees elbow flexion with relaxed shoulders ______ fingerbreadths should be present between _____ rest and ______ for the axilla

20; 30 2 axillary bottom

Fitting canes can be determined in standing or supine: Standing: Place cane parallel to _____ and ______ with foot of the cane on the ______ or at the bottom of the heel of shoe Hand piece should reach _____ crease, ______ ______, or ______ styloid process

femur; tibia wrist greater trochanter ulnar

Fitting canes can be determined in standing or supine: Supine: Use a tape measure to measure from the ______ ______ to heel with hip and _____ straight

greater trochanter knee

Fitting canes can be determined in standing or supine: Fit confirmed with patient in standing: Tips should be positioned ____ inches laterally and __-___ inches anterior to toe of shoes

2 4; 6

Fitting forearm crutches: Same as _____ measurement for height and handpiece Forearm cuff- top of the cuff should be ___-_____ inches distal to the ______ process when the pt. grasps the hand piece with _____ in neutral

cane 1; 1.5 olecranon wrist

Fitting forearm crutches: Fit confirmed w/ pt in standing Tips should be positioned ___ inches laterally and __-___ inches anterior to toe of shoes

2 4; 6

When guarding, you should stand slightly to _____ _______ and _______ the patient

one side behind

When guarding in _____ stance: The ______ foot should be ______ the assistive device and the patient's foot; other foot _____ when you walk

stride outside behind trails

When guarding, you want to stand on the side where the patient is most likely to ______

fall

With guarding, there should be a ______ grip with gait belt and other hand on the patient's _____ or ________

underhand shoulder chest

With guarding and a underhand grip, you want which muscles engaged?

biceps triceps pecs

With guarding on level surfaces: Stand behind patient and slightly to ______ side One hand on gait belt with ________ grip Other hand resting on patient's _______

weaker supinated shoulder

With guarding on level surfaces, the PT's stance should be staggered: ________/________

anterior posterior

With guarding on level surfaces, advance the ______ foot with assitive device and the trailing foot moves when the _____ moves

front PT

Guarding during LOB: Balance lost forward - Pull ______ on gait belt - Other hand pulls trunk _____ and ______ - May need to push forward on ______ as pull back on the trunk

back upward; back pelvis

Guarding during LOB: Balance lost backward - Push ______ on pelvis and trunk

forward

Guarding during LOB: Balance lost to one side (away from PT) - Pull gait belt towards ______

you

Guarding during LOB: Balance lost to one side (towards PT) - Turn _____ so that you face patient's side - Widen ______ - Use body to ______ patient

body BOS support

Guarding during LOB and can't control fall: Balance lost forward: Instruct patient to let go of _____ Firmly, but slowly, pull ______ on gait belt and avoid excessive ______ Step ______ with _______ foot to control descent If possible, instruct patient to cushion fall by ______ elbows and _______ to one side Instruct patient to turn ______ to one side and avoid injury to ______

AD back force forward outside bending rolling head face

Guarding during LOB: You're not trying to stop the fall, but instead _______ it down to give enough ______ for important structures to be __________

slow time protected

When choosing an AD, you should match the _____ and ______ of the patient with the qualities of the device

needs; abilities