PCM- AD and Guarding Flashcards
A tilt table is used when patients need to acclimate to a ________ position
upright
Tilt tables are elevated _________
Vital signs should be measured ______, ______, and _______
gradually
before, during, after
Parallel bars are used for _______ training, teaching specific ______ patterns, and support while measuring an ______
balance; gait; AD
With parallel bars, it is ____-____ degrees of ______ flexion w/ 2 inches wider than either ______ _______
20; 30
elbow
greater trochanter
With parallel bars, the top of the bar should be even with the ______ _______ or _______ crease in standing with UEs at sides
greater trochanter; wrist
________ ____s are devices that provide external support during gait training in an upright posture
Ambulatory AD
Major indications for use with ambulatory ADs:
__________ deformity, _______, injury, or disease resulting in ability to _____ weight through LEs
_______ deficits
structural
amputation
bear
balance
ADs help to increase a patient’s _______
BOS
ADs provide a method for ________ weight normally borne through LEs to UEs
redistributing
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
With Trendelenburg gait, it is due to _____ or _______
weakness; pain
Tredelenburg gait is caused by large ______ moment due to natural placement of ______
adductor; COM
Patients compensate with Trendelenburg gait by leaning over to the _______ side, this _______ the adductor moment
weaker; decreases
Left to right describe the pictures of using a walker…?
Standard position of walker
Lifting walker
Placing walker out in front
Stepping into walker
Know this
More GRF creates what???
stress on the hip joint and can lead to pelvic drop
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
Know this
Impairment or Functional Limitation:
_______
How ADs improve biomechanical function:
- Decreased WB
- Distribution of force over larger surface area
- Improved joint stability
Pain
Impairment or Functional Limitation:
__________
How ADs improve biomechanical function:
- Increased BOS
- Redirection of the line of action of forces
Weakness
Impairment or Functional Limitation:
_________ ________
How ADs improve biomechanical function:
- Redirection of line of forces
- Stabilization of uninvolved joints
Limited PROM
Impairment or Functional Limitation:
_________ ________
How ADs improve biomechanical function:
Improved efficiency of movement
Decreased Endurance
Impairment or Functional Limitation:
_________ ________
How ADs improve biomechanical function:
Increased BOS
Balance deficits
Impairment or Functional Limitation:
_____ ______ ______
How ADs improve biomechanical function:
Increased BOS
Increased WB
Impaired Motor Control
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
