S1_L1: Intro to Assistive Devices Flashcards
What is the most basic and stable assistive device (AD)?
Parallel bars.
It is the first AD given to pts who are prescribed with amb training.
In the criteria for AD measurement, what is the position of the pt’s elbows?
Patient’s elbows should be maintained at 20-30° flexion.
Landmark/s for height of assistive devices
At the level of the pt’s greater trochanter, the wrist crease, or the ulnar styloid process with the arm straight along the side.
Minimum muscle grade requirement for reciprocal gait pattern & 2-point gait pattern
iliopsoas gr. 3/5
PT’s position during stair ascent
PT is behind posterolateral to
involved side
Standard cane handle that is :
• more stable since it distributes the weight when the pt is weight-bearing on the cane
• balances out the Ground Force Reactions when bearing weight on the device
J-point handle
Type of cane that is useful for stair negotiation and is narrower and higher in terms of BOS
Small Based Quad Cane (SBQC) /
Narrow Based Quad Cane (NBQC)
Percentage of support a walker provides
At least 75%.
25% will come from the patient
What is the cane generally used for?
Pain relief
Stair Climbing Walker Considerations
During stair ascent: (1)
During stair descent: (2)
- Anterior leg is shorter than posterior leg.
- Anterior leg is longer than posterior leg.
The best assistive device for patients with stroke
Hemi Walker / Hemi Cane
Reason: For use with one hand only. The other walker types are impractical because they could not hold the other handlebar and these will be heavy for them.
What happens if the assistive device height is too low?
Excessive trunk flexion.
In axillary crutches, prolonged leaning on the —- bar can result in
vascular and/or nerve damage on axillary space.
Axillary
Differentiate the following,
Step to: (1)
Step through: (2)
Step to: LE do not go beyond the line of the AD
Step through: Both AD and bad LE advances forward, while the good LE goes beyond the line of AD
The highest progression in terms of assistive device
prescription.
Canes
Type of cane that is more stable, but does not fit in the stairs.
Wide Based Quad Cane (WBQC)
Gait pattern in using a walker
Walker → Involved / weak leg → Uninvolved / strong leg
What happens if the height of the axillary crutches is too high?
Trunk extension and excessive compression on the axillary space that hits the neurovascular structures.
Structure/s that can possibly be damaged by prolonged leaning on the axillary bar.
Axillary artery and radial nerve
Assistive device for pts with difficulty initiating movement (i.e. bradykinesia, apraxia)
Rolling (Wheeled) Walker
What assistive device will you prescribe to pts with rheumatoid arthritis, wounds or burns on the hands?
Forearm platform crutch
Reason: Allows WB on the forearm and it is used for patients who are unable to bear weight through their hands and wrists.
TRUE OR FALSE: The tip of the cane should be placed 5 inches lateral to the 5th toe.
False. It should be placed 6 in. lateral
AD that provides 50% of support to the pt.
Crutches
TRUE OR FALSE: In pts with PWB, the 2-point gait pattern and modified 3-point gait pattern can be prescribed.
True.
Gait pattern prescribed if one of the pt’s leg is PWB.
Modified 3-Point OR 3 One Point Gait Pattern
and 2-point gait pattern
TRUE OR FALSE: WB should be on the grab bar and not on the axillary bar.
True
Proper way of positioning the crutch and the lofstrand crutch in standing position to make the pt stable:
The tip of the crutch should be (1) and (2) in relation to the big toe.
1) 2” forward
2) 6-8” lateral
A pt can progress from walkers to crutches if:
1) and 2).
1) If pt will not benefit anymore from a walker
2) Pt now has a good to normal balance and tolerance. They are able to be challenged when standing.
A pt can now progress from parallel bars to walkers if:
1) and 2)
1) Once the pt is able to maneuver inside a parallel bar
2) Pt has good standing balance and tolerance
In using a cane, how much effort should the pt. provide?
75%
TRUE OR FALSE: In the parallel bars, the pt stands erect & grasps the bars approx. 6” anterior to hips and the bars should be approx. 2” wider than the pt’s greater trochanters when centered between the bars.
True.
Source: Pierson & Fairchild
TRUE OR FALSE: Instruct the pt to pull on rather than push down on the parallel bars while ambulating.
False. Pt should push down on the parallel bars.
Source: O’ Sullivan
Assistive device for patients with debilitating conditions, fair balance or LE injury if crutches is precluded d/t balance problems.
Walkers
TRUE OR FALSE: Walkers give the patient greater medial & posterior stability.
False. They provide greater lateral & anterior stability.
This type of walker sacrifices stability and promotes mobility.
Folding (Collapsible) Walker and Rolling (Wheeled) Walker.
For pts with a known degree of postural instability (e.g. Parkinson’s disease), this type of walker should not be prescribed.
Rolling (Wheeled) Walker
TRUE OR FALSE: The stair climbing walker has two anterior extensions and additional hand grips off of the rear legs for use on stairs.
False. It has two posterior extensions.
TRUE OR FALSE: Reciprocal walkers are hinged and allow advancement of one side of walker at a time. These walkers provide a high level of stability and a sense of security for patients fearful of ambulation.
True. Source: O’ Sullivan
TRUE OR FALSE In using a walker with PWB:
Move the walker out to arms length, then move the PWB limb forward. The body weight is transferred partially to the PWB limb and partially through the UEs to the walker.
Afterwhich, the uninvolved limb is moved forward past the PWB limb.
True.
PT’s position during stair descent
PT is in front anterolateral to the involved side.
TRUE OR FALSE: In gait patterns, the stronger leg is always posterior to the weaker leg.
True
Walkers provide — degree of stability, while crutches provide — degree of stability.
Walkers - maximal, Crutches - moderate
How to measure the crutch measurement quickly during injury or in emergency situations?
- One arm: Shoulder abd, elbow flex
- Other arm: Shoulder abd, elbow extend
- Measure from the olecranon process of the bent arm to tip of the contralateral 3rd finger
Type of crutch that is given to pts who have SCI with affectation and weakness from pelvis down and has no problem with the upper trunk.
Forearm / Lofstrand / Canadian Crutches
TRUE OR FALSE: In measuring Lofstrand / Canadian crutches, the cuff should cover the distal third of the forearm.
False. The cuff should cover the proximal third of the forearm. It should also be 1-1.5” below the elbow / olecranon process.
TRUE OR FALSE: The axillary crutches provide increased upper extremity WB over the Lofstrand / forearm crutches.
True. For this reason, functional strength of the upper extremities and trunk muscles is required to use the axillary crutches. (Source: Pierson & Fairchild)
Case: Pt. is dx c (R) hip osteoarthritis. You are considering to prescribe a cane. However, you noticed that the pt walks with less balance and stability. What can you prescribe instead?
Quad cane. Reason: It has four contact points with the ground that makes it much more stable than the standard, single point cane.
Assistive device that provides limited stability and unweighting, but provides a lot of mobility to the pt?
Canes
PT’s position to guard a pt. on a level surface?
PT is posterolateral at the involved side
Provide the stair climbing pattern during:
1) Ascent
2) Descent
1) Ascent: Uninvolved LE → AD → Involved LE
2) Descent: AD → Involved LE → Uninvolved LE
TRUE OR FALSE: In Four Point Gait Pattern, the AD and opposite LE advance alternatively.
True
TRUE OR FALSE: In Two Point Gait Pattern, the AD and opposite LE advance simultaneously.
True
Which gait patterns make use of only one AD (i.e. one cane or crutch)?
Modified Two-Point & Modified Four-Point
Gait pattern that provides a slow stable gait as 3 points of the floor contact are maintained.
Four-point gait pattern
Also known as the Step To / Step Through Gait Pattern
Three-point gait pattern
TRUE OR FALSE: Modified 3-point / 3 One point gait pattern is for pts with PWB of one leg, while 3-point gait pattern is for pts with NWB of one leg.
True
Gait pattern that is taught to pts with only one functional UE or if one LE is affected (e.g. stroke pts)
Modified 4-point gait pattern
TRUE OR FALSE: In modified 4-point and modified 2-point gait patterns, the assistive aid is held in the hand opposite the affected LE.
True.
TRUE OR FALSE: Weight bearing status in modified four-point and modified two-point is weight bearing as tolerated (WBAT).
True
CASE: 81 y/o female diagnosed with multiple sclerosis. at present, she has 3/5 muscle strength on (B) LE with fair standing tolerance and balance. What AD will you prescribe?
Walker.
If she has weak UE, you may prescribe rolling (wheeled) walker (easier to move it around)
Which of the following may lead to severe back & neck pain?
A. an AD that is too short
B. an AD that is too high
A. Too short.
Reason: Excessive trunk flexion, stress on back
TRUE OR FALSE: Guarding
One of the therapist’s hands is placed posteriorly on the guarding belt and the other anterior to, but not touching, the pt’s shoulder on the weaker side.
True. Source: O’ Sullivan
TRUE OR FALSE:
In the swing to gait, there is forward movement of both crutches simultaneously, weight is shifted onto the hands, and the LEs swing beyond the crutches.
False. LEs swing within the line of the AD (crutches)
Source: O’ Sullivan
TRUE OR FALSE: In the swing through gait, the crutches are moved forward together, weight is shifted onto the hands, and the LEs are swung beyond the crutches.
True. Source: O’ Sullivan
What grip is always used when grasping the guard belt?
Underhand grip. Source: O’ Sullivan
Pt must have good standing balance and tolerance and stability if this type of walker is to be prescribed, as it sacrifices stability.
Folding (Collapsible) Walker and/or Rolling (Wheeled)
In pts with pelvic obliquity where the greater trochanter is unleveled, what criterion should be used instead?
Elbows maintained at 20-30° flexion
Used to initiate and make the pt aware of a good standing posture
Parallel bars
TRUE OR FALSE: It may be difficult to perform a normal gait pattern using a walker
True
Walker with its legs farther from the patient’s body angled to maintain
floor contact and to improve stability
Hemi walker
Sequence of Modified 4 point gait pattern
Weight bear on AD > bad leg > good leg > AD
Sequence of Modified 3 pt gait pattern
Both AD + opposite PWB leg > good leg
Sequence of Modified 2 point gait pattern
Good leg > (WBAT) bad leg + AD
Sequence of 3 point gait pattern
both AD + NWB LE → unaffected LE
Sequence of 4 point gait pattern (Right AD goes first)
right AD → left LE → left AD → right LE
Sequence of 2 point gait pattern (Left AD goes first)
Left AD + Right LE → Right AD + Left LE
TRUE OR FALSE: Parallel bars are used for balance training, to teach specific gait patterns, & to provide support while measuring an assistive device
True
Source: Pierson & Fairchild
Walker that facilitates walking as a continuous movement sequence
Rolling (Wheeled) Walker
When axillary crutches (as well as forearm crutches) fit
properly, the patient’s stance should form a triangle of the
crutch tips and the patient’s foot or feet
This stance is called?
Tripod Position / Stance
Source: Pierson & Fairchild
TRUE OR FALSE: The most functional type of crutch for stair climbing
activities for individuals wearing bilateral
knee-ankle-foot orthoses (KAFOs) is the forearm platform crutch
True
Rubber crutch tips are (1)— in diameter
- 1.5 inches
