Supportive Devices/Gait Training Lab (10/11a) [Examination/Intervention] Flashcards
Basic guarding technique
Wide stance
Stand to side of patient, a bit behind
One hand at pt low back, one hand on anterior aspect of shoulder closest to you
Why use the basic guarding position?
If pt loses balance, you can use position to hug them close to your body
If pt knees buckle, you can hug them close to you and have them sit on your bent knee/assisted fall
Common assistive devices
Walker (standard, rolling, rollator, UE platform)
Hemi Walker
Quad Cane (wide base; narrow/small base)
Single Point Cane
Axillary Crutches
Forearm Crutches
Indications for use of an AD
Decreased ability to bear weight on LE
Decreased trunk and/or LE strength
Impaired balance
Impaired kinesthetic awareness
To offset LE pain
Levels of Weight Bearing
Full Weight Bearing
Weight Bearing as Tolerated
Partial Weight Bearing
Toe Touch Weight Bearing
Non-Weight Bearing
Full Weight Bearing (FWB)
no restrictions
Weight Bearing as Tolerated (WBAT)
allowed to put as much weight on extremity
as patient can tolerate
usually needs an AD due to pain and/or weakness
Partial Weight Bearing (PWB)
allowed to but some but not all weight on an
extremity
defined by a percentage (EX: 25%, 50%)
Toe Touch Weight Bearing (TTWB)
no weight through the limb
big toe on the
ground (helpful input for balance)
Non-Weight Bearing (NWB)
limb does not touch the ground or weight bearing surface
Sizing guide for AD
When pt standing upright with shoulders relaxed and hands placed on the hand grips, elbows should be bent 15-30 deg
Grips of AD should align with wrist creases when relaxed
Standard and Rolling Walkers - Benefits
Provide an increased base of support
Most are able to be folded for easier storage when note in use
Allow for UE platform attachments
– Used for UE weight bearing restrictions, poor UE strength (especially grip)
Allow for tray / basket attachments
Can be used for all levels of unilateral LE weight bearing restrictions
Standard Walker
Offers stability during forward body advancement for pt with a single LE NWBing status
Pt must be able to pick up the walker to advance it, having all 4 legs leave the ground at the same time and contact the ground at the same time
Rolling Walker
Pushed like a shopping cart, maintains contact with the ground at
all times
Can be used for pt with a single lower extremity WBing restriction
Pt must be able to control the forward movement of the walker to decrease risk of falls
Can be difficult for some pt to advance over changes in surfaces
Can add walker skiis for improved fluidity of transition from surface to
surface
Wheels can be fixed, or swivel
Rollator Walker
Not used with WB restrictions
Can help for pt with mild balance deficits
Very helpful for pt with endurance deficits (provides immediate seat)
Has breaks to help slow it down (pull up) and lock into place (push down)
Must be cognitively intact to safely lock/unlock the breaks during transfers
and safely control the walker
Front wheels swivel to increase ease of maneuverability
Walker - Limitations
Rather bulky and difficult to use in crowded or narrow spaces
Can lose their stability/effectiveness on uneven surfaces
Eliminate the capability for arm swing
Unless front wheels are swivel wheels, can be difficult to maneuver/change in direction during ambulation
Not functional for stair negotiation
If used improperly, can promote forward flexed posture, or posterior loss of balance
Rolling Walker Gait - Step To Pattern
walker → impaired → good matches
Good starting place for gait training, especially with WB restrictions
STEPS
1) Move walker ahead
2) Lead with impaired LE
3) Match up with non impaired LE
Rolling Walker Gait - Step Through Pattern
walker → impaired → good passes
more normalized pattern, improved fluidity
STEPS
1) move walker ahead
2) lead with impaired LE
3) step with non impaired LE, passing the placement of impaired LE
Walker Gait - NWB
Achieve NWB by flexing the hip and knee
STEPS
1) Advance walker forward
2) Bear weight down through hands, extending elbows, and
depressing shoulders
3) Unweight body enough to advance the intact LE forward
Axillary Crutches - Benefits
Can be used for all levels of unilateral LE WBing
Easier to negotiate in crowded or narrow areas
Easier to use on uneven terrain than walker
Able to be used on stairs
Wider variety of gait patterns, including 2 that incorporate modified UE swing
Axillary Crutches - Limitations
Require a much higher level of balance and coordination than walkers
Requires good UE and trunk strength and control
More difficult to for pt to free their hands for carrying objects
Axillary Crutches - Fitting
HEIGHT
- 3 finger width btwn top of axillary pad and pt’s armpit
HAND GRIPS
- 15 to 30 deg elbow bend
- has separate adjustment
POSITION
- upright, shoulders relaxed, hands on grips
- crushes 2” in front and 6” to side of pt feet
Crutches - Sit to Stand
Both crutches on impaired side
Pt at edge of chair, lean forward and use intact UE to assist in pushing to stand
Once standing, pt reaches across body with intact UE to grasp outer crutch and place on intact side
Using hand of impaired side, pt twists remaining crutch into position under impaired side
Crutches - Stand to Sit
Back of pt legs against chair edge
Reverse sit to stand directions
Reach back for chair with intact UE and slowly lower self
Crutches Gait - NWB 3 Point
Impaired LE off the floor via knee or hip flexion
Crutches held in position, body swings through
Crutches moved forward 6-8”
Bear weight down on hands, extend elbows, depress shoulders
Lift intact LE off flow and swing body through crutches, impaired LE swings forward and through
Intact LE placed in front of crutches
Crutches brought forward, repeat steps
Crutches Gait - PWB or TTWB Modified 3 Point
Partial weight through impaired LE
Advance crutches forward
Advance foot of impaired LE to line of crutches, foot flat but not full weight
Bear weight down on hands, extend elbows, and depress shoulders while bringing intact foot forward to match/slightly pass crutches
Bring both crutches forward
Crutches Gait - 4 Point
Slow gait pattern, requires coordination
Max stability bc 3 points of contact while one limb/crutch moves
Promotes reciprocal pattern with incorporating UE swing
requires 2 crutches or canes
STEPS
Advance one crutch, followed by advancement of opposite LE
Other crutch advanced, followed by opposite LE
Crutches Gait - 2 Point
faster than 4 point gait, low energy expenditure, requires coordination
allows more natural arm/leg motion
requires 2 crutches or canes
One crutch and opposite LE advance together, followed by other crutch and LE advancing together
Crutches Gait - Modified 2 Point
Similar to 2 point gait but with only one crutch or cane
Forearm Crutches (Loftstrand/Canadian Crutches)
BENEFITS
- same benefits and gait patterns as axillary crutches
- frees hands for limited use without having to drop crutch
LIMITATIONS
- requires more balance, increased UE strength, and highest level of coordination
FITTING
- arm cuff 1-1.5” inferior to olecranon process to not interfere with elbow flexion
Hemi Walker - Benefits
Widened base of support for pt with limited/no use of single UE, or who have heme-body weakness (with limited/no WB of single LE)
Flexibility of placement during ambulation
Usually has additional lower grip that can be used during sit to stand
Folds for easy storage
Hemi Walker - Limitation
Can’t be used for pt with NWB LE
Bulky
Slowed gait pattern
Step to → Step through gait pattern, doesn’t promote smooth reciprocal pattern
Not functional on stairs
Quad Canes - Benefits
For pt requiring mild added support for balance
Offsets pressure to painful/mildly weak LE when used on contralateral UE
Stays standing up on its own
Requires use of only one UE
Promotes more natural gait
Can be used on stairs
Easy to store and transport
Quad Canes - Limitations
Slower than single point cane
Compromised steadiness on uneven surfaces
Quad Canes - Gait
Flat edge of quad cane face outside of the foot of the side it’s used on
SEQUENCING
- for pt with weakness on one side, NBQC/WBQC used on intact side
- for pt with balance deficits, they may feel more comfortable sequencing quad cane with dominant side
GAIT PATTERNS
- step to
- step through
- modified 2 point
Single Point Cane (SPC)
BENEFITS
- for pt needing additional input for balance
- offset pressure of painful/mildly weak LE when used on contralateral UE
- requires use of only one UE
- promotes natural gait with minimal interruption to speed
- can use on stairs, easy to store/transport
- can use on uneven surfaces
LIMITATIONS
- smallest BOS so least stability
Single Point Cane - Gait
SEQUENCING
- for pt with weakness on one side, cane used on intact side
- for pt with balance deficits, may feel more comfortable with cane on dominant side
GAIT PATTERNS
- step to
- step through
- 2 point (2 SPCs)
- Modified 2 point
- 4 point (2 SPCs)
Elevation LE Pattern - Ascending
“Up with the good”
Lead with intact leg
Impaired leg comes up next, joining intact leg on same step
Elevation LE Pattern - Descending
“Down with the bad”
Lead with affected leg
Intact leg comes down next, joining impaired leg on same step
Stairs - With Railing Options
No AD
Single Side Crutch (axillary/forearm) → accommodates NWB to FWB
2 Axillary Crutches (both kept under one arm) → accommodates NWB to FWB
Quad Cane (turn it sideways for better fit on stairs) → WBAT
Single Point Cane → WBAT
Stairs - No Railing Options
Single Crutch (axillary/forearm) → WBAT
2 Axillary Crutches: one under either arm → NWB to FWB
2 Forearm Crutches → NWB to FWB
Quad Cane (turn it sideways for better fit on stairs) → WBAT
Single Point Cane → WBAT
2 Single Point Canes → WBAT
Gait Pattern - 2 Point
DEVICES
- bilateral ADs (canes, crutches)
WB STATUS
- WBAT
DESCRIPTION
- one AD and opposite LE move forward
simultaneously
- each step is one point and a complete cycle is two points
Gait Pattern - 4 Point
DEVICES
- bilateral ADs (canes, crutches)
WB STATUS
- WBAT
DESCRIPTION
- one AD is moved forward and placed on the floor, followed by the opposite LE
- other AD is
moved forward and placed on the floor, followed by the opposite
LE
- EX: left cane, right foot, right cane, left foot left cane…
Gait Pattern - Modified 4 Point
DEVICES
- unilateral ADs (cane, crutch)
WB STATUS
- WBAT
DESCRIPTION
- cane/crutch in one hand advances, contralateral LE advances
- ipsilateral LE advances, cane advances
- repeat
Gait Pattern - 3 Point
DEVICES
- bilateral crutches, walker
WB STATUS
- NWB
DESCRIPTION
- crutches/walker advances, pt hops forward on intact LE keeping LE NWB
Gait Pattern - Modified 3 Point
DEVICES
- bilateral crutches, walker
WB STATUS
- TTWB, PWB, WBAT
DESCRIPTION
- crutches/walker advances, pt steps forward with impaired LE, placing it down WBAT
- steps with intact LE
Gait Pattern - Step To
DEVICES
- bilateral crutches, walker
WB STATUS
- NWB
DESCRIPTION
- crutches/walker advances, LEs advance only to point of AD
Gait Pattern - Step Through
DEVICES
- bilateral crutches
WB STATUS
- NWB
DESCRIPTION
- crutches advance, both LEs simultaneously swing beyond point of AD
