transfers & functional tasks w AD - exam 1

Question 1

sit –> stand with walker

Answer 1

hips forward in seat
unaffected LE slightly posterior to affected
B hands on armrest of chair or one hand on walker one on chair/bed
trunk leans forward “nose over toes” w simultaneous push through UEs and strongest LE

Question 2

stand –> sit with walker

Answer 2

pt approaches chair and pivots on the stronger LE until back is to the chair
steps back until strongest LE is in contact with the chair
reaches with one hand at a time for the arm rest and uses UEs to control descent

Question 3

sit –> stand w/ NWB LE or forearm crutches w WBAT:
- hips moved _____ in chair
- place ____ or _______ anterior to ______ OR PT can support _______
- hand pieces of both crutches are in hand on _______ side slightly ______ of the chair
- strong side hand is on ?
- to stand:
- switch _____ to ______ once stable

Answer 3

• forward
• NWB or weaker LE; stronger LE; NWB LE
• weaker side; in front
• arm rest or supporting surface
• nose over toes. push through BUEs and stronger LE
• one crutch to other hand

Question 4

stand –> sit w/ NWB LE or forearm crutches w WBAT:

Answer 4

reverse the sit to stand process

Question 5

sit –> stand w/ cane:
- hips moved _____ in chair
- cane is placed _____
- to stand:
- if chair doesn’t have armrests:

Answer 5

• forward
• either side next to armrest
• nose over toes pushing through BUEs and LEs
• pt can use cane in hand opposite weaker LE

Question 6

when guarding on stairs or ramps, where do you stand during descent? during ascent? alternate method?

Answer 6

in front of pt
behind pt

OR place one foot on step pt is standing on and one 2 steps down

Question 7

what is recommended if no handrail is present when ambulating stairs or ramps?

Answer 7

2 people to guard

Question 8

if pt uses a walker for balance only and relatively strong, how can they go up stairs or curbs with handrails?

Answer 8

close walker and use like a 4 pt cane

Question 9

if pt uses a walker and has significant strength deficits, how do they go up stairs with hand rails?

Answer 9

use walker opened for greater stability
up with good, down with bad

Question 10

how does a patient go up stairs with handrails with bilateral canes or SPC?

Answer 10

hold both canes in one hand with other on HR
OR
hold one cane in hand holding onto HR parallel and other cane in other hand

up with stronger LE, weaker LE and canes follow

Question 11

how does a patient go up stairs with handrails using bilateral axillary crutches (pt is NWB, WBAT, or PWB)

Answer 11

hold both crutches in one hand
OR
in one hand in a “T” formation
OR
one in one hand the other parallel to the HR in the other hand

up with strong LE

Question 12

how does a patient go down stairs or curbs with handrails using a walker

Answer 12

back two legs on the same step with patient
front two legs on the step below

down with weaker LE

Question 13

how does a patient go down stairs or curbs with handrails using bilateral canes or SPC

Answer 13

hold both canes in one hand with other on HR
OR
hold one cane in hand holding onto HR parallel and other cane in other hand

down with weaker LE and canes while slightly flexing stronger LE hip and knee

Question 14

how does a patient go down stairs or curbs with handrails using bilateral crutches?
pt is NWB, WBAT, PWB

Answer 14

hold both crutches in one hand
OR
in one hand in a “T” formation
OR
one in one hand the other parallel to the HR in the other hand

down with affected LE

Question 15

how does a patient go up a curb/stairs without a handrail with bilateral canes or SPC OR bilateral crutches WBAT or PWB?

Answer 15

up with stronger LE, weaker LE and canes to follow

Question 16

how does a patient go up a curb/stairs without a handrail with bilateral crutches NWB?

Answer 16

NWB LE is held in hip ext and ER w either knee ext or flex
up with strong LE

Question 17

how does a patient with a walker get up a low curb without a handrail/

Answer 17

place walker onto curb with stronger LE

Question 18

how does a patient with a walker get up a high curb without a handrail?

Answer 18

pt backs up to curb and goes up with stronger LE
backs away from edge prior to turning around

Question 19

how does a patient go down curbs without handrails using bilateral canes, SPC, or bilateral crutches WBAT or PWB?

Answer 19

down with weaker LE and canes while slightly flexing stronger LE hip and knee

Question 20

how does a patient go down curbs without handrails using bilateral crutches NWB

Answer 20

down with crutches and affected LE

Question 21

how does a patient with a walker go down a curb without a handrail?

Answer 21

place walker onto lower surface
down with the weaker LE first followed by stronger

Question 22

you tell your patient to flex their stronger LE as AD is being lowered down. They ask you why. what do you tell them?

Answer 22

it increases support and stability and lowers your COG

Question 23

if you or your pt feel unsafe at any point, do you continue to proceed?

Answer 23

no

Question 24

how does a patient transfer to the floor with crutches?

Answer 24

shift both crutches to side of weaker LE
pt reaches to floor with stronger side UE using crutches for balance
kick involved leg out

Question 25

how does a patient get up from the floor if they use crutches?

Answer 25

side sit and grasp both crutches on side of weaker LE
push to stand using stronger LE and both hands

Question 26

how do you instruct your pt using crutches to move to the right on level surfaces?

Answer 26

position L AD to outside of L foot
position R AD 6-8 inches away from R foot
pt steps towards the R AD
reposition crutches as necessary

Question 27

how do you instruct your pt using crutches to move in a turning movement on level surfaces?

Answer 27

initially learn to pivot on the stronger side but learn both directions eventually
AD should be moved in the direction of the turn

Question 28

how does a patient with crutches get through a door if the door opens towards the pt?

Answer 28

approach at an angle facing the hinges
position body outside of where the door needs to open but close to it
shift weight to opposite LE/crutch and use hand close to the door to quickly pull it open
hand returns to crutch and crutch is placed to act like a door stop

Question 29

how does a patient with crutches get through a door if the door opens away from the pt?

Answer 29

approaches at an angle w back to the hinges
shift weight to opposite LE/crutch and use hand close to door to quickly push it open
hand returns to crutch and crutch is placed to act as a door stop
OR
pt can use body to keep door open and use side movements to get outside