Week 11- Assistive Devices; Types and Safety, Gait Patterns, Wheelchair Components and Measurements Flashcards
ASSISTIVE DEVICES: TYPES AND SAFETY
ASSISTIVE DEVICES: TYPES AND SAFETY
What are the 5 weight bearing status descriptors?
FWB (full weight bearing)
-All weight put on limb
WBAT (weight bearing as tolerated)
-“Allowed” to put full weight, may not due to pain
PWB (partial weight bearing)
-Some weight put on limb, in form of %
TDWB/TTWB (touch down/ toe touch weight bearing)
-little or no weight, foot or toes more so for balance
NWB (non weight bearing)
-No weight put through limb
Who determines weight bearing status?
Ultimately the medical doctor overseeing their care.
What things are important for guarding during gait training?
- Determine if 1 or 2 to guard.
- Stand behind and slightly to one side of pt.
- Note assist level.
- Keep BOS wide yet feet out of the way.
- Move in step with the pt.
If there is a unilateral dysfunction with an assistive device, do we want to stand on the same side or opposite of the assistive device?
Opposite
What 3 things should we be aware of when using assistive devices?
- Patient concentration
- Fatigue
- Methods of instruction
With Guarding:
- Always use a gait belt properly when necessary.
- Do not interfere with individual’s __________.
- Stay _____.
- Constantly __-_______.
- __________
- Be observant.
- Do not leave a patient _________ in standing.
- Manage all other appliances connected to patient.
- movement
- alert
- re-evaluate
- anticipate
- unattended
Precautions to gait training:
- Appropriate _________
- Safe walking _________
- Clear _________
- Place to ____ if needed
- Appropriate footwear
- Safe walking surface
- Clear pathway
- Place to sit if needed
What responses to activity should we be on the lookout for when walking?
- vitals
- S/Sx
- fatigue, SOB
Should we use clothing to guard?
NO!
If a patient has a loss of balance, what should we do?
- Stop the fall early
- React quickly and determinedly
If the patient can not recover balance, what should the PT do?
Lower patient slowly to the floor, protect head and neck.
What are the 4 levels of assistance (before a patient requires help) and their description?
Independent
-Completes task without assistance or device.
Modified Independence
-Completes task without assistance but uses some sort of device.
Supervision
-No physical assistance needed, requires cueing (due to safety, cognition, etc.)
Contact Guard (CTG or CG)
-No physical assistance needed, but hands are on the individual “just in case” or for manual cues.
What are the 4 levels that require a PT to help and their description?
Minimal Assist (min A) -Individual performs more than 75% effort Moderate Assist (mod A) -Individual performs 25%-74% effort Maximal Assist (max A) -Individual performs <25% effort Total Assist or Dependent -Individual performs 0% (unconscious, spinal cord injury, etc.)
- Minimal assist (min A) = pt performs more than __% effort.
- Moderate assist (mod A) = pt performs __% - __% effort.
- Maximal assist (max A) = pt performs
- 75%
- 25%-74%
- 25%
- 0%
What are some indications for using assistive devices?
- Correct gait deviation
- Pain
- Limited weight bearing
- Balance issues
- Promote or assist with healing
- Sensory or coordination impairment
- Structural deformity
- Muscle weakness or paralysis
- Fear?
What are the biomechanical effects of assistive devices (ADs)?
- Increases BOS
- Redistributes weight
- Provides larger “cone of stability” where the CoG can shift without loss of balance.
- Provides a redistribution of support within the wider BOS.
What are some common types of ADs?
- Parallel bars
- Walkers
- Crutches (axillary or forearm)
- Canes
- Knee walker; iwalk
What are the 3 main things that contribute to the selection of an assistive device?
- Weight bearing status
- Strength
- ROM (both UE and LE)
- If NWB, TTWB, or PWB, a __________ device is required.
- Only WBAT or FWB can use a ___________ device.
- two-handed device
- one-handed device
Why are we concerned about ROM and strength for ambulating with assistive devices?
- Do they have the ROM to even use the device.
- Strength to take weight off LE as needed.
What other factors go into the selection of an assistive device?
- Medical status (endurance, IV?, oxygen)
- Balance
- Cognitive status
- Overall mobility
- Home environment
Preperation for Gait Training:
- Review patient’s __________ to determine safety of ambulation and weight bearing status
- Evaluate patient’s strength, ROM, sensation/proprioception, balance, transfers, etc.
- Determine appropriate equipment, level of assistance and gait pattern based on your assessment
- Prepare the ___________.
- Use gait belt when ___________.
- Guard or assist patient using appropriate points of control.
- Maintain proper ____________ for yourself and patient.
- Adjust ambulation aid to ensure proper fit.
- Be flexible and open to trying other devices.
- medical record
- environment
- necessary
- body mechanics
What are a few pre-ambulation devices?
- Parallel bars
- Tilt table
When is a tilt table used?
Used on someone to get them used to being upright. (orthostatic hypotension)
What are some one-handed devices?
- Loftstrand and platform crutches
- Hemi-walker
- Quad cane
- Straight cane
What are some two-handed devices?
- Standard walker
- Rollator walker
- Tripod rollator walker
- Folding rolling walker
What are some specialized equipment?
- Platform attachments
- Cane handles
- Cane tps
- Knee walker; iwalk
Parallel Bars:
- Pros?
- Cons?
- Indications?
Pros -most supportive and easiest to learn, excellent for training Cons -can't take it with you; limit mobility Indications -training, pre-gait activities
Walkers:
- Pros?
- Cons?
- Indications?
Pros
-high degree of staility, easy to learn/use, easiest to reduce weight bearing, many designs
Cons
-may be cumbersome, difficult to use on stairs, reduces ambulation speed, difficult to store/transport
Indications
-decreased weight bearing and/or impaired balance or stability
What is the use of a posterior posture walker?
Person pulls from behind to improve posture and hip extension.
What is the use of a gait walker?
Designed to stabilize and support disabled individual to unweight them and catch them if they fall.
Axillary Crutches
- Pros?
- Cons?
- Indications?
Pros
-allow greater selection of gait patterns, increased ambulation speed, easier to use in crowded areas, fair stability, may be used on stairs
Cons
-fair stability, axillary compression, requires good balance, requires trunk and UE strength
Indications
-reduced weight bearing, good UE and trunk strength, good coordination
Forearm Crutches
- Pros?
- Cons?
- Indications?
Pros
-highly adaptable, no pressure on axillary vessels/nerves, easy to store/transport
Cons
-less stable than a. crutches, requires functional balance, requires UE and trunk strength, there are better options if decreased WB is required
Indications
-pt’s with functional balance and strength that require increased access to the environment
Cane
- Pros?
- Cons?
- Indications?
Pros
-maximum access to the environment, lots
of options for increased or decreased stability,
easy to use on stairs, easy to transport
Cons
-there are better options to limit weight
bearing, provides relatively little support, small
BOS
Indications
-pt’s that have mild weight bearing
or stability deficits
List these ADs from most stability/support to least.
- Rolling walker
- Axillary crutches
- Two canes
- Forearm crutches (Lofstrand)
- One cane
- Parallel bars
- Standing walker
- Parallel bars
- Standard Walker
- Rolling walker
- Axillary crutches
- Forearm crutches (Lofstrand)
- Two canes
- One cane
Fitting Assistive Devices General Guidelines:
- __________ check (pads, screws, tips, grip, etc.).
- Upright standing posture with ________ shoulders and elbows fully _________.
- Elbow flexion should be __-__ degrees when gripping grips.
- Confirm fit.
- equipment
- relaxed shoulders and elbows fully extended
- 20-30 degrees
Grip should be at the level of the ______ _______ ________.
ulnar styloid process
Parallel bars should have __-__ degrees of elbow flexion when the patient grips the bars 6 inches anterior to the hips. The bars should also be __ inches wider than the patient’s greater trochanters.
- 20-25 degrees
- 2 inches
Canes hand grip should be at the level of the _______________ when the tip of the cane is positioned at __ degrees ant. and lat. and the elbow is fully extended. Elbow should flex __-__ degrees when the patient grips the hand grip.
- ulnar styloid process
- 45 degrees
- 20-30 degrees
Axillary crutches grip should be at the ____________ when arm hanging down with elbow in extension, and tip of crutches at __ degrees ant. and lat.
-Elbows should flex __-__ degrees when the patient grips the hand grips. Therapist should be able to fit _______ in the axilla between the axillary pad and the patient’s axilla.
- ulnar styloid process
- 45 degrees
- 20-30 degrees
- 2-3 fingers
Forearm crutches are the same as axillary crutches except for the cuff, which should be positioned as ____ on the forearm as possible as long as it doesn’t interfere with elbow motion. The cuff should not bind, but should stay on the arm when the patient releases the hand grip.
high