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FND III > FND III - EXAM 2 > Flashcards

FND III - EXAM 2 Flashcards

1
Q

Definition of ambulation

A

Action of walking freely or move about freely; being able to walk

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2
Q

Definition of gait

A

The manner or style of walking. Can provide early diagnostic clues for a number of disorders.

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3
Q

Walking/ambulation is the process of repeated…

A

weight shifting over advancing lower extremities (COM moves out of BOS in controlled manner and BOS moves under COM)

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4
Q

Goal of gait training?

A

Determine right kind of assistance for patients to achieve the greatest mobility with the least risk of injury. Maximum functional independence and safety at a reasonable energy cost.

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5
Q

Ambulating vs. gait training

A

Ambulating: assisting patient with walking but not providing direct education and intervention to overcome gait problems

Gait training: problem solving, clinical and critical decision making to assist in improving person’s walking style or some aspect of gait

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6
Q

Normal walking has 5 major attributes

A
  1. Stability in stance
  2. Sufficient foot clearance in swing
  3. Appropriate preposition of foot for contact
  4. Adequate step length
  5. Energy conservation
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7
Q

What is a gait pattern?

A

Configuration, design, sequence of activity that could use ambulation aids during the process of instructing patients with a method of ambulation

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8
Q

Gait patterns are selected on the basis of

A 
Balance
Coordination
Weight bearing status
Muscle function
Cognitive abilities
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9
Q

History of falls questions

A

SPLATT

Symptoms experience at time of fall
Previous number of falls
Location of fall
Activity at time of fall
Time of day
Trauma associated
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10
Q

What is a tilt table

A

Mechanical lifting device used to provide patients with safe experience of gradually assuming the vertical position or down to horizontal position.

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11
Q

What should be done each time tilt table is repositioned?

A

Vital signs to indicate how they are handling new position

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12
Q

Indicators of patient intolerance to tilt table

A 
Excessive changes in vital signs
Changes in consciousness
Excessive perspiration
Pallor
Edema
Loss/decrease in pedal pulses
Nausea, dizziness
Numbness, tingling
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13
Q

What can you use to improve venous return on tilt table?

A

Abdominal binders or elastic stockings

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14
Q

Types of patients that would benefit from tilt table?

A

SCI
OH
Bedrest
Stroke

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15
Q

When can you try standing after working with a tilt table?

A

If patient can tolerate 20 min at 70 deg incline without adverse issues.

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16
Q

Indications for tilt table

A 
Facilitate weight bearing
Prevent development of osteoporosis
Improve OH
Improve pulmonary ventilation
Increase arousal levels
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17
Q

Contraindications for tilt table

A

Bilateral LE WB limitations
Unstable SCI
Unstable BP
Poor cardiac responses on EKG

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18
Q

Indications for ambulation aids

A 
Decreased ability to bear weight
Structural deformities; loss of limb; injury
Muscle weakness/paralysis
Balance disturbances, altered stability
Pain
Decreased ROM
Decreased sensation
Endurance issues
Impaired motor control
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19
Q

Purpose for ambulation aids

A

Increase BOS, add more points of floor contact
Redistribute BOS to shift weight without balance loss
Psychological support

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20
Q

Fatigue in gait training can be caused by:

A 
High energy cost with devices
Greater concentration levels
Weight of devices
Physiological response
Comorbidities
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21
Q

Energy cost: rolling vs. standard walker

A

Rolling is less energy cost

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22
Q

ADs can hold up to how many pounds? What would you use to hold more than that?

A

Up to 300 pounds. Use bariatric cane after that.

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23
Q

Concentration considerations in gait training

A

New motor learning experience
Need for visual input
Distractions
Obstacles

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24
Q

What are parallel bars used for?

A

Focus on achieving specific gait objectives; instills confidence; pre-gait activities; gait training activities; measure ADs

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25
Q

Measurement for assistive devices

A

Handles at level of greater trochanter or ulnar styloid process

20-30 deg elbow flexion

Crutches: 2 fingers below axilla
Bars: 2 fingers between hips and bars

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26
Q

If patient is FWB or WBAT, which leg do you lead with?

A

Can use either one, most patients choose dominant first.

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27
Q

What is the ATNR method of measuring a crutch?

A

Crutch height measured from elbow to opposite hand in ATNR position

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28
Q

What is the difference between a 3 pt gait and a modified 3 pt gait (according to O and S)?

A

3 pt: NWB; crutches first, then good leg

Modified 3 pt: PWB/TTWB; heel toe progression to prevent heel cord tightness; crutches-bad-good

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29
Q

Why hold cane on contralateral side?

A

Counterbalances gravitational movement of abductor muscles of weak hip; decreases compressive forces on affected side

Resembles normal reciprocal gait

Reduces forces during stair climbing

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30
Q

Why should arm be at 20-30 deg angle?

A

Arm can lengthen and shorten during gait cycle; allows this leeway

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31
Q

Look for the following problems during gait training

A 
White knuckle grip
Pain and numbness in arm/hand
Too flexed posture
Cane too far to side
Nonuse
Nonadherence
Looking down
Rocking
Slow gait
Walker wobbles
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32
Q

TTWB

A

Foot can rest on the ground for balance, but no weight bearing

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33
Q

PWB

A

20-50% body weight, flat foot on ground

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34
Q

When measuring an assistive device, a crutch or cane should be placed…

A

2 inches lateral and 6 inches anterior to the foot

35
Q

The only ADs you can use for altered weight bearing status are…

A

walkers or crutches

36
Q

Advantage of rollator walker?

A

Has a seat

37
Q

Walker attachments

A

Glides - plastic attachments in place of rubber tips on legs

Platforms - for NWB in wrist/hand

Enlarged/molded handgrips for arthritis

38
Q

Why would it be a good idea for some patients to have 2 walkers at home?

A

One for the top of the steps, one for the bottom

39
Q

Axillary crutches used…

A

to increase balance and unload a LE

Allows increased gait speed and more selection of gait patterns

Requires more upper body strength

40
Q

When to use forearm crutches

A

For patients with good upper body strength and control (less stability than axillary crutches)

Allow for greater mobility and easier on stairs when in KAFOs

41
Q

When to use a hemi cane

A

When need more stability than a regular cane but only 1 UE can be used

42
Q

Why use a cane

A

Improve balance by widening BOS and decrease load on LE joints

43
Q

When to use 2 canes

A 
Bilateral trendelenberg
Hip OA
Neuro deficits (ALS, MD, CP)
44
Q

Parallel bar activities

A 
Sit to stand
Standing tolerance
Standing balance
Weight-shifting
Forward progression of gait
Gait patterns
Turning to the strong side
45
Q

Medicare pays how much per time based unit?

A

$30.34

46
Q

Medicare’s 8-minute rule

A

Number of units billed is determined by number of minutes of gait training

  • 1 unit: 8-23 min
  • 2 units: 23-38 min

etc.

47
Q

Types of gait patterns

A 
Antalgic
Ataxic
Festinating
Trendelenberg
Hemiplegic
Scissoring
Steppage
Waddling (wide-based)
Circumducted
Narrow-based
48
Q

How wide should doors be for wheelchairs?

A

36 inches wide

49
Q

Every inch of step equals

A

12 inches of ramp

50
Q

How heavy is a lightweight w/c?

A

32 lbs

51
Q

How heavy is an ultra-light w/c?

A

17-25 lbs

52
Q

Medicare/Medicaid: home vs. community

A

Medicare only concerned for needs within the home

Medicaid concerned about community needs

53
Q

Insurances will consider new equipment if…

A

not reparable every 5 years or if pt gained or lost over 50 lbs (will pay for repairs)

54
Q

What are the 3 classification of sitters

A
  1. Hands free - maintains erect trunk position without hand support
  2. Hands dependent - uses UE support
  3. Prop sitter - needs full support and total contact of seat
55
Q

What kind of chair: if postural alignment is fixed or flexible

A

Fixed deformity - chair will need to accommodate to it

Flexible deformity - chair will need to correct it

56
Q

How to assess sitting classification

A

Sit independently and raise arms overhead

57
Q

What can be adjusted in the wheelchair to avoid sacral sitting?

A 
Seat to back angle
Hanger bar (90-70-60 deg angles)
58
Q

3 methods of pressure relief in wheelchair

A
  1. Pushup (need armrests)
  2. Lateral leans (armrests to support)
  3. Power tilt, tilt in space, or reclining chair
59
Q

Wheelchair: posterior pelvic tilt =

A

increased seat depth

60
Q

Wheelchair: scoliosis =

A

obliquity

61
Q

Wheelchair: kyphosis =

A

head position, vision

62
Q

Wheelchair: hyperlordosis =

A

decreased seat depth

63
Q

Wheelchair: hip add/IR =

A

pummel

64
Q

Wheelchair: hip abd/ER =

A

contour for legs/hip guides (lateral hip positioners)

65
Q

Wheelchair: PF contracture =

A

angle adjustable footplates

66
Q

Anatomical measurements for seated examination

A

Hip width (trochanter to trochanter) - add 1-2 inches

Buttock to popliteal fossa (seat depth)

Popliteal fossa to heel (footrest)

Chest width

Chest depth from back to front

Buttock to top of head

Buttock to scapula (manual chair) - leave superior scapula exposed

Buttock to flexed elbow (armrests)

67
Q

Considerations for a manual chair

A

Sufficient upper body strength and endurance to propel all day

Reducing the weight or increasing maneuverability of the wheelchair enhances independence

ADLs are easier in manual

Smaller, lighter, less expensive

No chronic pain in arms/shoulders

68
Q

Considerations for power chair

A

Insufficient endurance or functional ability

Need to conserve energy during long distances

Creates more independence in daily living, work, and recreation

Find access to personal or public transportation that accommodates a full-sized power chair or scooter

Power chair is wider, heavier to accommodate battery and technology

69
Q

Considerations for rigid wheelchair

A

Fewer components, better durability

Lighter weight

Fewer removable parts

Required to meet National Wheelchair Basketball Association specifications

Seat to back angle is adjustable

Need to remove wheels for loading in car

Bumpier ride

Does not fold into small package for car or plane

70
Q

Considerations for folding wheelchair

A

Compact for car and plane

Flexes to enable all 4 wheels to stay on ground when on uneven surfaces

Folded and stowed without removing parts

More moving, adjustable and removable components

May not meet needs for sports/leisure

Seat to back angle usually not adjustable

71
Q

Location of rear axle: anterior vs. posterior COG

A

Anterior: tippy, easy to reach, less stress on UE muscles

Posterior: stable but hard to reach, more stress on UE muscles

72
Q

What makes wheelchair lighter

A

Kevlar tires
Spokes
Seating system
Actual frame (aluminum, titanium)

73
Q

What affects wheelchair stability

A

Axle location and caster position
Increased camber for lateral stability
Anti-tippers

74
Q

Larger vs. small casters

A

Large: absorb forces better and can cushion the wheelchair; better over obstacles (5-8”)

Small: increase speed, harder ride, less weight, swivel more easily without hitting feet (3-4”)

75
Q

Indoor household speed

A

5 mph

76
Q

Community w/c speed

A

3-10 mph

77
Q

Obstacle climbing; large obstacles =

A

large or pneumatic casters

78
Q

Direct drive systems

A

Rear wheel drive - most common and least expensive

Midwheel drive - narrow turning radius and great for rugged outdoors

Front wheel drive - power is near front and has narrow turning base

79
Q

When does a patient fall?

A

When walking in an uncontrolled manner and COM moves far beyond patient’s BOS to be recovered

80
Q

Collapsing fall

A

Supporting structures such as legs lose their ability to support

81
Q

Angular fall

A

If COM moves too far beyond BOS in any direction, or if patient is unable to bring BOS under COM, dynamic stability is lost

82
Q

How to respond to collapsing fall

A

Move close to patient, lift on gait belt to allow pt to regain support

If not possible, help pt sit down hopefully in nearest chair

If no chair, rest pt on thigh while call for help

If pt unconscious, lower to floor keeping them close to you

83
Q

How to respond to angular fall

A

Quickly move/stand close to pt and bring COM over BOS in the diagonal

  • Pt falls forward, pull back
  • Pt falls backward, push forward
  • Pt falls lateral, shift hips back over feet
84
Q

Getting up from the floor when fall alone

A

Remain calm and assess situation

Roll over, locate nearest sturdy chair

Crawl or shuffle to chair

Kneel, then stand up using chair

Turn and sit down

Call or wait for help

FND III (5 decks)

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