Exam 3 Flashcards
(102 cards)
1
Q
Gait
A
- more detailed aspects of walking instructions
- takes skill
- how to do heel to toe push off, weight shifts, up and down stairs, doorways, etc
2
Q
Ambulation
A
- just walking around with patient
- not something to be paid for
- no skilled intervention
3
Q
NWB
A
- non weight bearing
- no weight allowed on LE
4
Q
TTWB & TDWB
A
- toe-touch weight bearing
- toe-down weight bearing
- foot may touch or rest on the floor for balance, but no weight can go through the foot
5
Q
PWB
A
- partial weight bearing
- usually a percent of body weight from 20-50%
6
Q
WBAT
A
- weight bearing as tolerated
- patient determines how much weight to put on the LE
7
Q
FWB
A
- no limitation on weight bearing status
8
Q
Who decides the weight bearing status
A
- physician, not you
- must track down physician if not in chart
9
Q
Reasons to protect a limb from full WB
A
- healing after a fracture, surgery
- protection of a joint during an inflamed status
- decrease in pain with pressure on joint
- for every pound of weight loss, there is 4lbs less pressure on knee jt
10
Q
Methods of monitoring weight bearing status
A
- bathroom scale
- limb-load monitor
- computerized monitor
11
Q
Bathroom scale method of monitoring WB status
A
- pos: cheap and most common method
- neg: must have a static position, need two similar ones
12
Q
Limb load monitor method of WB status
A
- pos: can do dynamic training, low in cost
- neg: not the person’s own shoe, hard to find a shoe that matches the height
13
Q
Computerized monitor of WB status
A
- pos: dynamic, uses patient’s own shoes
- neg: expensive
14
Q
Patient assessment for ambulation aids
A
- safety
- impaired balance
- alteration in coordination movements
- pain during WB
- absence of lower extremity
- altered stability
15
Q
Outcomes of ambulation aids
A
- improve functional mobility
- allow LE weight bearing adjustments to assist with fracture healing, etc
- safety
16
Q
Preparing for ambulation
A
- review medical chart
- assess patient’s ROM, muscle performance, sensation, balance/coordination, cognition
- make sure they know how to use ambulation aid properly
17
Q
Pre-ambulation considerations
A
- assistive device selection
- amount of PA needed
- safety 1-2 person PA
- gait belts
- patient’s tolerance/vitals
- cognition/ability to follow commands
18
Q
Ambulation aids
A
- tilt table
- standing frames
- parallel bars
- platform walkers
- walkers
- rolling walkers
- crutches
- standard cane, LBQC, SBQC, hemi-walker
- age, physical ability, balance, and activity help determine
19
Q
Tilt Table
A
- orthostatic hypotension
- check BP and HR
- abdominal binder
- elastic thigh - or - knee-high stockings (TED hose)
- E-stim
- may help manage spasticity
20
Q
Indications to use tilt table
A
- SCI
- LE amputees
- obese
- prolonged bed rest
- if BP drops when sit up all way
21
Q
Standing Frames
A
- same indications and considerations as tilt table
- very variable
22
Q
Parallel Bars
A
- maximal stability, support, safety
- confidence booster
- pre-gait and gait activities
- adjustable height and width
- limited length
- constant turning around
- helps with weight shifting
23
Q
Platform walkers
A
- use when need significant trunk support
- very weak LE muscles
24
Q
Muscle strength testing
A
- scale 1-5 (low to high)
- 1 = can see muscle contracting/trying but little to no movement of extremity
- 2 = can’t do movement against gravity
- 3 = can do movement without resistance
- 4 = use moderate resistance and can still hold
- 5 = normal strength, can hold against resistance and can take maximal hold
- need at least 4 to walk well in LE.
25
Platform walkers
- use when greater trunk support needed and LE weakness, reduced ROM or pain, or when UE contracture or wrist/hand injury prevents WB
- very weak LE muscles
- pacer
26
Standard Walker
- patient must be able to lift and advance walker
- greater attention demand
- adjustable, nonadjustable
- folding
- reciprocal
- must be able to pick it up and move it
- no wheels
- doesn't allow for normal gait training b/c doesn't move how do during walking
27
Rolling walkers indications
- cognition/unable to follow commands
- cardiopulmonary issues
- patient carries standard walker
- therapist advocated more continuous gait pattern
28
Height of walkers
- higher for back surgeries
29
Rolling walker stability
- less stable than 4 pt or 3 pt
- people that need stability but are limited from picking up walker (cadiovasc issues) use ones with wheels even if not best for stability
30
Handgrip measure on walker
- level of greater trochanter
- level or ulnar styloid process
- level of wrist crease
31
Elbow flexion measure on walker
- 20-25deg flexion
32
Walker feet measure on walker
- middle of foot, all four walker feet on ground
- hips and knees straight
- middle of foot lines up with back two feet of walker
33
Disadvantages of walker
- difficult to store/transport
- stairs
- slower
- decreased stride length
- crowds = not good
- possible hand injuries b/c too much elbow extension creating more wrist extension
34
Walker modifications
- walker replacement glides (made of water-resistant plastic, make moving across any surface smooth)
- walker replacement hand grips
- allow more mobility but less stability
35
Axillary crutches
- more mobility, less stability
- greater speed
- cognition
- coordination
36
Crutches anatomy
- crutch pad = top part under armpit
- hand grip = what hold onto
- crutch length adjustment area = bottom portion
37
Axillary crutch fit
- 77% times height of patient in inches
- standing: 2-3 finger widths between axillary pads and axilla
- elbow flexion: 20-25deg
- crutch tips on ground, 2 inches lateral, 4-6 inches anterior to tip of shoe
- avoid wrist flexion or extension while grasping hand grip
38
Common errors in axillary crutch fitting
- shoulder elevation
- shoulder depression
- no shoes vs shoes on....know the different lengths of measurements so can adjust depending on activities
- absence of tripod position (crutches are brought out from body) during adjustments
- always reassess fitting prior to ambulation
39
disadvantage of axillary crutches
- decreased stability
- possible injury to brachial plexus and blood vessels, hands
- require strong, UEs, endurance, coordination, balance, cognition
40
Forearm crutches
- loftstrand, canadian
- bilateral UE support, not as much WB
- hands can be free when standing
41
Forarm crutch anatomy
- forarm collar = what goes around arm, is adjustable
- hand grip = what hold onto
- snap button = button for adjusting height
- anti rattle collar = around bottom of adjustment height area (right above tip)
- tip = very bottom, what touches floor
42
Handgrip adjustments with forearm crutch
- greater trochanter
- ulnar styloid process
- wrist crease
43
elbow cuff measurement for forearm crutch
- 1.5 inches below olecranon
44
elbow flexion measurement for forearm crutch
- 20-25deg
| - crutch tips on ground, 2 inches lateral, 4-6 inches anterior to toe
45
Disadvantages of forearm crutches
- less stability and support
- requires better standing balance
- support rather than replacement
- hand injuries
46
Hemi-walker
- used when greater support needed
| - side-placement
47
Canes
- used in UE contralateral to the affected LE
- 2 categories
- most mobile, least stable
- bases can trip patient
- based canes can feel insecure
48
SBQC
- small base quad cane
49
LBQC
- large base quad cane
50
elbow flexion measurement for cane
- 20-25deg
51
tip of cane placement for cane
- tip of cane is 2 inch lateral and 4-6 inches anterior to toe
52
SBQC and LBQC leg measurement
- short legs of cane base closest to patient's leg
| - adjust as necessary
53
Disadvantages of canes
- very limited support
- cannot perform some gait patterns
- hand injuries
54
What to use if UE not required for balance/WB and no WB required
- standard cane
55
What to use if UE not require for balance/WB and WB is required
- WB required occasionally = offset cane
- WB required frequently = quad cane
- WB required continuously = hemi-walker
56
What to use if UE is required for balance/WB and WB is not required
- four-wheeled walker
57
What to use if UE is required for balance/WB and WB is required
- WB required occasionally = front-wheeled walker or forearm crutches
- WB required frequently = front-wheeled walker or standard walker
- WB required continuously = standard walker or front-wheeled walker
58
Devices in order from more stability to most mobility
- parallel bars
- walker
- bilateral axillary crutches
- bilateral forearm crutches
- bilateral canes
- hemiwalker
- quad cane
- single-point cane
- no device
59
walker and cane gait patterns
- step to vs step through
60
Axillary crutch gait pattern
- swing to vs swing through
61
cruches gait pattern
- 2-point, 3-point, 4-point
62
Two-point gait pattern
- assistive device and contralateral LE advance and contact floor simultaneously
- used with one or two canes, one or two crutches, or hemi walker
- faster speed, low energy, stable pattern, similar to normal gait pattern
63
Three-point gait pattern
- assistive device with one WB LE remain in contact with the floor
- often used when one LE has restricted WB, device and involved extremity are advanced together, then stabilized, followed by advancement of uninvolved extremity
64
Four-point gait
- in sequential order of contact, with device initiating movement
- i.e. leeft cane followed by right LE then right cane and then left LE
- sometimes callled deliberate 2-pt gait
- slower than two-point gait but increased stability
- alternating reciprocal pattern
- low energy
- max stability and support
65
Step-to gait
- LE in swing phase is advanced only as far as assistive device
- often used when patient is first learning to use an assistive device b/c allows increased time in double-stance
- having both extremities in line with assistive device places patient at greater risk of anteroposterior loss of balance
66
Step-through gait
- LE in swing phase is advanced beyond assistive device
- represents a more normal gait pattern that is possible when patient can manage the momentum and increased time in the swing phased of gait to be able to step beyond assistive device
67
Swing-to gait
- pattern in which both crutches are simultaneously advanced, followed by simultaneous advancement of bilateral LE up to line or assistive device
- noreciprocal pattern: simultaneous bilateral advancement of LEs up to the lime of the assistive device. may rely on momentum generated by trunk to advance to LEs
68
Swing-through gait
- pattern where both crutches are simultaneously advance, followed by simultaneous advancement of bilateral LE advance anterior to placement of assistive devices
- simultaneous bilateral advancement of LEs beyond line of assistive device, often relies on momentum generated by trunk
69
Tripod alternating gait
- first one crutch and then the other is advanced, followed by simultaneous bilateral advancement of LEs
- bilateral LE advancement typically initiated by trunk "dragging" LEs forward
- typically used with forearm crutches by someone with lower trunk and/or LE neurological involvement
- may advance to plane of crutches or past plane of crutches
70
Tripod simulatenous gait
- same as tripod alternating, except both crutches are advanced simultaneously
- sometimes referred to as "drag-to" or "drag-through"
71
Reciprocal gait
- IE and contralateral LE are advanced simultaneously
- results in normal trunk rotation pattern during gait
- two-point gait is a good example of a reciprocal gait pattern
72
Three or four point NWB pattern
- swing to or swing through pattern
- one NWB extremity
- higher energy expenditure
- good strength in UE
73
Three-one-point gait
- bilateral ambulation aids
- FWB one extremity, PWB on other
- more stable than regular three-point
- requires less strength and energy than 3-pt
74
Documentation of Aid
- describe type of ambulation aid
- SBQC, hemiwalker, axillary crutches
- document fitting of aid
- document adaptive devices on aid
- document patients instruction and performance of gait pattern
- document amt of assistance needed for safety and support
- max, mod, min, CGA, SBA, etc
75
Stairs documentation
- rails, unilat or bilat
- step length
- step width
- step height
- ambulation device
76
Injuries associated with forearm vs axillary crutches
- forearm crutch: hand injury
| - axillary crutch: brachial plexus injury
77
Hemi walker
- used when greater stability needed
78
Cane shelf placement
- small shelf on inside and towards hand that cane is on
79
Guarding During Gait
- decrease distance between your patient's COM and your own COM without interering with mobility
- stabilize your spine, feet apart, one in front of the other, flex hips and knees slighty
- stand behind and to side of patient
- try to keep one forearm horizontal at level of patients COM, other in position to control the COM
80
How to deal with falls during walking
- be a little to side and behind weaker leg
- if fall, take a big step, pull them back towards you, shifting their momentum back instead of forward
- then they can use your leg to slide down leg and safely go down
81
Standing on good side or bad side
- stand to the side patient is weak/bad on b/c they are most likely to fall on that side
82
Advanced Gait activities
- stairs
- up and down from a chair
- ramps (lean forward while ascending, take longer steps....when descending take shorter steps)
- curbs
- managing doors
83
Sit to stand
- back up until you feel the chair with the back of your leg
- hold both crutches in the hand on the affected side
- grab the armrest or side of the chair with your free hand
- lower yourself onto the front of the chair, then slide back
- to get up, reverse the 3 steps
84
In and out of a car
- back up until you feel the car chair against your back/legs
- use the doorjamb or the dashboard for support as you lower yourself. watch your head
- don't hold on to car door, or it may close on you
- with hands, lift your affected leg into the car. or use your unaffected leg to hook your affected leg behind the ankle and lift it in
- place car seat back and down to help ease patient in and out...try not to recline too far
85
How to PUSH a door open with assistive device
- stand sideways and push the door open with your body.
86
How to PULL a door open with assistive device
- stand to the side.
- Get your balance and pull the door fully open with your hand.
- Plant the tip of the nearest crutch inside the door to act as a doorstop.
- Leave the crutch in place until you’ve walked through.
87
Approaching curb with walker going up backwards
- back up to curb
- lean on the walker
- step up backwards onto curb with strong leg first
88
Approaching curb with walker going up forwards
- stand right up against curb
- pick up walker and put on curb
- put strong foot up first
89
Going down a curb forwards with walker
- get to edge of the curb
- place the walker on the lower ground
- step down with weak foot first
90
Stepping down a curb with walker
- move to the edge of the curb with your walker
- put walker on the ground below you
- step down with your weaker leg
- step down with stronger leg
91
Important Qs to ask about stairs
- rails
- step length
- step width
- step height
- ambulation device: crutches, cane, walker
92
Guarding up and down stairs
- one hand on gait belt, one hand on railing
| - be one step below patient no matter what the direction (up or down)
93
If no railing when guarding stairs
- use the wall and make sure have wide BOS
94
Guarding stairs with crutches
- always be one step below
95
Partial or Non-WB with 2 railing
- back up to the steps with your walker and keep hands on walker grips
- put 50% of weight through the arms as you lift the strong leg onto 1st step.
- Use the strong leg to lift your entire body up the step
- once on the 1st step, transfer hands from walker to handrails
- repeat steps as many times as needed
- once on landing, use your walker to make your way to the door
96
Partial or Non-WB with 1 railing and 1 person assistance
- back up to steps with walker and keep hands on walker grips
- put 50% of weight through arms as you lift the weak leg onto first step. use strong leg to lift entire body up the step
- once on step, place one hand on the railing, and one hand will be supported by a helper on opposite side
- repeat as needed
- once on landing, use walker to make way to door
97
Assistive device on one side going up stairs
- stand close to bottom step
- put good leg up first
- lean forward, taking weight on good leg
- lift operated leg and crutches up
- climb 1 stair at time and have helper stand behind or beside you
98
Where to put crutches when doing stairs
- put both crutches under the arm away from the railing and use both crutches as one
- hold the railing with your free hand and stand close to rail
99
Going down stairs with assistive device
- stand close to edge of top step
- move your hand down railing
- lower your crutches, then your operated leg, to next step
- step down with good leg
- step down 1 at a time
- if helper, have them stand in front or to the side of you
100
Define a fall
- unintended loss of balance that causes a person to land on a lower surface
101
Collapsing fall options
- move closer, hug and lift on gait belt from sides or anterior
- help patient sit down on floor, gently lower
- do not try and keep them upright with your arms alone!!
- deepen stride and sit patient on thigh
- keep body close and allow them to slide down to floor
102
Angular Fall options
- falling at an angle
- move close and attempt to bring COM over BOS
- forward falling: pull patient toward you
- backward falling: allow them to lean on you
- sideways fall: use central control to shift patients hips back over their BOS
