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1 Patient Management > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Indications for assistive device use

A

wide BOS/increase area in which COG can be shifted
allow for redistribution of body weight within the BOS

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2
Q

Assistive Devices

A

ADs
you choose based on aerobic cost; some will cause more energy depletion. Some ADs are more focused on STABILITY vs MOBILITY

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3
Q

Parallel Bars

A

most table place to measure fit of other devices
often is a starting point for initial standing, pre-gait activities, and gait training

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4
Q

Standard walker

A

no wheels
pick-up
lots of aerobic cost

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5
Q

Front Wheeled walker

A

FWW
wheels in front, most common

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6
Q

Four wheeled or rollator

A

4WW
has only wheels
also has a seat and brakes

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7
Q

Hemiwalker

A

for individuals with one side of body paralyzed (hemiplegia), large BOS

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8
Q

Platform walkers

A

decreases or eliminates weight-bearing on wrists/hands
helpful in situations of broken wrists, arthritis. Eliminates that force going through the wrists

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9
Q

Crutches

A

axillary
forearm, lofstrand, canadian

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10
Q

Straight cane

A

single point
SPC

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11
Q

small based quad cane

A

SBQC

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12
Q

Large base quad cane or wide base quad cane

A

LBQC, WBQC
pay attention to the orientation of the base. wider part goes away from the pt to increase BOS and not trip pt

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13
Q

When to use walkers

A

maximal patient stability and support are required

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14
Q

When to use axillary crutches

A

pt who need less stability or support, allow greater selection of gait patterns and ambulation speed while still providing stability and support

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15
Q

When to use forearm crutches

A

eliminate the danger of injury to axillary vessels and nerves
more functional on stairs and in narrow, confined areas
less stability than normal crutches, more than a cane

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16
Q

When to use a cane

A

used to compensate for impaired balance or to improve stability and are more functional on stairs and in narrow, confined areas

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17
Q

Full-weight bearing

A

FEB

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18
Q

Weight bearing as tolerated

A

WBAT
pain tolerance

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19
Q

Partial weight bearing

A

PWB
some % of body weight, or actual weight allowed is typically specified

20
Q

Toe-touch weight bearing or touch-down

A

TTWB or TDWB
foot is in contact with the floor, but no weight is translated through it

21
Q

Non-weightbearing

A

NWB
foot does not touch the floor

22
Q

Reciprocal gait pattern

A

arm and legs move in alternating pattern

23
Q

Four-point gait pattern

A

bilateral ADs
contralateral AD moves before corresponding LE
naturally evolves into a two-point

R crutch
L foot
L crutch
R foot

24
Q

Two-point gait pattern

A

bilateral AD. AD moves w/contralateral leg

L crutch + R foot
R crutch + L foot

modified two-point = take away 1 AD

25
Three-point gait pattern
1 LE is NWB R Foot L + R crutch modified = 1 LE is toe touch
26
Step-to vs step-through
Modified gait patterns Step-to = wedding pattern, AD first, then legs together Step-through = weaker leg & AD forward, contralateral LE follows
27
Swing-to/swing-through
these terms are only used when the person is advancing both LEs at the same time, aka a reciprocating gait is not possible
28
Swing-to
swinging both legs TO the same position as the crutches
29
Swing-through
swinging both legs PAST the position of the crutches
30
How to choose the best AD
greatest quality of life w/least amount of risk Based off of ICF Activity limitations, impairments (i.e legs), secondary impairments (i.e. arms), health conditions, contextual factors, personal factors (previous use of AD, ability to learn, pt preference), environmental
31
Adjusting AD to fit pt
always ensure pt safety while measuring & adjusting
32
Fitting axillary crutches
set HEIGHT first (how tall are you?) Adjust hand grip LAST standing: tripod position w/crutches, 2-finger width distance btwn crutch and axilla in sitting = on arm straight to side, other w/elbow flexed to 90° 15° of elbow flexion when hands are on grips
33
Fitting forearm/lofstrand crutches
measure grip height FIRST adjust cuff height next cuff should be 1-1.5 in below olecranon process. proximal 1/3 forearm.
34
Fitting walkers, canes, hemiwalkers
hand grip = use wrist crease single point cane should be held on contralateral side of affected LE
35
When to use hemiwalker
used for people with hemiplegia gripped in person's unaffected hand provides an extended, large BOS to allow person to shift weight toward unaffected side to help the affected LE to be able to swing forward
36
Quad canes
orientation of the base is key wider base must be away from the person. towards the person interferes with achieving gait pattern
37
Guarding
can guard from back; moving from the side to the back can guard from front; PT opposite leg blocks pt's affected leg
38
Guarding during ambulation
PT's palm is always UP other hand is on anterior shoulder don't hold so tight that you prevent movement you should stand slightly to the side of the injured area hands on at all times unless person is S or I
39
Clinical benefits of ADs
increased confidence, increased activity level, increased independence. decreased risk of falls biomechanics stabilization = increases BOS reduction of LE loads propulsion and braking during gait augmentation of somatosensory cues
40
Stop using AD
20-50% of people abandon AD after receiving it use of unprescribed device inappropriate device prescription inadequate user training difficult or risk to use repetitive stresses on UEs
41
Problems with ADs
destabilizing biomechanic effect attentional and neuromotor demands interference with limb movement during balance recovery upper-limb loading and strength demands metabolic and physiologic demands`
42
Documentation of Ads
Who, what, distance ambulated, assistive device used, weightbearing/gait pattern, level of assistance Ex: PT ambulated 25 ft with SBQC w/modified 4point gait pattern and MIN A
43
Balance lost forward
standing/even surface = pull back on gait belt ambulating/even surface = pull back on gait belt, widen stance, turn sideways. pull on upper trunk. ascending = pull back on gait belt and trunk/shoulder. Grasp handrail with other hand. descending = move directly in front, push on shoulder or chest. pt releases aids and straightens/looks up. or pull back on gait belt if behind
44
Balance lost backwards
standing/even surface = push forward on pelvis/trunk ambulating/even surface = one side towards patient, widen stance, let them come back towards you ascending = one side towards patient, widen stance, let them come back towards you, grasp guardrail descending = pull forward and grasp guardrail. or press forward with pelvis and grasp handrail if behind
45
Balance lost to side, away from PT
standing.even surface = pull on gait belt towards you ambulating/even surface = pull on gait belt, push forward against pelvis, pull back on shoulder ascending = gait belt to pull towards. grasp handrail descending = pull on gait belt towards you. grasp handrail. same if behind them
46
Balance lost to side, towards PT
standing = face pts side, widen stance, support pt with body ambulating = one side is turned toward pt back, use gait belt for control ascending = use hand or shoulder to press against trunk. grasp guardrail or gait belt descending = hand or shoulder to press against side of chest to move pt away from you. or use body to support the pt if standing behind.

1 Patient Management (8 decks)

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