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Mobility / Gait Devices Flashcards

1
Q

how is ambulating a patient different than gait analysis

A

ambulation deals with little concern in a patient’s gait pattern. focus is on the distance and quality of movement

analysis - analyzing what elements of the pattern are normal and which elements deviate from it

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2
Q

what is the #1 predictor of falling

A

having fallen in the last 6 months

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3
Q

what is the fear of falling bad for

A

obviously falling
can make a patient scared to do much which in turn decreases their ability to do anything at a rapid rate.

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4
Q

what can contraidicate weight bearing on one side?

A

fracture healing
amputations
open wounds

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5
Q

what are the main ways gait devices facilitate mobility

A

redirection of body weight from affected to normal limb
increased stability from increased BOS

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6
Q

how does a gait device increase base of support

A

moves it from just under the patient to all around the patient

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7
Q

major muscle groups in the trunk used during ambulation

A

scapular depressors and stabilizers
trunk extensors
trunk flexors

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8
Q

what muscles are used in the UE during ambulation with a device

A

shoulder flexors/extensors
elbow extensors
finger flexors

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9
Q

what LE muscles are used during ambulation w a device

A

hip abductors
hip extensors
knee extensors
ankle dorsiflexors

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10
Q

what is NWB

A

non-weight bearing
no weight allowed to be transmitted
important to keep knee bent if the LE is NWB

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11
Q

what is TTWB or TDWB

A

toe-touch weight bearing
touch-down weight bearing

foot/toes are allowed to touch the ground but no weight can be transmitted through affected LE
mainly just used for balance instead of WB

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12
Q

what happens with prolonged TTWB

A

can have gastrocnemius contracture if kept in position for a long time

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13
Q

what is WBAT

A

weight bearing as tolerated
limited by patient’s tolerance
somewhere between 50-100%

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14
Q

how can a patient better understand their partial weight bearing status

A

allow the patient to push into a scale to better understand how much of their force results in the amount of weight they are allowed to push into

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15
Q

what is a limb-load monitor

A

monitor attached to footwear that gauges and provides feedback
will beep if the patient exceeds weight limit

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16
Q

what are common types of walkers

A

wheeled/rolling
folding
posterior rollator
hemi-walkers

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17
Q

what are the common types of crutches

A

axillary and forearm

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18
Q

what are the common types of canes

A

large/small based quad canes
single point cane

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19
Q

most stable to most mobile

A

parallel
walker
axillary
forearm
cane in both hands
hemi walker
quad cane
single point cane
no device

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20
Q

what type of patient would be introduced to parallel bars

A

PT who was eligible for a tilt table
one who has been immobile for quite some time

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21
Q

what is the set up that makes parallel bars the most stable

A

wheel chair behind patient, bars on each side, therapist in front

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22
Q

what are some balance/preambulation activities

A

weight shifts (side to side/forward and backward)
stepping forward/backward
anterior posterior hand placement
single hand support - high fiving therapist
hip hikes
step ups / marches

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23
Q

what is a standard walker

A

4 legs with rubber tips

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24
Q

what are the cons of standard walkers

A

cumbersome
difficult to store
no stairs
decreases ambulation speed
impedes gait pattern
too wide for narrow spaces

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25
what do walkers do for a patient
increase base of support enhance lateral stability support patient weight
26
what/who are front wheeled walkers best for
patients with a gait that is too fast for standard walker or difficulty lifting it wheels allow for a more standard pattern but can decrease stability
27
what are some walker accessories
fixed / swivel wheels glide / wheel brakes baskets skis / tennis balls
28
where do wheels always have to be on walkers
in the front
29
what do skis and tennis balls do?
reduce friction on back to legs can allow for greater ambulation speeds which in turn can increase a patient's confidence
30
when does one implement a walker with a platform attachment
when a patient is unable to weight bear in one wrist or hand can instead put weight through the shoulders and elbows
31
what is a gaurdian strider
pediatric walker with an extra wide base for stability wheels in the front
32
what is a reverse postural walker
pediatric walker that provides stability by moving the COM posteriorly. decreases flexion angles of the trunk hip and knee can decrease the oxygen consumption rate
33
what is an a frame walker
pediatric walker that more resembles a normal walker
34
what is something important for patients using four wheeled walker
can be used for improving endurance and increasing distance that one can walk
35
can a four wheel walker be given to a patient with a heavy reliance upon upper extremity strength
no device can roll away
36
what qualifies a candidate for four-wheel walkers
mild to moderate balance disorder mild "cautious gait" ataxia or compromise exercise endurance
37
what diseases can the U-step walker be used for?
movement disorders parkinson's, ALS, MS, TBI
38
what does the U-step walker have
laser lights that give a patient a goal to step to always in brake position, only moves when patient presses the lock
39
how much faster can a patient walk with the U-step
3-4x faster can also turn around easily can traverse over uneven surfaces as well as avoiding jolts
40
what can the cardiac walker be used for? aka platform walker?
support of weight by allowing the patient to shift a lot of weight in the UE and none in LE
41
what is the weight capacity of standard axillary crutches
250 lbs
42
disadvantages of axillary crutches
less stable can cause axillary nerve impingement require good balance can make patient feel insecure functional strength of UE and trunk are needed
43
what should the gap between crutch and armpit be?
3 fingers
44
what is tripod position
crutches positioned in 2 inches laterally 6 inches forward elbow bent at 20-30°
45
what happens if the elbow is bent too much or not enough during tripod position
too much = mechanical disadvantage too little = active insufficiency in triceps
46
what are forearm crutches good for? what are some characteristics
stability as well as independence for long term basis plastic cuffs that pivot 90° weight limit is 240
47
advantages of forearm crutches
eliminates potential axillary damage more functional on stairs / tight areas use of hands more cosmetic fits into cars
48
disadvantages of forearm crutches
less stable requires great amounts of UE/Trunk strength greater standing balance hard to take off not for elderly cost more than axillary
49
what does a hemiwalker give a patient compared to a normal cane
more broad base support better for patients requiring continuous weight bearing only in one arm
50
what is the main advantage of the quad cane
can stand upright when not in use allowing for patient to use other hand
51
what is the main disadvantage of the quad cane
all legs of the cane need to be in contact with ground
52
how may the main disadvantage of the quad cane affect gait
may slow ones gait down because the patient is moving too fast to place all 4 legs down consistentyl
53
what WB status can a cane be used for
FWB only
54
advantages of cane
functional on stairs and tight areas inexpensive stored/transported easily can mimic normal gait patterns
55
disadvantages of a cane
limited support least stable, most mobile
56
if the device is fit to the patient correctly, it will
facilitate upright posture require less energy to ambulate
57
when fitting a device, what is one clothing item that you want the patient to have on
the shoes that they will be wearing when using the device
58
what is the proper fitting of parallel bars for a patient
bars are level and at the height where a patient can have a 20-30° bend in the elbows bars are 2" wider than the hips height of bars is at the greater trochanter or ulnar styloid
59
proper fitting of a walker
elbows able to bend at 20-30° hand grips at ulnar styloid/greater trochanter
60
proper fitting of forearm crutches
handgrip at the greater trochanter forearm cuffs about 1-1.5 in from olecranon process 20-30° elbow flexion
61
proper fitting for canes
tip just lateral to toes handgrip at greater troch/ulnar styloid 20-30° elbowflexion
62
what are some common errors when fitting a device
patient's shoulders are not relaxed patient slumps forward measurement without shoes not in tripod wrist not in neutral
63
events in a sit to stand to gait device
lock breaks on wheel chair scoot forward hold on arm rests push off to stand up with "nose over knees"
64
where should the therapist stand during a sit to stand
on affected side if one leg is substantially weaker if both legs are equally weak, stand on non dominant side
65
is it ok for the patient to use the walker as a brace to get up?
no, they will not be able to get their body up because they will pull the device towards themselves
66
what is the therapists position during ambulation
feet staggered to increase BOS slightly behind and to the affected side one hand on gait belt and one hand in front
67
why should the therapist be on the affected side?
better control of the side/limb can better predict/control a fall promotes neurological facilitation
68
contraindications of a gait belt include
recent abdominal surgery severe cardiac/respiratory conditions phobia regarding belts
69
what hand placement should the therapist have on a gait belt
supinated not pronated and definitely not with it wrapped around the wrist great way to break your wrist
70
tell me about four point gait
requires bilateral ambulation devices (2 crutches/canes) alternate and reciprocal movement slow but utilizes maximal stability with lower energy expenditure
71
when to use 4 point gait
partial weight bearing on one of the LEs or patient is allow WBAT or full WB but not strong enough for two point
72
what is the sequence of four point gait
one crutch advanced (unaffected) contralateral leg advancement (affected) advancement of other crutch advancement of other leg
73
when to use two point gait
patient is allowed WBAT or full WB stronger than 4 point
74
what is required for two-point
bilateral ambulation devices simultaneous movement relatively stable faster more coordination
75
pattern of two point gait
one crutch and opposite extremity move in sequence followed by opposite crutch and extremity allows for natural arm and leg motion
76
when to use 3 point gait
patient has NWB on one LE patient has PWB on one LE patient has WBAT on one leg but not strong enough, needing a stable assistive devices
77
what is required for 3 point gait
bilateral ambulation or a walker less stable require good UE, LE and trunk strength high energy expenditure
78
how is swing to different than swing thru
swing to level of device or swing thru past the device
79
what muscle involvement can a single cane or crutch decrease
gluteus medius
80
gait pattern with one crutch
advancement of device on contralateral side (forward and laterally) advancement of affected LE advancement of uninvolved LE
81
where would a therapist stand when practicing at steps?
toward bottom of the steps on "down" side with a wide BOS stand on tandem steps not just one
82
when ascending, what is the sequence of actions
Good LE Bad LE Device
83
when descending what is the sequence of events
Device Bad LE Good LE
84
ascending with no hand rails
Good LE Shift weight forward onto good LE Bad LE and device at same time
85
if a patient's arms are not strong enough to move themselves forward in the wheelchair, what does a therapist do to assist
one hand on lower back and one leg on knee one side at a time
86
quote at the end of the power point
all truly great thoughts are conceived while walking Friedrich Nietzsche

Patient Care Skills (3 decks)

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