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Patient Care Skills > Mobility with Assistive Devices > Flashcards

Mobility with Assistive Devices Flashcards

1
Q

What is the difference between ambulation/gait analysis/gait training?

A

ambulation: goal = distance, not necessarily worried about gait style
analysis: goal = moving safely/normal/how they are moving, not worried about distance
training: goal = teaching how to ambulate safely (with/without ambulation device)

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2
Q

What are some of the indications of needing to use a gait device?

A

pain
weakness/balance impairment
decreased endurance/exercises tolerance
fear of falling
WB on one side is contraindicated/not possible/has restriction

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3
Q

What is the #1 predictor of falling?

A

patient has had a fall in the last 6 months

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4
Q

What is the #2 predictor of falling?

A

fear of falling (whether from inactivity/shrinking of lifestyle creating LE weakness, etc.)

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5
Q

What are the two main mechanisms in which gait devices facilitate mobility?

A

redirect body weight from the affected limb to the normal limb
increase stability by increasing base of support

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6
Q

What is the definition of base of support?

A

all points of contact around patient, including ambulation device

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7
Q

How do we assess or know about a patient’s gait impairments?

A

verbal report from healthcare professional/patient
chart review
knowing about pathology (hip fracture, stroke, etc.)
watching the patient ambulate before your intervention/observation in patient’s room

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8
Q

what are the major muscle groups used for ambulation with assistive devices in the trunk?

A

scap depressors/stabilizers
trunk extensors and trunk flexors (for stability)

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9
Q

what are the major muscle groups used for ambulation with assistive devices in the UE?

A

shoulder flexors/extensors
elbow extensors
finger flexors (grip)

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10
Q

what are the major muscle groups used for ambulation with assistive devices in the WB LE?

A

hip abductors/extensors
knee extensors
ankle dorsiflexors

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11
Q

what is the first thing to determine when evaluating a patient for an assistive device?

A

WB status

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12
Q

are we allowed to change the WB status of a patient?

A

no

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13
Q

what is NWB?

A

non-weight bearing

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14
Q

what is TTWB/TDWB/FeWB?

A

toe-touch weight bearing
touch-down weight bearing
feather weight bearing

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15
Q

what is PWB?

A

partial weight bearing (typically given % of BW)

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16
Q

what is WBAT?

A

weight bearing as tolerated

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17
Q

what is FWB?

A

full weight bearing

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18
Q

is the patient allowed to transmit weight through affected extremity during NWB gait?

A

no

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19
Q

when patient is NWB, what is the best way to ensure the patient does not transmit weight through the leg?

A

have the patient flex the knee (if LE) to keep it off of the ground
if in a straight leg cast, just need to monitor the foot being off of the floor

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20
Q

why is TTWB/TDWB/FeWB safer than NWB?

A

allows the patient to use affected limb for balance, less chances of a fall or accident

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21
Q

how can you enforce the patient using TTWB,TDWB,FeWB?

A

use the reference on a potato chip/egg shell being underneath the foot when stepping

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22
Q

what is a common issue seen when a patient uses TTWB gait pattern for a prolonged period of time?

A

calf tightness

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23
Q

what is the range of typical % used when prescribed PWB?

A

between 20-50% of BW

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24
Q

what is the best and most cost effective way to enforce % of PWB?

A

using a scale and asking patient to put x% of BW force through extremity

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25
Q

how does a limb load monitor work?

A

footwear with a monitor attached, provides auditory feedback if the patient transfers too much weight into the affected limb

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26
Q

in addition to the patient’s medical condition, your assessment, and expected prognosis… what else should be considered when choosing a gait device?

A

patient’s needs/abilities/preferences
what the patient wants/setting (indoor/outdoor)
short and long term goals

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27
Q

what is the typical weight capacity of standard gait devices?

A

up to 300 lbs

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28
Q

what is the typical weight standard of bariatric gait devices?

A

500 lbs

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29
Q

list the common types of gait devices in order from most stable to least stable:

A

parallel bars
walker
axillary crutches
forearm crutches
cane in both hands
hemiwalker
quad cane
single point cane
no gait device

30
Q

what are some pre-gait exercises that can be performed in the parallel bars?

A

shifting weight
anterior/posterior hand placement
single-hand support (claps)
hip hikes
step ups
stepping forward/backward/side-to-side
forward progression/turning

31
Q

when the patient is in the parallel bars, where should the therapist/gait device be in relation?

A

therapist in front, wheelchair behind

32
Q

front-wheel walkers are best for which kinds of patients?

A

those with a gait that is too fast for a standard walker or have a difficult time lifting a standard walker

33
Q

when would platform walkers be utilized?

A

patient has a NWB restriction of an UE
arm weakness

34
Q

what is the main purpose of a four-wheeled walked/rollator?

A

increase the patient’s endurance/ambulation distance

35
Q

u-step walkers are typically utilized when patients are diagnosed with what conditions?

A

Parkinson’s
ALS
MS
TBI
other balance disorders

36
Q

what are the advantages of a walker?

A

lightweight
may/may not fold
offers the greatest stability
4 points of contact = wide BOS
provides sense of security
easily adjustable

37
Q

what are some disadvantages of a walker?

A

cumbersome
difficult to store
difficult/impossible to use on stairs
decreases speed of ambulation
impedes normal gait pattern
often too wide for narrow spaces

38
Q

what are some advantages of axillary crutches?

A

greater selection of gait patterns
greater ambulation speed
easy to store and transport
maneuver in crowded/narrow spaces
can be used on stairs

39
Q

what are some disadvantages of axillary crutches?

A

less stable than a walker
can cause injury to axillary nerve
require good standing balance
patient may feel insecure
requires function UE/trunk strength

40
Q

what are some advantages of forearm crutches?

A

eliminates potential of axillary structural damage
even more functional on stairs/tight spots
allows use of hands
more cosmetic
fits into cars easier

41
Q

what are some disadvantages of forearm crutches?

A

less stable
requires even greater UE/trunk strength
requires greater standing balance
difficult to doff due to forearm balance
not for the elderly
typically cost more than axillary crutches

42
Q

when would a hemiwalker typically be utilized?

A

patient requires continuous WB on only one arm
patients with hemiparesis with moderate/severe loss of LE function

43
Q

what is the main advantage of a quad cane?

A

can stand upright on the floor when not in use

44
Q

what is the main disadvantage of using a quad cane?

A

all legs of the cane need to contact the floor simultaneously

45
Q

what WB status must a patient have in order to use a single point cane?

A

FWB

46
Q

what are the advantages of a cane?

A

more functional on stairs/tight areas
inexpensive
stored/transported easily
can mimic normal gait patterns

47
Q

what are the disadvantages of a cane?

A

limited support
two canes do not provide sufficient support for a 3-point gait pattern

48
Q

when fitting a gait device, ensure the patient is wearing _______

A

typical footwear

49
Q

what is the proper fitting of the parallel bars in reference to the patient?

A

bars level
patient’s elbows at 20-30 degrees
bars 2” wider than the width of the hips
height of bars at greater trochanter or ulnar styloid

50
Q

what is the proper fitting of a walker in regard to the patient?

A

patient standing within BOS of walker
hand grips level with ulnar styloid
elbows flexed 20-30 degrees

51
Q

what is the proper fitting of axillary crutches?

A

tripod position (2in to side, 6in in front)
fit 2 fingers under axilla
handle at ulnar styloid with arms down

52
Q

what is the proper fitting of forearm crutches?

A

can be measure standing or supine
handgrip height at greater trochanter
forearm cuffs 1-1.5” below olecranon
elbows flexed 20-30 degrees

53
Q

what is the proper fitting of a cane?

A

tip just lateral to toes
handgrip at ulnar styloid
elbows 20-30 degrees of flexion

54
Q

what are some common errors while fitting a device?

A

elevated/hunched shoulders
slump forward
measure without shoes
not in tripod position
too much wrist flexion/extension

55
Q

what are the steps in performing a sit to stand with gait device?

A

lock breaks of wheelchair
scoot forward
hold w/c arm rests
push off to stand up (nose over knees)

56
Q

what are some ways a patient can compensate a sit-to-stand?

A

patient getting momentum
patient putting legs on the back of a chair to get a force couple
patient bringing knees together
patient placing hands on the thighs

57
Q

once the patient is standing, what things should you check before moving?

A

ensure static balance
ensure patient is not dizzy/nauseous/extreme pain
ensure feet are hip width apart
re-check height of walker/crutch/cane
pre-gait activities

58
Q

what is the rule of thumb in regard to pain scale?

A

if >6/10, do not walk

59
Q

what is the therapist’s position during ambulation?

A

standing slightly behind on involved side while holding gait belt and guarding at the shoulder

60
Q

when should you utilize a 4-point gait pattern?

A

patient is allowed PWB on one LE
patient is allowed WBAT or full WB but not strong enough to try two-point gait

61
Q

what is the 4 -point gait sequence?

A

crutch contralateral to affected limb
advance affected limb
crutch ipsilateral to affected limb
advance strong limb

62
Q

what is the sequence of two-point gait?

A

contralateral crutch/affected limb simultaneously
ipsilateral crutch/strong limb simultaneously

63
Q

when do you utilize 2-point gait pattern?

A

patient is allowed WBAT or FWB and ready to progress from 4-point

64
Q

when do you utilize 3-point gait pattern?

A

patient has NWB/PWB in one LE, or WBAT but needs stability

65
Q

what is the sequence of 3-point gait?

A

both crutches/walker
bad leg
good leg

66
Q

what is swing-to gait?

A

extremity swing to the point of the device

67
Q

what is swing-through gait?

A

extremity swing past the point of the device (requires crutches)

68
Q

what gait pattern should you use to go up the stairs?

A

GBA

69
Q

what gait pattern should you use to go down the stairs?

A

ABG

70
Q

quote at the end of the ppt???

A

all truly great thoughts are conceived while walking.
-friedrich nietzsche

71
Q
A

Patient Care Skills (6 decks)

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