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62nd Sem: Int. Lab II > SC1 > Flashcards

Flashcards in SC1 Deck (61):
1

You receive orders to evaluate, treat, and gait train a patient following right hip arthroscopy. The patient's weight bearing status is toe-touch weight bearing on the right. Which of the following would be most appropriate to teach the patient?

A. To ambulate with bilateral crutches permitting only the great toe to touch the floor on the right foot (no weight through phalanges 2-5)

B. To ambulate with one crutch under the left arm permitting weight bearing as able to tolerate without pain

C. To ambulate with bilateral canes permitting the right foot to rest on the floor without bearing weight (balance assistance only)

D. To ambulate with bilateral crutches permitting the right foot to rest on the floor without bearing weight (balance assistance only)




















Answer: D

2

2. You are treating a patient following a spinal cord injury and wish to MAXIMIZE stability (support). Which of the following assistive devices would be most appropriate for this patient initially?

A. Parallel bars
B. Single-point cane
C. Hemi walker
D. Bilateral forearm (Lofstrand) crutches








Answer: A

3

3. During which of the following scenarios would it be appropriate to gait train without the use of a gait belt?

A. Instructing an 85 year old male with a history of falls in the use of a front wheeled walker

B. Instructing a 5 year old female who recently sustained a severe ankle sprain in use of bilateral axial crutches

C. Therapeutic gait training (minimal assist) with a 62 year old female using a front wheeled walker 2 days post total knee arthroplasty

D. None of the above- a gait belt should be worn in all of the above scenarios











D. None of the above- a gait belt should be worn in all of the above scenarios

4

4. You are instructing a patient with left sided-weakness following a right CVA to perform a sit to stand transfer for the first time. The patient has difficulty following commands and you are unable to perform traditional manual muscle testing to adequately assess lower extremity strength; however, you observe anti-gravity movement in the non-affected (right) lower extremity. Which of the following would be the SAFEST and MOST appropriate way to instruct this transfer the first time?

A. Transfer the patient toward the right side while guarding the right side
B. Transfer the patient toward the left side while guarding the right side
C. Transfer the patient toward the right side while guarding the left side
D. If manual muscle testing cannot be performed, the patient should not be allowed to perform this transfer


















Answer: A

5

BELOW ARE FLASHCARDS FROM THE FIRST 4 LABS (in preparation for Skills Check 1)

LAB 1 next

ok

6

What are some principles of GOOD body mechanics:

- Use large muscles
- Lift with legs, not your back
- Keep your back straight
- Hold weight close to body / COM
- No twisting, pivot your feet
- Wide stance, big base of support
- Exhale during exhalation
- PUSH, don't pull
- Plan ahead and develop and communicate plan
- GET HELP whenever you can
- Have patient do as much of the work (lifting) as possible
- Raise plynth, lower plynth, etc.

7

What are the 4 different squat types. Explain them, why/when they are used, pros/cons:

1) Deep Squat:
- Hips below knees, back straight, lift with legs
- Lift really heavy objects
- You can hurt your back with too heavy load / wrong form

2) Power Lift:
- Half squat, hips above knees
- (Same as above, not as heavy a load)

3) Single Limb Stance Lift:
- WB'ing on one limb partially flexed, NWB limb extended out
- Easy, good for light objects and patients with limited ROM
- Can't lift heavy objects, and must be good with balance

4) Half Kneeling Lift:
- Kneel on one knee beside object, lift object to thigh, go up to standing
- Pretty stable, you get close to object, lift with legs
- But a weird transition that takes coordination

8

Imagine doing these scenarios, and practice them, using GOOD body mechanics. Explain how you would do them, and which of the 4 squat types you would use:

1) Lift a really heavy box from the ground and place it on the table to your right?
2) Move a heavy box from one end of the plynth to the other
3) Lift a pencil from the floor
4) Lift a small child from the floor

1) Use the Deep Squat lift and lift with legs, keep back straight, lower table if you can, rotate feet and don't twist your back.
2) Power lift (or push): ... either squat half way down and lift it up then shuffle over, or PUSH box, don't pull.
3) Single limb stance lift: bend over on one leg half flexed, and extend other leg out.
4) Half Kneel Lift: Kneel on one knee, bring child close to body, lift on knee, stand using leg muscles.

9

When do we drape?

Why do we drape?

How (or what can you use) to drape:

WHEN: You should drape any time there is skin showing, you or patient feels uncomfortable, clothes may get soiled, protect skin, keep patient warm, access needed area, etc.

WHY: Drape to be professional, keep patient modest, be respectful, dignity, build rapport, help patient feel comfortable, avoid any awkward or uncomfortable situation.

HOW: use a gown, sheet, blanket, towel. And only expose the area being worked on.

10

For patient positioning in SHORT TERM ...

What should you consider and do for SHORT term positioning in SEATED position?

What should you consider and do for SHORT term positioning in SUPINE LAYING position?

What should you consider and do for SHORT term positioning in SIDE LAYING position?

What should you consider and do for SHORT term positioning in PRONE LAYING position?



Short-Term Seated: Have good lumbar support (pillow behind), knees flexed (pillow under).

Short-Term Laying SUPINE: Pillow under head, pillow under knees

Short-Term SIDE Laying: Pillow for neck, towell under lumbar, knees flexed with pillow between knees, pillows to prop back so patient has back support.

Short-Term PRONE Laying: Face in a cut-off hole ideally, pillow under abdomen, pillow under ankles.

11

For patient positioning in LONG TERM ...

What should you consider and do for LONG term positioning in SEATED position?

What should you consider and do for LONG term positioning in SUPINE LAYING position?

What should you consider and do for LONG term positioning in SIDE LAYING position?

What should you consider and do for LONG term positioning in PRONE LAYING position?

Seated: Same

Supine: Maybe another pillow under shoulders, calves, sacrum, and keep moving them to a slight angle on one side (back and forth) every few hours.

Side: roll them forward or back a bit with pillow support. Keep hand from falling off table below heart. Pillow under places ulcers could occur

Prone: less common for long term.

12

Think through this scenario below. How would you POSITION and DRAPE a patient:

1) Soft tissue mobilization to low back
2) Ultrasound to lateral shoulder
3) Sleeping position for someone with neck pain
4) Palpation and inspection of the knee in acute care setting

1) Lay prone. Get permission and clearly explain you'll expose low back (only expose what you need). Put towel over shorts and shirt. Prop up ankles and maybe pillow under stomach. Just ask if they are comfortable or what else they need.

2) Explain what you'll do, and need. Ask if they want a gown or remove portion of shirt to expose shoulder. Cover shirt with towel to protect, and cover what they feel comfortable with/want (mid section) ... or get gown. Overly communicate, ask for approval. Have them seated with pillow behind back, knees, maybe under arm. Pull hair up.

3) Side lying or supine, whatever they are comfortable with. Good pillows under neck, knees/ankle (keep good spinal alignment). Prop back if long term. Drap and cover for modesty and warmth. Overly communicate, ask what they need and if they are comfortable, etc.

4) Explain and communicate, ask permission. Wear shorts, pull pants up, get gown- whatever they are comfortable with. Prop knee up a bit, drap and cover as needed. Put pillow behind lumbar for support.

13

If someone just had a TKA, do you prop their knee up with a pillow?

If someone just had a THA, what 3 movements can you NOT do?

TKA: NO

THA:
1) Hip flexion
2) Adduction (or cross leg)
3) Internal rotation

14

When transfering a patient (from wheelchair to bed, from bed to bed, from supine to sitting, from sitting to standing, etc.) what are some basics to remember during mobility transfers:

- Good body mechanics (SAFETY)
- GET PATIENT TO DO AS MUCH AS THEY CAN
- Explain and demonstrate first
- GAIT belt for protection
- Lock wheels of wheelchair / plinth
- Get help from others
- Have a plan
- Overly communicate
- Maintain modesty (drape)

15

T or F: Bed mobility, or going from sitting to standing, or from wheelchair to bed, etc. ... these are actually assessments and interventions?

TRUE ... only if you make sure the patient does as much of the work as they can. We as PT want to see how they are doing with those simple daily functions, to determine if they can be d/c to go home and do them independently.

16

With BED MOBILITY, there are several types of movement (below). Explain each for a independent patient (can do it themselves):

- Lateral Movement
- Cranial / Caudal movement
- Supine to sidelying
- Supine to sitting
(***Supine to sitting alternative)

When/why would you use supine to sitting vs. the alternative?

- Lateral Movement: Patient gets in hooklying position, then has triceps on bed and lift with feet and triceps and laterally shift hips over. Then patient lifts head and upper body to scoot over.

- Cranial / Caudal movement: Patient gets in hooklying position, lifts head, gets up on elbows, transfers weight (cranial / caudal) to shift body weight up or down.

- Supine to sidelying: (going to the right) ... put right arm at 90 degrees up on bed, left leg flexed/bent, left arm reaches over and grabs bed, rotate over.

- Supine to sitting: patient roles from supine to sidelying (see point above), then moves legs off bed while pushing up with hand and elbow.

- **** Supine to sitting alternative: Patient push up on elbow, and then hands, then rotate to have legs go off bed.

- Sitting to supine: Opposite motions of supine to sitting above.

Do NOT use alternative if they have incontenence, cathether, or abdominal weakness.

17

What is the "hooklying" position

How can you remember this?

When patient is supine laying on the bed, and brings their feet up to bottom (flex hip, flex knees, bring feet up to bottom).

Remember the PT will "hook" their arms through patients legs under their knee ... while patient is lying on their back.

18

ACCRONYMS / ABBREVIATIONS:

s/p
d/c
ORIF
MVA
THA
TKA
NWB
WB
WBAT
TTWB
CVA
Paraplegia
Quadriplegia
Hemiplegia
Bi vs. unilateral
SBQC

s/p = status post surgery
d/c = discharge
ORIF = open reduction internal fixation
MVA = motor vehicle accident
THA = total hip arthroplasty
TKA = total knee arthroplasty
NWB = non weight bearing
WB = weight bearing
WBAT = weight bearing as tolerated
TTWB = toe touch weight bearing
CVA = Cerebrovascular accident (stroke)
Para = paralysis of legs
Quad = paralysis of arms (neck down ... depending on where)
Hemi = one side of body (stroke)
Bi = both sides, uni = one side
SBQC = small base quad cane

19

LAB 2 Cards Below:

Ok

20

You will FAIL your skills check if you don't do these 4 things:

1) Introduce yourself, ask permission, WASH HANDS
2) PUT A GAIT BELT ON PATIENT during any transfer / balance
3) Lock wheelchair during any transfer (or plinth)
4) DEMONSTRATE (and explain) before having patient do it.

21

When should a gait belt be worn?

If you are doing a transfer

If patient is NWB (or PWB)

Any balance issues

Patient at fall risk

Older patient unstable (PWB, TKA, etc.)

22

How should a gait belt be held?

What if patient is pregnant, or has an incision, where does gait belt go?

Where do you guard with a gait belt?

Wrap fingers under towards patients body, then point fingers up to heaven.

Above belly/baby, above incision

On stairs, always guard DOWN a stair. Hold gait belt on the good side with NWB, and on the bad side with PWB.

23

If a patient is doing a sit to stand transfer, what muscle would you want to quickly test to ensure strength?

If patient is getting up in bed to sit up (supine to sitting), or do movement in bed, what muscles would you want to test?

LE: quads, hip extensors, plantar flexors

UE: Triceps, Lats

24

Explain the 2 options of mechanical transfers:

EZ Lift: For NWB patients and it lifts entire body. You put sling under patient, with the leg parts going under hamstrings and crossing over to other side hooks. Then lift them into wheelchair.

Easy Stand: For PWB patients to get blood flow, put weight on leg, etc. Put harness on and stand them up.

25

For Manual Transfers Sit to Stand (and Standing Pivot):

1) When or why would PT block both the patients legs?

2) When or why would PT block only one of patient's legs?

3) When or why would PT block the GOOD or unaeffected or uninvolved leg?

4) When or why would PT block the BAD or affected or involved leg?

5) If you move to the RIGHT with a patient, be sure to explain what that means. What does it mean?

1) To be very conservative and safe during transfer, or PT preference. Usually it is when patient is NWB or PWB in BOTH legs.

2) They have a good strong leg to help, or PT wants to strengthen one leg.

3) The bad leg is too weak, so PT blocks GOOD leg as patient uses it to stand and transfer ... for safety.

4) To strengthen the affected / bad / involved leg (remember this would be a form of therapy).

*** Patient should use GOOD limb and PT block the good limb to be very conservative. But to strengthen, patient stands with BAD limb and PT blocks bad limb (for therapy / practice / strength).

5) To the patients RIGHT. Not the PT's right. Explain that to them so there is no confusion which direction you'll be going once you get up.

26

For Manual Transfers Standing Pivot:

1) Would you transfer to the stronger or weaker side? When would you do stronger, when would you do weaker?

2) Why would you pivot to the stronger side?

1) Usually the stronger side. Stronger to be conservative and safe, weaker to do therapy / practice / strengthening.

2) Because they can put more weight on that side, so it is safer.

27

**** On what side of body do you put a cane?

Why?

On the side OPPOSITE the affected (involved / bad) limb.

So when the patients steps forward on weak leg, it widens base of support out wide. Also, remember the torque concept. With a weak leg, you shift body weight over GOOD leg, so put cane by good leg to push off and counter act with an opposing torque.

28

Slide Board Transfers:

1) When and why would you use a slide board transfer?

2) What are the KEYS during a slide board transfer ... and if you DON'T do them, you will fail a skills check?

3) Explain process in a slide board transfer

1) For patients NWB or bilateral weakness in BOTH legs (both ankles/knees/hips).

2) LOCK WHEELCHAIR WHEELS. USE GAIT BELT. And DEMONSTRATE.

3)
- Put wheelchair close AT AN ANGLE
- Remove arm and leg rest on that side of wheelchair
- LOCK WHEELS and USE GAIT BELT
- Explain and DEMONSTRATE to patient
- Make a plan and explain it well
- Patient scoots up to edge of seat (as much as they can)
- Transfer downhill ideally
- Patient uses palms of hands to push up without getting them pinched under the board
- PT in front to guard

29

TOTAL ASSIST MANUAL TRANSFERS:

1) When or what situations (and why) would you use a two person lift

2) What movements in a bed would you use a draw sheet to move a patient?

1) From wheelchair to bed (when patient is NWB)

2) Cranially (up), caudally (down), laterally (sideways), and supine to sitting

30

Keys to remember about transfers or treating patients on / from a plynth

- Higher / lower plynth for patient to sit down on it or get off it comfortably
- Higher / lower plynth for the PT for their biomechanics safety
- LOCK the wheels

31

LAB 3 BELOW:

List advantages and disadvantages of using:

- Cane
- Crutches
- Walker
- Loftstrand Crutches

- Cane:
AD: Speed, mobility, light, easy to use, good gait mechanics, not cumbersome/bulky, easily transferable
DIS: Not stable, can't do NWB

- Crutches:
AD: Mobility, speed, do NWB/PWB
DIS: Hard, energy taxing, cordination, hard to transfer around

- Walker:
AD: stable, has wheels (quick), better gait, less energy
DIS: bulky, ackward (stairs, car, shower), has wheels, have to fold it up

- Loftstrand Crutches:
AD: Takes weight off wrists, used for long term
DIS: needs lots of UE strength

32

FITTING ASSISTIVE DEVICES:

1) When / where should you fit an assistive device?

2) Where does cane or walker handle, or hand position for crutches go? WHY?

3) How much room between top of crutch and axilla? WHY?

1) Fit it before they use it. Have them sit or lie down, and make sure it meets criteria below.

2) Base of ulnar styloid, so it creates a little elbow flexion so you can push off for leverage.

3) A 3 finger width for crutches between top and axilla, so you don't compress brachial plexus and axillary arteries.

33

GAIT PATTERNS WITH ASSISTIVE DEVICES:

1) WHAT is a 4 point, WHEN is it used, WITH what device(s)

2) WHAT is a 4 point modified, WHEN is it used, WITH what device(s). This is only ONE crutch, but does it go by good or opposite bad leg?

3) WHAT is a 2 point, WHEN is it used, WITH what device(s)

4) WHAT is a 2 point modified, WHEN is it used, WITH what device(s)

5) WHAT is a 3 point, WHEN is it used, WITH what device(s)

6) WHAT is a 3 point modified, WHEN is it used, WITH what device(s)

1)
WHAT: Crutch, step, other crutch, other step
WHEN: PWB needing most stability
WITH: Bilateral crutches (or canes)

2)
WHAT: Crutch, step, (pretend crutch), other step
WHEN: PWB needing stability
WITH: One crutch (or one cane)
The one crutch (cane) goes opposite affected/involved/bad

3)
WHAT: Crutch and step at same time, then opposite crutch and step
WHEN: PWB but are fairly stable
WITH: Bilateral crutches (or canes)

4)
WHAT: Crutch and step at same time, then opposite (pretend crutch) and step
WHEN: PWB but really stable and confident
WITH: One crutch (or cane) ... opposite bad leg

5)
WHAT: Two crutches forward, good leg forward (with bad leg held up)
WHEN: NWB
WITH: Two crutches, or walker

6)
WHAT: Two crutches forward with bad leg, then good leg comes up after.
WHEN: PWB, TTWB, WBAT
WITH: Crutches, canes, or walker

34

Usually you would put one crutch or one cane on the side of the good/uneffected/uninvolved limb, or on the opposite side of bad/effected/involved limb?

Put crutch or cane on Opposite / Bad / Involved / Effected limb.

35

3 step is only used when?

NWB

36

"Step to" crutch vs. "Step through" crutch means what ... and when would you do that?

Is "step through" good or bad?

Step to: someone is still NWB or PWB and weak, so they step only TO the crutch

Step Through: someone is much more confident or PWB strongly and they can step through past the crutch.

"Step through" is bad at first because patient isn't as stable or confident, so it is more dangerous. BUT, in time, you want them to "step through" because this is quicker but more importantly it is a more natural gait pattern.

37

Remember every question and situation is "IT DEPENDS"

1) But, in general, the most stable to least stable gait pattern is:

2) When would you use 3 point gait pattern?

3) What gait pattern is MOST stable

4) Which gait pattern allows greatest SPEED

5) Which gait pattern helps facilitate most natural gait pattern?

6) If I want to speed up a patient, have them do what?

7) If I want to slow down a patient, have them do what?



1) 4 point, 4 point modified, 2 point, 2 point modified


2) NWB

3) 4 point

4) 2 point and 3 point modified

5) 2 point and 4 point (but 2 point the most)

6) 2 point

7) 4 point

38

SIT TO STAND WITH AN ASSISTIVE DEVICE:

1) What is the first thing you will make sure you do?

2) 2nd most important thing you will do ... so you don't fail

- what should you do with assistive device before using?

3) Explain process of what the patient will do in a sit to stand with a cane or crutches

4) What will PT do to help patient?

5) What about from standing to sitting ...



1) GAIT BELT

2) DEMONSTRATE and explain first.

- FIT IT to patient properly

3) Patient will scoot to edge of chair, put assistive device in arms OPPOSITE effected leg, then use arm opposite assistive device to push off arm rest to stand up.

4) Block leg / legs, use gait belt to lift (using good body mechanics), help support till they are up and ready

5) PT helps by holding gait belt, and patient reaches back and grabs armrest with hand of bad leg and assistive device in arms opposite effected leg.

39

If doing a sit to stand with a walker, everything from point above applies, but what changes?

Have their arms push off/up from the STABLE surface - the chair, not the walker. If they reach out and grab walker and use that as leverage, walker is not stable.

40

Case Scenarios:

1) 32 year old female is diagnosed with paraplegia (L2) secondary to a rock climbing accident 4 weeks ago. She is medically and orthopedically stable and capable of tolerating a rigorous physical therapy program. Perform a transfer from the plinth to a chair. HOW would you do it?

2) 54 year old female with rheumatoid arthritis underwent L THA 2 days ago. She is WBAT and needs to adhere to THA precautions. Perform sitting/standing pivot transfer.

3) 76 year old male sustained a CVA one week ago with resulting right sided hemiplegia and moderate loss of communication. He understands what is said but has difficulty talking. He needs to begin bearing more weight on his legs in order to gain endurance for pre-gait tasks. Perform a sit to stand transfer in preparation for pre-gait activities.

1) So she can't move her legs, but otherwise is good. If she is total NWB, I'd get 2 people and do a transfer from plinth to chair. But, in this scenario I will LOWER plinth to her level, put gait belt on, Explain/demonstrate first, I use proper body mechanics, I guard BOTH her legs, chair should be stable so she can push off plinth and then grab chair on way down to help me take off some load, etc.

2) THA precautions are NO hip flexion, IR, and adduction of leg. So have leg out and keep it out (don't let it come in or flexed). Stand over/guard good leg with gait belt and lift up and rotate to the GOOD side. Have her help lift up, and grab chair as she sits back down to help.

3) Gait belt first, with stable chair. DEMONSTRATE and overly explain. Have him PWB on the bad/right side (for therapy) and you guard that leg. Do a sit to stand.

41

More Case Scenarios:

1) An otherwise healthy 15 year old female sustained a femur fracture during a MVA 2 weeks ago. She is currently NWB on the L LE. Select an appropriate assistive device and instruct her in proper use of the device.

2) A 54 year old female with rheumatoid arthritis underwent a L THA 2 days ago. She is WBAT, but needs to adhere to THA precautions. Select an appropriate assistive device and instruct her in proper use of the device.

3) A 76 year old male who reports experiencing two falls in the past month is referred to outpatient therapy for balance training. He does not currently use an assistive device. Select an appropriate assistive device and instruct him in proper use of it.

1) Because she is young and coordinated, I'd do crutches. I'd tell her to start with a 3 point, and demonstrate how first. I'd adjust the crutches to fit her. (I'd use a walker for older more unstable patients).

2) Because she is 54 and had a THA (no hip flexion past 90, no adduction or crossing legs, no IR or ER), I'd probably go with a walker for a bit more stability. We could move to crutches if she feels confident, but start with walker. Because she is WBAT, we'd do 3 point modified, but ensure she does NOT bring leg in or flex it because of walker.

3) Because he feels unstable and has fallen, I'd recommend a cane to give more support, and widen his base of support. Adjust it to his height (base of ulnar styloid). I'd have him do 2 point modified because he only needs one cane, and it is most natural gait pattern (cane goes opposite the bad leg ... but in this case he has not bad side, so his preference, usually hold cane with NON-dominant hand).

42

If person needs to use a cane just for a bit more stability, and has a bad leg, should cane go opposite bad leg, or on side of bad leg? Why?

If person needs to use a cane just for a bit more stability, but both legs are equally fine, where should cane go? Why?

Opposite of bad leg. Gives more stable wider base of support and counteracts torques.

It is his preference. Usually in this case, put cane in non-dominant hand (so dominant hand is free).

43

LAB 4 BELOW:

ok

44

If the PT needs to guard a patient when they are walking or going up stairs, the PT would obviously hold the gait belt, but what side of the body would the PT be on if the patients was:

NWB

PWB

NWB: Side of GOOD / uneffected / uninvolved leg

PWB: Side of BAD / effected / involved leg

45

When going up and down stairs with any assistive device, what is the rule of thumb (or saying):

How can you remember this?

UP with the GOOD, DOWN with the BAD

Because GOOD people go UP to heaven, and BAD people go DOWN to .... :)

46

If patient is going UP stairs, PT stands where if they are guarding?

If patient is going DOWN stairs, PT stands where if they are guarding?

Down a stair (where gravity will pull patient).

Down a stair (where gravity will pull patient).

47

Should you use a railing if it is available? Why or Why Not?

ALWAYS use a railing if possible. Railings are the most stable secure thing you have - use it.

48

Do assistive devices move with the GOOD or BAD limb?

Assistive devices usually always move with the BAD limb.

49

If a patient has bilateral crutches, and is going UP the stairs (with no railing), what would you as the PT do (explain how, demonstrate what the patient does, where do you stand):

- FIRST put gait belt on. Then DEMONSTRATE (and explain it) ... and make sure assistive device is measured properly
- Patient goes UP with GOOD first (hop), then follow with crutches and bad. Repeat
- PT will have gait belt on and guard. If NWB, PT on side of good leg; if PWB, PT on side of bad leg. PT stands down a step where gravity is.

50

If a patient has bilateral crutches, and is going DOWN the stairs (with no railing), what would you as the PT do (explain how, demonstrate what the patient does, where do you stand):

- FIRST put gait belt on. Then DEMONSTRATE (and explain it) ... and make sure assistive device is measured properly
- Patient goes DOWN with BAD and CRUTCHES first (KICK BAD LEG OUT), then follow with GOOD. Repeat
- PT will have gait belt on and guard. If NWB, PT on side of good leg; if PWB, PT on side of bad leg. PT stands down a step where gravity is.

51

If a patient has bilateral crutches or just one crutch, and is going UP the stairs with a railing, what would you as the PT do (explain how, demonstrate what the patient does, where do you stand):

- FIRST put gait belt on. Then DEMONSTRATE (and explain it) ... and make sure assistive device is measured properly
- Patient holds to railing with assistive device(s) in opposite hand/arm. Patient goes UP with GOOD first (hop), then follow with crutch(es) and bad. Repeat
- PT will have gait belt on and guard. If NWB, PT on side of good leg; if PWB, PT on side of bad leg. PT stands down a step where gravity is.

52

If a patient has bilateral crutches or just one crutch, and is going DOWN the stairs with a railing, what would you as the PT do (explain how, demonstrate what the patient does, where do you stand):

- FIRST put gait belt on. Then DEMONSTRATE (and explain it) ... and make sure assistive device is measured properly
- Patient holds to railing with assistive device in opposite hand/arm. Patient goes DOWN with BAD and CRUTCHES first (KICK LEG OUT), then follow with GOOD. Repeat
- PT will have gait belt on and guard. If NWB, PT on side of good leg; if PWB, PT on side of bad leg. PT stands down a step where gravity is.

53

If a patient has a WALKER, and is going UP the stairs, what would you as the PT do (explain how, demonstrate what the patient does, where do you stand):

- FIRST, gait belt on, demonstrate (and explain it). Patient should be sitting.
- Have patient sit on a chair (if possible) and fold up their walker
- PT helps them up (with gait belt)
- Position walker firmly into stairs with front leg/wheel up into stair as much as you can so it doesn't move.
- Up with good, followed with walker and bad
- Down with walker and bad, then the good

*** Ideally have the patient get another person to help at home, have a chair at the top of stairs so they can sit to unfold, and worse case scoot up backwards if they can't

54

If a patient has a WALKER, and is going DOWN the stairs, what would you as the PT do (explain how, demonstrate what the patient does, where do you stand):

Same as above ...

Walker and bad leg down (KICK LEG OUT), then good leg down.

55

Why might you instruct person to scoot up backwards on stairs to go up ... and what are drawbacks to that?

If they just can't do it, or are not safe, tell patient to sit down backwards and scoot up stairs backwards on back side.

But, when they get to the top, how do they get up? That is the bad part.

56

For going UP a curb, how would you instruct a patient to go UP a curb with:

- Crutches
- Cane
- Walker

- Crutches: up with good, followed by bad and crutches

- Cane: up with good, followed by bad and cane

- Walker: WALKER up first, then good, then bad

57

For going DOWN a curb, how would you instruct a patient to go DOWN a curb with:

- Crutches
- Cane
- Walker

- Crutches: Crutches and bad down first, then good

- Cane: Cane and bad down first, then good

- Walker: Walker down first, then bad, then good

58

As a PT, where would you stand for patient practicing going up and down a curb?

And where do you guard for NWB and PWB?

Always downhill where gravity is greatest (since that is where they will fall).

And you guard for NWB on good leg, and PWB on bad leg.

59

Case Scenarios:

1) Patient is 2 months post-CVA and is prepared to d/c home from an acute rehabilitation hospital. This patient is using a SBQC currently.
- What gait pattern would this patient be performing
- Demonstrate/explain how this patient should ascend and descend steps with a railing at home
- Demonstrate/explain how this patient should ascend and descend a curb in community.

2) A patient is 3 days s/p R THA and is ready to d/c home. He resides in a split level home (stairs have a rail on the R going up) and intends to return to work in 2 weeks. His WBing status is TTWB for 8 weeks.
- What assistive device options are available to him? And what is your rationale for each
- What gait pattern would this patient be performing
- Discuss/demonstrate how you would instruct this patient to ascend/descend steps at home
- Discuss/demonstrate how you would instruct this patient to ascend/descend a curb in the community

1)
- Probably a 2 point modified
- Up with good, then bad and cane. Down with cane and bad, then good. Hold railing with cane in opposite hand.
- Up with good, then bad and cane. Down with cane and bad, then good.

2)
- Crutches for a younger more stable patient, walker for older patient needing more stability.
- 3 point modified
- (SEE EVERYTHING ABOVE)

60

Should you fit crutches in supine?

Yes, you can. BUT, when they stand, double check and make sure they are correct once they stand up.

61

When blocking during a sit to stand pivot transfer, remember to keep body open. What does that mean?

Make sure if you are turning to right, you block with left leg so you can keep body open. If you block with right leg, and turn right, your body can't turn and open as much.