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Unit 2 > Supportive Devices/Gait Training Lab (10/11a) [Examination/Intervention] > Flashcards

Supportive Devices/Gait Training Lab (10/11a) [Examination/Intervention] Flashcards

1
Q

Basic guarding technique

A

Wide stance

Stand to side of patient, a bit behind

One hand at pt low back, one hand on anterior aspect of shoulder closest to you

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2
Q

Why use the basic guarding position?

A

If pt loses balance, you can use position to hug them close to your body

If pt knees buckle, you can hug them close to you and have them sit on your bent knee/assisted fall

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3
Q

Common assistive devices

A

Walker (standard, rolling, rollator, UE platform)

Hemi Walker

Quad Cane (wide base; narrow/small base)

Single Point Cane

Axillary Crutches

Forearm Crutches

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4
Q

Indications for use of an AD

A

Decreased ability to bear weight on LE

Decreased trunk and/or LE strength

Impaired balance

Impaired kinesthetic awareness

To offset LE pain

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5
Q

Levels of Weight Bearing

A

Full Weight Bearing

Weight Bearing as Tolerated

Partial Weight Bearing

Toe Touch Weight Bearing

Non-Weight Bearing

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6
Q

Full Weight Bearing (FWB)

A

no restrictions

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7
Q

Weight Bearing as Tolerated (WBAT)

A

allowed to put as much weight on extremity
as patient can tolerate

usually needs an AD due to pain and/or weakness

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8
Q

Partial Weight Bearing (PWB)

A

allowed to but some but not all weight on an
extremity

defined by a percentage (EX: 25%, 50%)

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9
Q

Toe Touch Weight Bearing (TTWB)

A

no weight through the limb

big toe on the
ground (helpful input for balance)

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10
Q

Non-Weight Bearing (NWB)

A

limb does not touch the ground or weight bearing surface

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11
Q

Sizing guide for AD

A

When pt standing upright with shoulders relaxed and hands placed on the hand grips, elbows should be bent 15-30 deg

Grips of AD should align with wrist creases when relaxed

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12
Q

Standard and Rolling Walkers - Benefits

A

Provide an increased base of support

Most are able to be folded for easier storage when note in use

Allow for UE platform attachments
– Used for UE weight bearing restrictions, poor UE strength (especially grip)

Allow for tray / basket attachments

Can be used for all levels of unilateral LE weight bearing restrictions

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13
Q

Standard Walker

A

Offers stability during forward body advancement for pt with a single LE NWBing status

Pt must be able to pick up the walker to advance it, having all 4 legs leave the ground at the same time and contact the ground at the same time

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14
Q

Rolling Walker

A

Pushed like a shopping cart, maintains contact with the ground at
all times

Can be used for pt with a single lower extremity WBing restriction

Pt must be able to control the forward movement of the walker to decrease risk of falls

Can be difficult for some pt to advance over changes in surfaces

Can add walker skiis for improved fluidity of transition from surface to
surface

Wheels can be fixed, or swivel

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15
Q

Rollator Walker

A

Not used with WB restrictions

Can help for pt with mild balance deficits

Very helpful for pt with endurance deficits (provides immediate seat)

Has breaks to help slow it down (pull up) and lock into place (push down)

Must be cognitively intact to safely lock/unlock the breaks during transfers
and safely control the walker

Front wheels swivel to increase ease of maneuverability

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16
Q

Walker - Limitations

A

Rather bulky and difficult to use in crowded or narrow spaces

Can lose their stability/effectiveness on uneven surfaces

Eliminate the capability for arm swing

Unless front wheels are swivel wheels, can be difficult to maneuver/change in direction during ambulation

Not functional for stair negotiation

If used improperly, can promote forward flexed posture, or posterior loss of balance

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17
Q

Rolling Walker Gait - Step To Pattern

A

walker → impaired → good matches

Good starting place for gait training, especially with WB restrictions

STEPS

1) Move walker ahead
2) Lead with impaired LE
3) Match up with non impaired LE

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18
Q

Rolling Walker Gait - Step Through Pattern

A

walker → impaired → good passes

more normalized pattern, improved fluidity

STEPS

1) move walker ahead
2) lead with impaired LE
3) step with non impaired LE, passing the placement of impaired LE

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19
Q

Walker Gait - NWB

A

Achieve NWB by flexing the hip and knee

STEPS
1) Advance walker forward
2) Bear weight down through hands, extending elbows, and
depressing shoulders
3) Unweight body enough to advance the intact LE forward

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20
Q

Axillary Crutches - Benefits

A

Can be used for all levels of unilateral LE WBing

Easier to negotiate in crowded or narrow areas

Easier to use on uneven terrain than walker

Able to be used on stairs

Wider variety of gait patterns, including 2 that incorporate modified UE swing

21
Q

Axillary Crutches - Limitations

A

Require a much higher level of balance and coordination than walkers

Requires good UE and trunk strength and control

More difficult to for pt to free their hands for carrying objects

22
Q

Axillary Crutches - Fitting

A

HEIGHT
- 3 finger width btwn top of axillary pad and pt’s armpit

HAND GRIPS

  • 15 to 30 deg elbow bend
  • has separate adjustment

POSITION

  • upright, shoulders relaxed, hands on grips
  • crushes 2” in front and 6” to side of pt feet
23
Q

Crutches - Sit to Stand

A

Both crutches on impaired side

Pt at edge of chair, lean forward and use intact UE to assist in pushing to stand

Once standing, pt reaches across body with intact UE to grasp outer crutch and place on intact side

Using hand of impaired side, pt twists remaining crutch into position under impaired side

24
Q

Crutches - Stand to Sit

A

Back of pt legs against chair edge

Reverse sit to stand directions

Reach back for chair with intact UE and slowly lower self

25
Crutches Gait - NWB 3 Point
Impaired LE off the floor via knee or hip flexion Crutches held in position, body swings through Crutches moved forward 6-8" Bear weight down on hands, extend elbows, depress shoulders Lift intact LE off flow and swing body through crutches, impaired LE swings forward and through Intact LE placed in front of crutches Crutches brought forward, repeat steps
26
Crutches Gait - PWB or TTWB Modified 3 Point
Partial weight through impaired LE Advance crutches forward Advance foot of impaired LE to line of crutches, foot flat but not full weight Bear weight down on hands, extend elbows, and depress shoulders while bringing intact foot forward to match/slightly pass crutches Bring both crutches forward
27
Crutches Gait - 4 Point
Slow gait pattern, requires coordination Max stability bc 3 points of contact while one limb/crutch moves Promotes reciprocal pattern with incorporating UE swing requires 2 crutches or canes STEPS Advance one crutch, followed by advancement of opposite LE Other crutch advanced, followed by opposite LE
28
Crutches Gait - 2 Point
faster than 4 point gait, low energy expenditure, requires coordination allows more natural arm/leg motion requires 2 crutches or canes One crutch and opposite LE advance together, followed by other crutch and LE advancing together
29
Crutches Gait - Modified 2 Point
Similar to 2 point gait but with only one crutch or cane
30
Forearm Crutches (Loftstrand/Canadian Crutches)
BENEFITS - same benefits and gait patterns as axillary crutches - frees hands for limited use without having to drop crutch LIMITATIONS - requires more balance, increased UE strength, and highest level of coordination FITTING - arm cuff 1-1.5" inferior to olecranon process to not interfere with elbow flexion
31
Hemi Walker - Benefits
Widened base of support for pt with limited/no use of single UE, or who have heme-body weakness (with limited/no WB of single LE) Flexibility of placement during ambulation Usually has additional lower grip that can be used during sit to stand Folds for easy storage
32
Hemi Walker - Limitation
Can't be used for pt with NWB LE Bulky Slowed gait pattern Step to → Step through gait pattern, doesn't promote smooth reciprocal pattern Not functional on stairs
33
Quad Canes - Benefits
For pt requiring mild added support for balance Offsets pressure to painful/mildly weak LE when used on contralateral UE Stays standing up on its own Requires use of only one UE Promotes more natural gait Can be used on stairs Easy to store and transport
34
Quad Canes - Limitations
Slower than single point cane Compromised steadiness on uneven surfaces
35
Quad Canes - Gait
Flat edge of quad cane face outside of the foot of the side it's used on SEQUENCING - for pt with weakness on one side, NBQC/WBQC used on intact side - for pt with balance deficits, they may feel more comfortable sequencing quad cane with dominant side GAIT PATTERNS - step to - step through - modified 2 point
36
Single Point Cane (SPC)
BENEFITS - for pt needing additional input for balance - offset pressure of painful/mildly weak LE when used on contralateral UE - requires use of only one UE - promotes natural gait with minimal interruption to speed - can use on stairs, easy to store/transport - can use on uneven surfaces LIMITATIONS - smallest BOS so least stability
37
Single Point Cane - Gait
SEQUENCING - for pt with weakness on one side, cane used on intact side - for pt with balance deficits, may feel more comfortable with cane on dominant side GAIT PATTERNS - step to - step through - 2 point (2 SPCs) - Modified 2 point - 4 point (2 SPCs)
38
Elevation LE Pattern - Ascending
"Up with the good" Lead with intact leg Impaired leg comes up next, joining intact leg on same step
39
Elevation LE Pattern - Descending
"Down with the bad" Lead with affected leg Intact leg comes down next, joining impaired leg on same step
40
Stairs - With Railing Options
No AD Single Side Crutch (axillary/forearm) → accommodates NWB to FWB 2 Axillary Crutches (both kept under one arm) → accommodates NWB to FWB Quad Cane (turn it sideways for better fit on stairs) → WBAT Single Point Cane → WBAT
41
Stairs - No Railing Options
Single Crutch (axillary/forearm) → WBAT 2 Axillary Crutches: one under either arm → NWB to FWB 2 Forearm Crutches → NWB to FWB Quad Cane (turn it sideways for better fit on stairs) → WBAT Single Point Cane → WBAT 2 Single Point Canes → WBAT
42
Gait Pattern - 2 Point
DEVICES - bilateral ADs (canes, crutches) WB STATUS - WBAT DESCRIPTION - one AD and opposite LE move forward simultaneously - each step is one point and a complete cycle is two points
43
Gait Pattern - 4 Point
DEVICES - bilateral ADs (canes, crutches) WB STATUS - WBAT DESCRIPTION - one AD is moved forward and placed on the floor, followed by the opposite LE - other AD is moved forward and placed on the floor, followed by the opposite LE - EX: left cane, right foot, right cane, left foot left cane...
44
Gait Pattern - Modified 4 Point
DEVICES - unilateral ADs (cane, crutch) WB STATUS - WBAT DESCRIPTION - cane/crutch in one hand advances, contralateral LE advances - ipsilateral LE advances, cane advances - repeat
45
Gait Pattern - 3 Point
DEVICES - bilateral crutches, walker WB STATUS - NWB DESCRIPTION - crutches/walker advances, pt hops forward on intact LE keeping LE NWB
46
Gait Pattern - Modified 3 Point
DEVICES - bilateral crutches, walker WB STATUS - TTWB, PWB, WBAT DESCRIPTION - crutches/walker advances, pt steps forward with impaired LE, placing it down WBAT - steps with intact LE
47
Gait Pattern - Step To
DEVICES - bilateral crutches, walker WB STATUS - NWB DESCRIPTION - crutches/walker advances, LEs advance only to point of AD
48
Gait Pattern - Step Through
DEVICES - bilateral crutches WB STATUS - NWB DESCRIPTION - crutches advance, both LEs simultaneously swing beyond point of AD

Unit 2 (27 decks)

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