Transfers and Gait Training 2

Question 1

Estimating Axillary Crutch Fit

Answer 1

adjust overall height before grip height

Question 2

Methods to estimate axillary crutch fit

Answer 2

• Patient’s height minus 16 inches
• 77% of patient’s height
• Height markings on crutch
• “ATNR” (asymmetric tonic neck reflex) pose

Question 3

Confirming Crutch Fit

Answer 3

• Recheck with crutches in functional stance
• Two fingers should fit between axilla and axillary pad
• Elbows in 20 to 30 degrees of flexion
• Wrists in neutral flexion/extension

Question 4

Sit to Stand with Axillary Crutches

Answer 4

• Both crutches to one side (holding crutch grip on the inside)
• Push down on chair armrest and crutch grips
• Stand and balance
• Transfer a crutch under each arm

Question 5

• Forward Gait with Axillary Crutches
  
  • Typical gait progression:

Answer 5

Crutches
involved extremity
uninvolved extremity

Question 6

Forward Gait with Axillary Crutches
Progress from

Answer 6

step-to to step-through gait

Question 7

Stairs with Axillary Crutches

Answer 7

• “Up with the good, down with the bad”

Or “up with the non-involved leg and down with the involved leg”

• Keep crutches on same step as the involved or weaker LE

Question 8

Forward Gait with Forearm Crutches

Answer 8

• Erect posture
• Do not allow patient to rest weight on axillary pads, to avoid damage to nerves and vessels
• Two-point, three-point, four-point gaits
• Step-through or swing-through gaits
• May begin with step- (or swing-) to and progress to step- (or swing-) through gait pattern

Question 9

Knee Walker/Scooter

Answer 9

• More stable than crutches
• Require less upper body strength and energy expenditure than crutches
• Not suitable for limited WB at or above knee or on stairs

Question 10

Hemi Walker

Answer 10

• One-sided support with more stability than a cane
• FWB, PWB, WBAT

Question 11

With a Hemi Walker, Consider progressing to a standard cane when

Answer 11

patient’s stability increases or when gait speed causes patient to “rock” the hemi walker

Question 12

Canes

Answer 12

• Can be used singly (typically opposite the involved LE) or bilaterally
• Progress from wide-based and small-based quad canes to single-point cane (SPC)

Question 13

Sit to Stand with Cane

Answer 13

• Move into ready position
• Lay cane to the side, holding the handle in the same hand with the armrest
• Push to standing and place cane upright

Question 14

Sit to Stand with Cane
If the cane can stand on its own (e.g. quad cane):

Answer 14

• Place cane next to chair
• Push to standing on both armrests
• Grasp cane

Question 15

Stairs with Cane

Answer 15

“Up with the non-involved leg, down with the involved leg”

Question 16

Stairs with cane
keep cane on same step as

Answer 16

involved leg