243 Equipment, Devices And Modalities (Edm): Ambulatory Aids And Wc

Front 1

what muscles are required to use ambulatory aid?

Back 1

-shoulder depressors

1. lower trapezius

2. pec major

3. lats

-need to strengthen shoulder depressors if aids to be used for a long time

Front 2

Indications for crutches

Back 2

1. Used to increase BOS
2. Provide moderate degree of stability
3. Relieve WB on the LE

-can be used with PWB (e.g. THR, balance problems, etc)

Front 3

Crutch measurement:

Back 3

1. 20-30 degrees of elbow flexion is desirable
2. For standing patients, subtract 16 inches from the patient's height or measure from a point 2 inches below the axilla to a point 6 inches in front and 2 inches lateral to the foot.
3. For supine patients, measure from the axilla to a point 6-8 inches lateral to the heel
4. Forearm crutches: the cuff should cover the proximal third of the forearm, 1-1.5 inches below the elbow

Front 4

Advantages and disadvantages of axillary crutches?

Back 4

1. Provide increased UE WB over forearm crutches

2. can be used for stair climbing
3.. May be difficult to use in small areas
4. Prolonged leaning on the axillary bar can result m vascular and/or nerve damage (axillary artery/radial nerve)

Front 5

what are advantages and disadvantages of forearm crutches?

Back 5

1. Have a forearm cuff & a hand grip
2. Provide slightly less stability but increased ease of movement
3. Frees hands for use without dropping the crutch (secured by cuff)

Front 6

what does PWB mean?

Back 6

toes or ball of involved foot contacts floor and allows limited amt of WB

Front 7

Three-point gait:

Back 7

1. Both crutches & involved leg are advanced together, then uninvolved leg is advanced forward
2. Requires use of two assistive devices (crutches or canes) or a walker
3. Indicated for use with involvement of one extremity; e.g., LE fracture

Front 8

Two-point gait:

Back 8

1. One crutch & opposite extremity move together, followed by the opposite crutch & extremity
2. Requires use of two assistive devices (canes or crutches)
3. Allows for natural arm & leg motion during gait,

4. good support & stability from two opposing points of contact

Front 9

Four-point gait:

Back 9

1. slow gait pattern in which one crutch is advanced forward & placed on the floor, followed by advancement of the opposite leg
Then the remaining crutch is advanced forward, followed by the opposite remaining leg
2. Requires the use of two assistive devices (crutches or canes)
3. Provides maximum stability with three points of support while one limb is moving

Front 10

Swing-to gait:

Back 10

1. Both crutches are advanced forward together
2. Weight is shifted onto hands for support & both legs are then swung forward to meet the crutches
3. Requires the use of two crutches or a walker
4. Indicated for individuals with limited use of both LE and trunk instability

Front 11

what is swing-through gait

Back 11

1. Both crutches are advanced forward together
2. Weight is shifted onto hands & both legs, which are swung forward beyond point of crutch placement
3. Requires the use of two crutches

Front 12

when are swing to and swing through gait patterns used?

Back 12

1. (B) LE involvement, & trunk instability
Ex: patient with paraplegia, spina bifida
2. Not as safe as swing-to gait

Front 13

what assistive devices are safe for used in descending and ascending stairs?

Back 13

crutches or cane(s)

Front 14

ascending stairs with assistive devices?

Back 14

Uninvolved leg always goes up first
Followed by the crutches (or cane) & involved leg together

Front 15

Descent on stairs:

Back 15

Crutches (or cane) & involved leg go down first, followed by the uninvolved leg

Front 16

Indications for canes:

Back 16

1. widen BOS to improve balance
2. Provide limited stability

3. relieve pain

4. unweighting (can unload forces on involved hip by 30%)
held in opposite hand

Front 17

Cane measurement:

Back 17

1. 20-30 degrees of elbow flexion is desirable
2. Measure from greater trochanter to a point 6 inches to the side of the toes

Front 18

Quad cane does what?:

Back 18

1. Provides increased stability with 4 contact points with ground

2. but slows gait cadence
No stairs with large based

small-based quad cane is used on stairs

Front 19

Gait patterns with cane:

Back 19

1. Cane is held in the hand opposite to the involved extremity
2. Cane & involved extremity are advanced together, followed by the uninvolved extremity

3. 2 canes can be used for 2-,3-,or 4-point gait patterns

Front 20

Indications for walkers:

Back 20

1. Widen base of support,

2. provide increased lateral and anterior stability
3. Can reduce WB on one or both LE

4. easy to use
5. Frequently prescribed for patients with debilitating conditions, poor balance, or LE injury when use of crutches is precluded

Front 21

Negative features for walkers include:

Back 21

1. No reciprocal arm swing
2. Increased flexor posture

3. unsafe for stairclimbing

Front 22

Advantages of folding walker?

Back 22

1. Facilitate mobility in community,

2. can be placed in cars

Front 23

what is a stair climbing walker?

Back 23

Has two posterior extensions & additional handgrips off the rear legs for use on stairs

-still unsafe for stair climbing

Front 24

what are reciprocal walkers?

Back 24

1. Hinged in middle
2. Allow advancement of one side of walker at a time
3. Used with reciprocal gait patterns, reciprocating orthoses

Front 25

Gait patterns with a walker?

Back 25

1. the walker is moved first followed by one leg at a time

2. in PWB or NWB, involved goes first while weight is shifted onto arms

3. can be used for swing-to and 3-point gait pattern

Front 26

Typical gait changes for obese pts. include:

Back 26

1. Greater hip ABD & rotation
2. Less knee flexion

3. pronated feet
4. Difficulty weight-shifting

Front 27

how to guard on stairs?

Back 27

therapist positioned below pt

ascent: stand behind and to involved side

descent: in front, on involved side

Front 28

what may be required for sit-to-stand transfer with bariatric patient?

Back 28

mechanical lift to help transfer

or stand pole

Front 29

what other equipment for bariatric patients is useful to assist in transfers?

Back 29

1. mechanical stretcher chair: accommodates up to 1000 lb and 40 inches in width; used for transfers and converting to sitting position

2. bariatric treatment table: motorized; crucial if dealing with population of 400-700 lb or more

Front 30

what are the disadvantages of WC Sling seat: standard on wheelchairs

Back 30

Hips tend to slide forward,

thighs tend to ADD & IR
Reinforces poor pelvic position (posterior pelvic tilt)

Front 31

WC Insert or contour seat creates what?

Back 31

1. Stable, firm sitting surface
2. Improves pelvic position (neutral pelvic position)
3. Reduces the tendency for the patient to slide forward or sit with a posterior pelvic tilt (sacral sitting)

Front 32

WC Seat cushion does what?:

Back 32

1. Distributes WB pressures
2. Assists in preventing decubitus ulcers in patients with decreased sensation,

3. prolongs WC sitting times

Front 33

what is the standard back support for w/cs?

Back 33

Support to the midscapular region

Front 34

what are the purposes of lower back ht w/c?

Back 34

increase functional mobility
May also increase back strain

Front 35

indication for high back w/c?

Back 35

1. poor trunk stability

2. extensor spasms

Front 36

Indications for contour backs?

Back 36

Improve trunk extension & overall upright alignment

Front 37

what are indications for WC Lateral trunk supports:

Back 37

1. Improve trunk alignment for patients with scoliosis,

2. poor stability

Front 38

what are wraparound (space saver) armrests?

Back 38

reduce overall width of chair by 1.5 inches

Front 39

when are elevating leg rests contraindicated?

Back 39

knee flexor hypertonicity

Front 40

what are the w/c measurements?

Back 40

1. seat width

2. seat depth

3. leg length (seat to footplate length)

4. seat height

5. arm rest height

6. back height

Front 41

WC Seat width measurement:

Back 41

Measurement on the patient: width of the hips at the widest part
Chair measurement: add 2 inches to the patient's measurement

Front 42

WC Seat depth measurement:

Back 42

1. Measurement on the patient: posterior buttock to the posterior aspect of the lower leg in the popliteal fossa
2. Chair measurement: subtract 2-3 inches from the patient's measurement

Front 43

Seat depth that is too short _____

Back 43

fails to support the thigh adequately.

Front 44

Seat depth that is too long______

Back 44

compromise posterior knee circulation or result in a kyphotic posture, posterior tilting of pelvis and sacral sitting

Front 45

WC Leg length/seat to footplate length measurement:

Back 45

Measurement on the patient: from the bottom of the shoe to just below thigh in the popliteal fossa
When a seat cushion is used, the height must be subtracted from the patient's measurementq

Front 46

Excessive leg length

Back 46

will encourage sacral sitting & sliding forward in the chair

Front 47

Length that is too short

Back 47

create uneven weight distribution on thigh and excessive weight on the ischial seat

Front 48

WC Seat height measurement:

Back 48

Chair measurement: minimum clearance between floor & footplate is 2 inches, measured from the lowest point on the bottom of the footplate
Add 2 inches to the patient's leg length measurement

Front 49

WC Arm rest height (hanging elbow height) measurement:

Back 49

1. Measurement on the patient: from seat plat­form to just below elbow held at 90 degrees with shoulder in neutral position
2. Chair measurement: add 1 inch to the patient's hanging elbow measurement

Front 50

Armrests that are too high

Back 50

will cause shoulder elevation

Front 51

Armrests that are too low

Back 51

encourage leaning forward

Front 52

WC Back height measurement:

Back 52

1. Measurement on the patient: from seat plat­form to lower angle of scapula, midscapula, top of shoulder, based on the degree of support desired
2. If the patient plans to use a seat cushion, the height of the cushion must be added to the patient's measurement

Front 53

Added back height may

Back 53

increase difficulty in getting the chair into a car or van

prevent the patient from hooking onto the push handle for stabilization-and weight relief

Front 54

standard w/c measurements?

Back 54

seat width: 18

depth: 16

height: 20

Front 55

what determines the frame construction selected for w/c?

Back 55

-lighter weight frames are easier to use

-level of expected use should determine frame construction

-folding = easier storage and transport

-rigid= lighter and sturdier

Front 56

what are the purpose of caster locks?

Back 56

add stability to w/c during transfers

Front 57

what is diameter of casters?

Back 57

8 inches

Front 58

what are the types of w/c tires?

Back 58

1. pneumatic (air filled) = smoother ride with increased shock absorption

2. rubber = durable and require low maintenance

Front 59

what are features of sports w/c?

Back 59

1. lightwt

2. rigid frame

3. low seat

4. low back

5. slanted drive wheels

6. small push rims

Front 60

what are features of amputee w/c?

Back 60

1. drive wheel posterior to back support to accomodate change in COG for pts with bilat LE amputation

Front 61

what is a hemiplegic w/c?

Back 61

low to ground to allow propulsion with uninvolved UE and LE

ht = 17.5 inches

Front 62

what is a tilt-in-sapce w/c?

Back 62

1. Motorized
2. Entire seat and back may be tipped backward (normal seat to back angle is maintained at 90 deg)
3. Indicated for patients with extensor spasms that may throw the patient out of the chair, or for pressure relief

Front 63

what is a one-arm drive w/c

Back 63

drive mechanisms are located on one wheel

-usually 2 outer rims

-propel by pushing on both rims

-difficult for some pts to use (e.g. pt with left hemiplegia, cognitive/perceptual impairments)

Front 64

when is reclining back w/c indicated?

Back 64

1. Who are un­able to independently maintain upright sitting position
2. electric

3. assist in pressure relief if pt cannot do active push-ups or pressure relief maneuvers (e.g. upper cervical quadriplegia)

Front 65

Bariatric wheelchair:

Back 65

-The bariatric client has a center of body mass that is positioned several inches forward compared to the normal-sized person
-For WC stability, the rear axle is displaced forward compared to the standard WC
-This forward position allows for a more efficient arm push (full-arm stroke with less wrist extension)

-hard tires instead of pneumatic for durability

-adjustable back rest to accommodate increased posterior bulk

-reclining feature to accommodate for cardiorespiratory compromise (e.g. orthostatic hypotension

-power chair bc of endurance issues

Front 66

what support does BWS without treadmill begin with and what is progression?

Back 66

40% initially

progression to decr by 10% increments until there is no support

Front 67

what weight percentage is contraindicated in BWS treadmill?

Back 67

>55% bc interferes with achieving foot flat

Front 68

what is speed progression for BWS treadmill?

Back 68

slow speed 0.6-0.8 progress to near normal walking (2.6-2.8 mph)