Assistive Devices, Gait Instructions, And Guarding Techniques

Front 1

Determining appropriate assistive device: when to use a standard walker

Back 1

*generalized weakness
*poor balance and coordination
*need to reduce weight bearing on LE's
*inability to use crutches
*elderly patients

Front 2

Determining appropriate assistive device: when to use a wheeled walker

Back 2

*decreased UE strength
*back surgery
*sternal surgery

Front 3

Determining appropriate assistive device: when to use a platform walker

Back 3

*unable to bear weight through hand, wrist or forearm
*poor or absent grasp

Front 4

Determining appropriate assistive device: when to use crutches

Back 4

*generally younger patients
*need to reduce weight on LE's or have weakness in 1 or both LE's
*must have F to G balance and F strength in UE's

Front 5

Determining appropriate assistive device: when to use forearm crutches

Back 5

*need for crutches permanently or for long periods of time
*must have good trunk stability

Front 6

Fitting of Ambulation Devices: anatomical landmarks-Walkers/canes

Back 6

*wrist crease/ulnar styloid
*elbow flexion: 20-30 degrees

Front 7

Fitting of Ambulation Devices: anatomical landmarks-axillary crutches/forearm crutches

Back 7

*2 finger-width below axilla
*wrist crease/ulnar styloid
*elbow flexion -20-30 degrees

Front 8

What should you avoid when applying a gait belt?

Back 8

avoid tubes, lines, incisions, etc

Front 9

Where should the therapist stand to guard patient that's using assistive device?

Back 9

stand to one side and slightly behind the patient

Front 10

Procedure: sit to stand with assistive device

Back 10

1. Therapist positioned to one side and slightly behind pt with one hand on gait belt and over the shoulder girdle
2. pt's hand placement: one hand on assistive device and one hand on armrest or both hands on armrests
3. patient is positioned at the front edge of the seat
4. Patient pushes to standing

Front 11

Procedure: stand to sit with assistive device

Back 11

1. Therapist positioned to noe side and slightly behind patient with hand on gait belt and over the shoulder girdle
2. back of patient's LE's touch the front edge of w/c
3. patient's hand placement - one hand on assistive device and one hand on armrest OR both hands on armrests
4. Patient lowers to sitting position

Front 12

If patient weight bearing status is NWB, what ambulation assistive devices may be used?

Back 12

walker
crutches

Front 13

If patient weight bearing status is TTWB, what ambulation assistive devices may be used?

Back 13

walker
crutches

Front 14

If patient weight bearing status is PWB, what ambulation assistive devices may be used?

Back 14

walker
crutches

Front 15

If patient weight bearing status is WBAT, what ambulation assistive devices may be used?

Back 15

walker
crutches
cane

Front 16

If patient weight bearing status is FWB, what ambulation assistive devices may be used?

Back 16

walker
crutches
cane

Front 17

How is determination of gait pattern (swing to, swing through, three point) made?

Back 17

determined by the amount of weight patient places through the extremity

Front 18

When to use "swing to" gait pattern?

Back 18

to decrease wt. bearing on one LE
use walker or 2 crutches
used of LE paresis or paralysis

Front 19

Procedure: "swing to" gait pattern

Back 19

1. advance assistive device
2. shift weight bearing onto assistive device
3. swing both LE's to assistive device

Front 20

Procedure: "Swing-through" gait pattern

Back 20

use crutches
1. advance both crutches
2. shift weight onto crutches
3. swing both LE's beyond the crutches

Front 21

Procedure: three point gait pattern

Back 21

Use walker, 2 crutches or 2 canes
1. advance assistive device
2. advance INVOLVED extremity
3. shift weight onto assistive device
4. advance NONINVOLVED extremity

Front 22

Procedure: floor transfers

Back 22

1. approach chair or couch on hands/knees
2. places hands on chair
3. position in tall kneeling/half kneeling
4. lift onto chair by turning and rest on 1 hip
5. reposition hands and complete turn

Front 23

Guarding techniques with ADL's: gait belt placement

Back 23

avoid tubes, lines and incisions

Front 24

Guarding techniques with ADL's: signs of intolerance

Back 24

1. Monitor vitals
2. Diaphoretic (excessive sweating)
3. Patient stops talking
4. Weakness, tremors
5. Pallor

Front 25

Guarding techniques with ADL's:
Tubes, lines and drains

Back 25

1. keep lines slack
2. proper placement of drains
3. foley catheter lower than the bladder
4. chest tube lower than the heart
5. arterial line transducer at level of heart
keep IV pole in front of patient
strap O2 tank to IV pole
In ICU, always ask nurse to work with patient

Front 26

Guarding Techniques with ADL's: Edge of Bed ADL's

Back 26

*Therapist sit on bed beside pt or in front of pt
*second therapist position behind pt on bed if pt displays decreased postural/righting reflexes, poor head or trunk control, pushing syndrome, etc.
*position flaccid extremity
*observe signs of intolerance
*observe hip, back and sternal precautions (no reaching above level of incision)

Front 27

Guarding Techniques with ADL's: Sink ADL's

Back 27

*Therapist stand beside and slightly behind pt.
*Observe signs of intolerance
*Have chair close

Front 28

Ascending/Descending Stairs:Guarding the patient

Back 28

*Therapist holds gait belt and places hand on pt's trunk over the shoulder girdle
*Ascending stairs: therapist stands below the pt. to the side and behind
*Descending stairs: Therapist stands below the pt to the side or in front
*Therapist stands in stride-place the feet on different stair treads

Front 29

Ascending Stairs: Sequencing

Back 29

1. Step up with the uninvolved leg
2. Bring AD up onto the stair
3. Step up with the involved leg

Front 30

Descending Stairs: Sequencing

Back 30

1. Bring AD down onto the stair
2. Step down with the involved leg
3. Step down with the uninvolved leg