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91 Cards in this Set
- Front
- Back
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3 Major indications for using assistive devices
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1. Structural deformity or loss, injury or disease, which decreases the ability to bear weight on the LE.
2. Muscle weakness or paralysis of the trunk or LE's 3. Inadequate balance |
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Important muscles to strengthen for gt
UE- Scapular Stabilizers |
Serratus anterior (protraction and upward rotation)
Trapezius (elevation, retraction, depression) Rhomboids (retraction and downward rotation) |
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Important muscles to strengthen for gt
UE- Shoulder depressors and extensors |
shoulder depressors:
traps shoulder extensors: Latissimus Dorsi Teres Major |
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Important muscles to strengthen for gt
UE- elbow extensors and finger flexors |
elbow extensors:
Triceps finger flexors |
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Important muscles to strengthen for gt
LE- Hips extensors and hip abductors |
hip extensors:
hams glut max hip abductors: glut medius |
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Important muscles to strengthen for gt
LE- Knee flexors/knee extensors/ankle dorsiflexors |
knee flexors:
hams knee extensors: quads ankle dorsiflexors: anterior tibs |
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Preparation for Gait Activities
Review/assess/determine... |
1. Review the patients medical record for information to assist in planning the ambulation activities.
2. Assess or evaluate the patient to determine limitations and capabilities to assist in planning the preambulation activities and gait pattern. 3. Determine the appropriate equipment and pattern based on the medical record, your assessment and the goals of the treatment. |
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Preparation for Gait Activities
Prepare/Remove... |
4. Prepare the patient for ambulation ( ie, explain the pattern, obtain consent and improve physical abilities).
5. Remove the items in the area that may interfere with ambulation to maintain a safe environment. |
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Preparation for Gait Activities
Verify... |
Verify the initial measurement of the equipment to ensure a proper fit and determine that the equipment is safe; tighten loose nuts and bolts, be certain sppring adjustment buttons are secure, and examine rubber tips for dirt or cracks in the rubber
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Preparation for Gait Activities
safety... |
7. Always apply a gait belt to the patient.
8. Be certain the patient is mentally and physically capable of performing the selected gait pattern |
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Preparation for gait activities
Explain and demonstrate... |
Explain and demonstrate the gait pattern for the patient; ask the patient to describe the pattern, how it is to be performed, and what the pt is expected to do. Do not ask the pt if they understood your instructions. Instead, require the patient to explain the procedure or activity to verify that they truly understand and comprehend.
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Preparation for gait activities
points of control and body mechanics... |
10. Use the gait belt, pelvis and the patients shoulder as points of control when guarding the patient.
11. Maintain proper body mechanics for yourself and the patient. |
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Precautions for Gait Activities
Footwear and physiological response... |
1. Be sure the patient is wearing appropriate footwear; do not allow the patient to ambulate in slippers, in loose fitting shoes or no shoes. This can lead to patient insecurity and injury from falling.
2. Monitor the patients physiologic responses to gait and evaluate vitals, general apperance, and mental alertness while walking |
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Precautions for Gait Activities
points of contact and dealing with the unexpected... |
3. Avoid guiding or controlling the patient by grasping clothing or upper extremities.
4. Anticipate the unexpected, and be alert for unusual patient actions or equipment problems; pt may slip, lose stability or balance at any time. |
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Precautions for Gait Activities
guarding |
5. Guard the patient by standing behind and slightly to the side, maintain a grip on the gait belt until the patient is able to gait independently and safely.
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Precautions for Gait Activities
leaving patient unattended/protecting pt appliances/ trip hazards... |
6. Do not leave that patient unattended while standing due to instablilty.
7. Protect the patient appliances, cast drainage tubes, iv tubes, and dressings during gait. 8. Be certain the area used for gait is free of hazards, equipment, furniture, and that the floor is dry. |
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What device is best to begin gait training with?
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If possible it is best to begin gait training activities in the parallel bars.
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Benefits of the parallel bars...
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most stable place. requires the least amount of coordination.
allows pt to become accustomed to upright posture. allows safe place to teach a gait pattern. you can fit the assistive device to the Pt in the bars and practice within the safety of the bars. |
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precaution when using parallel bars?
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Be careful not to let the Pt become too dependent on the parallel bars.
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points to consider when choosing gait device for a patient
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pts strength, ROM and balance
pts stability and coordination type of problem pt has or general condition provides necessary Pt support can be manipulated by the pt fits the pts environment |
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Most stable to least stable devices...
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Parallel bars
Walkers Axillary crutches Forearm crutches 2 canes hemiwalker WBQC NBQC STC |
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Least Coordination required for use to most...
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Parallel bars
Walker One cane- hemi and all canes 2 canes axillary crutches Lofstrand crutches |
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What will the gait pattern used with patient be dependent upon?
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Gait Pattern will depend on the pts weight bearing status, Pt coordination and the pts condition
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Considerations when choosing a gait pattern
Weight Bearing: |
: amount of weight allowed to be borne on a LE during a gait activity. The MD will prescribe a weight bearing status to be followed depending on the pts condition and the medical management of the condition (cemented versus noncemented etc).
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Degrees of Weight Bearing status
NWB |
NWB: non weight bearing: LE can not bear any weight and is usually not permitted to touch the floor
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Degrees of Weight Bearing status
TTWB or TDWB |
TTWB or TDWB: toe touch or touch down weight bearing. Pt can rest toe on the ground for balance but can not weight bear through the limb.
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Degrees of Weight Bearing status
PWB |
PWB: partial weight bearing: a limited amount usually described in pounds or percentages of weight can be borne throughout the LE. Can be checked by scales , electronic device or therapist analysis
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Degrees of Weight Bearing status
WBAT |
WBAT: weight bearing as tolerated: pt is allowed to determine the amount of weight they can tolerate. Usually begins with minimal weight and inc
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Degrees of Weight Bearing status
FWB |
FWB: full weight bearing: all weight allowed on LE. May have to encourage pt to do so.
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Gait Patterns
2 point gait, key points... |
requires 2 canes, crutches or reciprocal walker
pt usually has muscle weakness, pain, or decreased balance a reciprocal gt: L assistive device and R LE move as a unit, followed by the opposite side requires a lot of coordination |
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Gait Patterns
4 point gait, key points... |
AKA "a deliberate 2 point gait”
same assistive devices and pt types as with 2 point may be used to teach pt before advancing to 2 point slower than 2 point, breaks it down into 4 steps R arm, L leg, L arm, R leg |
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Gait Patterns
3 point gait, key points... |
most common pattern. used on pts with 1 involved LB due to weakness, pain, injury, or a need to decrease weight bearing.
requires 2 canes, crutches, or a walker. assistive device forward followed by the "bad" leg then the good. once the pt becomes more adept the "bad" leg and the assistive devicewill move forward together. can step to or step through. single canes and hemiwalkers do a modified 3 point or 2 point gt. NWB can also be 3 pt gt |
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Gait Patterns
swing to... |
requires 2 crutches or a walker
for pts with bilateral LE weakness, paresis or paralysis, or a need to decrease weight bearing (NWB) Pt moves the assistive device then slides/swings the LE's together just to the point of the device |
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Gait Patterns
swing through... |
same as " swing to"except the LE's are advanced past the point of the assistive device
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Gait Instruction
1. begin with a description and a demonstration (key points) |
keep it concise and simple
must teach the Pt how to get up and sit down safely on varying surfaces: toilets, cars, couches, WC, chairs with and without arm rests once the Pt is safe on level surfaces you must also instruct them on: carpet, outdoors, curbs, ramps, elevators, up and down stairs, and also how to fill and get back up. |
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Gait Instruction
2. Safety issues (key points) |
remove throw rugs from home
watch wet, polished or icy areas (teach to decrease step length if can not avoid) be aware of carpet pile height be aware of uneven surface to always check equipment |
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Gait Instruction
safety issues PTA must be aware of |
using a gt belt
guarding on involved side amount of assistance the Pt requires: I, SBA, CGA, Min,Mod, Max type of gt pattern used weight bearing status |
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Gait Instruction
3. Guarding the pt (key points) |
keep pt from falling
always use a gt belt have l hand on belt and one on the pts shoulder stand to the side and slightly behind the Pt on the involved side if a pt starts to fall pull him back and toward the uninvolved LB if you want to increase wt bearing pull the pt toward the involved LB |
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Gait Instruction
guarding on "sit to stand" and stairs |
sit to stand: guard the pt to the side or in front
stairs: therapist should always be below the Pt in case they fall back have 1 hand on their gt belt and 1 hand on the rail to steady yourself. Have your feet on 2 different steps to put you in a stride position. If you have 2 therapists have one above and one below the Pt. |
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Some Common Problems during gt training
pt fatigue can be due to... |
increased activity
increased energy consumption secondary to using an assistive device increased need to concentrate while learning the activity physiologic responses due to the stresses of their illness or injury in treatment: give frequent rests or treat for multiple short sessions |
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Gait training
pt concentration... |
during the initial training allow your Pt to focus on their task, have minimal conversations. Pts may also want to look at their feet, get them out of this habit as soon as they are stable.
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Gait training
best training environment |
in treatment: initially train them in quiet, less challenging environments. Once they are beginning to master the skill add more challenges: more conversation, busy corridors etc
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Assumption of sit to stand
to stand... |
lock WC or stabilize starting place
remove all unnecessary equipment have Pt come to the front of the seat place feet flat on the floor (unless the condition precludes this) and side by side or slightly in stride to increase BOS (uninvolved behind involved) have pt push up from the wheelchair with at least 1 hand on the chair (can have the other hand on the walker or crutches.) |
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Assumption of sit to stand
to sit... |
back up to the chair until can feel on the back of the LE's
reach for the chair and lower self down (both hands on chair; for walker one on each for crutches may need to have pt slide involved LE out as they lower self down to decrease pain or to assist with hip precautions |
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Tilttable
when used? |
if the pt has severe orthostatic hypotension or has been bed bound for extended periods you
may begin acclimating to upright using the tilt table |
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Parallel Bars
how adjustable? |
adjustable: crank, push button lock, and motorized
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Parallel Bars
how to fit to pt |
pt stands in relaxed posture (especially shoulders), adjust bars to be at the level of the wrist crease (ulnar styloid process) this will give the Pt approximately 20 -30degrees of elbow flexion
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Parallel Bars
basic motion used? |
the pt lifts their body by taking the weight through their arms, depressing their shoulders and extending the elbows
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walkers, types
rolling: |
rolling: 2 or 4 wheels (will need a brake with 4) folding: for easy transport
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walkers, types
reciprocal |
reciprocal: advances one side at a time to keep pt from having to lift entire walker
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walkers, types
ring: |
ring: gives trunk support
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walkers, types
adductor boards: |
adductor boards: prevents add of LE and scissoring neither collapse and are cumbersome
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walkers, types
reverse or K walkers: |
reverse or K walkers: for pediatric pts encourages an erect posture
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walkers
specifications... |
very stable
require little coordination used for pts with: generalized weakness, debilitating conditions, a need to decrease weight bearing on one or both LB's, have poor balance and coordination or an injury to one LB and can not use crutches. Used primarily with the elderly |
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walkers
Adjusting to fit the pt: |
pt stands in relaxed posture (especially shoulders), adjust hand grips to be at the level of the wrist crease (ulnar styloid process) this will give the Pt approximately 20 - 30 degrees of elbow flexion
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walkers
Assuming standing and sitting: |
one or both hands on the stable surface to rise
both hands on surface to sit |
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walkers
gait training, key points... |
the pt lifts their body by taking the weight through their arms, depressing their shoulders and extending the elbows. walker, bad then good patterns rolling or standard. reciprocal 2 point or 4 point always lead with the bad. make sure the Pt lifts and places all 4 legs simultaneously, no rocking. keep feet behind the cross bars
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walkers
going up stairs, technique... |
PT guards with gt belt and 1 hand on rail
pt turns walker sideways, and brings 2 legs up 1 step pt has 1 hand on walker, 1 on rail step up with the good first follow with the bad lift walker and repeat |
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walkers
going down stairs, technique... |
PT below pt
pt turns walker sideways, and brings 2 leg down 1 step pt has 1 hand on walker, 1 on rail step down with the bad first follow with the good lift walker and repeat |
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walkers
on a single curb w/ no rail, technique... |
walker up first followed by the good leg, followed by the bad to go up
walker down first followed by the bad leg then the good to go down |
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walkers
going through doors, technique... |
if opens toward pt:
stand outside door arc pull open block with walker and proceed through if opens away from pt: push open and progress through with walker blocking |
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Axillary Crutches
general specs... |
provides moderate stability
requires more coordination than walkers used for pts with: a need to decrease weight bearing on one or both LE's, weakness on one or both LE's, or need some trunk support |
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Axillary Crutches
adjusting to fit the patient |
pt stands in relaxed posture (especially shoulders) adjust the length of the crutches to allow 2- 3 finger widths between the axilla and pad while the crutch is positioned at 6- 8 inches in front and 3 - 4 inches to the side of the pts toes
adjust hand grips to be at the level of the wrist crease (ulnar styloid process) this will givethe Pt approximately 20- 30 degrees of elbow flexion tighten all wing nuts after final fit |
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Axillary Crutches
Assuming standing and sitting: |
one hand on both crutches one on WC
rise and bring outside crutch over turn other crutch under reverse to sit |
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Axillary Crutches
gait training |
the Pt lifts their body by taking the weight through their arms, depressing their shoulders and extending the elbows. Pt must also adduct the crutches against side to stabilize, do not lean on crutches
crutches, bad, then good for 3 point reciprocal 2 point or 4 point, always lead with the bad. make sure the Pt lifts and places both crutches simultaneously for 3 point |
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Axillary Crutches
Up and down stairs, curbs, and ramps... up with rail, technique |
therapist same position as with walker
pt can hold second crutch in either hand or place both under axilla good foot up 1st bad foot crutches or the bad and crutches together |
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Axillary Crutches
going down with rail, technique... |
Crutches
Bad Good or crutches and bad together |
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Axillary Crutches
on ramps, technique... |
shorten step lengths and lead with the good up and the bad down
may have to go in zig zag pattern if too steep |
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Axillary Crutches
going through doors, if door opens towards pt... |
stand outside door arc
pull open block with crutches and proceed through |
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Axillary Crutches
going through doors, if door opens away from pt... |
push open and progress through with crutches blocking
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Falling
what must be decided at onset? |
if pt begins to fall the therapist must determine if the pt can be righted or if they must control the fall
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Falling
to prevent the fall? |
to prevent: pull the pt into your BOS by shifting to the supporting LE and pulling back toward you
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Falling
if it cannot be prevented... |
if the fall can not be prevented: instruct the Pt to get rid of the crutches by pushing them away from the sides, the therapist will step into a wider stance, and lower the Pt to their hands, turn to side then long sit
pt then is transferred into a WC independently or with assist depending on ability and if injured |
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For All pts regardless of device: train the pt that if they start to lose their balance to stop and steady, do not try to walk out of it. If they fall on their own, to get the device out of their way and fall on their side. Then pull self to a stable chair and pull self back into it. Call for help
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For All pts regardless of device: train the pt that if they start to lose their balance to stop and steady, do not try to walk out of it. If they fall on their own, to get the device out of their way and fall on their side. Then pull self to a stable chair and pull self back into it. Call for help
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Forearm or Lofstrand Crutches
general specifications... |
more difficult to use than axillary but provide greater ease of movement
cuffs allow you to take your hand off the crutches and not drop them -used for pts with: same as axillary except trunk support. Pts who will need crutches permanently or for long term use prefers these because they are lighter and more maneuverable |
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Forearm or Lofstrand Crutches
adjusting to fit the pt |
pt stands in relaxed posture (especially shoulders) adjust hand grips to be at the level of the wrist crease (ulnar styloid process) this will give the Pt approximately 20 - 30 degrees of elbow flexion
cuff should be 1-2 inches distal of the olecranon process |
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Forearm or Lofstrand Crutches
Up and down stairs, curbs, and ramps: up w/ rail... |
therapist in same position as with walker
pt can hold second crutch in either hand or place both under axilla good foot up 1st bad foot crutches or the bad and crutches together |
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Forearm or Lofstrand Crutches
Up and down stairs, curbs, and ramps: down w/ rail... |
Crutches
Bad Good or crutches and bad together |
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Forearm or Lofstrand Crutches
on a single curb or no rail... |
same as down w/ rail except both crutches are used
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Forearm or Lofstrand Crutches
on ramps: |
shorten step lengths and lead with the good up and the bad down may have to go in zig zag pattern if too steep
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Forearm or Lofstrand Crutches
going through doors: if opens toward the pt... |
stand outside door arc
pull open block with crutches and proceed through |
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Forearm or Lofstrand Crutches
going through doors: if opens away from pt... |
push open and progress through with crutches blocking
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Canes
Types... |
single tip/Standard/J
WBQC NBQC |
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Canes
general specs... |
provide limited stability and decreased weight bearing capabilities
aluminum or wood used for pts with: slight LE weakness, LE pain, decreased balance should be on opposite side of involved extremity (tripod effect) |
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Canes
adjusting to fit the pt... |
Pt stands in relaxed posture (especially shoulders) adjust hand grips to be at the level of the wrist crease (ulnar styloid process) this will give the pt approximately 20 - 30 degrees of elbow flexion
or at the level of the greater trochanter |
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Canes
Assuming standing and sitting |
both hands on wc to rise or sit
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Canes
gait training patterns... |
modified 3 point or 2 point
cane, bad, good or cane and bad, good |
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Canes
Up and down stairs, curbs, and ramps up with rail... |
therapist same position as with walker
good foot up 1st bad foot cane or the bad and cane together |
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Canes
Up and down stairs, curbs, and ramps down w/ rail... |
Cane
Bad good or cane and bad together |
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Canes
Up and down stairs, curbs, and ramps ramps... |
shorten step lengths and lead with the good up and the bad down may have to go in zig zag pattern if too steep
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Canes
going through doors... |
if opens toward pt:
stand outside door arc pull open block with cane and proceed through if opens away from pt: push open and progress through with cane blocking |
