Mark K Lecture 4: Crutches, Canes, Walkers, Delusions, Hallucinations, Psychosis, Psychotic and Non-Psychotic Hallucinations, Illusion, Delusion

How do you measure the length of crutches?

it is measured by holding it vertically and placing the tip on the ground

having 2-3 finger widths between the pad and the anterior axillary fold

RULE out answers that have LANDMARKS in them or say axilla!

How do you measure hand grip on crutches?

the angle of elbow flexion is 30 degrees

the wrists should be at the level of the handgrip

How to teach crutch gait for 2 point

move a crutch and opposite foot together, then the other crutch with the other foot together

FOR: mild bilateral leg weakness

How to teach crutch gait for 3 point

move (2 crutches and BAD leg together then follow with the unaffected leg

the affected (BAD) leg is not in the ground while the unaffected (good) leg is on the ground

How to teach crutch gait for 4 point

move everything separately

move crutch, move opposite foot, follow with the other crutch, then the opposite foot

How to teach swing through

for amputees/ non-weight bearing

similar to 3 point

the unaffected foot gets pass the tip of both crutches

the person may be an amputee or does not bear weight

can move fast

Rule for when to use gaits?

use even point gain for even

use odd point gait for odd

ex: 3 point gait for one leg affected

4 point (severe)

2 point (mild/ moderate cases)

What is the rule for going up and down stairs

UP with the GOOD and DOWN with the BAD

no matter what both crutches move with the BAD leg

Canes rules

canes go on the unaffected (GOOD) side

advance a cane with the opposite side for a wide base of support

handgrip should be at the level of the wrist

Correct way to use a walker

the walker is on the side of the patient and the patient picks it up and sets it down then walks to it

once the walker is in front of the patient, they will hold on to a chair (or other strong base) stand up then grab the walker

What is the first question you ask yourself when you have a psych question?

Psychotic (no insight and is not reality based) or non psychotic (has insight and is reality based)

If patient is non psychotic what is the process?

good therapeutic communication, you would use on any other patient

Delusions are

a false fixed belief or idea

- paranoid -> people are going to kill me

- grandiose-> I am Christ

- somatic -> I have x ray vision

Hallucinations are

Sensory experiences with no reality

- Auditory

- Visual

- Tactile

- Gustatory (taste)

- Olfactory

Illusions are

misinterpretations of reality (I hear people talking, they are saying something bad about me)

What are the 3 categories of psychosis?

Functional psychosis

psychosis of dementia

psychosis of delirium

Example sof Functional Psychotics

those with chemical imbalances in their brain

bipolar-> in acute mania

Schizophrenia, schizoaffective disorder, major depression, and mania

If patient is functional:

acknowledge their feelings

present reality

set limits

enforce limits

If patient is demented:

acknowledge their feeling

redirect them

If patient is delirious:

acknowledge feeling

reassure them of their safety and the temporariness of their condition

Psychosis of Delirium is:

temporary, sudden, dramatic, episodic, secondary to some chemical imbalance in the body