Lab Concepts 2: Gait Patterns, Assistive Devices

list common assistive devices + PT role

• 2-Wheeled Walker (2WW) • 4-Wheeled Walker (4WW) • Hemiwalker (HW) • Single Point Cane (SPC) • Large-Base Quad Cane • Small-Base Quad Cane • Crutches

-PT role: pick device they should use, and how they should use it

2-Wheeled Walker (2WW)

stability : mobilitiy

-Most common assistive device utilized in hospitals

-Provides a good combination of mobility efficiency (wheels on front) with stability (wide 4 bases of support)

-Requires good grip strength bilaterally, and good leg strenght

-Fit

4-Wheeled Walker (4WW)

lower stability: higher mobility

-4-wheels (pivoting), seat, storage area, brakes (*but can’t use seat if bad coordination)

-Designed for most efficient mobility while providing mild support for balance

-NOT typically used immediately after injury/surgery in hospital setting…WHY???=need more stability

-Fit

*easier to push so can do work longer (if pt has okay strenght but not good endurance)

Hemiwalker (HW)

higher stability: lower mobility

-One-sided device, largest base of support

-Commonly used with post-CVA patients

-Not an efficient device for mobility (designed for stability) (*good acutely)

-Fit

*good gait training tool; not for community use

Single Point Cane (SPC)

lower stability:higher mobility

-Small point of contact for balance only (not designed for weight-bearing)

-Held in opposite arm of affected lower extremity

-Slightly different styles

-Fit

*good for everyday (in home, community, etc.)

*opposite arm and opposite leg (mimick normal gait pattern); ex=if L knee injured put cane on R side

what side should a cane go?

want opposite side!

-ex=if L knee injured put cane on R side

Small-Base Quad Cane (SBQC)

stability:mobility

-Larger points of contact for some weightbearing/offloading of affected lower extremity

-All 4 points must be in contact with ground (*press down on all 4 at same time)

-“K” facing away from the patient

-Fit: straight side against pt

*not used often, for specific pts (ex: storke and past HW but still need more stability)

Large-Base Quad Cane (LBQC)

*pretty much like small, but more stability and better if larger pt

-Wider BOS than SBQC

-Larger points of contact for some weightbearing/offloading of affected lower extremity

-All 4 points must be in contact with ground

-“K” facing away from the patient

-Fit

Crutches (axillary)

lower stability:higher mobility

-Requires good balance, coordination and cognition from patient (*not age necessarily)

-Can be used unilaterally or bilaterally

-More common with orthopedic diagnoses

-Fit: on opposite side of surgical leg

Gait Patterns

Four-Point (two canes or crutches, two lower extremities)

-1) Device -> 2) Affected Leg -> 3) Device -> 4)Unaffected Leg

*for specific pts (ex=CP)

[two and three point most common; cane or crutches…]

Three-Point

-1) Device -> 2) Affected Leg -> 3) Unaffected Leg

*if need extra stability than two point

Two-Point

-1) Device and Affected Leg – 2) Unaffected Leg

*preferred, normal walking pattern; walkers

PT guarding patient during gait

-Stand on the weak side

-Position yourself slightly posterior and lateral to the patient

-Hip-to-hip

-One hand on gait belt, other hand positioned where needed

-Guarding will slightly vary depending on the device, diagnosis and patient presentation

exception to pt guarding on side

-if using HW and need to knee block, you stand on side more

PT cues to patient during gait

-pick 1-2 things to focus on

-Internal vs External cues

list common adaptive equipment

-Leg Lifter, Long-handled shoehorn, Sock Aide, Grabber/Reacher, Dressing Stick

leg lifter

-Helps the patient utilize their arms to lift their affected lower extremity

-Most common after THA/TKA

long-handled shoehorn

-Assists patient to put on shoes when unable to bend forwards

-Common after posterior hip replacements, lumbar surgeries

sock aide

-Assists patient to put on socks when unable to bend forwards

-Common after posterior hip replacements, lumbar surgeries

grabber/reacher

-Assists patient to access small/light items on the floor when they are unable to bend forwards

-Common after hip replacements, lumber surgeries, balance issues/concerns (*bad shoulder)

dressing stick

-Used to assist in lower extremity dressing

-Common after lower extremity or spine surgeries, balance issues/concerns

list common braces/external supports + how Rx them

-surgeon/doctor gives Rx/says when wear, will give it to them

-PT 1) educate them 2) helps transition them out of these

walking boot

-Commonly utilized following ankle/foot injuries and surgeries

-Typically ordered by MD

-Could be WB or NWB in the boot

-Prevents ankle movement

-Mobility considerations?: ~90DF; can take on/off to check incision and do PT

straight leg brace

-Commonly utilized after patellar/quad tendon repairs, tibial plateau fractures

-Prevents flexion of the knee

-Mobility considerations?: not meant to bend knee at all; in most of the time but can take off at therapy

hinged knee brace

-Allows increased support of the knee joint

-Can be locked in any variation of knee flexion/extension

-Common after ACL and meniscal repairs/reconstructions (*decreased quad strenght)

-Mobility considerations?: dial starts at zero and then hinge and lock at specific degree, doctor decides frequency and we help transition them

Lumbosacral Orthosis (LSO)

-Utilized to prevent excessive movement at the lumbar spine

-Common after lumbar fusions or other lumbar surgeries

-Mobility considerations?: how get on/off and how use it

*in hospital; cause weak core

cervical spine collar

-Utilized to prevent excessive movement at the cervical spine

-Common after cervical surgeries

-Mobility considerations?: protective, but muscles weak in brace

shoulder sling

-Utilized to prevent shoulder movement

-Common after rotator cuff operations, shoulder replacements, sometimes after CVA’s (*labral tear)

-Mobility considerations?: removable to can work on shoulder at PT; little shoulder flexion