Challenges of Ambulating

What is toe touch weight bearing (TTWB) or touch down weight bearing (TDWB)?

0% WB; foot may rest on the floor but extremity does not bear weight

Toe touch weight bearing is used for _____ rather than _____?

support; functional ambulation

How can toe touch pose a potential problem?

when it is used for prolonged periods, it can facilitate an abnormal gait pattern

How are bathroom scales used to monitor weight bearing?

patient shift weight from one scale to the other for feedback about static WB

When using an LLM what must you make sure of?

that the footwear of the FWB LE is equal in height to the LLM

The more _____ an assistive device is the less mobile it is.

stable

Unilateral WBAT generally allows assistive device selection of what?

any unilateral or bilateral device

What is a swing-to gait pattern?

when both LEs advance simultaneously with the forward swing and land in line with the assistive device

What is a discontinuous gait?

when LEs progressively stop-and-start while assistive device is advanced

Where might patients need to be encouraged to look during gait?

ahead instead of at their feet

During forward gait, what should you encourage?

relaxed, upright posture and forward gaze

What is a good rule of thumb when guarding a patient?

always be between the patient and the floor

What is non-weight bearing (NWB)?

0% WB; toes and foot do not touch the ground

What is partial weight bearing (PWB)?

30-50% WB

What is weight bearing as tolerated (WBAT)?

50-100% WB; limited only by the patient's tolerance

What is weight bearing (WB)?

100% WB; no limitations

UE WB restrictions can affect what if UE is used to compensate for LE limitations?

gait

What do you do if a patient has a WB restriction of the UE?

they must use a unilateral assistive device or forearm platform

What does LLM stand for?

limb load monitor

What does a limb load monitor do?

provides audible feedback to patient and clinical regarding WB during gait; adjust sensitivity as needed

What is a not recommended way to asses WB status?

placing your finger under a patient's foot; provides limited data and can cause injury to the therapist

What are assistive devices typically used for?

to increase support load and stability through an enlarged BoS

The more _____ an assistive device is, the less stable it is.

mobile

What is the most supportive assistive device?

parallel bars

What is the least supportive assistive device?

Single point cane (SPC)

Unilateral LE TTWB or NWB allows assistive device selection of what?

walkers or bilateral crutches

Unilateral LE PWB generally allows assistive device selection of what?

walkers or bilateral crutches

What can significantly reduce the stability of any device and compromise the user's safety?

friction between contact points (Ex: worn tips and slick floors)

What might people with Parkinson's disease experience during gait?

"freezing"; sudden, brief inability to move their feet forward despite the intention to walk

What are common symptoms of Parkinson's disease?

tremors, slowed movement, increase muscle stiffness, and balance disturbances

Gait deviations tend to increase what?

energy expenditure

Who tends to expend more energy walking long distances?

older adults

What requires more energy expenditure, standard walkers or rolling walkers/canes?

standard walkers

When fitting a patient for an assistive device, what should you have them do?

be in good posture and wear their typical footwear

How do you guard a patient when walking them?

slightly behind them on their weak side with one hand on the gait belt and the other hand contralaterally hovering the shoulder

The handle of the assistive device should be where on the patient?

bend of the wrist

What should you do when fitting a patient for an assistive device before you begin functionally walking with them?

always confirm the fit is correct

What degree should the elbow be at when a patient is gripping the handle of an assistive device?

20-30 degrees

After the fit of an assistive device has been confirmed, do you still need to check at every patient visit?

yes

What is a gait pattern?

ordered process of advancing the LEs and assistive devices

What does laterality refer to?

the side of the body on which the assistive device is used

What is a step-to-gait pattern?

when the step by the 2nd foot land in line with the assistive device

What is a step-through gait pattern?

when the step lands beyond the assistive device

What is the swing-through gait pattern?

when both LEs advance simultaneously with the forward swing and land beyond the assistive device

What is a reciprocal gait?

when opposite arm and leg move forward at the same time

What is a continuous gait?

when LEs continuously progress forward while assistive device is advanced

How do you instruct a patient during gait?

-demonstrate technique

-encourage mental rehearsal and "teach back"

-begin with simple tasks and progress in complexity/challenge

-provide external and internal cues

-instruct in care/maintenance of assistive device

How does a patient go from sit to stand?

-scoot forward

-position feet as far back as possible while maintaining full contact with floor

-lean trunk forward

-push hands down on armrest (never on AD)

-extend hips and knees intro upright position

How do a patient go from stand to sit?

-back up fully to chair

-if WB restricted, move affected LE forward before sitting

-reach back for chair one hand at a time

-control descent with LEs and UEs

If a patient has weak quadricep muscles or is reluctance to lean forward, how might them compensate on sit to stand?

-relying heavily on UE strength

-rocking for momentum

-bracing lower legs against fixed seat for leverage

-pressing knees together (adducting hips) for leverage

What UE muscles are used for standing/sitting?

-shoulder depressors

-shoulder extensors/flexors

-elbow extensors

-wrist stabalizers

What LE muscles are used for standing/sitting?

-hip extensors

-hip abductors/adductors

-knee extensors

What trunk muscles are used for standing/sitting?

-trunk extensors

-upper/lower trunk stabilizers

Gait training on a treadmill provides what?

gait speed data that directly relates to functional mobility

During forward gait, how should you begin?

level, clear surfaces and progress to more challenging enviornments

When inquiring about a handrail at a patient's home, what should you do?

determine whether the handrail is sturdy and reliable

What is the typical rule when ascending and descending stairs?

up with the good foot, down with the bad foot

What is the exception to the "up with the good" rule when ascending a curb?

using a walker

What is a two-point gait?

two points of contact; AD and stronger LE advance together

What is a three-point gait?

three points of contact; AD is advanced followed by limited LE then stronger LE

What is a four-point gait?

four points of contact; AD, opposite LE, other AD, opposite LE

Gait speed has been associated with what?

functional ability and overall health

When should the clinician pull on the patient's gait belt?

only when it is necessary to help recover the patient balance

What do you do if a patient begins to fall?

the clinician moves closer and lifts slightly on the gait belt, bringing the CoM back over the BoS, to help the patient regain support

How do you manage a fall?

deepen your stride and rest the patient on your forward thigh or carefully lower the patient to the floor (squatting down to maintain good spinal alignment)

When helping a patient go up the stairs, where do you guard?

from behind

When helping a patient go down the stairs, where do you guard?

in front

If it always a good idea to check what on an assistive device during a patient's visit?

tips of cane, crutch, or walker

What are common problem areas on assistive devices?

-loose fasteners

-worn rubber tips

-loose or worn handgrips & pads

What should a patient do when walking on inclines with assistive devices?

-lean forward when ascending

-take slightly long steps when ascending

-take slightly shorter steps when descending

How can a patient reduce the steepness when walking on an incline?

follow zigzag path

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