Equipment, devices, modalities

Non weight bearing gait

3 point pattern

Toe touch weight bearing gait

3 point pattern

Partial weight bearing gait

3 point pattern

Two point gait

AD (cane or crutches) and opposite extremity move together, then opposite crutch and extremity

Modified two point gait

only one cane or crutch, on opposite of affected extremity. Moves with affected limb

Three point gait

AD and involved leg advance together

Four point gait

left crutch, right leg, right crutch, left leg

Swing to

both crutches advance together, both legs swing to meet crutches

Swing - through

Both crutches advance together and both legs swing beyond crutches

Walker

All levels of WB, provides good stability

20-25* elbow flexion

3 point gait pattern

Axillary crutches

All levels of WB, requires more coordination

hand grip at ulnar styloid process, 20-25* elbow flexion

6in in front and 2in lateral to patient

Loftstrand crutches

All levels of WB

requires most coordination

Cane

For balance assistance, minimal stability

Not appropriate for partial WB

on opposite of involved side

What muscle must be strong to use crutches

Lats

Platforms

allow WB on forearm for patients that can’t bear weight through hands/wrist

Lumbar traction

joint distraction: 50% of body weight

Disk protrusion, spasm, stretching: 25% body weight

Cervical traction

supine with 20-30* flexion

10-15lb or 7-10% body weight

Measurement for seat width on wheelchairs

Add 2in to patients hip width

Wheelchair seat depth measurement

posterior buttock to posterior knee then subtract 2 in

Ratio of slope to rise for ramp measurements

1:12

When is swing to pattern used

limited use of both LEs

Can ultrasound be used over metal implants

Yes

Iontophoresis

application of continuous direct electrical current to transport medicine through skin

Brief intense TENS

used to minimize pain during painful procedures

Pulse frequency: high

Pulse duration: long

NMES

facilitate skeletal muscle activity

Pulse rate frequency: 35-50 pps

Pulse duration: 150-200 msec for small muscles and 200-350 for large muscles

Conventional TENS (high rate)

Comfortable tingling sensation, but creates no muscle response

High frequency, short pulse duration

Acupuncture like TENS (low rate)

strong but comfortable rhythmic muscle twitches to treat chronic pain

TENS

pain management by inhibiting pain transmission

indications and goals for pneumatic compression

amputation, lymphedema, venous insufficiency

Decrease chronic edema, stasis ulcer

inflation pressures for pneumatic compression

30-60mmHg for UE

40-80 mmHG for LE

pressure should not exceed diastolic BP

Short stretch bandage

produce low pressure at rest and high working pressure when muscles are moving

used during exercise

long stretch bandage

high pressure at rest but little pressure when patient is moving

best for immobile patients

continuous ultrasound

For soft tissue extensibility, alteration of nerve conduction velocity

thermal effects 100% duty cycle

Pulsed ultrasound

For wound healing, reduce inflammation, tissue healing

Non thermal effects 20% duty cycle

Ultrasound frequency

1MHz = deeper tissues up to 5cm

3MHz= superficial tissues 1-2 cm

Contraindications for ultrasound

impaired sensation, over plastic, reproductive and vital organs or pacemakers

Malignant tumors, DVT, vascular insufficiency

Phonophoresis

Use of ultrasound to apply medication

lidocaine, dexamethazone, etc

pulsed 20%

Buoyancy

upward force of water on immersed body that is equal to weight of water that it displaced

“weightlessness”

Vicosity

Increased vicosity creates resistance

moving slowly= less resistance

moving fast= more resistance

Indications for hydrotherapy

pressure ulcers, burns/wounds, post hip fracture, chronic neck/shoulder/back conditions

Contraindications for hydrotherapy

Incontinence, bleeding, maceration, epilepsy, cardiac/pulmonary instability, decreased sensation

Ultrasound using water immersion would be most likely used to treat

ankle

Ultrasound setting for chronic lateral epicondylitis

Continuous, 3MHz

PPE for airborne precautions

N-95 respirator

Influenza and pneumonia precautions

droplet

PPE for droplet precautions

facemask

Tuberculosis precautions

Airborne

Meningitis precuations

droplet

Asepsis

disinfectants

Droplet precautions

transferred by coughing, sneezing, talking
Mumps, rubella, influenza

Airborne precautions

illnesses transferred by air currents
TB, measles, chicken pox.

nosocomial infection

acquired within institution
staph, E-coli, MRSA, c-diff, RSV

Contact precautions

wear gloves, wash hands, gown if clothing will contacs infected materials

Sterilization

total destruction of all microbial life forms

disinfection

reduction of organisms on an inanimate object

Antisepsis

inhibition of microoganisms on living tissue

Donning sequence

hat and shoe covers, mask, gown, gloves

doffing sequence

gown, gloves, mask, hat and shoe covers

Corset

provide abdominal pressure and relieve low back pain

assists with respiration for spinal cord injuries

TLSO

limit or present trunk motion

usually used after surgery, fractures, or scoliosis

Taylor brace

TLSO that limits flexion/extension by a 3 pint control system

Milwaukee brace

promotes realignment for scoliosis

Halo vest

full restriction of cervical motion used in cervical spinal cord injuries

Solid AFO

control PF/DDF and IV/EV

allows no movement

posterior leaf spring

prevents foot drop, assists with dorsiflexion

inserts in shoe

KAFO

provides support and stability to knee and ankle

Craig Scott KAFO

for paraplegia, allows patient to stand with posterior lean of trunk

Heel wedge

prevents excessive eversion or inversion due to pes planus or pes cavus

Heel lift

for leg length discrepancy or to take pressure off achilles tendon

Heel cushion

for plantar facsciitis

Metatarsal pad

relieve pressure of toes

rocker bar

for limited foot mobility

cock up splint

for RA, fracture of carpal bones, carpal tunnel, or colles fracture

thumb spica splint

immobilize thumb for scaphoid fracture or De Quervain’s tenosynovitis

Airplane splint

immobilize shoulder after burn or fracture