Implementing Device-Specific Gait

What are the advantages of parallel bars?

-the greatest amount of stability

-transition toward greater ambulatory mobility

-focus can be on practicing isolated components of gait

What are the disadvantages of parallel bars?

-not very portable

-not accessible to patients at home or some outpatient settings

Where does the therapist guard for parallel bars

within the bars in front of the patient

When do you consider progressing from parallel bars?

when patient can walk the length of the bars with good form

How do you fit parallel bars to a patient?

-height of bars should be at wrist bend of patient (elbows 20-30 degrees flexed)

-2 in between bars and greater trochanter

When a patient is turning which way do they turn?

towards their stronger side

The walker provides ____ and ____ of one LE.

stability; unloading

Which walker require more energy use from the patient?

"pick up" (standard) walkers

What are the types of walkers?

-standard

-rolling

-rollator

-reciprocal

-stabilizing

-posterior/reverse

-electric

-platform

What program encourages participants to remind each other to walk with an upright posture during daily activities?

postural watch

What are the advantages of a walker?

-4 point of contact with the floor

-lots of stability

-sense of security

-lightweight/easy to use

What are the disadvantages of a walker?

-awkward in small/confined spaces

-difficult to maneuver through doorways/over obstacles

-eliminates normal arm swing

-standard walkers create a slower, halting gait

-rollators promote trunk flexion during gait

How do you fit a walker to a patient?

hand grip should be at the bed of the wrist

When a patient is going from sit to stand with an AD that can stand on its own, should them grab onto it?

no

When a patient is going from sit to stand with an AD that cannot stand on its own, should them grab onto it?

yes; with their strong side

What is an alternative way for a patient to go from sit to stand with a walker?

use one hand to push off the armrest and the other to push on the center crossbar of the walker

When using a standard walker, should the patient step-through or step-to during gait?

step to

When using a walker, should the patients hips be flexed or extended?

extended

When ascending a curb or stairs with a walker, what goes first?

walker then stronger LE

When descending a curb or stairs with a walker, what goes first?

walker then weaker LE

When a therapist is helping a patient ascend stairs, where should they stand?

behind the patient

When a therapist is helping a patient descend stairs, where should they stand?

in front of the patient

When can a patient substitute handrails for their walker?

when there are bilateral handrails the patient can comfortable reach at the same time

How do you use one handrail and a folding walker on one side?

rail on one side, folded walker on the other

How do you use one hand rail and a turned walker on one side?

rail on one side, walker turned sideways on the other

When do consider progressing from the walker?

when the patient is able to walk easily with minimal pressure through the hand grips

What should you keep an eye out for when a patient is walking with a walker?

rocking

What is a sign that a patient is ready to move on from a standard walker?

rocking

What are the 2 types of axillary crutches?

wooden and metal

What is type of crutch other than axillary crutches?

ortho (forearm) crutches

What are the advantages of axillary crutches?

-improve balance/lateral stability

-greater functional ambulation with restricted WB

-easily adjustable

-relatively inexpensive

-easy to store

What are the disadvantages of axillary crutches?

-less stable

-require greater upper body strength

-awkward/more hazardous in small or crowded areas

-can damage brachial plexus if used incorrectly

If a patient with axillary crutches wants to rest, what can they do instead of hanging their axilla on the axillary pads?

push the crutches slightly forward, cross the arms, and place the hands over the axillary pads

During ambulation with crutches, if a patient is NWB on one LE where should their affected foot be?

off the ground and in front of their body

Are the height markings found on crutches accurate?

no

How do you fit axillary crutches to a patient?

the hand grip should rest at the bend of the wrist and the axillary pads should be 2-3 fingers from the armpit with the tips of the crutches 6in to the side

How can you estimate the fit of axillary crutches to a patient?

77% of patient's height

When you are checking the fit of axillary crutches what should you pay attention to?

patient's posture; make sure both of the patient's shoulders are relaxed

How do you ascend stairs with axillary crutches?

crutches then stronger LE

How do you descend stairs with axillary crutches?

crutches then weaker LE

How can a patient use stairs with one handrail and crutches?

-two crutches under one arm

-using one crutch with the other one parallel to the handrail in the opposite hand and holding the handrail

-using one crutch with the other one parallel to the handrail in the same hand

When do you consider progressing from the axillary crutches?

when the patient becomes WBAT or FWB

What are the advantages of forearm crutches?

-shorter/more lightweight than axillary crutches

-more functional in confined spaces

-promote more upright posture

-more functional stair climbing method

-eliminates danger of brachial plexus

-cuff allows patient to release handles without crutch falling

-more stability than a cane

What are the disadvantages of forearm crutches?

-require more standing balance

-require good upper body strength

How do you fit forearm crutches to a patient?

hand grip should rest and the bend of the wrist and the top of the cuff should be 1 in from the olecranon process

Do you ascend and descend stairs with forearm crutches the same as axillary crutches?

yes

What is muscular dystrophy?

group of genetic diseases that cause progressive weakness and loss of muscle mass

Who is most affected by muscular dystrophy?

young children

What is the most common type of muscular dystrophy?

Duchenne muscular dystrophy

When do you consider progressing from forearm crutches?

when the patient becomes WBAT or FWB unless the patient is has permanent impairments and uses forearm crutches long-term

If a patient with crutches falls backward, what should they do to prevent impact at the head?

tuck their chin

If a patient with crutches falls backward, what should they do to minimize the overall impact?

bend the knees and bring the arms out to the side with palms down

If a patient with crutches falls forward, what should they do to protect their face?

turn the head to the side, drop the crutches out of the way, and reach forward with elbows bent

How can you help a patient with crutches learn effective motor skills to recover balance in the event of a near fall?

have them practice responding to balance perturbations in different directions

How does a patient get off the floor with crutches?

-patient moves into tall kneeling with crutches on the weaker side

-patient brings stronger LE forward into half-kneeling position

-pushing down on the distal thigh of the stronger LE, patient rises to a standing position

-once upright and stable, patient repositions crutches and continues

What gait patterns can you do with parallel bars?

-2 point

-3 point

-4 point

What gait patterns can you do with crutches?

-2 point

-3 point

-4 point

What gait patterns can you do with a walker?

-2 point

-3 point

What gait patterns can you do with a cane?

-2 point

-3 point

How do you reduce the risk of a patient falling during independent ambulation?

-improve their balance and gait ability

-minimize environmental hazards

-review medications

What are the advantages of a hemi walker?

-provide support with the use of only one LE

What are the disadvantages of a hemi walker?

-promote increased lateral shift of body weight

What are the advantages of a knee walker?

-more stable than crutches

-require less upper body strength

-require less energy

What are the disadvantages of a knee walker?

-not suitable for limited WB at or above the knee

-can't use on stairs

When do you consider progressing from a hemi walker?

when patient's stability increases

What are the advantages of canes?

-relatively inexpensive

-portable

-compact

-fit easily in confined spaces

What are the disadvantages of canes?

-point of support is anterior to the downward force from he hand

-draw attention to impairment

What side of the body should unilateral ADs be?

stronger side

How do you fit a cane to a patient?

hand grip should be at the bend of the wrist

What can be a substitute for support by a cane?

an orthotic garment with an attached elasticized strap that generates supportive tension across the hip abductors and extensors of the involved LE

What AD is gaining popularity as walking aids in some rehab centers?

hiking/trekking poles

What are the types of canes?

-straight cane with offset handle

-candy cane

-small based quad cane

-wide based quad cane

How do go from sit to stand with a can that cant stand up?

lay cane to the side, holding the handle in the same hand with the armrest the push to standing and place cane upright

For a patient with impaired cognition, the demands of learning to use an AD may be enough to have what?

paradoxical effect that adversely affects gait and balance, increasing fall risk

When using a quad cane on the stairs, what might the patient need to do?

turn the cane sideways

How do you move through a door that opens toward you with an AD?

-stand close to the door, turned slightly toward hinges

-pull door open, then push it fully with the same hand

-block door if needed

-walk through doorway

How do you move through a door that opens away from you with an AD?

-stand close to the door, facing door handle

-push door wide open

-block door is needed

-walk through doorway