PE 2 Unit 3: Gait training, stairs, and assistive devices

how much of the gait cycle is the stance phase

60%

how much of the gait cycle is the swing phase

40%

what is the stance phase

time of the reference limb spent in a weight bearing position

what is the swing phase of gait

the time the reference leg is advancing or moving through to the next step

what is initial contact (heel strike)

the initial moment the reference limn contacts the ground

what is loading response (flat foot)

the body starts to accept the weight into the foot

what is midstance

the individual is straight up and down on top of their supporting limb

what is terminal stance (heel off)

the limb moves behind the individual and their trunk is moving forward

what is pre-swing (toe off)

the individuals knee flexes forward, releasing from double limb support ad transitioning into the swing phase

what is initial swing (acceleration)

the start of the swing phase

what is midswing

works to clear and advance the limb in front of the body

what is terminal swing (deceleration)

last portion of swing that prepares the foot and lower extremity to properly align itself and transition into stance phase

what are assistive devices used for

improving the patients stability and mobility by giving them an expanded BOS, reducing weight bearing, or compensating for weakness or balance deficits

what are perambulation devices used for

allows the patients to understand and tolerate weight bearing in an upright position before using an ambulatory device

what are the pros of a walker

stable and easy to use

what are the cons of a walker

difficulty with stairs and uneven surfaces

what can walkers have added on

they can have wheels or a platform attachment

what are axillary crutches

standard crutches that go under the arm

what gait patterns can be used with axillary crutches

all gait patterns

what is required to use crutches rather than a wheelchair

more coordination and balance

what can occur with improper use or fit of axillary crutches

pressure on the axillary area

what are forearm crutches (lofstrand crutches)

crutches that have a cradle for the forearm and handles for the hand

what gait patterns can forearm crutches be used with

all patterns

what is required to use forearm crutches over axillary crutches

increased upper extremity and trunk control due to less trunk stability than axillary crutches

what is a quad cane

a cane with 4 points of contact

what patients can't use a quad cane

NWB patients

what is a single point cane

a cane with one point of contact

what patients can't use a single point cane

NWB patients

what is a hemi walker

A one-sided walker used with one hand (wider side should be facing inward)

what is the most stable unilateral assistive device

hemi walker

what should be done to an assistive device before standing the patient up for the first time

the device should be pre set to an appropriate length and then adjusted if needed

what should be done as the patient when evaluating the fit of assistive devices

shoes should be worn

what are errors that can occur with improper assistive device fitting

improper posture

elevating or hunching shoulders

shoulder drop

lateral lean

hip flexion

how is a walker fitted

with the patient standing the back leg of the walker should be aligned at the midpoint of the shoe

the ulnar styloid process should be at the level of the hand rim

with the hands on the device the elbow should be 20-25 degrees

how are axillary crutches fitted

with the patient standing and the crutches under the arms with the tips 2 inches lateral and 4-6 inches anterior to the toes

the crutches should be at a 45 degree angle and the patient should grab the grips with wrist straight leaving 2 inches between the top of the crutch and axilla

the patients elbows should be 20-25 degrees

how are forearm crutches fitted

the top of the forearm cuff should be 1-1.5 inches distal to the olecranon process

how is a cane fitted

the handgrip should be at the greater trochanter, the wrist crease, or the ulnar styloid process

what is required to use a 4 point or 2 point gait pattern

patient must be weight bearing as tolerated or full weight bearing

what is the difference between 4-point/2 point and 4-point modified/2 point modified

the modified version must use a single unilateral AD while the 4-point and 2- point use bilateral AD

how is 3-point or 3-point modified pattern differentiated

based on the weight bearing status that utilize bilateral crutches or a walker

what patients use a 2 point gait pattern

weight bearing as tolerated or full weight bearing requiring bilateral AD

what is the progression of a 4 point pattern

2 point pattern

what patients use a 3 point pattern

patients who are touch down weight bearing, tow touch weight bearing, or partial weight bearing requiring the use of bilateral crutches or a walker

who utilizes a 4-point modified pattern

patients who are weight bearing as tolerated or full weight bearing requiring a unilateral AD opposite of the affected leg

who uses a modified 2 point pattern

patients who are weight bearing as tolerated or full weight bearing and require a unilateral AD on the opposite side of the affected leg

when is modified 2 point pattern used

to transition to no AD use

what is NWB

patient cant contact affected limb with ground

what is TTWB/TDWB

toe touch or touch down weight bearing

patient can just rest the affected limb on the ground

instruct to not break the egg

what is PWB

partial weight bearing

patient will have an identified weight percentage that they are able to put down

what is WBAT

weight bearing as tolerated

patient is able to increase pressure up to full weight as it is comfortable

what is FWB

full weight bearing

what does understanding the prescribed weightbearing status allow the PT to do

understand the proper AD and gait pattern

how is a 3 point pattern used with a walker

the patient is NWB with a walker, they move the walker forward, move the affected limb forward while NWB and then hop with the unaffected side

how is a modified 3 point pattern used with a walker

same process as 3-point pattern with a walker but the patient is TTWB or TDWB

how is a 3 point pattern used with axillary crutches

patient is NWB, moving the crutches first, affected leg, then unaffected leg

how is a modified 3 point pattern used with axillary crutched

patient is PWB doing the same process as 3 point pattern

how is the 4 point gait pattern used with axillary crutches

patient is WBAT, the patient would move forward right crutch, left leg, left crutch, right leg

how is a 2 point pattern used with axillary crutches

patient is WBAT

left crutch and right leg at same time then right crutch and left leg at same time

how is a modified 4 point pattern done with a hemi walker

patient has hemi walker on opposite side

hemi walker first, contralateral leg, ipsilateral leg

how is a modified 2 point pattern used with a hemi walker

hemi walker and affected leg (opposite side) then unaffected leg

what gait patterns can be used with someone who is WBAT/FWB with bilateral AD

four point and two point

what gait patterns can be used with someone who is WBAT/FWB with unilateral AD

modified 4 point and modified 2 point

what gait patterns can be used for PWB, TTWB, TDWB with bilateral AD

modified three point

what gait patterns can be used for NWB with bilateral AD

three point

how can you go down stairs with a walker

swing the affected leg out with the walker on that side

use hand on guard rail and walker and hop down with the unaffected side

reset the walker and repeat

how can you go upstairs with a walker

weak leg away from the railing

move affected knee up, hop up with the unaffected side, then reposition the walker

how can you go down stairs with crutches

crutches down first, extend affected side out, then hop down with affected side

how can you go up stairs with crutches

hop up on unaffected side, bring affected knee up, then bring up crutches

how to go down stairs with a quad cane

turn the quad cane so the flat side matches the flat side of the stairs

cane down first, same side leg next, then other leg lst

how to go upstairs with a quad cane

cane on affected side and affected side on opposite side of railing

turn cane

unaffected up first, then affected, then cane