Acute Care and Ambulatory Aids

Inflammatory Phase AKA Acute phase

1.) immediate to a few days, essential (too much inflammation can be a bad thing)

2.) Defends against foreign intruders, removing damaged tissue and debris, immobilize area 

3.) avascular or poorly vascularized tissue won’t heal well 

Joint Effusion

1.) contained by joint capsule

2.) feels like a water balloon

3.) moves when palpated then returns

Edema

1.) fluid in interstitial space, press on tissue with finger (dent/pit remains)

2.) measurement of edema with circumference is reasonable accurate and correlates well with CT scans

Acute care

1.) protect

2.) rest → protects against further injury and inflammation, conserves energy needed for healing

3.) Ice

Compression 

decreases edema and bleeding, mechanical support

External compression

wrap from distal to proximal, adding horseshoe or J shaped felt pad held in place with an elastic wrap increases the compression

Internal compression

muscle contraction, ROM, pumping ankles, alphabet, isometrics

External compression: pushes fluid toward the heart

1.) therapeutic and prophylactic for deep venous thrombosis and venous thromboembolism

2.) pushes arterial blood into the extremity → ischemia, intermittent, claudication 

Intermittent Compression 

1.) acute or chronic edema, mechanical device

2.) inflates and compress part

Intermittent sequential graded compression

1.) most common, 3 compartments (distal, intermediate, proximal)

2.) inflated for minutes then deflated then repeated hours per day

Elevation

1.) gravity augments lymph flow, elevation above heart level significantly reduced edema in 20 minutes

2.) dependent position increases edema (in normals) → probably more profound in inflammation 

Support takes many forms 

1.) nutritional: vitamins, anti-inflammatory diet

2.) education: acute injury, ADLs, spine sparing, chiropractic

3.) referral for emotional support

4.) bracing, taping, crutches, canes 

Taping and bracing 

1.) effective for acute support, athletic tape (White tape) stretches in 20-30 minutes

2.) bracing may inhibit muscle action

Ambulatory Aids

1.) Support of assist when patient is unable to walk or bear weight on one extremity

2.) need to fully elevate patient for inability to ambulate, weight bearing is better than non-weight bearing when structural and functional integrity of joint is not severely compromised 

3.) localized rest to a lower extremity 

4.) still maintain a partial weight bearing 

Fitting crutches 

1.) Crutch tip → 6” from outer margin of shoe, 2” in front of shoe 

2.) arm brace → 1-2” below anterior axillary fold

3.) hand brace → elbow flexed to 30 degrees 

Improper use/fit 

1.) abnormal stresses 

-lumbar/pelvis subluxation 

-low back strain 

-hip strain 

Crutch palsy

1.) pressure on axillary nerves and vessels

2.) temporary or permanent numbness

Walking with crutches

1.) non-weight bearing = tripod gait

2.) partial weight bearing = tripod or 4-point gait

3.) always use upright spinal posture

4.) discourage patients from resting on underarm braces

Tripod Gait: non-weight bearing

1.) affected foot fully elevated → crutch tip moves 12-15 inches ahead of feet

2.) lean forward, straighten elbow, pull underarm brace firmly against torso

3.) swing both legs between crutches, step onto unaffected foot, recover crutches to forward position

swing-to gait

bring foot to the crutches, easier, less coordination

Swing-through gait 

foot lands in front of crutches, faster and more coordination 

Tripod Gait for Partial weight bearing (Four point gait)

1.) affected leg and crutches move forward together → partial weight placed on affected leg

2.) swing through with body and unaffected limb

3.) recover crutches and affected limb to forward position

Handrail stair gait

1.) unaffected leg steps first → follow with crutches and involved leg

2.) going down stairs → place crutches down first, affected leg steps down, unaffected leg steps down

3.) hand rail and crutches bear weight on affected leg

Fitting Cane

1.) wearing low-heeled street shoes

2.) cane length = superior aspect of greater trochanter of femur, cane is used on opposite side of involvement

3.) moves with the involved side