Transfers and AD

stance and swing phase

What are the two phases of walking?

Stance phase

single and double limb support; characterized by stance limb extension and stability

Swing phase

swing limb advancement; characterized by hip extension/knee flexion followed by hip flexion/knee extension to clear the floor with the foot, then position the foot for weight acceptance

cyclical

continuous

efficient

adaptable

How would you describe a normal gait pattern?

discontinuous

inefficient

inflexible

How would you describe a pathologic gait?

loss of stability in stance

loss of mobility in swing

increase time in double limb support

decreased speed and distance

loss of balance

pain

What may a pathologic gate be marked by?

NWB

involved LE not permitted to touch ground

Toe touch WB

toes can rest on the ground for balance, but not for weight bearing

PWB

limited amount of weight bearing, typically 50% of body weight

WBAT

patient determines amount of weight bearing that will occur

FWB

patient permitted to bear full weight on LE, assistive device used for balance

Loss of bony or soft tissue integrity

decreased strength

alterations in ROM

impaired balance

Alteration in motor control

pain with WB

What can assistive devices help compensate for?

tolerance for standing

stability in standing

What are the two steps in preparation for walking?

parallel bars

What tool is used for initiation of gait training and is the most restrictive setting?

elbow flexed 20-30 degrees (grip at wrist when arms at straight)

width 2 inches wider than greater trochanter

What is the fit for all assistive devices hand grips?

supported standing

weight transference

progression to walking

What are examples of pre-gait activities?

walker

What assistive device provides maximal stability with mobility?

does not adapt well

limited access to pt hips and knees if support is required

What are limitations to a walker?

same position for hand grips

tip 6 inches away from toes at 45 degree angle

2-3 finger widths inder axilla

What is the fit for axillary crutches?

axillary crutches

loftstrand crutches

What assistive devices require good standing balance, but are easily adapted to an environment?

same hand grip

forearm cuff as high as possible on forearm

What is the fit for lofstrand crutches?

opposite of affectedl limb?

On what side do you use a cane?

Two point gait

bilateral assistive devices, assistive device moves simultaneously with opposite LE (ex. R crutch+L foot, L crutch+R foot)

Four-Point gait

deliberate 2-point pattern (ex. R AD, L foot, L AD, R foot)

Three point gait

unilateral LE involvement, crutches/walker move forward, then involved LE, the uninvolved LE (ex. R+L crutch, involved LE, normal LE)

Step-to gait

crutches/walker/cane, crutches moved forward simultaneously the LE moved forward simultaneously to same point as AD (ex. cane, involved foot steps to cane, normal foot steps to cane)

Step-through gait

crutches/cane moved forward simultaneously then LE moved forward beyond AD (ex. cane, involved foot steps to cane, normal foot steps through)

Non-reciprocal

'up with the good, down with the bad', not stepping one over the other on the stairs

Reciprocal

step over step on the stairs

mostly rail/device combination

devices accompanies most compromised limb

How are assistive devices used on stairs?

devices descends first going down

How are assistive devices used on curbs?

Moderate assist

patient performs 50-75% or more of the activity

Maximal assist

patient performs 25-50% or more of the activity

Bed mobility

Rolling, movement side to side, movement up and down, supine to sitting, preparation for transfers out of bed

Squat pivot

Sitting to sitting transfer where pt has both feet on floor; one or both knees stabilized, and one or more helpers

Dependent lift

two or more people lift and move pt

Standing transfer

one surface to another using standing as the transitional position

No

Would you use a stand-pivot transfer if more than one helper was needed?

Independent

Patient performs all elements of the transfer safely and consistently, does not require presence of caregiver

Contact guard

patient required physical contact or tactile cues from the caregiver, is likely to require assistance or protection during the activity

Dependent

Patient requires total physical assistance for the activity

WBAT

pt determines amount of weight bearing that will occur; will typically use assistive device

FWB

pt permitted to bear full weight on LE; no need for assistive device for off-loading

log rolling

If a pt has back pain or spinal cord injury what is some times required or highly encouraged?

Transfer

safe movement of a person from one surface or location to another or from one position to another

Transfer board

Sitting to sitting transfer where pt has feet on floor, knees stabilized, and completes a series of movements across a board with one or more helpers

Stand-pivot

Sit to stand transition, followed by pivot or stepping to turn, followed by sitting down (one or both knees and/or hips may be stabilized)

Recumbent transfer

used for patients unable to stand up

Supervision (set up or standby)

patient required verbal cues, direction, or coaching from the caregiver; may require pre-transfer assistance with setup (no physical contact)

General precautions for Transfers

Strength of pt

Sensation/perception

Cognitive status

Musculoskeletal status

Integumentary status

Emotional/behavioral status

Patient with THR

this pt should avoid adduction, IR, flexion beyond 90, extension beyond neutral

Sitting to sitting

one surface to another while in sitting

Sitting to standing

the act of standing up (one or both knees and/or hips may be stabilized)

Minial assist

Patient performs 75% or more of the activity

NWB

involved LE not permitted to touch ground

Toe Touch WB

toes can rest on the ground for balance, but not for WB

PWB

limited amount of weight bearing, typically approximately 50% of body weight

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