List the types of weight bearing status
- FWB
- WBAT
- PWB
- TDWB/TTWB
- NWB
describe WBAT
weight bearing as tolerated
allowed to put full weight, but person may not be able to due to pain or weakness
describe PWB
partial weight bearing
some of your weight is put on limb
may be in the form of a percentage
describe TDWB/TTWB
touch down or toe touch weight bearing
little to no weight is put through the leg
foot or toes are on ground more for balance than to bear weight
where should you be positioned to guard a pt during gait training?
position opposite to assistive device if unilateral
List the various levels of assistance
- Independent
- Modified independence
- Supervision
- Contact guard (CTG or CG)
- Min A
- Mod A
- Max A
- Total assist or dependent
describe the assistance level modified independence
completes task w/o assistance but uses some sort of assistive device
describe the assistance level “supervision”
no physical assistance is needed, but requires cueing (due to safety, cognition, etc.)
describe the assistance level CTG
no physical assist is needed, but hands are on the individual “just in case” or for manual cues
decribe the assistance levels min, mod, max and total assist
- Min A → they perform >75% of effort
- Mod A → they perform 25-74% of effort
- Max A → they perform <25% of effort
- Total → they perform 0%
- unconscious, spinal cord injury, etc
List some indications for the use of an Assistive device
- Correct gait deviations
- Pain
- Limited WB
- Balance issues
- Promote or assist w/healing
- Sensory or coordination impairment
- Structural deformity
- Muscle weakness or paralysis
- Fear
what are the biomechanical effects of an AD?
increase BOS
redistribute weight
List types of ADs
- Parallel bars
- Walkers
- Crutches
- axillary and forearm (Loftstrand)
- Cane(s)
- Knee walker; iwalk
list some big parameters to abide by when selecting an AD for use
- WB status
- if NWB, TTWB, or PWB → 2 handed device required
- WBT or FWB can use 1 handed device
- Strength and ROM
- for both UE and LE
- Medical status
- Balance
- Cognitive status
- Overall mobility
- Home environment
List pre-ambulation devices that can be used
parallel bars
tilt table
list pros, cons, and indications for
parallel bars
- Pro → most supportive and easiest to learn, excellent for training
- Con → can’t take it with you; limit mobility
- Indications → training, pre-gait activities
list pros, cons, and indications for
Walkers
- Pros → high degrees of stability, easy to learn and use, easiest to reduce WB, many designs
- Cons → may be cumbersome, difficult to use on stairs, reduces speed of ambulation, difficult to store and transport
- Indications → decreased WB and/or impaired balance or stability
list pros, cons, and indications for
Axillary Crutches
- Pro → allow greater selection of gait patterns, increased ambulation speed, easier to use in crowded areas, fair stability, may be used on stairs
- Cons → fair stability, axillary compression, requires good balance and trunk UE strength
- Indications → reduced WB, good UE and trunk strength, good coordination
list pros, cons, and indications for
forearm crutches
- Pros → highly adaptable, no pressure on axillary vessels or nerves, easy to store and transport
- Cons → less stable than Axillary crutches, requires functional balance and UE and trunk strength (better options available if decreased WB required)
- Indications → pt’s w/functional balance and strength that require increased access to the environment
list pros, cons, and indications for
Canes
- Pros → max access to environment, lots of options for increased/decreased stability, easy to use on stairs, easy to transport
- Cons → there are better options to limit WB, provide relatively little support, small BOS
- Indications → pts that have mild WB or stability deficits
List AD in order from those providing the most stability and support to least
- Parallel bars
- Standard walker
- Rolling walker
- Axillary crutches
- Forearm crutches
- Two canes
- One cane
Describe some general AD fitting guidelines
- check equipment
- upright standing posture w/relaxed shoulders and elbows fully extended
- grip at level of ulnar styolid process
- Elbow flexion should be 20-30 degrees when gripping grips
- Confirm fit
list some additional general guidelines for fitting parallel bars
- 20-25 degrees of elbow flexion when pt grips bars 6 inches anterior to hips
- bars 2 inches wider than the pt’s greater trochanters
list some additional general guidelines for fitting a cane
- hand grip should be level of ulnar styloid process when tip of cane is immediately next to the small toe and elbow fully extended
- elbows should flex 20-30 degrees when gripping the grip
how do you know an axillary crutch is the right height for a patient?
therapist should be able to fit 2-3 fingers in the axilla between the axillary pad and patient’s axilla
List some common AD fitting errors
- measurements are not adjusted for postural imbalances in upright positions
- measurements do not account for footwear
- measurements are not confirmed in standing
- optimal resting standing position is not maintained during measurement
List some commonly used gait patterns used with AD
- 4-point gait
- modified 4-point gait
- 3-point gait
- Modified 3-point gait
- 2-point gait
- Modified 2-point gait
- Step-to/Step-through gait
- Swing-to/Swing-through gait
how do you determine which gait pattern to use with an AD?
- check pt’s impairments
- strength
- balance
- multi-limb coordination
- WB status
- endurance
- unilateral vs bilateral involvment
- determine pt’s functional limitations
- inability to ambulate on flat surfaces/stairs/ramps
- environmental constraints
what is 4-point gait? describe the sequencing
2 crutches (or canes)
right crutch → left foot → left crutch → right foot
list the indications, requirements, and equipment needed for 4-point gait
- indications
- bilateral weakness
- pain
- problems with balance
- Requirements
- no WB restrictions
- Equipment
- 2 crutches/canes
list advantages of 4-point gait
- uses a reciprocal gait pattern
- stability
- safety
- low energy expenditure
- somewhat similar to normal gait pattern
list disadvantages to 4-point gait
- complex task → requires multi-limb coordination
- slow
what is the difference between 4-point and modified 4-point gait?
modified 4-point uses only 1 crutch/cane
sequence = crutch → contralateral foot → ipsilateral foot
what is 3-point gait? describe it’s sequencing
uses 2 crutches or a walker (NOT CANES)
sequencing = both crutches forward → keep involved leg off ground → stronger extremity moved forward while placing BW on arms
list the indications, requirements, and equipment needed for 3-point gait
- Indications
- one non-WB LE
- good UE and trunk strength
- one unaffected LE strength
- Requirements
- one FWB limb
- good trunk and UE strength
- Equipment
- 2 crutches
- walker
- NOT bilateral canes
list some advantages for 3-point gait
- can use with non-WB LE
- can be relatively fast, especially on crutches
List disadvantages for 3-point gait
- moderately complex
- high energy expenditure
- less stable
- not similar to normal gait pattern
- requries functional UE strength
how is modified 3-point gait different from 3-point gait?
modified 3-point gait allows for the involved limb to PWB or TTWB
3-point gait does not allow the involved limb to bear any weight
list the indications, requirements, and equipment for modified 3-point gait
- Indications
- one PWB or TTWB LE and one FWB LE
- good UE, trunk and unaffected LE strength
- or pt w/o WB restrictions
- Requirements
- one FWB LE or no WB restrictions
- good trunk and UE strength
- Equipment
- 2 crutches
- walker
- NOT with bilateral canes
list advantages for modified 3-point gait
- can use with PWB or TTWB LE
- allows involved LE to function actively and bear weight
list disadvantages to modified 3-point gait
- moderately complex
- high energy expense
- less stable
- requires functional UE strength
describe the sequencing for 2-point gait
2 crutches/canes
sequencing = right crutch and left foot → left crutch and right fot
sequencing resembles normal walking
list the indications, requirements, and equipment for 2-point gait
- Indications
- bilateral weakness, pain, problems w/balance
- no WB precautions
- Requirements
- no WB precautions on either extremity
- Equipment
- 2 crutches
- 2 canes
list advantages to 2-point gait
- safety
- low energy expense
- more like normal gait pattern
- faster than 4-point
list disadvantages to 2-point gait
- less stability than 4-point
- complex task → requires multi-limb coordination
what is the difference between 2-point and modified 2-point gait?
modified 2-point gait only uses 1 AD
what is swing-to/swing-through referring to?
swinging the involved limb either to (next to AD)
or
swinging it through (past the AD)
what is step-to/step-through referring to?
stepping the involved limb to (next to AD)
or
stepping it through (past the AD)
how should an individual ascend stairs with an AD?
up with good leg
bring bad leg up
bring AD up last
how should an individual descend stairs with an AD?
AD goes first
bring bad leg next
good leg comes last