ADLRehabLecture III

1
ADL/Rehab/Lecture III

• Pregait Activities, Parallel Bars, Gait Training
• Veronica Southard PT MS GCS

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Indications for Assistive Devices

• Impaired Balance
• Decreased strength
• Incoordination
• Pain upon WB
• Amputation

• Altered stability
• Decreased functional ability
• Impaired function
• Assist healing

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Purpose of prescribing assistive devices

• Optimal security
• Safety
• Function
• Energy saving

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Considerations for device selection

• 1. Environment pt will amb in
• 2. Expected/desired amb activities
• 3. Prognosis for improvement or regression of
  condition and abilities

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Patient examination

• Special attention to
• balance impairments
• incoordination
• ROM
• strength
• endurance

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Types of WB

• 1. NWB
• 2. TTWB
• 3. PWB
• 4. PWBAT
• 5. FWB

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Precautions for Pregait/Gait training

• Appropriate footwear.
• Monitor pt. VS, Genl appearance, Mental
  alertness.
• Guard with a secure belt or gait belt. Avoid
  using loose clothing.
• Be alert for the unexpected.
• Never leave a pt. in trainings side!!!!!
• Watch out for other tubes.
• The floor should be dry.

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Training approach

• Start in ll bars
• Explain gait pattern
• Demonstrate
• Practice
• Once proficient in ll bars move out

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STABILITY

• Parallel bars
• Walkers
• Crutches
• Single Crutches
• Bilateral Canes
• Single canes

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Parallel Bars

• Max support
• Max stability
• Effective venue for teaching gait patterns
• Measuring devices

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Walkers

• Max support while providing multidirectional
  mobility
• Types
• Standard
• Reciprocal
• Stairclimbing
• Wheeled gliding
• Triwheeled
• Sam Hall
• 1 handed

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AXILLARY CRUTCHES

• Indicated when a patient needs less stability or
  support then provided by ll bars or walker. Good
  for use in crowded areas
• Variety of gait patterns
• Increased speed
• Easily fitted
• Easily stored
• Made of wood or aluminum

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FOREARM CRUTCHES

• Two Varieties Lofstrands, Canadian
• Provide almost the stability and support of
  axillary crutch where shoulder girdle and trunk
  control are adequate, eliminating axillary
  compression.
• More stability and support than canes.
• More functional on steps and in narrow areas. Pt
  can still reach for objects.

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Platform attachments

• Used when the patient is unable to WB through the
  wrists or hands.
• Also severe deformities, elbow contractures,
  shoulder fx.
• Disadvantages
• Loss of tricep to elevate and maintain body
  during swing
• Another person may be required to apply
• Stairs!!!!!

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CANES

• INDICATED Impaired balance, improve stability,
  WB.
• More functional on stairs and narrow places.
• Types SAC, NBQC, WBQC,Tripod cane
• Disadvantage Limited support because of sm
  base. Two canes dont provide sufficient support
  for a 3 point gait.

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Measurement of Assistive Devices

• If measured in sitting always check when the pt.
  Stands
• ll bars there should be 15-25 flex at elbow
• Canes handgrip at gr trocanter
• Forearm crutch top of cuff 1-1.5 distal to
  olecranon. Neutral wrist
• Axillary crutches several methods

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Confirming Crutch Fit

• Always check a second time. Improper fit causes
  decreased stability, increased energy
  expenditure, decreased function, decreased safety
  for pt.

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Tripod position

• A triangle is formed between the crutch tips and
  the pts foot/ feet.
• Provides the best base of support and starting
  position for most gait patterns.

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Basic Gait Patterns

• Four point gait slow, stable alternate
  reciprocal movement. Low energy requirements.
• Two point gait Simultaneous and reciprocal
  forward movement. Also NWB form
• Three point gait Three points of contact. PWB,
  Touch down

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Balance and Pregait activities

• Starting in ll bars
• WS A/P S/S. Hold each position 3-5 sec
• Remove hand from ll bars alternately
• Pushups in ll bars
• Lifting opposite alternate extremities
• Gait pattern practice
• Gait pattern practice with amb aid

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SAFETY CONSIDERATIONS

• Guard pt on the affected side and slightly
  behind.
• Use a gait belt

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STAIRS

• Ascending Lead with the uninvolved LE. Guard
  behind and slightly to side using and a/p stance.
  One foot on step below the other.
• Descending Stand in front toward affected side.
  A/p stance. Pt leads with the affected foot

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Curbs and Ramps

• Curbs guard as on steps
• Ramps as pt moves up, behind
• In front as pt moves down
• Teach the pt. To turn toward the strong side.
• Pts with THR must turn not pivot.
• Some will sit on steps

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Practice Lab III

• Amb on levels with all the different devices.
• Use the NYCOM II steps.
• Falling with crutches
• Sit to stand with devices and different WB
  precautions