Gait training

Question	Answer
What are the three requirements for gait?	Stability, mobility and dynamic stability
What is dynamic stabililty?	maintaing posture while shift weight
How do we think of gait?	Constant falling and recovering from falling. COG in BOS
What do you need to know before getting a pt up?	any wt bearing restrictions
When do you use parallel bars?	for a pt who needs support or are weak
How do you position the wheelchair in the parallel bars?	Make sure foot rests are off and you move the wheel chair into position so that it is locked
What is orthostatic hypotension?	change in body position when BP drops. Do ankle pumps and deep breathing to increase O2 return, get initial BP if not DVT!
What are weight shifting techniques and when are they used?	front/back, side/side, single hand, with/without challenge (pevis push or pull), used to start gait training
What is the open or closed chain activities for gait	hip hike and partial squats
Why teach foward and backwards stepping?	requires wt shift and push down on parallel bars for wt restrictions
Why is turning in parallel bars imporant?	turn to stronger side, ears can adjust to space, and cordination with other systems
What are some advance moves in the parallel bars?	Add resistance, stepping over, step up, speed, walking backwards, sidesepping, braiding,change of diection
What are considerations for gait training	pt level of cognition, motivation, pt readiness, general health, ablitiy to tolerate pain, saftey, vital signs, pts prior expereince, wt bearing restictions
What is NWB?	Non wt bearing (always 3 pt)
What is TTWB	Toe touch wt bearing (3 pt mod)
What is PWB	Partial wt bearing (always 3 pt)
What is WBAT	Wt bearing as tolerated
What is FWB	Full wt bearing (cane)
How do you measure for a cane?	when standing elbow bent 25-3o degrees, cane at creast of wrist, ht of greater trochanter
How do you use a cane?	Opposite involved leg, involved leg steps with the cane
List the 4 types of crutches	standard axillary crutch, ortho crutch, forarm (lofstand) crutch, plateform attachement
What are two different 3 point gait patterns with a crutch?	step to, step through (explain the difference)
What are gait patterns with a crutch	4 point gait, two point gait, swing to, swing through
What are the different types of walkers and explain the differences?	standard walker,rolling walker, platform walker
How do you guard on stairs?	be down of the pt
How do you instruct the pt to go up stairs?	up with good leg, down with the bad, when bad leg moves so does the assisted device
How do you use a walker on the stairs?	Use it like a cane
How do you use crutches on the stairs?	Like a cane
What does documentation look like for gait?	assistive device required, transfer level, wt bearing statis, distance, speed, function, surface, level of assistance
planning gait	review medical record, appropriate equip, explain or demo activity, clear area, gard with gait belt, maintain body mechanics
safety first	appropriate foot wear, monitor vitals, pay attention, clear area
guard pt	stay alert, guard behind and to weak side, pt sits while alone, care for appliances
pregait activities	develop base of strength balance and coordination, improve use of devices, increase pt confidence
assistive devices	provide support, increase balance, BOS, and decrease wt bearing
parallel bars	most stable, not long enough/ use for gait and pre-gait activites
walkers	max stability with mobility/difficult to store, use on stairs, slow, to perform normal gait patterns, and use in crowded spaces
crutches	bi or unilateral, provide speed, less stable can damage axillary area, requires balance
loftstrand	cuff all the advantages of crutches, but requires balance and upper body strength, cuff makes if difficult to remove
canes	compensate for impaired balance or improve stability/provide limited support, not to be used for NWB
fit parallel bars	2 in from trochanter, level with styloid process
walker and cane	even with styloid process
fit crutches	hold 4 in anterior to toes, 3 in or 2 fingers below auxillary fold. hand rest at styloid process
4 point and mod 4 point	alternate between each stick and each leg, alternate one stick, one leg
2 point and mod 2 point	affected leg and both sticks, affected leg with stick then good leg