Podcast
Questions and Answers
What is defined as the process of moving on foot?
What is defined as the process of moving on foot?
Which phase is characteristic of running gait but not walking gait?
Which phase is characteristic of running gait but not walking gait?
What distinguishes gait training from ambulation?
What distinguishes gait training from ambulation?
What is a common method used in gait training to assist patients?
What is a common method used in gait training to assist patients?
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Which of the following best describes walking within gait?
Which of the following best describes walking within gait?
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What is one of the main goals of gait training?
What is one of the main goals of gait training?
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Which statement is true regarding ambulation?
Which statement is true regarding ambulation?
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What is an incorrect use of the gait belt?
What is an incorrect use of the gait belt?
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In which situation would a front wheeled walker be used?
In which situation would a front wheeled walker be used?
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Which of the following is NOT a safety consideration prior to gait training?
Which of the following is NOT a safety consideration prior to gait training?
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Which grip is considered unsafe when holding a gait belt during a patient's fall?
Which grip is considered unsafe when holding a gait belt during a patient's fall?
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What should be included in the safety plan when working with a patient during gait training?
What should be included in the safety plan when working with a patient during gait training?
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What is a recommended strategy for gait training in beginning sessions?
What is a recommended strategy for gait training in beginning sessions?
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During gait training, what should the therapist be particularly aware of regarding the patient?
During gait training, what should the therapist be particularly aware of regarding the patient?
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Which factor should be avoided to ensure safe gait training conditions?
Which factor should be avoided to ensure safe gait training conditions?
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Study Notes
Gait Training Assisted Devices
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Parallel Bars: Commonly used for gait training and come in various forms:
- Wall-mounted: Bolted to the wall, more stable, often foldable.
- Floor-mounted: Bolted into the floor, extremely stable, not portable.
- Platform-mounted: More portable, foldable and self-adjustable/electric.
- Width: Should allow 2 inches of clearance on either side of the patient's hips.
- Height: When the patient's arms are relaxed at their sides, the bar should be at the wrist crease or level with the greater trochanter
- Hand Position: When hands are positioned 6 inches anterior to the hips, elbows should be flexed 20-25 degrees
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Walkers: Come in a variety of styles:
- Rollator Walker: 4-wheeled walker, often with handbrakes, a seat, and a basket.
- Front-Wheeled Walker: Often has an additional forearm platform attachment, more portable.
- Fixed Frame Walker: No wheels, must be picked up and moved, provides high stability.
Choosing an Assistive Device
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Patient Factors:
- Goals (short term and long term)
- Cost
- Functional capabilities
- Prior experiences with devices
- Awareness of limitations
- Environment (physical and social)
- Perception of using an assistive device
- Cost
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Therapist Factors:
- Impairments and functional limitations
- Purpose of using a device (redirect load, address pain, weakness, decreased endurance, increase stability, address impaired balance, improve motor control, address fear of falling, improve energy expenditure)
Weight Bearing Restrictions
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Non-weight bearing (NWB):
- 0% body weight through the involved leg
- Foot and toes do not touch the ground.
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Toe Touch Weight Bearing (TTWB):
- Allowed to touch the floor with the involved leg, but no weight applied
- Used for balance purposes, not support
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Foot Flat Weight Bearing (FFWB):
- Touch down on the heel or foot flat on the ground
- Encourages weight bearing through the lower extremity
- Toe touch weight bearing can lead to abnormal gait patterns, plantar flexor shortening, and overactive hip flexors
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Partial Weight Bearing (PWB):
- Prescribed with a percentage of body weight allowed (e.g., 20% or 20 pounds)
- Range from 20% to 50%
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Weight Bearing as Tolerated (WBAT):
- Full weight bearing allowed
- Limited by patient's tolerance
- Gradual buildup period to 100% full weight bearing
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Full Weight Bearing (FWB):
- No weight bearing limitations
Assistive Device Selection
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Base of Support Only:
- Best Choices: Parallel bars or walkers
- Minimal assistance: Single point cane or crutch
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Full Lower Extremity Unloading (NWB or TTWB):
- Best Choices: Parallel bars, front wheeled walker, or bilateral crutches
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Partial Lower Extremity Unloading (PWB):
- Similar to full unloading but can consider a single arm walker or bilateral canes
- Bilateral crutches or a front wheeled walker are still the more ideal options
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Weight Bearing as Tolerated (WBAT):
- Best Choice: single arm walker, single cane, or single crutch
- Allows for a more normalized gait pattern
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Full Weight Bearing (FWB):
- No restrictions on assisted device choice
Monitoring Weight Bearing Restrictions
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Challenges:
- Compliance with restrictions
- Patient perception of weight bearing and adherence
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Monitoring Methods:
- Biofeedback sensors: Placed under the foot, provide accurate information on force applied
- Hand or foot under foot: Inaccurate and risky
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Two bathroom scales:
- Ensures feet and pelvis are at the same level
- Allows patient to see how much weight is being placed through their lower leg
- Can be progressed to internal feedback (feeling the pressure)
Limitations of Monitoring Methods:
- Healthy individuals and individuals with injuries have difficulty maintaining a consistent weight bearing load limit.
- Weight bearing during stance may be different from how weight is borne during walking.
Gait Patterns and Assistive Devices
- Gait pattern: The ordered process of advancing the lower extremities and assistive devices.
- Laterality: The side of the body that the assistive device is used on.
- Two-point gait: One lower extremity and an assistive device advance forward together and contact the floor together, followed by the other lower extremity and assistive device. Can be used with bilateral crutches, canes, or a single-armed walker.
- Modified two-point gait: Used with a unilateral device (cane, single crutch, or hemi walker) on the opposite side of the affected lower extremity. The device advances forward with the affected leg.
- Three-point gait: Utilizes bilateral assistive devices (crutches or a front-wheeled walker) for non-weight bearing status in one lower extremity.
- Modified Three-point gait: Used for partial weight bearing or toe-touch weight bearing status. Uses bilateral crutches, a front-wheeled walker, or forearm crutches.
- Four-point gait (also known as deliberate two-point gait): One point moves forward at a time. Utilizes bilateral canes, crutches, or a walker.
- Modified four-point gait: Utilizes only one assistive device (crutch or cane) on the unaffected side. Device advances first followed by the contralateral extremity, then the ipsilateral extremity.
- Step-to gait: The foot stops at the level of the assistive device.
- Step-through gait: The foot advances beyond the assistive device.
- Swing-to gait: Bilateral crutches. Lower extremities stop at the level of the crutches.
- Swing-through gait: Lower extremities advance beyond the assisted devices, powered by trunk momentum.
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Factors to consider when choosing a gait pattern:
- Weight bearing restrictions
- Appropriate assistive devices
- Advantages and disadvantages of each gait pattern
- Queuing for patient instruction
Ensuring Compliance with Weight Bearing Restrictions
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Monitoring weight bearing:
- Biofeedback sensors under the foot are reliable but not readily available in most clinics.
- Placing a hand or foot under the patient's foot is inaccurate and risky.
- Using two bathroom scales of equal height is a better but not perfect method.
- Patient perception: Patient perception and adherence to weight-bearing precautions during ambulation can be unreliable.
Considerations for Assistive Device Selection
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Stability vs. Mobility:
- More stable devices often restrict mobility.
- Less stable devices allow for more agile movement but offer less support.
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Energy Expenditure: Normal gait patterns are the most energy-efficient.
- Compensatory gait patterns increase energy expenditure.
- Assistive devices can also increase energy expenditure.
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Cardiopulmonary Considerations:
- Individuals with compromised cardiopulmonary systems need to choose devices that allow them to ambulate the greatest distance safely.
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Relative Energy Costs of Assistive Devices (least to most costly):
- Cane or knee walker
- Crutches
- Rolling walker
- Standard walker
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Factors to consider when selecting a device:
- Patient's functional needs and goals
- Device features and suitability
- Patient preferences and lifestyle habits
- Safety and stability provided by the device
- Cost and availability
- Assistive device must match the patient's weight bearing restrictions.
- The device should allow the patient to maintain weight bearing status safely.
Transferring with Parallel Bars
- Lock wheelchair brakes before transfer.
- Sit to stand: Patient scoots to the edge of the chair, feet underneath, leans forward, pushes from armrests. Therapist stands in front with a hand on the gait belt.
- Stand to sit: Patient turns around, backs up until legs contact the chair, reaches back to grab armrests, slowly descends.
- Avoid pulling up by using the bars.
Transferring to a Walker
- Lock wheelchair or bed brakes before transfer.
- Sit to stand: Therapist stands on the involved side, one hand on the gait belt, the other on the shoulder. Patient scoots forward, leans forward, pushes up through armrests, places one hand on the walker handle, then the other.
- Stand to sit: Patient extends the involved leg, reaches back to grab armrests, slowly descends.
- Alternative method: lean forward, place one hand on the walker crossbar, the other on the armrest, push up.
Transferring with Crutches
- Lock wheelchair or bed brakes before transfer.
- Sit to stand: Therapist stands on the involved side, one hand on the gait belt, the other on the shoulder. Crutches are on the uninvolved side. Patient scoots forward, pushes through crutch hand grips and armrest.
- Stand to sit: Patient transfers both crutches to the uninvolved side, reaches back for the armrest, slowly descends.
- Crutches should be used for support, not to pull up.
Transferring with Canes
- Consider the presence of armrests.
- Use cane in the same hand as the armrest, push up or down.
- If no armrests, the patient can push down on the cane, but pushing up from the chair is safest.
Ascending Stairs
- Therapist stands behind the patient, slightly to the affected side, in a staggered stance.
- Non-weight bearing: Patient keeps involved leg flexed and off the ground, advances the stronger leg, then both crutches.
- Partial weight bearing: Patient advances the stronger leg, then the involved leg, then both crutches.
- "Up with the good, down with the bad" mnemonic can be used for sequencing.
Descending Stairs
- Therapist stands in front of the patient, slightly to the affected side, in a staggered stance.
- Non-weight bearing: Patient hovers involved leg, advances both crutches, then the non-involved leg.
- Partial weight bearing: Patient advances both crutches, then the weaker leg, then the stronger leg.
- "Up with the good, down with the bad" mnemonic can be used for sequencing.
Ascending Stairs with Walker
- Handrail available: Open walker sideways (legs on steps), push through higher handgrip. Folded walker sideways, use top handle.
- No handrail: Back up walker, lift back legs onto the step, use stronger leg to step up.
- Step up with the non-involved leg first.
Descending Stairs with Walker
- Handrail available: Open walker sideways (legs on steps), push through higher handgrip to avoid tipping. Folded walker sideways, use higher handhold.
- No handrail: Not typically the case, consider safety.
- Step down with the involved leg first.
Descending Stairs with Walker
- Step down with weaker/ involved leg first, then advance stronger leg
- Move walker to edge of step, grasp posteriorly to hand grips, position front legs of walker on step
- Repeat for each step
Ascending Curbs
- Place walker close to curb, position patient close to curb
- Lift walker, place all four legs securely on curb
- Lean forward, position stronger leg on curb, then involved leg
Descending Curbs
- Position walker close to edge of curb, position patient close to curb
- Advance walker on lower surface, ensure all four legs are secured
- Lean forward, position weaker/ involved leg first between walker bases, then advance stronger leg
Stair and Transfer Training with Assistive Devices
- Need to understand sit to stand and stand to sit transfers using various devices
- Must know how to perform transfers for non weight bearing patients as well as those with weight bearing restrictions
- Understand positioning, guarding, cueing, and instructing patients
Stair Training with Different Devices and Restrictions
- Instruct patients with various weight bearing restrictions
- Know how to position yourself, cue the patient
Key Considerations for Stair and Transfer Training
- Perform safely to avoid injury and maximize patient performance
- Transfer and stair training should be conducted in patient's home and community environment
- Ensure patient's safety and effectiveness in different environments
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Description
This quiz assesses your understanding of gait training, including techniques, safety measures, and key distinctions between walking and running gaits. Test your knowledge on the important aspects of assisting patients during gait training and identifying common practices used to ensure safety. Perfect for students and professionals in physical therapy and rehabilitation.
