GAIT Exam 2 PDF

Sit-to-Stand with Axillary Crutches • Both crutches on one side (holding on inside) • Crutches are best held opposite the “involved” side • Push down on armrest and crutch grips • Stand and balance; transfer a crutch under each arm • Reverse to sit Sit-to-Stand With Cane • Move into ready position...

Sit-to-Stand with Axillary Crutches • Both crutches on one side (holding on inside) • Crutches are best held opposite the “involved” side • Push down on armrest and crutch grips • Stand and balance; transfer a crutch under each arm • Reverse to sit Sit-to-Stand With Cane • Move into ready position • Lay cane to the side, holding the handle in the same hand with the armrest • Push to standing and place cane upright • OR if the cane can stand on its own: • Place cane next to chair • Push to standing on both armrests • Grasp cane Fitting an Assistive Device •You can estimate with the patient seated •Most devices have a weight limit ~260-300 lbs. – check for bariatric options as needed *Always confirm fit in Standing (and functional walking position, if needed): • Have the patient in good posture and wearing typical footwear when fitting the device • Guard appropriately during fitting • Two fingers should fit between the axilla and the axillary pad. • Device handle is typically at the level of the greater trochanter or ulnar styloid process • Patient should have approximately 20-30 degrees of elbow flexion to allow triceps activation Up and Down Curbs with Walker Ascending a curb: ◦ Walker first, followed by STRONG Leg Descending a curb: • Walker first, Weaker Leg, STRONG Leg. Up and Down Curbs with Crutches (no rail) Ascending Curb with Crutches: If patient is steady: 1. 2. Up with STRONG Leg Weaker Leg + B/L Crutches If patient is Less steady: 1. 2. 3. Up with STRONG leg Weaker leg Crutches Descending Curb with Crutches If patient is steady: 1. 2. 3. Down with B/L Crutches Weaker Leg STRONG leg If patient is Less steady: 1. 2. 3. 4. Down with 1 Crutch from the Strong Leg side Down the other Crutch Weaker Leg STRONG leg Up and Down Curbs with Cane (no rail) Ascending Curb with Cane: If patient is steady: 1. 2. Up with STRONG Leg Weaker Leg + Cane If patient is Less steady: 1. 2. 3. Up with STRONG leg Weaker leg Cane Descending Curb with Crutches 1. 2. 3. Down with Cane Weaker Leg STRONG leg Guarding – Ascending Curb Ascending: Typically, behind and slightly to the weaker side: o Therapist’s starting position: • 1 foot on the same step as the patient. • Other foot: 1 step behind the patient. • Hand Placement: anterior shoulder + pelvis/low back/hips and on gait belt. Guarding – Descending Curb Descending: Typically, Guard on the weaker side: o Therapist’s starting position: • 1 foot on 1 step down – ready to receive walker. • Other foot: 1 step behind the patient. • Hand Placement: anterior shoulder + pelvis/low back/hips and on gait belt. Walking on Ramp/Inclines With Assistive Devices • Lean forward when ascending. • Take slightly longer steps when ascending. • Take slightly shorter steps when descending. • Follow zigzag path if necessary to reduce steepness of path. Stairs with Axillary Crutches • “Up with the good, down with the bad.” • Move crutches with the involved or weaker LE (requires more coordination and trunk control) • If more stability is needed, then GAS up and SAG down Stairs with Cane • “Up with the good, down with the bad.” • May move cane to other hand in order to use handrail • May need to turn quad cane sideways for secure placement • Step-to-step or step-over-step Stairs with Walker…? Debatable….. risk of loss of balance considering the unsteadiness and challenge to place FWW on an even surfaces to support patient’s body weight. Guarding – Ascending Stairs Ascending: o Therapist’s Starting Position: • behind and slightly to the weaker side • Hand Placement: anterior shoulder + pelvis/low back/hips on gait belt. • 1 foot on the same step as the patient. • Other foot: 1 step below and behind the patient. • Patient and Therapist take turns to step (Avoid taking step at the same time) Guarding – Descending Stairs Descending: o Therapist’s Starting Position: • Face patient (therapist will descend backward) • Hand Placement: anterior shoulder + anterior part of gait belt. • 1 foot 1 step lower than the patient. • Other foot: 2 steps lower than the patient. Bottom Scooting Up Stairs May be needed for emergencies (teach it!) Safest option if you have limited strength to complete the task: 1. Position yourself in front of the stairs so that they are behind you. 2. Pushing through the unaffected leg and both hands, raise yourself up the stairs one at a time. HTTPS://WWW.PAT.NHS.UK/DOWNLOADS/NEW%20NCA%20LEAFLETS/PHYSIOTHERAPY/483%20%20GOING%20UP%20AND%20DOWN%20STAIRS%20ON%20YOUR%20BOTTOM.PDF