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What are some factors that influence walking?
- conscious effort
- ROM
- strength
- sensation (proprioception in feet)
- coordination/balance
- external appliance (brace)
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What 2 phases are included in the gait cycle?
stance and swing
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What is the first phase of the gait cycle?
stance
period of time when at least 1 foot is in contact with the ground
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What are the 5 components of the stance phase in order?
- heel-strike
- foot-flat
- mid-stance
- push-off
- toe-off
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What is the 2nd phase of the gait cycle?
swing
period of time when foot is not in contact with the floor
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What are the 3 components of the swing phase in order?
- acceleration (limb swinging forward)
- mid-swing (when foots under the greater trochanter)
- deceleration (limb coming back down)
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What happens right after deceleration of the swing phase?
heel-strike of the stance phase in other foot
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What is a cycle?
time that 1 foot is in contact with the ground
heel-strike to heel-strike of same foot
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What is base of support?
width of stance/walking base
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What is stride length?
distance between heel strikes of same foot
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What is step length?
measurement of heel strike of 1 foot to heel strike of other foot
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What is cadence?
number of steps per unit of time
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What is double support?
both feet on ground at the same time
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What UE muscles are very important to strengthen?
- scapular depressors
- shoulder depressors
- shoulder extensors
- elbow extensors
- finger flexors
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What LE muscles are important to strengthen?
- hip extensors (gluts, hamstrings)
- hip abductors (gluteus medius)
- knee flexors (hamstrings)
- knee extensors (quads)
- ankle dorsiflexors (tibialis anterior)
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What are some types of gait patterns?
- 4 point
- 2 point
- modified 2 point
- modified 4 point
- three point
- three one
- drag to
- swing through
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What is the general progression of assistance levels? (5)
parallel bars ->axillary crutches ->forearm crutches ->quad cane ->cane
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What are some general safety precautions?
- guard slightly behind and on affected side
- IV's, casts
- floors dry
- gaitbelt
- footwear
- physiologic response (vitals)
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What should be included in the gait progress note?
- type of assistive device
- gait pattern with amt of weight bearing
- level of independence
- tolerance
- balance
- stairs
- transfers (level of independence, tolerance)
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What is the purpose of parallel bars, and where do you spot from?
- maximal stability
- measuring for another AD
- teaching new gait pattern
- balance training
spot from inside the bars; in front of pt if 1 person, if 2 people, one in front and one in back
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How do you measure a pt for pbars?
- 15-25 degree flexion at elbow when hands are on bars 6" ant. to hips (stand with elbows straight and 6" ant. to hips, bars should rest at the wrist crease)
- 2" from hip to bar on each side
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What is the purpose of crutches (axillary, forearm, longstrand, canadian)?
- widen pts BOS for greater stability
- cheap
- allow us to limit weight bearing
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What are the components of crutches?
- 2 uprights
- axillary crossbar
- hand grip
- suction tip
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Who is normally going to use longstrand crutches?
paraplegics - they're for long term use
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How do you measure for axillary and forearm crutches?
- feet 2-3" apart
- tip of crutch 2" lat. and 4-6" ant. to toe
- 2-3 finger widths between armpit and pad
- 15-25 degree elbow flexion when hands are on grips (wrist crease should come to pad with elbows straight)
*forearm- same except arm cuff shold be 1-1 1/2" below elbow
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How do you teach a patient to get out of a chair while on crutches?
hold both crutches on the affected side, and push up from the chair arm on the unaffected side
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When would you use a platform crutch?
- when pt is NWB on wrist.
- helps rest the arm (handle to hold onto)
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What are some indications that you need to use a cane?
assist with balance (dont want to rely on for WB-more for balance)
- decreased balance, coordination, strength
- pain
- dizziness
- slight decreased WB
- elderly
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In which hand would you hold a cane?
ALWAYS in the good sides hand (unaffected side)
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What are some disadvantages to canes?
- slows gait
- safety (hard to keep all 4 tips down at once)
- hard to use on stairs
- heavy
- expensive
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What hand do you hold a hemi cane in, and what is the disadvantage of it?
- always hold in good sides hand
- pt tends to lean on them
*measure same as crutches
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What are disadvantages of a walker?
- slows gait
- hard to safely use on stairs
- hard to use normal gait patterns
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How do you measure for a walker?
- stand pt with feet at back of walker (back walker leg should be in middle of foot)
- 15-25degree of elbow flexion (measure wrist crease when arms are straight)
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What are some types of walkers?
- standard
- wheeled
- reciprocating
- forearm support
- folding
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When ambulating with an AD, which leg should move with the device?
bad leg ALWAYS goes with device
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What gait patterns require bilateral ambulation aids?
- 4 point
- 2 point
- 3 point
- modified 3 point (three one)
- drag/swing to
- swing through
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What gait patterns require only unilateral AD?
- modified 4 point
- modified 2 point
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What is the 4 point gait sequence?
- right UE
- left LE
- left UE
- right LE
always maintaining 3 points of contact
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The 2 point gait can be performed more rapidly than the 4 point; what is the 2 point sequence?
- right UE and left LE together
- left UE and right LE together
requires more coordination and balance than 4 point
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What is the sequence of the modified 4 point gait?
AD held in the uninvolved hand
AD, then bad leg, then good leg
sometimes called hemi gait or hemi pattern
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The modified 2 point is the natural progression from the modified 4 point; what is the gait sequence of the modified 2 point?
AD held in uninvolved hand
AD and bad leg together, then good leg
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What is the only gait pattern used for NWB?
3 point pattern
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What is the gait sequence of the 3 point pattern?
both AD's forward, than hop to or swing through the device with good leg (NWB leg is held in air)
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When turning with AD's, which way should you turn?
toward the good side if possible
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In the modified 3 point pattern, PWB is permitted on involved leg; what is the gait pattern?
AD's and infected leg together, then uninvolved leg
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What types of pts use the drag to/swing through gait patterns?
paraplegics - they're unable to use any LE musculature so they use their trunk to swing through
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What is the gait pattern of the drag to/swing through gaits?
AD's forward then use trunk muscles to drag legs to/through the AD's
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