ambulation and gait training

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  • Ambulation- act of walking or being able to walkAmbulation aid- piece of equipment used to provide support or stability to a person while walkingGait- the manner or style of walkingUnilateral- one sidedBilateral- two sided or both sidesExtremities- arms (upper) or legs (lower)

  • ASSISTING WITH AMBULATION AND GAIT TRAININGAssistive devices are used to make safe ambulation possible

  • 1) decreased ability to bear weight on the lower extremities (legs)2) muscle weakness or paralysis of the trunk or lower extremities3) poor balance in the upright posture

  • 15 year old boy fractures RLE tibia and fibula. The boy had surgery to repair and doctors orders NWB for 2 months. As the physical therapist, what assistive device will you instruct him to use?

  • 6.3 Demonstrate appropriate use of equipment and devices as directed by rehab professionals.

  • What device have we already learned about?

  • CrutchesArtificial supports that assist a patient who needs help walking.Ordered by a physicianMade of wood or aluminum

  • How do you fit patient for crutches?#1 Measurement points:Height of heels on shoes: low broad heels, approx. 1 to 1 inches high, non skid solesPosition crutches: 4-6 inches to the side and front of the pts footDistance b/t axilla and axillary bar: 2 inches

    Degree angle for elbows: 25 30 degrees

  • #2 Bear weight on both legs 4-point gait

    Each step is separate:(crutch- opposite foot-crutch-opposite foot)

    Used: cannot bear full weight on either leg

  • #2 continuedWhen 4-point is mastered then the pt can advance to: 2-point

    1) Crutch-opposite foot (move together)2) Crutch-opposite foot (move together)

  • After the patient gains strength in the arms and shoulders, faster gaits such as the swing-to or swing-through are taughtSwing-to: Move both crutches forwardMove feet up to crutchesSwing-through:Move both crutches forwardSwing both legs in front of crutches

  • #3 If a pt can bear weight on only 1 leg, the first crutch gait taught is the 3-point

    Move both crutches and the weak foot at the same time (3)Then advance the good foot forward.When the pt gains strength in the arms and shoulders, faster gaits such as the swing-to or swing-through are taught.

  • # 4 Why is it important to avoid pressure on the axillary area when crutch walking?Nerve damage can occur.

    *Always instruct patients to look straight ahead and not down at his/her feet.

  • crutch walkingswing to

  • Using Rubric You will grade each other on Assisting your partner with the swing-to of crutch walking Why swing-to?1st I will show you what I expect.Student Demonstrates & I gradeStudent demonstrates as we grade togetherYou demonstrate with each other- and grade one another other You Do

  • Since you have practiced with crutches, what conclusion can you make about the criteria required to place a patient on crutches?

  • Review standard & next lessonLIA - what you learned, what was interesting, and how can you apply?

  • Demonstration is usually the primary method of instruction.Once a patient has become proficient on level surfaces, instruction or teaching in the use of stairs, curbs, ramps, and doors can be given.The patient is taught to climb and descend stairs on the right-hand side since this is the usual method used throughout the US.

  • Assistive devices also helpto increase the patientsbase of support, allowinga re-distribution of weight within the base of support

  • Made of wood or aluminumCan be adjusted for maximum fit

    Measure pt from the armpit to the

  • The patient may needrange of motion orstrengthening exercisesbefore beginning anambulatorytherapy program

  • To provide maximum stability, the patient may need to practice on the parallel bar. This will help him become accustomed to the upright position and learn the sequence for gait or walking in relative safety.

  • CrutchesWalkersParallel bars

    Bilateral canesCrab canes Single canes

  • It is important to instruct the patient how to protect himself during a fall and how to get up after a fallIt is important to teach the patient how to check his ambulatory aid for its safe operation and useThe patient should avoid throw rugs

  • Generally the first step- gives the most support than anyHeight- elbows are bent 25-30 degrees when the patient is standing and holding on to the bars with his hands

  • Used for impaired balance or to improve stabilityThe handgrip should be placed so that it is as tall as a persons wrist from the floorPlace the cane parallel to the femur and tibia with the foot of the cane on the floor or at the bottom of the heel of the shoe

  • #5 - Cane should be used on the unaffected (good) side#6 Canes should be at the height of the pts top of the femur at hip joint. Elbow should be flexed at 25 to 30 degree angle.Ambulate cane on good sideCane moves with opposite leg.(this prevents leaning toward bad side)3 point gait/2 point gait

  • Using a cane improve your balance as you walk or help you compensate for an injury or disability. choose a cane? If you need the cane only for balance - a standard cane with a single tip. If you need the cane to bear weight - offset cane with four tips. (quad cane)

  • Should be adjusted so that the elbow can be flexed 25-30 degrees when the patient is standing with his hands on itThe walker is 1st lifted with both hands and then placed forward 25-30 centimeters. It is stepped into, first with the stronger leg and then the weaker leg

  • # 7 Handles on a walker should be at the level of the patients femurs. The elbows should be flexed at 25 to 30 degrees# 8- Rubber tips prevent slipping.#9 Caution a patient against sliding a walker b/c it is so lightweight it may tip over. They should lift them.

  • To start the patient s/b standing in the walkerLift the walker, so that the back legs are even with toesTransfer weight forward slightly to the walkerInstruct pt to use walker for support and to walk into the walker.

  • Always walk with patient on their weak side, slightly behind them#10 - If using a transfer belt keep a firm hold in case the patient falls, eased to the floor, protecting head and neck.