Introduction to Assistive Devices and Gait Training
I. Assistive devices or ambulation aids
A. Equipment that helps the pt. compensate for:
B. Assistive devices increase the pt's. stability by:
C. Major concept pertaining to assistive devices states that you must sacrifice stability for mobility and vice versa. If a particular assistive device is mobile it won't be as stable as one not as mobile.
D. Types of assistive devices listed from most stable/least mobile to the least stable/most mobile.
1. Parallel bars
c. Disadvantage -
b. Types -
a. Axillary - composed of aluminum or wood and are adjustable.
(2) Disadvantages -
(3) Disadvantages -
c. Platform attachment
(1) Can be attached to either style crutch or walker
(2) Used to accommodate pts. who can't weight bear through their hands and/or wrists or:
(3) who have severe deformities that make it difficult to grasp a handpiece
(4) This device causes the pt. to lose the help of the triceps in elevating
and holding the torso during the swing phase of the gait pattern.
II. Basic Gait Patterns
A. 4-point pattern (Fig. 6-10 p111)
1. Requires the use of bilateral asst. devices
2. This pattern calls for alternately advancing the crutch or cane with the reciprocal advancement of the opposite LE. ie. R. crutch/cane then... L. foot then... L. crutch/cane then... R. foot etc.
3. Most stable, requires a low expenditure of energy
4. Very slow ambulation speed.
B. 2-point pattern (Fig. 6-11 p111)
1. Requires bilateral asst. devices.
2. This pattern utilizes the simultaneous advance of the asst. device and the reciprocal limb. ie. L.crutch/cane and R. foot then... R. crutch/cane and L. foot. etc.
3. Less stable but faster than 4-point gait
4. Very similar to normal gait.
5. Requires good pt. coordination
C. 3-point pattern (Fig. 6-13 p113)
1. Requires bilateral crutches or a walker, Canes CANNOT be used.
2. Utilizes the step to or step through pattern. Crutches/walker and the non-weight bearing (NWB) limb advance first then... the pt. steps to the walker or through the crutches with the opposite weight bearing (WB) LE.
3. Pattern is used when the pt. is able to full weight bear (FWB) on one LE but cannot weight bear (NWB) on the opposite LE.
4. Allows for rapid ambulation and fair mobility on stairs.
5. Requires good strength in the upper body and the WB LE.
6. Requires a high expenditure of energy because of the need to lift, support and propel the body with the Ues.
7. Least stable of all the gait patterns
D. 3-1 or Modified 3-point pattern (Fig. 6-14 p114)
1. Requires bilateral crutches or a walker
2. This pattern is used when a pt. is permitted to FWB on one LE but only partial weight bear (PWB) on the opposite LE.
3. Bilateral crutches or walker is advanced first then the PWB LE is advanced, weight is borne between the PWB LE and the hands while the FWB limb is in swing phase. The FWB foot should come to rest slightly ahead of the PWB foot.
4. This pattern allows the PWB LE to gain the positive effects of weight
bearing and exercise.
E. Preparing to Ambulate a Patient (Box 6-1 p101)
1. REVIEW MEDICAL RECORDS for:
a. Doctor's orders authorizing ambulation
b. weight bearing status
c. treatment goals
d. the primary diagnosis and any secondary complications.
e. the Past Medical History (PMH) to determine if there are any preexisting conditions that may require you to use special precautions. ie. MI, CVA, CHF, osteoporosis, diabetes, hypertension, etc.
2. Assess patient's present physical condition and mental status
a. Test strength and flexibility in those muscles and joints most important to ambulation. Improve if necessary.
(1) UE - scapular muscles, elbow extensors (triceps), and finger flexors
(2) LE - Hip extensors & abductors, knee flexors & extensors and the ankle dorsiflexors
b. Ask pt. 3 w's to test alertness & orientation
3. Select the proper assistive device based on the assessment of the patient and treatment goals
4. Demonstrate and explain the proper use of the assistive device and the gait pattern you want them to perform.
5. Have the patient repeat the procedure back to you in their own words to be sure they understand it.
6. ALWAYS APPLY A GAIT BELT TO THE PATIENT BEFORE TRANSFERRING THEM TO STANDING
7. Use the GAIT BELT and the patient's shoulder as control points when guarding.
8. Maintain proper body mechanics for you and the pt.
9. Provide a safe environment that is free of obstacles.
F. General Precautions (Box 6-2 p101)
1. Be sure the pt. is wearing the appropriate footwear - pt's. own non-slip shoes or sneakers whenever possible.
2. Frequently observe the pt's. general appearance and mental alertness during ambulation. Be alert for signs of intolerance such as: sudden pallor, diaphoresis, and confusion.
3. Use the GAIT BELT to guide and control the patient, NOT HIS/HER EXTREMITIES OR CLOTHING.
4. Be constantly alert. DO NOT BECOME COMPLACENT OR DISTRACTED. Be ready for the patient to lurch or fall at any time!
5. Never leave the pt. unattended while he/she is standing or sitting on the edge of the bed.
6. Protect pt's IV line, catheters, and other appliances while ambulating and transferring.
7. Be aware of any special precautions that may be necessary to protect
the pt. ie. THR, TKR, Fxs.
III. Gait Related Functional Activities
A. Standing and Sitting Activities
1. Axillary Crutches (Fig. 6-16 p117)
2. Forearm Crutches (Fig. 6-19 p120)
3. Walker (Fig. 6-21 p121 & Fig. 6-22 p122)
B. Ascending and Descending Curbs
1. Walker (Fig. 6-37 p137 & Fig. 6-39 p138)
2. Crutches 3-1 & 3-point patterns
3. Cane (Fig. 6-36 p136 & Fig. 6-38 p137)
C. Ascending and Descending Stairs
1. Axillary Crutches w/ handrail 3-1 pattern
2. Lofstrand Crutches w/o handrail 3-1 pattern
3. CaneProper guarding positions (Fig. 6-26 + 6-27 p127 -Fig. 6-28 +
6-29 p128 - Fig. 6-30 p129)
1. Self-closing with crutches