Ad Gt Patterns

8/12/2019 Ad Gt Patterns

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Gait Training & Gait Analysis

Ambulation Aids, Gait Patterns,Fitting Assistive Devices


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Preparing for Ambulationn Teach gt pattern with A.D., wt bearing

status; teach by verbal instructions,demonstrations, & pt practice

n Apply gait beltn Guard correctlyn Maintain proper body mechanics

Muscles Needed forGait with A.D.n Scapular Stabilizersn Elbow Extensorsn Elbow Flexorsn Finger Flexorsn Hip Extensorsn Knee Extensorsn Ankle Dorsiflexors* What are the names for the muscles?

Precautions for Ambulationn Foot wearn Monitor HR, general appearance, mental

alertnessn Use Gait Beltn Guard: pt could lose balance or experience

syncope at any timen Guard using correct techniquen NEVER leave patient alonen Protect IV, catheters, privacyn Remove obstacles in path


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Pre-Gait Activitiesn Appropriate strengthening exercises

n Weight shift activities/balance

n Instruction in weight bearing status

Types of Assistive Devicesfor Gait & Gait trainingn Parallel Barsn Walker

n Standardn Roll/wheeledn Forearmn Folding

n Crutchesn Axillaryn Lofstrand

n Canen Straightn Quad (large or small base)n Hemiwalker

Measurement & Fit of A.D.sn May do the initial fit with the patient supine, BUT

always check in standing to determine if fitscorrectly!

n Incorrect fit reduces safety!

n Parallel bars: greater trochanter/pts wrist creasen Walkers: greater trochanter/ pts wrist creasen Canes: greater trochanter/ pts wrist crease


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Measurement & FIT of crutches

n Axillary pad of crutch should be 2-3fingers below pt.s axilla (2 inches)

n Elbow Angle with hand on crutch handgrips = 20-30 degrees of elbow flexion

n Pt should be in TRIPOD position whenassessing the above!!!!

Common Errors in FittingCrutches

n Patient raises shouldersn Patient drops shouldersn Patient flexes at the trunk or hipsn Patient flexes/extends wrist and handpiece is

positioned to highn Patient shoes change heightn Crutch eval without patient being in the

tripod position

Confirmation of fit for Crutchesn Confirmation of fit

n Stand in tripod positionn Crutch tips 6-8 inches anterior to toes; 2-4 inches lateral

n

Shoulders relaxedn Trunk uprightn Hips extendedn Pelvis leveln Knees slightly flexedn Feet flat on floor (unless wt bearing restriction


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Measurement & Fit of Crutchesn Axillary Crutches ways to measure

n Multiply pts height by 77%n Subtract 16 inches form pts heightn Measure from anterior axillary fold to 6-8 inches

lateral to pts heel; pt should be supine for safetyn Have pt abduct shoulder to 90 with elbow

extended on one side; shoulder abducted to 90with elbow flexed to 90 on opposite side; measurefrom elbow of flexed UE to middle finger of armthat is extended

Measurement & Fit of Lofstrand Crutchesn Hand grip 20-30 degrees of elbow

flexionn Can measure handgrip like you measure

for canes or walkersn Forearm piece should be 1 to 1.5 inches

inferior to olecranon processn Confirm fit with crutches 2 inches

anterior to toes and 4-6 inches lateral

Basic Gait Patternsn Choose Gait pattern based on:n Balancen Strengthn Coordinationn Functional needsn Weight bearing statusn Energy level/endurancen Diagnosis


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Gait patternsn Type gait pattern chosen determines:

n Speed of ambulation

n Energy expenditure

n Base of support (BOS)

n Difficulty

Gait Patternsn 3 point (NWB)n 3 point modified or 3 point 1 (PWB)n 4 pointn 2 pointn 4 point modifiedn 2 point modifiedn Swing throughn Swing to

3 Point Gt Pattern

n For unilateral NWBn Crutches or walkern

Move A.D, then hop forward ontounaffected LEn Walker or crutchesn Can NOT perform this gait pattern with

1 cane or 1 crutch


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3 point 1 or 3 point modifiedn PWB on one LEn Move A.D., then PWB LE, then

unaffected LEn Walker or crutchesn Can NOT perform this gait pattern with

just 1 cane or 1 crutch

Four Pointn 2 crutches or 2 canesn Alternate/reciprocal forward movementn i.e. left A.D., then right foot, then right

A.D., then left footn Often used when patient has bilateral

involvementn What types of diagnosis would this be

appropriate for or not appropriate for?

Four point

n Advantages

n Disadvantages


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Two Pointn 2 crutches or 2 canesn Simultaneous/reciprocal forward movementn i.e. right crutch & left foot THEN left crutch

and right footn Two point gait pattern is NOT used with pt.s

with weight bearing restrictionsn Two point may be used with bilateral

weakness or balance deficits

Two point

n Advantages

n Disadvantages

MODIFIED two or four pointn Modified means instead of an A.D. on each side, now

there is only ONE A.D. on one side

n When using only 1 cane or crutch, the A.D. is placedon the opposite side of the affected LE

n Modified 2 pt & modified 4 pt can NOT be used withwt bearing restrictions i.e. PWB, NWB

n Modified gait patterns are appropriate for a pt withunilateral weakness or mild balance deficits


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Modified four pointn 1 ambulation aide i.e. cane or crutchn Cane is held in opposite hand of involved LEn move cane, then involved leg , then

uninvolved legn Modified 2 point move cane and involved

leg simultaneously, then uninvolvedn

Modified two point

n 1 crutch or 1 canen move cane AND involved leg

simultaneously, then uninvolved legn Advantages? Disadvantages?n Type Diagnoses not appropriate for?

Swing to & Swing throughn Used with lofstrand crutchesn Bilateral weaknessn Hand on Y ligament to maintain hip & knee

extensionn Swing through will be faster than swing ton Swing through = both LEs swing forward

simultaneously and land anterior to crutchesn Swing to = both LEs swing forward

simultaneously and land even with crutches


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Gt Patterns & Appropriate A.D.s

Type Gt patternn 3 pointn 3 point 1n 4 pointn 4 point modifiedn 2 pointn 2 point modifiedn Swing throughn Swing to

A.D.s appropriate?

Guardingn Must use Gait Beltn Stand behind and slightly to one side of ptn SPTA one hand above pts shoulder, other

hand supinated holding gait beltn SPTA Feet in A-P positionn SPTA outermost LE moves anteriorn SPTA innermost LE is b/n A.D. and pts LE

Sit to Stand with walkern Scoot toward front of chairn Position feet correctly (ankle

slightly behind knees unlesswt bearing restriction)

n Wt bearing restriction LE ispositioned with foot anteriorto knee

n Walker in front of chairn Pt LEANS forward & pushes

on arm restsn Reach for walker with hand

on affected LE side 1 st thenwith hand on unaffected side


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Stand to Sit with walkern Step back until back of LEs

touches chairn Position feet correctly (ankle

slightly behind knees unlesswt bearing restriction)

n Wt bearing restriction LE ispositioned with foot anteriorto knee

n Walker in front of chairn Pt reaches back for chair

with hand of unaffected side1st

n Reach with hand on affectedside 2 nd

Sit to Stand with Crutchesn Scoot forward in chairn Both crutches held on affected

side with hand on hand gripn Hand on unaffected side is on

arm rest of chairn Position feet slightly behind

knee; if wt bearing restrictionfoot positioned anterior to knee

n Lean forward and push tostanding

n Gain balance then place onecrutch under axilla onunaffected side

n Other crutch then placed underaxilla of affected side

n Assume tripod position

Stand to sit with crutchesn Back up until LEs

against chairn Place both crutches on

affected side; hold to

crutches at handgripn Position feet with

affected LE forward if wt bearing restriction

n Reach for armrest withhand on unaffected side

n Lower to chair


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Sit to Stand with Canesn Scoot forward in chairn Position cane on

unaffected siden Position feet slightly

behind kneesn Lean forward & push up

from armrestsn Take hold of canen *if straight cane can

have in hand as pushfrom armrest

Stand to sit with Canen Back up until feel

back of LEs touchchair

n Reach for armrestwith free hand

n Reach for armrestwith other hand

n Lower self to chair

Stairs & A.D.sn Up with the good n Down with the bad n For crutches, and canes use the

followingn Going UP stairs

n First: good unaffected LEn Second: bad/affected LEn Third: A.D.


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Stairs & A.D.sn Going DOWN stairs

n First = A.D.n Second = bad/affected LEn Third = good/unaffected LE

n *these gt patterns on stairs help to protectthe weaker LE and improve safety

Walkers Going UP Stairs

n 1st Walker turnedsideways with closedportion next to pt.

n 2nd Position top end of walker 1 step abovepatient

n 3rd Hand positioned ontop end of walker

n 4th Good LEn 5th Affected LE

Walkers Going DOWN Stairsand guarding with

n 1ST Walker turned sidewayswith closed portion next toPT.

n

2ND Position bottom end of walker 1 step below patient

n 3RD Hand position onbottom end of walker

n 4th Affected LE

n 5th Good LE


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Guarding from behind withpatient going DOWN stairs

Crutches on Stairsn Up

n 1st unaffected LEn 2nd affected LEn 3 rd crutches

Or 1 st unaffected LEn 2nd affected LE AND Crutches

n Downn 1st crutchesn 2nd affected LEn 3 rd unaffected LE

n OR 1st crutches AND affected LEn 2nd unaffected LE

Guarding going UP stairsn Position posterior and

slightly lateral to pt(weakest side)

n Maintain wide stancewith your feet, your feetshould have 1 foot onsame step as pt.s and2nd foot one step belowpt.s

n One and supinatedholding gait belt

n One hand above pt.sshoulder


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Guarding in front with patientgoing DOWN stairsn Maintain wide

stance; one foot onstep pt descendingto; other foot below

n One hand at pt.santeriorchest/shoulder

n One hand supinatedholding to gait belt

Affected LE Modifications tonormal technique

Full length castn Going up

n extend/ER to go upn affected leg trails crutches

n Going downn flex hip so heel clearsn affected leg leads crutches

Cane on Stairs or a step

n UPn 1st Strongest, unaffected LEn 2ND Cane & affected LE

n DOWNn 1ST Affected LEn 2nd Strongest, unaffected LE & AD

* assistive device goes with affected LE inMOST cases but not all


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Choosing Best A.D. & Gait Pattern

n Dxn Agen PMHn Previous functional leveln Home environmentn Work environmentn Type work n Restrictionsn Strengthn Coordinationn Balancen Current functional abilitiesn Cognitionn Assistance at home?

Functional Ambulationn Functional activities selected depend on pt.s

needs, goals, normal and anticipatedactivities, problems, A.D.

n Transfers must be able to get up from avariety of surfaces to amb

n Level surfacesn Uneven surfaces: yard, ramps, curbs, stairsn Include precautions i.e. wet floor, throw rugs,

crowded rooms etc

Ad Gt Patterns

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