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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