What is the purpose of assistive devices in ambulation?
Provide external support for the musculoskeletal system
They help redistribute weight to decrease loss of balance.
What should be ensured regarding the functioning/safety of equipment before ambulating with assistive devices?
Ensure the equipment is functioning and safe
This is critical for patient safety throughout the ambulation process.
What is the first step in preparing the patient for ambulation with assistive devices?
Obtain consent
This is essential to ensure the patient is informed and agrees to the procedure.
When guarding a patient during ambulation, where should the therapist stand?
Posterior-lateral to the AFFECTED side
This position allows for better support and balance.
What are the precautions to take during ambulation?
- Monitor patient’s response/tolerance to activity
- Check vitals
- Assess mental status/alertness
- Observe for pain
- Watch for fatigue
- Evaluate general appearance
Always anticipate the unexpected and have a fall contingency plan.
What are the weight capacities for standard walkers?
- 300 lbs
- 400 lbs
The unit weight of a standard walker is approximately 5.75 lbs.
List the advantages of using walkers.
- Lightweight
- Adjustable
- May fold (compactable)
- Offers stability
- Can support all levels of LE weight-bearing precautions
- Wide base of support
- Usable for temporary or chronic conditions
Walkers provide a sense of security for patients.
What are the disadvantages of using walkers?
- Difficult to store or transport
- Difficult to use on stairs
- Impedes normal gait pattern + arm swing
- Cumbersome in narrow spaces
- Wheels can be unstable
- May encourage forward flexed posture
These factors can limit the effectiveness of walkers in certain situations.
What is the 3-point gait pattern for non-weight bearing?
Walker → Uninvolved limb → Involved limb avoids contact with floor
This pattern is used for patients with NWB on one lower extremity.
What is the swing-to gait pattern?
Walker is advanced forward and weight is shifted onto hands with both legs swung forward between the front wheels
This pattern is used for patients with limited use of bilateral lower extremities.
What are the advantages of axillary crutches?
- Relatively inexpensive
- Ability to progress through different gait patterns
- Increased ambulation speed
- Easy to store and transport
- Maneuverable in crowded spaces
- Easier to use on stairs than walker
Axillary crutches provide support while allowing for a more normalized gait pattern.
What are the disadvantages of axillary crutches?
- Less stable than a walker
- Can cause injury to axillary structures if not measured correctly
- Require adequate standing balance, coordination, and endurance
- May cause patient to feel insecure or fatigued
Proper fitting and training are essential to mitigate these disadvantages.
What is the 4-point gait pattern?
L crutch → R LE → R crutch → L LE
Each movement equals one point, and the full gait cycle consists of four points.
What is the modified 4-point gait pattern?
Cane is held opposite to involved limb → Cane → Involved limb → Uninvolved limb steps to the involved limb
This pattern is used for patients with greater support needs due to balance or coordination deficits.
What is the step-through gait pattern?
Patient advances the AD simultaneously with involved limb and steps beyond the AD with uninvolved limb
This pattern is suitable for patients with mild balance impairments.
What is the swing-through gait pattern?
Both crutches advanced together and weight is shifted onto hands with both legs swung beyond the crutches
This requires adequate upper extremity strength and coordination.
What is the fitting measurement for canes?
Device should be approximately 6 inches lateral to the patient
The handle should be measured at the ulnar styloid process with the arm relaxed by the side.
What are Functional Outcomes in physical therapy?
The result of implementing the PT management plan which impact overall physical function
Functional outcomes are essential for assessing the effectiveness of physical therapy interventions.
What does the PT Management Plan include?
- Selected PT interventions
- Interprofessional collaboration
- PT Goals
- Functional Outcome Measures
The PT management plan is crucial for guiding patient care and achieving desired outcomes.
Define Outcome Measures.
Standardized tests used to identify change in functioning over time
Outcome measures can be qualitative or quantitative, and performance-based or self-report.
What is the role/purpose of Functional Outcome Measures?
- Identify pertinent functional tasks and measure a patient’s ability to do them
- Determine baseline for goal-setting
- Measure current abilities and progress
- Assess safety and injury/fall risk
- Ascertain or track the effectiveness of an intervention
- Collect data for quality improvement or research initiatives
Functional outcome measures are essential for evaluating patient progress and planning discharge.
Name some tools used for assessing Functional Mobility.
- AMPAC 6-clicks
- DeMorton Mobility Index
- Self-Selected Gait Speed
- 4 m walk test
- Daily Mobility Level
- Johns Hopkins Highest Level of Mobility
- ICU Mobility Scale
These tools help assess a patient’s mobility and functional abilities.
What does the AMPAC 6-clicks scoring for difficulty indicate?
- 1 = Total, Dependent
- 2 = A lot, MAX/MOD A
- 3 = A little, MIN/CGA/Supervision
- 4 = None, no assist
This scoring system helps determine the level of assistance a patient requires.
What does the AMPAC 6-clicks scoring for assistance/help indicate?
- 1 = Unable, not able to perform without special equipment or help
- 2 = A lot, struggling, requiring great effort or time
- 3 = A little, can manage but takes more effort/time
- 4 = None, no problems performing
This scoring helps assess the patient’s ability to perform activities independently.
