Gait.txt

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Author:
jpowell22
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127805
Filename:
Gait.txt
Updated:
2012-01-19 22:09:44
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lecture
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maureen lecture
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  1. What are some factors that influence walking?
    • conscious effort
    • ROM
    • strength
    • sensation (proprioception in feet)
    • coordination/balance
    • external appliance (brace)
  2. What 2 phases are included in the gait cycle?
    stance and swing
  3. What is the first phase of the gait cycle?
    stance

    period of time when at least 1 foot is in contact with the ground
  4. What are the 5 components of the stance phase in order?
    • heel-strike
    • foot-flat
    • mid-stance
    • push-off
    • toe-off
  5. What is the 2nd phase of the gait cycle?
    swing

    period of time when foot is not in contact with the floor
  6. What are the 3 components of the swing phase in order?
    • acceleration (limb swinging forward)
    • mid-swing (when foots under the greater trochanter)
    • deceleration (limb coming back down)
  7. What happens right after deceleration of the swing phase?
    heel-strike of the stance phase in other foot
  8. What is a cycle?
    time that 1 foot is in contact with the ground

    heel-strike to heel-strike of same foot
  9. What is base of support?
    width of stance/walking base
  10. What is stride length?
    distance between heel strikes of same foot
  11. What is step length?
    measurement of heel strike of 1 foot to heel strike of other foot
  12. What is cadence?
    number of steps per unit of time
  13. What is double support?
    both feet on ground at the same time
  14. What UE muscles are very important to strengthen?
    • scapular depressors
    • shoulder depressors
    • shoulder extensors
    • elbow extensors
    • finger flexors
  15. What LE muscles are important to strengthen?
    • hip extensors (gluts, hamstrings)
    • hip abductors (gluteus medius)
    • knee flexors (hamstrings)
    • knee extensors (quads)
    • ankle dorsiflexors (tibialis anterior)
  16. What are some types of gait patterns?
    • 4 point
    • 2 point
    • modified 2 point
    • modified 4 point
    • three point
    • three one
    • drag to
    • swing through
  17. What is the general progression of assistance levels? (5)
    parallel bars ->axillary crutches ->forearm crutches ->quad cane ->cane
  18. What are some general safety precautions?
    • guard slightly behind and on affected side
    • IV's, casts
    • floors dry
    • gaitbelt
    • footwear
    • physiologic response (vitals)
  19. What should be included in the gait progress note?
    • type of assistive device
    • gait pattern with amt of weight bearing
    • level of independence
    • tolerance
    • balance
    • stairs
    • transfers (level of independence, tolerance)
  20. What is the purpose of parallel bars, and where do you spot from?
    • maximal stability
    • measuring for another AD
    • teaching new gait pattern
    • balance training

    spot from inside the bars; in front of pt if 1 person, if 2 people, one in front and one in back
  21. How do you measure a pt for pbars?
    • 15-25 degree flexion at elbow when hands are on bars 6" ant. to hips (stand with elbows straight and 6" ant. to hips, bars should rest at the wrist crease)
    • 2" from hip to bar on each side
  22. What is the purpose of crutches (axillary, forearm, longstrand, canadian)?
    • widen pts BOS for greater stability
    • cheap
    • allow us to limit weight bearing
  23. What are the components of crutches?
    • 2 uprights
    • axillary crossbar
    • hand grip
    • suction tip
  24. Who is normally going to use longstrand crutches?
    paraplegics - they're for long term use
  25. How do you measure for axillary and forearm crutches?
    • feet 2-3" apart
    • tip of crutch 2" lat. and 4-6" ant. to toe
    • 2-3 finger widths between armpit and pad
    • 15-25 degree elbow flexion when hands are on grips (wrist crease should come to pad with elbows straight)

    *forearm- same except arm cuff shold be 1-1 1/2" below elbow
  26. How do you teach a patient to get out of a chair while on crutches?
    hold both crutches on the affected side, and push up from the chair arm on the unaffected side
  27. When would you use a platform crutch?
    • when pt is NWB on wrist.
    • helps rest the arm (handle to hold onto)
  28. What are some indications that you need to use a cane?
    assist with balance (dont want to rely on for WB-more for balance)

    • decreased balance, coordination, strength
    • pain
    • dizziness
    • slight decreased WB
    • elderly
  29. In which hand would you hold a cane?
    ALWAYS in the good sides hand (unaffected side)
  30. What are some disadvantages to canes?
    • slows gait
    • safety (hard to keep all 4 tips down at once)
    • hard to use on stairs
    • heavy
    • expensive
  31. What hand do you hold a hemi cane in, and what is the disadvantage of it?
    • always hold in good sides hand
    • pt tends to lean on them

    *measure same as crutches
  32. What are disadvantages of a walker?
    • slows gait
    • hard to safely use on stairs
    • hard to use normal gait patterns
  33. How do you measure for a walker?
    • stand pt with feet at back of walker (back walker leg should be in middle of foot)
    • 15-25degree of elbow flexion (measure wrist crease when arms are straight)
  34. What are some types of walkers?
    • standard
    • wheeled
    • reciprocating
    • forearm support
    • folding
  35. When ambulating with an AD, which leg should move with the device?
    bad leg ALWAYS goes with device
  36. What gait patterns require bilateral ambulation aids?
    • 4 point
    • 2 point
    • 3 point
    • modified 3 point (three one)
    • drag/swing to
    • swing through
  37. What gait patterns require only unilateral AD?
    • modified 4 point
    • modified 2 point
  38. What is the 4 point gait sequence?
    • right UE
    • left LE
    • left UE
    • right LE

    always maintaining 3 points of contact
  39. The 2 point gait can be performed more rapidly than the 4 point; what is the 2 point sequence?
    • right UE and left LE together
    • left UE and right LE together

    requires more coordination and balance than 4 point
  40. What is the sequence of the modified 4 point gait?
    AD held in the uninvolved hand

    AD, then bad leg, then good leg

    sometimes called hemi gait or hemi pattern
  41. The modified 2 point is the natural progression from the modified 4 point; what is the gait sequence of the modified 2 point?
    AD held in uninvolved hand

    AD and bad leg together, then good leg
  42. What is the only gait pattern used for NWB?
    3 point pattern
  43. What is the gait sequence of the 3 point pattern?
    both AD's forward, than hop to or swing through the device with good leg (NWB leg is held in air)
  44. When turning with AD's, which way should you turn?
    toward the good side if possible
  45. In the modified 3 point pattern, PWB is permitted on involved leg; what is the gait pattern?
    AD's and infected leg together, then uninvolved leg
  46. What types of pts use the drag to/swing through gait patterns?
    paraplegics - they're unable to use any LE musculature so they use their trunk to swing through
  47. What is the gait pattern of the drag to/swing through gaits?
    AD's forward then use trunk muscles to drag legs to/through the AD's

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