Assistive & Adaptive Devices – Flashcards
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Benefits of AD
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helps w/people who have illness (CVA) injury (post THR) provide safety security and function w/min energy expenditure improves base of support
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AD compensate for
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decreased muscle strength weight-bearing restrictions dec.mobility and body function, stability, balance increased pain during ambulation neurological deficits amputations of LE, or new prosthetic or orthotic device
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How to Prepare for ambulation
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Medical record selection of equipement Prepare for ambulation (obtain consent) move objects check equipment apply gait belt capability (mental and physically ready) train family as needed
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Precautions
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Proper footwear ck vital signs, appearance, alertness frequently gait belt guarding - stand behind and slightly to one side protect pt's appliances (cast, tubes, iv)
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Pre-ambulation equipment
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provides prep and training for Pt's who will walk with AD gives PTA chance to give Pt. a practice session allows Pt to develop confidence in the use of the AD
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Types of AD
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hospital bed bedside commode bathroom w/rail stairlift tilt table & standing table parallel bars walkers crutches canes
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Hospital beds
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air fluidized support bed (CLINITRON) for infected lesions,pressure ulcers, and burn patients Low air loss therapy bed for prolonged immboilization
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Tilt table
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used for pts who are attempting to physiologically accommodate to a upright position ck vitals everytime table is elevated
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How to use a walker
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instruct pt. to lift or push the walker to the point that rear legs are in line with the patient's toes
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Disadvantage of the walker
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difficult to store and transport impossible to use on stairs may be difficult to perf a normal gait pattern hard to use in crowded areas need stronger UE
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Hemiplegic walker
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BOS slightly larger than quad cane for pt. who dont have motor control of hand
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Axillary Crutches
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easy to transport increase mobility wider variety of gait patterns and speed adjustable can be used on stairs
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Disadvantage of crutches
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less stable than walker can cause injury to axillary artery and radial nerve if used wrong need good balance elderly insecure using crutches req good UE and trunk strength
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Lofstrand Crutches
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more stability than cane eliminates damage of axillary structures more functional in narrow areas forearm cuff keeps crutch on when reaching allows for functional hand use
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Disadvantages of Lofstrand
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less stability than axillary elderly are insecure cuff difficult to remove req. functional standing balance and UE/trunk strength
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Cane
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compensate for impaired balance or improve stability more functional on stairs and confined space some adjustable limited support due to small BOSS held in UNINVOLVED EXTREMITY
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Quad cane
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four point base provides larger BOS than SC pt. education req. (they can trip on it)
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// bar fit
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provide 20-25degree elbow flexion hands on bar 6 '' anterior to hip 2'' away from GC
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Walker Fit
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Pt. standing hand grip level w/GC or ulnar styloid process 20-25degree elbow flexion
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Axillary Crutch fit
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subtract 16'' from pt. height Pt. supine measure axillary fold to 6-8'' lateral to heel Pt. makes "L" line crutch for approx. Measure from olecranon process to the tip of the long finger of the extended arm
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Axillary hand piece
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should be aligned with GC, or ulnar styloid process top of each crutch should be 2-3 width below armpit position crutch 2-4'' lateral 4-6'' anterior bear weights through hands not armpits
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Cane fit
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position cane so tip is 2'' lateral 4-6'' anterior to toes top of handle is at height of GC or USP elbow 20-25 degree flexion
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Forearm crutch fit
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length measured like cane top of forearm cuff located 1 to 1 1/2'' distal to olecranon process
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Considerations for Choosing AD
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stability vs. mobility choose LRAD appropriate for pt. weight bearing status diagnosis pt mental abilities pt physical abilities pt environment expected ambulation activites prognosis for improvement
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Safety Considerations
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always push up from arms of chair vs. AD stand on Pt weaker side when guarding clear **** outta way gait belt no tennis ball on walkers in hospitals (pathogens)
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Standing from chair w/ axillary crutches
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Gait belt on pt pt slides forward to edge of chair stronger leg back leans foward push up w/strong arm from chair and stronger leg once upright place crutches on arms
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w/c to stand w/axillary crutches
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lock w/c caster wheel forward gait belt slide forward on w/c slide good leg back lean foward push up w/strong arm from armest of w/c and strong leg pt places both forearm crutch on each arm
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chair to stand w/walker
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lock w/c caster wheel forward gait belt slide forward on w/c strong foot back lean forward pushup on armrest and stronger leg pt leans forward and hold walker
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returning to w/c from walker
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lock w/c caster wheel forward gait belt pt backs up to w/c until front edge touches back legs keep strong leg back kick weaker leg forward reach for armrest and slowly sit
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Safety ascending stairs
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bodyweight on crutches lift uninvolved leg onto next step then INVOLVED up up with the good
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Safety descending stairs
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lower crutches and INVOLVED leg to lower step keeping BW on uninvolved leg the place BW on crutches and lower uninvolved leg down with the bad
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pt orientation to AD
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explain AD was specifically fit for them tech pt and caregiver how to use AD explain how to unfold/fold and maintain AD
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pt w/ poor cognition
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Poor carryover and compliance at home may create more safety issue than help need to train family/caregiver how to use AD, guard pt, and how important it is to use a gait belt
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Weight bearing status
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FWB full weight bearing WBAT weight bearing as tolerated PWB passive weight bearing NWB 0% weight bearing
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FWB
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100% pt weight on involved extremity no AD req unless for pain manegment
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WBAT
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as much of pt. weight as tolerated on involved extremity
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PWB
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limited amount of weight bearing on involved extremity % or in pounds
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NWB
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no weight on involved extremity
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TTWB
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toe touch weight bearing only toes contact ground encourages plantar flexion and possible muscle imbalance abnormal
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Documentation
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type of device used level of assistance required distance covered type of surface quality of gait compensations used
