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2/Objectives: Describe the components of the gait cycle

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2/Objectives: Describe a variety of gait patterns used when the patient has an assistive device

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2/Objectives: Describe typical postural deviations in patients/clients using assistive devices

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2/Objectives: Demonstrate appropriate documentation of the safety, status and progression of patients engaged in gait training

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2/Objectives: Demonstrate the ability to safely educate a patient in the use and care of a variety of assistive devices

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2/Objectives: Demonstrate the ability to instruct a patient to safely negotiate a variety of gait surfaces (stairs, ramps, curbs) using gait patterns appropriate for the assistive device being used

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2/Objectives: Demonstrate the ability to document the safety, status, and progression of patients while engaged in gait, locomotion, balance, wheelchair management and mobility

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2/Objectives: Demonstrate proper guarding during gait training activities

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3/Gait: Define gait.

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A person's method of walking

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3/Gait: What is the basic component of independent function?

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Basic component of independent function: Gait

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3/Gait: What 2 conditions commonly affect gait?

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Commonly affected by disease and injury

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3/Gait: What is the basic common goal of PT?

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Common goal of PT: Restore or improve ambulatory status

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3/Gait: What is gait analysis? What 2 ways can it be performed?

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Gait analysis - information about patient's ambulation method: 1 - Anatomic areas combined with movement analysis [use of pressure plates, video etc special outpt clinics] 2 - Simple (observation) to complex (motion analysis systems) what is usually done.

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4/Purpose of Gait Analysis: What do you need to identify, describe and classify in order to understand the gait characteristics of a particular disorder?

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To understand the gait characteristics of a particular disorder by: 1 - Identifying the gait deviations 2 - Giving an accurate description of the gait pattern 3 - Classifying the severity of the disability

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4/Purpose of Gait Analysis: What should you analyze, identify and describe in order to assist in movement deviation?

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To assist in movement diagnosis by: 1 - Analyzing gait deviations 2- Identify responsible mechanisms 3 - Describe the difference btw a patients performance and normal gait

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5/Purpose of Gait Analysis: How does gait analysis help guide the therapist with regard to interventions? (2)

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To inform selection of interventions by guiding the therapist in: 1 - Choosing the appropriate treatment to improve gait performance and 2 - Determining the need for assistive devices

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5/Purpose of Gait Analysis: How does gait analysis help guide the therapist with regard to treatment effectiveness? (2)

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To evaluate treatment effectiveness and guide the therapist in: 1 - Determining how interventions will affect gait 2 - Determining the effectiveness of devices and equipment

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6/The Gait Cycle: What is the beginning and end of the normal walking gait cycle?

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In normal walking the gait cycle has a beginning and an end. Begins: When the heel of the reference foot the contacts ground Ends: When the heel of the same foot contacts the ground again

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8/The Gait Cycle: What are the 2 phases of the gait cycle?

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The gait cycle is divided into two phases: stance phase and swing phase.

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8/The Gait Cycle: What is the stance phase? What percent of the cycle does it make up? A single gait cylcle contains what stance phases?

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Stance phase - interval in which the reference foot is in contact with the ground Constitutes 60% of the gait cycle. A single gait cycle contains a right and left stance phases

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8/The Gait Cycle: What is the swing phase? What percent of the cycle does it make up? A single gait cylcle contains what swing phases?

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Swing phase - interval in which the reference foot does not contact the ground. Constitutes 40% of the gait cycle. A single gait cycle contains a right and left swing phase

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9/The Gait Cycle: The gait cycle is divided into how many support periods? Name them

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The gait cycle is divided into two periods of single and double support.

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9/The Gait Cycle: Describe the single support period.

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Single support - two intervals in the gait cycle in which the body is supported by only one foot in contact with the ground

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9/The Gait Cycle: Describe the double support period.

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Double support - two intervals in a gait cycle in which the body weight is transferred from one foot to the other and both right and left feet are in contact with the ground at the same time

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11/The Gait Cycle: What are the 2 smaller parts of the gait cycle?

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The gait cycle can be also divided into smaller parts: Steps and Stride

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11/The Gait Cycle: What makes up a stride?

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One right step and one left step equals a stride

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11/The Gait Cycle: what does one stride equal to?

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One stride equals a gait cycle

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11/The Gait Cycle: Describe a step length

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Step length: Distance from the point of heel strike of one foot to the heel strike of the other foot.

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11/The Gait Cycle: Describe a stride length

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Stride length: Distance from the point of heel strike of one foot to the heel strike of the same foot

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12/ Gait Cycle Terminology: Name the 2 terminologies used to describe the phases of the gait cycle.

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There are two terminologies used to describe the phases of the gait cycle: 1 - Traditional 2 - Rancho Los Amigos

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12/ Gait Cycle Terminology: Who is Dr. Jacquelin Perry? Where is she from? What is she responsbile for?

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Rancho Los Amigos National Rehabilitation Center: Dr. Jacquelin Perry was responsible for the division of five stance phase periods and three swing phase periods of the gait cycle

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13/Gait Cycle Terminology: Heel strike, is the traditional term, what is the RLA? What phase?

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Initial contact / Stance phase

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13/Gait Cycle Terminology: Foot flat, is the traditional term, what is the RLA? What phase?

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Loading response / Stance phase

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13/Gait Cycle Terminology: Midstance, is the traditional term, what is the RLA? What phase?

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Midstance / Stance phase

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13/Gait Cycle Terminology: Heel off, is the traditional term, what is the RLA? What phase?

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Terminal stance / Stance phase

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13/Gait Cycle Terminology: Toe off, is the traditional term, what is the RLA? What phase?

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Preswing / Stance phase

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13/Gait Cycle Terminology: Acceleration, is the traditional term, what is the RLA? What phase?

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Initial swing / Swing phase

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13/Gait Cycle Terminology: Midswing, is the traditional term, what is the RLA? What phase?

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Midswing / Swing phase

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13/Gait Cycle Terminology: Deceleration, is the traditional term, what is the RLA? What phase?

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Terminal swing / Swing phase

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17/Guarding: When is guarding used?

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Used during ambulation and functional mobility

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17/Guarding: Who does it protect?

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Protects patient and caregiver from injury

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17/Guarding: What is the best tool for guarding during gait training?

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SAFETY BELT!!!

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17/Guarding: T/F You only need one person for guarding.

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False. You may require more than one person

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17/Guarding: Guarding technique may depend on 5 factors, name them.

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Guarding technique may depend on: 1 - Patient size 2 - Stature 3 - Weight 4 - Strength of the patient and caregiver 5 - type of activity

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19/Guarding for Gait Training: Where should the therapist stand when gait guarding?

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Stand slightly behind and to the side of the patient

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19/Guarding for Gait Training: Which side is recommended for the therapist to position themselves?

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Weaker side recommended, but either side is correct

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19/Guarding for Gait Training: Describe the hand placement of the therapist

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Hand nearest to the patient holds the safety belt, Other hand on patient's nearest shoulder. It controls the trunk

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19/Guarding for Gait Training: T/F Grab whatever is handy, ie pt's arm or their clothing.

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False. Never grab pt's arm or clothing

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19/Guarding for Gait Training: What direction should foot position be?

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Foot position: 1- Anteroposterior direction

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19/Guarding for Gait Training: The outside foot shold be where? When should it move? What is the precaution.

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Outside foot btw AD and pt's foot: 1 - Moves forward with the AD 2 - Careful not to kick the AD

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19/Guarding for Gait Training: The inside foot shold be where? When should it move? What might it also assist in?

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Inside foot trails as you move forward: 1 - Moves forward with the patient 2 - Control of AD if needed

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20/Guarding for Gait Training: What type of unexpected/unusual movements could happen with the pt? (3)

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Be alert for unexpected/unusual movements by the patient: 1 - Misplacement of AD 2 - Slippage of the AD 3 - Misstep

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20/Guarding for Gait Training: What direction should you be prepared to prevent or control if pt loses balance?

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Be prepared to prevent or control loss of balance, Forwards, Backwards & Sideways

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20/Guarding for Gait Training: How can you minimize injury of pt.?

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Minimize the possibility of patient injury by assisting patient to a safe and secure position, either on the Floor, Furniture or Stair step

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23/Common Deviations: Name 3 common postural deviations

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Postural:1 - Elevated shoulder girdle 2 - Trunk and cervical flexion 3 - Forward head posture

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23/Common Deviations: Name 3 common AD deviations.

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Using AD: 1 - Improper placement of AD 2 - "Rocking" SW or QC 3 - Pulling on AD to stand (push from seating surface)

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24/Pre-Ambulation Activities: Name 4 pre-ambulation activities

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1 - Explain and demonstrate 2 - Caregiver/family member instruction 3 - Practice 4 - Sit stand with prescribed AD

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24/Pre-Ambulation Activities: Name 4 areas to practice with pts.

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Practice: 1 - Different types of seating surfaces (i.e., armless chairs, low surfaces, car, toilet) 2 - Stairs, curbs, ramps, doors 3 - Ambulating on different surfaces (i.e., grass, concrete, carpet, gravel) 4 - Public transportation, elevators, escalators, crossing the street

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25/Safe Sit Stand: What is the 4 step process for safe Sit Stand

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1 - Move forward in seat (COG closer to BOS) 2 - Stronger foot posterior to weaker one 3 - UEs push simultaneously with Leg, hands on seating surface or in special cases on AD 4 - Trunk leans forward (COG over BOS)

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25/Safe Sit Stand: What is the 5 step process for safe Stand Sit

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Reverse process for stand sit: 1 - Approach chair and pivot close to the chair 2 - Back up until posterior LE contacts chair 3 - Reach back so UEs can help control 4 - descent 5 - Trunk leans forward (hip precautions?)

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26/Axillary Crutches: What is the Sit Stand process using ax. cr.?

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1 - Crutches together on involved side 2 - One UE pushes from arm of chair, other on crutches 3 - Once standing, Patient positions crutches, Involved side first

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26/Axillary Crutches: What is the reverse Stand Sit process using ax. cr.?

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Return to sitting is the reverse process

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26/Axillary Crutches: What is an alternative Sit Stand process using ax. cr.? What does it require? (2)

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Alternate: patient uses one crutch in each hand to stand; requires FWB in both LEs and very good balance

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27/Walker: What is the Sit Stand process using a walker?

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1 - Push up from arms of chair 2 - Part-way to standing 3 - Grasp walker with one hand 4 - Once standing, Hold on to walker with both hands

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27/Walker: What are 2 important security points to remember about a walker?

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Remember: Walker is not as secure as the chair and Rolling walker is not as secure as SW

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28/Cane: What 3 cane positioning guidelines.

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1 - Hook cane on armrest of chair (or other close-by, stable object) opposite to involved side 2 - QC positioned slightly anterior on non-involved side 3 - Reverse to sit

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29/Gait Training in Parallel Bars: What are the 3 "Ss" for pt. ambulation in //?

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Patient ambulation should be initiated using parallel bars to provide: 1 - Security 2 - Stability 3 - Safety

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29/Gait Training in Parallel Bars: where do you demostrate and explain the gait pattern?

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Demonstrate and explain the gait pattern in the // bars

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29/Gait Training in Parallel Bars: Where is the therapist when the pt. is using the //?

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Stay inside the // bars to guard and assist the patient

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31/Gait Sequencing Patterns: What are the 5 gait sequencing patterns?

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1 - 4-point gait 2 - 2-point gait 3 - Modified 4-point 4 - Modified 2-point 5 - 3-point NWB/PWB

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32/4-Point Gait Pattern: What type of AD is required for 4-point gait pattern?

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Requires bilateral AD

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32/4-Point Gait Pattern: Describe it and give an example.

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Alternating and reciprocating pattern, ex: right crutch, left foot, left crutch, right foot

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32/4-Point Gait Pattern: What are 5 charcteristics of 4-point gait pattern?

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1 - Very slow and stable 2 - Safest in crowded areas 3 - Provides maximum balance 4 - Requires low energy expenditure 5 - Approximates a normal gait pattern

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32/4-Point Gait Pattern: What type of pts. Typically use the 4-point gait pattern?

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Typically used with patients with: 1 - Poor balance and coordination 2 - Muscle weakness

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34/2-Point Gait Pattern: What type of AD is required for 2-point gait pattern?

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Requires bilateral AD

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34/2-Point Gait Pattern: Describe it and give an example.

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Simultaneous reciprocal forward placement of AD and opposite LE, ex: right crutch with left foot then left crutch with right foot

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34/2-Point Gait Pattern: What are 4 charcteristics of 2-point gait pattern?

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1 - Relatively stable (less than 4-point) 2 - Faster than 4-point, but requires more coordination 3 - Low energy expenditure 4 - Very similar to normal gait pattern

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36/Modified 4-Point and 2 point Gait Patterns: What is the modified 4-Point and 2 point Gait Patterns sometimes referred to?

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Sometimes referred to as "hemi" gait or pattern

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36/Modified 4-Point and 2 point Gait Patterns: What are 4 charcteristics modified 4-Point and 2 point Gait Patterns?

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1 -Patient has only one functional UE 2 - Patient only needs one AD, it is held in contralateral hand (opposite involved LE) 3 - Widens BOS 4 - Shifts COG away from involved LE

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36/Modified 4-Point and 2 point Gait Patterns: what is an example of a 4-point modified?

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4-point ex: Cane (in R), left foot, right foot

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36/Modified 4-Point and 2 point Gait Patterns: what is an example of a 2-point modified?

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2-point ex: right foot, cane (in R) with left foot

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39/3-Point NWB: What type of AD is required? Which one is excluded?

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Requires bilateral AD, BUT, CANNOT be performed with canes

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39/3-Point NWB: Describe the pt. and give an example of the gait.

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Pt is FWB on one LE and NWB on opposite, Ex: crutches together, FWB LE

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39/3-Point NWB: What are 3 charcteristics for 3-Point NWB?

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1 - Less stable; can be faster 2 - Requires good strength in upper extremities and lower trunk 3 - Energy expenditure is high

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39/3-Point NWB: What is meant by step-to?

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"Step-to" : Patient's FWB LE lands between crutches

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39/3-Point NWB: What is meant by step-through?

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"Step-through" : Patient's FWB LE lands past crutches

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41/3-Point PWB: What is the AKA for 3-Point PWB?

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AKA 3-1-point or Modified 3-point

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41/3-Point PWB: What type of ADs are required?(2) Which one not recommended?

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Requires bilateral AD: Walker or crutches, Not recommended with canes

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41/3-Point PWB: Describe the pt. and give an example of the gait.

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Pt must be FWB on one LE and PWB on opposite, Ex: crutches with PWB LE, then FWB LE

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41/3-Point PWB: What are 3 charcteristics for 3-Point PWB?

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1 - More stable 2 - requires less energy than regular 3-point pattern 3 - Slower pattern

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42/Ascending Stairs: How is the therapist positioned with the pt. on the stairs?

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1 - Stand behind and to the side of the patient, to weaker side if possible 2 - Grasp safety belt with one hand; handrail with other

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42/Ascending Stairs: How should the therapist guard is no handrail present?

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If no handrail, guard patient's posterior shoulder, If possible use two people to guard

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42/Ascending Stairs: Where is the therapist's outside foot?

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Outside foot on step patient standing on

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42/Ascending Stairs: Where is the therapist's inside foot?

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Inside foot on step below

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42/Ascending Stairs: When are the therapist's feet advanced?

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Advance your feet after patient has advanced

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42/Ascending Stairs: T/F Once the pt. is proficient they should keep a continuous pace up the stairs.

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False. The patient should stop on each step to regain balance and control

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44/Descending Stairs: How is the therapist positioned with the pt. on the stairs?

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Stand in front and to the side of the patient, Downstairs from patient! Grasp safety belt with one hand, hand rail with other

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44/Descending Stairs: How should the therapist guard is no handrail present?

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If no handrail, guard patient's anterior shoulder, If possible use two people to guard

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44/Descending Stairs: Where is the therapist's outside foot?

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Outside foot on step patient will go to, Alternate: on step where patient is

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44/Descending Stairs: Where is the therapist's inside foot?

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Inside foot one step below

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44/Descending Stairs: When should the therapist's feet advanced?

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Move feet after patient has moved

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44/Descending Stairs: T/F Even if the pt. is profiecient at descending stairs, they should continue to stop at each step to ensure they have full balance and control.

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True: Patient should stop on each step to regain balance and control

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44/Descending Stairs: What is the alternate method for guarding down the stairs. Is it recommended?

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Alternate method - behind patient - Not recommended

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46/Stairs with AD: What AD s ? Which are not recommended?

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Canes or crutches only, Avoid using walkers (unless designed for it)

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46/Stairs with AD: What is the mantra for stairs?

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Up with the good, down with the bad

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46/Stairs with AD: What is the sequence for ascending?

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Ascending: 1 - Non-involved LE ("Good" leg) 2 - AD with involved LE ("Bad" leg)

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46/Stairs with AD: What is the sequence for descending?

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Descending: 1 - Involved with/after AD ("Bad" leg) 2 - Non-involved ("Good" leg)

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47/Bumping: What is bumping?

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Ascending/descending stairs in seated position

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47/Bumping: Why teach bumping?

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Teach patient as a safety alternative, esp for fire

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47/Bumping: what is the process?

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1 - Lower safely to step 2 - Push up with UEs and strong LEs, Do not use LE with NWB (or PWB?)

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47/Bumping: What should be on the landing for bumping? Why?

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Chair/stool on landing to assist with standing

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47/Bumping: What kind of pt. would be able to perform? Why might it be better than using crutches to ascend descend?

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Requires UE/LE strength and energy, Offers opportunities to rest

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48/Documenting Gait Training: Name 7 attributes that can be documented when describing gait training.

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1 - Distance 2 -Assistance 3 -Assistive device used 4 - Weight bearing status (FWB implied) 5 - Descriptors (i.e., antalgic, slow, forward flexion) 6 - Cues or physical assistance required - i.e., hand placement, speed, safety awareness 7 - Surface type

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49/Documenting Gait Training: Give an example of gait training documentation.

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Objective: Gait Training: Pt. ambulated 25 ft x 2 with Min. A x 1 using NWB 3-point gait pattern with B/L axillary crutches on level tile floor. Pt. used a step-to pattern and required v/c to avoid Wt. bearing on the armrests of the crutches during rest periods.

PTA 125 – Lecture 12 – Gait and Stair Training – Flashcards

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