Term
Seated sliding board transfers
indications |
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Definition
| indications: inability to use LEs for support |
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Term
Seated A-P transfers
indications |
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Definition
| indications: usually for pts with paraplegia |
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Term
| Pivot transfers: Two types: Indications |
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Definition
Squat-pivot and standing pivot
Indications: limited use of LEs for support and stabiliy |
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Term
| Progress toward independence as pt's condition allows... |
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Definition
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Term
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Definition
Choose appropriate board length
WC should be the same height as the bed or mat
Position w/c at a 15 to 30 degree angle below bed
Remove near armrest
*generally guard from front
*for more independent pts, you may guard from behind
*some pts require 2 people |
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Term
| Pivot transfer knee blocking when pt has one reliable strong LE |
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Definition
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Term
| Pivot transfer knee blocking when neither leg is reliably strong |
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Definition
| block the stronger knee or both knees |
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Term
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Definition
2:2-PT's medial facets to pt's lateral facets
2:1-PT's medial facets to lateral and medial facets of pt's knee
1:1 straight on-PT's anterior aspect to pt's anterior aspect
1:1 lateral/medial-PT's foot on the outside, knee on the inside
GOAL: pt to be able to bear weight reliably on at least one LE!! |
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Term
| Assisting with a Squat-Pivot transfer |
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Definition
*Position w/c at 45 to 60 angle to bed/mat
*Pt scoots forward in chair
*place pt's feet parallel to each other with the leading foot forward
*PT's feet mimic pt's foot positions
*PT blocks knee(s) as needed, creating a leverage point
*Pt flexes trunk (nose over toes)
*On the count of 3 (rocking can be used)
*PT leans posteriorly, hands gripping slightly posteriorly on gait belt
*Pt comes to a partial stand, and as one, PT and pt pivot on the balls of the feet toward the bed (Lift, Shift, and Lower)
*To sit, the pt again flexes the trunk as the PT squats and leans slightly posteriorly, controlling the descent.
*Ensure pt's safety before leaving! |
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Term
| Where do the pt's hands go? |
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Definition
*pushing down on w/c armrests, then reaching for new surface with leading arm
*PT's forearms
*PT's waist
*** NEVER SHOULDERS of PT *** |
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Term
| Special Transfer Precautions |
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Definition
*THA- transfer TOWARD the involved side
(transferring away from the involved side places the pt at higher risk for dislocation.)
*Hemiplegia- Toward the stronger side is easier
*S/P spinal surgery- avoid trunk rotation |
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Term
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Definition
reciprocal gait
2-point
3-point
4-point |
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Term
Functional walking
3 critical functions |
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Definition
Smooth progression of COG over BOS
Gait must be adaptable
1.acceptance of wt by the supporting limb
2.period of single limb support
3.advancement of the limb |
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Term
| Ranchos Los Amigos Terminology-stance phase (traditional equivalence) |
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Definition
Initial contact (heel strike)
Loading response (foot flat)
Midstance-single leg stance
Terminal stance (toe off)
Pre-swing |
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Term
| Ranchos Los Amigos Terminology-swing phase (traditional equivalence) |
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Definition
Initial swing (acceleration)
Midswing
Terminal swing (deceleration) |
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Term
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Definition
*walk reflects a high level of motor control
*STEP LENGTH
*STRIDE LENGTH
*STRIDE WIDTH (BOS)
*walking velocity
*cadence
*step time
*stride time
*single leg support
*double support time |
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Term
| Which parameter of gait has high correlation with fall risk and mortality rates? |
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Definition
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Term
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Definition
rhythm of walk
ex: single leg, single leg
ex: long time in double stance |
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Term
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Definition
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Term
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Definition
| Wt acceptance and Single limb support |
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Term
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Definition
| Initial contact and loading response |
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Term
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Definition
| Midstance, terminal stance, preswing |
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Term
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Definition
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Term
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Definition
| Preswing, initial swing, midswing and terminal swing |
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Term
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Definition
trunk control
weight shifting
eyes closed (vestibular)
reaction times |
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Term
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Definition
*Move in and out of a chair
*Level surfaces
*Stairs
*Doors
*Curbs
*Ramps
*Elevators
*Uneven surfaces
*Falling |
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Term
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Definition
| no weight is to go through the affected limb |
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Term
TTWB/TDWB
NEED ASSISTIVE DEVICE, SINGLE LEG STANCE IN ONE LIMB
TOUCH FOR BALANCE |
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Definition
Toe-touch WB/ Touch-down WB
*for BALANCE only, not support
*No more than 20% of their body weight
*BEWARE! of adaptive mm shortening and abnormal gait patterns when used long term* |
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Term
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Definition
Partial weight bearing
*Highly variable interpretations among professionals
*Usually 20 to 50% of the pts body weight OR limit in lbs |
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Term
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Definition
Weight bearing as tolerated
*restricted only by pt comfort |
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Term
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Definition
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Term
| Problems with WB restrictions |
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Definition
*lack of agreement on clinical interpretation of terms
*% based on average adult body wt-people differ-->limb load monitor
*forces differ at different joints
*forces change at different points in gait cycle
*body weight is not the only force acting on the joint; NWB can create more force at the hip that TTWB |
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Term
| Which creates more force at the hip? NWB or TTWB |
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Definition
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Term
Limb load monitor
People can't maintain PWB consistently w/o feedback |
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Definition
*developed to monitor weight bearing under the heel and/or forefoot
*Provides audio and visual feedback to indicate whether the prescribed loading has been exceeded (or reached)
*Audio feedback threshold can be adjusted with the pt standing on A PAIR of bathroom scales |
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Term
Choosing an Assistive Device
Indications: |
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Definition
Stability v Mobility trade-off
*reduced wb
*LE weakness
*Impaired balance
***Choose least restrictive device*** |
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Term
Stability: Most to least
LRD= least restrictive device |
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Definition
1. Parallel bars
2. Walker (std, wheeled)
3. Axillary crutches
4. Forearm crutches
5. Two canes
6. Hemi-walker
7. Quad cane
8. Single point cane |
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Term
Energy Consumption
Least to most |
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Definition
1. normal gait
2. cane
3. crutches
4. rolling walker
5. standard walker |
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Term
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Definition
*standard walker: greater stability
*two wheeled walker: prevents walker from rolling while you step forward
*4 wheeled walker: if you do NOT need to lean on walker for BALANCE |
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Term
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Definition
| larger grip is best for joint health |
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Term
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Definition
*single tip: least stability/ most mobility: ONLY for balance
*Quad cane: use cane for WB
1.LBQC= large base quad cane
2.SBQC= small base quad cane |
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Term
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Definition
15 degree arm bend
grip at wrist when standing beside grip |
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Term
| PWB almost full WB devices |
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Definition
Unilat: 1 standard cane
Bilat: 2 standard canes |
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Term
| Different levels of PWB (least to most) devices |
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Definition
1.Unilat:1 crutch
Bilat: forearm crutch
2.Unilat:2 canes
Bilat:2 crutches or walker
3.Unilat:2 crutches
Bilat:2 crutches or walker |
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Term
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Definition
Unilat:2 crutches or walker
Bilat:unable to walk |
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Term
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Definition
Unilat:2 crutches or walker
Bilat:unable to walk |
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Term
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Definition
Unilat:1 standard cane
Bilat:standard canes |
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Term
| decreased strength (2 levels) device |
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Definition
1.unilat:1 quad cane
bilat:2 quad canes
2.unilat:1 crutch
bilat:forearm crutches |
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Term
| Significant weakness device |
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Definition
unilat:2 crutches or walker
bilat:2 crutches or walker |
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Term
| Balance minimally impaired device |
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Definition
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Term
| Balance intermediate (2 levels) |
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Definition
1. 1 forearm crutch
2. 2 crutches or walker |
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Term
| Balance significantly impaired |
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Definition
| 2 crutches or walker and guarding |
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Term
Elbow position determines...
Forearm position determines... |
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Definition
forearm position
line of force |
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Term
| 3 aspects in choosing a gait pattern |
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Definition
1. WB status (to increase or decrease WB)
2. LE weakness (support)
3. Impaired balance |
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Term
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Definition
deliberate 2-point/reciprocal gait
needs bilateral assistive devices |
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Term
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Definition
1.crutches
2.involved LE
3.uninvolved LE |
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Term
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Definition
Total
Max
Mod
Min
CGA
Tactile cueing
Visual cueing
SBA
Supervision
I |
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Term
| Guarding sit to stand transfer |
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Definition
*PT stands in stride to one side and slightly behind pt
*PT may need to stand in front of pt to assist with stand-pivot transfer |
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Term
| Guarding ambulating on level surface |
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Definition
*PT stands in stride behind and slightly to one side.
*One hand placed on gait belt and other hand hovers over pt's shoulder girdle
*stand on the side where the pt is more likely to fall |
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Term
| Guarding ascending and descending stairs |
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Definition
*PT usually stands below the pt and guards by holding on to the gait belt with one hand and side rail with the other
*Place feet on different stair treads
Exception? Guarding from behind with ascending steps |
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Term
| Ascending a single curb forward |
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Definition
up forward is the easiest way
1.face the curb
2.elevate casters
3.move chair forward until rear wheel contacts the curb
4.lower caster wheels on surface of curb
5.roll the chair forward
Easiest because:it provides greater control of the chair and requires less effort by the caregiver |
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Term
| Ascending a single curb backwards |
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Definition
more difficult
1.position chair so rear wheels contact the curb
2.tip the chair back so casters are elevated
3.Pull on the push handles
4.Bring the chair up the curb on its rear wheels
5.Make sure casters clear the curb before lowering the chair
More difficult because:requires more effort to pull the chair and it requires more control |
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Term
| Descending a single curb backwards |
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Definition
1.rear wheels close to the edge of the curb
2.stand behind chair and control chair as it rolls backwards
3.use your thigh for added control
4.Rear wheels come off first followed by casters
EASIEST BC:provides greatest control and requires less effort by the caregiver |
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Term
| Descending a single curb forward |
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Definition
1.position casters close to the edge of curb
2.tip the chair onto rear wheels
3.roll chair forward over the curb
4.lower the caster wheels onto the surface
MORE DIFFICULT:due to needed strength and ability for control |
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Term
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Definition
1.push the chair forwards
2.elevate casters
3.May need to zigzag up or down the slope if it is steep
***DO NOT PULL THE CHAIR UP SLOPE BACKWARDS ON ALL FOUR WHEELS*** |
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Term
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Definition
Forward:elevate casters
Backward:all four wheels
***DO NOT PUSH THE CHAIR DOWN A SLOPE FORWARDS ON ALL FOUR WHEELS*** |
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Term
| Ramps/inclines independently |
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Definition
1.Ascending forward:pt slides/leans forward:FIRM GRIP ON HANDRIMS
2.Descending forward:pt back in chair, friction to handrims
3.Ascending backward:for pt using UE/LE |
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Term
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Definition
UP BACKWARDS, DOWN FORWARD
1.strongest person holds push handles
2.additional helpers grasp the frame of the chair-not a removable part
3.tip chair back and roll drive wheels up or down over steps
4.pt in chair can assist in pulling back on handrim
5.at the top step roll the chair back until casters clear the step
***most safely performed with two or three people*** |
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Term
| W/C to car transfers sliding board |
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Definition
*if sliding board is necessary, us a longer board
*move the front seat back as far as possible and recline the back of the seat a little
*Remove the leg rests before bringing the chair up close to the car
*bring the chair close, facing forward, and wedge the chair as close to the front seat as you can
*lock the chair, feet on ground, scoot forward in the chair |
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Term
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Definition
*pt reaches into car onto any fixed part of the car
*Move hips in
*watch the pt's head
*legs in
*position and secure |
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Term
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Definition
Transfers are a step toward ambulation!
*enhance sensory integration
*improve trunk and pelvic control
*develop functional balance responses
*improve strength, power and endurance
*increase or maintain ROM
*handling and moving affected extremity
*develop postural stability
*develop dynamic stability |
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Term
| Pre-ambulation activities |
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Definition
*progress from low COG and large BOS to high COG and small BOS
*MAINTAINING a position PRECEDES ATTAINING a position
*STABILITY precedes MOBILITY
*STATIC to DYNAMIC |
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Term
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Definition
*re-acclimates pt to upright posture
*vital signs taken before, during and after the process
*used to prevent or reduce symptoms of orthostatic hypotension |
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Term
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Definition
*Excessive increase/decrease in BP and pulse
*change in consciousness
*Excessive perspiration
*edema in LEs
*decrease or loss in pedal pulse
*Reports of nausea or numbness
*vertigo
*Changes in facial or limb color |
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Term
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Definition
Monitor
3 straps placed:
1.Across ASIS, not abdomen
2.Just below the knee joint line: Knee blocking
3.Chest strap that goes around rib cage (based on trunk control level
FIRST TIME: 15 to 30 degrees
INCREASE BY: 15 to 30 degrees
***Do not need to take them over 70-80 degrees, they are ready for standing***
***Duration:20 minutes*** |
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Term
| Pre-ambulation activities goals |
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Definition
Dynamic stability and mobility:ability to maintain postural orientation with the COM (center of mass) over the BOS while in motion;controlled mobility
*Weight-shifting-->stepping
*Skill
*Consistency in performing controlled movement sequences |
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Term
| Pre-ambulation activity purposes |
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Definition
*preparatory for ambulation
*functional carry over to daily activities
*works on a variety of different goals |
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Term
| Bridging/Hooklying pre-amb |
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Definition
*allows wt bearing through the feet
*precursor to assuming the kneeling position
*BOS is reduced and COM is raised
*facilitates pelvic motions and strengthens lower back and hip extensors
***SCOOTING UP AND OVER IN BED*** |
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Term
Developmental positioning
How babies do it! |
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Definition
1.Prone
2.Prone to elbows
3.Quadruped
4.Kneeling/half kneeling
5.Kneeling
6.Modified plantigrade (holding to table and standing)
7.Standing
8.Marching in place (sitting or standing) |
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Term
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Definition
wide BOS and low COG
Improve upper trunk, UE and neck/head control
Increase extensor ROM at hip extensor |
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Term
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Definition
*Decreased BOS and Raises COM
*WB through hips and shoulder joints
*Improve upper trunk, lower trunk, LE, UE, neck/head control
*Side to side, frontward and backward, trunk control and holding head up
***Move up to raising opposite leg and arm*** |
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Term
| Functional implications of kneeling or half-kneeling |
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Definition
Tie shoe
get up from floor
Quad to 1/2 kneeling to standing or sitting |
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Term
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Definition
*Improve head/neck, upper trunk, lower trunk, and LE control
*WB through hips in upright antigravity position
*Improve balance reaction
Wide BOS, COM rises |
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Term
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Definition
*Narrow BOS, COM rises
*improve head/neck, upper trunk, lower trunk, and LE control
*WB through hips in upright antigravity position
*improve balance reaction
*(less stable than 1/2 kneeling) Need hip strength and control. If they don't have the strength and control their butt will stick out |
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Term
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Definition
*Wide BOS and high COM
*improve head/neck, upper trunk, lower trunk, and UE and LE control
*improves gravity reactions
*functional posture
*lead up for standing
(if hip flexion contractures, lead up to standing) |
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Term
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Definition
Seen in overweight individuals
Knees in,feet spread apart
Feet together=likely to fall! |
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