mazyad alotaibi gait training - ii. goals of gait training increase area of support, maintain center...
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Goals of Gait Training
Increase area of support, maintain center of gravity over support area
Redistribute weight-bearing area Maximize functional independence and safety at
a reasonable energy cost
Requirements ROM, muscle strength and endurance,
coordination, trunk balance, sensory perception, mental status
Amount of weight-bearing permitted on lower limb
Gait aids
Preparation for Ambulation Review medical record
Assess and know the patient’s problems and abilities.
Establish goals and expectations Determine selection, proper fit Safety belt Explain and demonstrate Body Mechanics
Preparing the Patient
Patients need to improve: Balance Coordination Flexibility (ROM) Strength Endurance
Major Muscle GroupsUpper Extremity Shoulder depressor – latissimus dorsi, lower
trapezius, pectoralis minor Shoulder adductor – pectoralis major Shoulder flexor, extensor and abductor – deltoid Elbow extensor – triceps Wrist extensor Finger flexor
Progression of Ambulation
Initiate in Parallel Bars Maximum security Stability Safety
Explain to patient prior to beginning treatment Demonstrate Remain inside bars to assist
decreases risk of injury (patient, self ) For PWB status, special devices may be used
Equipment
Purpose Increases stability by increasing BOS Decreases weight-bearing Permits mobility Decreases pain
Types Parallel Bars Walkers Crutches Cane
Parallel Bars Maximum stability No mobility Adjustable
Proper Fit 20-250 elbow flexion
greater trochanter
Walker Wider and more stable base of
support, but slow gait For patients requiring maximum
assistance with balance, uncoordinated
Add wheels to front legs for who lack coordination or power in upper limbs
Front of walker 12 inches in front of patient
Shoulder relaxed and elbow flexed 20 degree
Walker Types
Standard Adjustable, Non-adjustable
Reciprocal Stair-climbing Wheeled Folding
Proper Fit Grip at level of trochanter, wrist crease, or styloid process Feet of walker flat, even with heels Hips/knees straight, shoes on
Axillary Crutches Types
Standard adjustable and nonadjustable
Offset Triceps
Proper Fit 3 fingerbreadths from axilla Handpiece at level of greater trochanter, ulnar
styloid process, wrist crease 20-250 elbow flexion
Uses Unilateral non/partial weight bearing e.g.
fracture, amputee -> 3-point gait Bilateral partial weight bearing or in-
coordination/ataxia -> 2 or 4-point gait Bilateral weakness of lower extremities e.g.
paraplegia -> swing-to or through gait
Axillary Crutches Advantages
Increased selection of gait patterns, speed Easily adjusted (wood or aluminum) Easily stored, transported Can use on stairs, crowded/narrow areas
Disadvantages Less stable than walker Can cause injury to axillary nerve, vessels Requires good standing balance Elderly insecure Functional strength of UE, trunk required
Crutch Gaits Point gait – stability, slow Swing gait – more energy, fast
Four-point gait Good stability - at least 3 point contact ground Ataxia or incoordination Slowest, difficulty
Three-point gait/alternating Non-weight-bearing gait for lower limb fracture or
amputation 3-point PWB gait -> required 18-36% more energy per
unit distance than normal NWB required 41-61%more energy per unit distance
than normal
Swing-through gait Fastest gait, requires functional abdominal
muscles Required increase of 41-61% in net energy cost
(= 3-point NWB)
Forearm Crutches Used when stability, support of axillary crutches
not required, Requires more stability or support than cane. Eliminates danger of injury to axillary nerves
and vessels More functional on stairs Easy to store and transport
Forearm Crutches Disadvantages
Decreased stability Requires good standing balance and good UE,
trunk strength Difficult to remove Elderly insecure
Proper Fit Cuff 1-1½ inches distal to olecranon
Canes Body weight transmission for unilateral cane
opposite affected side is 20-25% Gluteus medius weakness, or pathological at knee
or ankle Cane eliminate necessary gluteus medius force
and reduces compressional force on hip
Proper Fit Measure tip of cane to level of greater trochanter,
elbow flexed 20-30 degree.
Cane Uses
Compensate for impaired balance Increased stability
Advantages More functional on stairs, confined areas. Easy storage, transport.
Disadvantages Provides limited stability
decreased BOS
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