Gait Training - II

Mazyad Alotaibi

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

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Patients need to improve:

     Balance Coordination Flexibility (ROM) Strength Endurance

Major Muscle Groups

Upper 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

Major Muscle Groups

Lower Extremity     Hip Extensors Hip Abductors Knee Extensors Ankle Dorsiflexors

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

Gait aids

Parallel Bars

   Maximum stability No mobility Adjustable  Proper Fit  20-25 0 elbow flexion  greater trochanter

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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

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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 20-25 0 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

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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

Two-point gait

  Faster than 4-point gait but less stability Decrease both lower limbs weight-bearing

Swing-through gait

  Fastest gait, requires functional abdominal muscles Required increase of 41-61% in net energy cost (= 3-point NWB)

Swing-to gait

 Both crutches -> both lower limbs almost to crutch level

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

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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.

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Cane

Uses   Compensate for impaired balance Increased stability Advantages   More functional on stairs, confined areas.

Easy storage, transport.

Disadvantages  Provides limited stability  decreased BOS