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Gait Training - II

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.

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Gait Training - II

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  1. Gait Training - II Mazyad Alotaibi

  2. 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

  3. Requirements • ROM, muscle strength and endurance, coordination, trunk balance, sensory perception, mental status • Amount of weight-bearing permitted on lower limb • Gait aids

  4. 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

  5. Preparing the Patient • Patients need to improve: • Balance • Coordination • Flexibility (ROM) • Strength • Endurance

  6. 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

  7. Major Muscle Groups Lower Extremity • Hip Extensors • Hip Abductors • Knee Extensors • Ankle Dorsiflexors

  8. 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

  9. Equipment Purpose • Increases stability by increasing BOS • Decreases weight-bearing • Permits mobility • Decreases pain Types • Parallel Bars • Walkers • Crutches • Cane

  10. Gait aids

  11. Parallel Bars • Maximum stability • No mobility • Adjustable • Proper Fit • 20-250 elbow flexion • greater trochanter

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. Two-point gait • Faster than 4-point gait but less stability • Decrease both lower limbs weight-bearing

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

  21. Swing-to gait • Both crutches -> both lower limbs almost to crutch level

  22. 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

  23. Forearm Crutches • Disadvantages • Decreased stability • Requires good standing balance and good UE, trunk strength • Difficult to remove • Elderly insecure • Proper Fit • Cuff1-1½ inches distal to olecranon

  24. 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.

  25. 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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