Mazyad Alotaibi

Gait Training - II

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

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 20-250 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

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

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