| Term | Definition |
|---|
| NMI stands for | Neuromuscular impairment,we are looking for those pt's who have involvment of the nerves and muscles. this can be all 4 extremities and the trunk, (tetraplegia or quadriplegia), BLE and trunk (paraplegia), or one side of the body (hemiplegia), examples include,CVA, MS, SCI, Parkinson's and TBI |
| Evaluate the pt's functioning | there are many factors that influence the ambulation training we provide. with respect to pt's who have a brain injury providing complications, we may need to consider coginitive deficits, cardiovascular complications, paresthesia, tone (flaccid/spastic extremtiy,)contractures, and hemianopsia |
| Body jacket/TLSO | are the required to wear this when in upright positon these are hot and many times uncomfortable, |
| HKAFO | Hip, knee, ankle, foot orthosis, Aid in Hip extension, and knee extension, Prevent Knee flexion and ankle PF |
| KAFO | Knee, ankle, foot orthosis, Aid in Knee extension and Prevent ankle PF |
| AFO | ankle, foot orthosis, Prevents PF stop to prevent foot drop during ambulation |
| Preambualtion activites-Mat activites | Bed mobility- are they independent in bed mobility or require assistance, If not independent is ambulation reasonable at this time. Strengthening exercises- exercises completed in bed to gain strength BEFORE ambulation training including quad sets, resistance exercises, weighted ROM |
| Sitting balance | static and dynamic |
| Standing balance | static and dynamic |
| what are the 3 types of ambulators | non-functional ambulators, functional ambulators and community ambulators |
| Physiologic reasons to stand | relieve pressure on buttocks, get weight through LE bones, cardio pulmonary work |
| Functional ambulators | functional ability to ambulate around the house with or without assistive device unable to do so independantly |
| Community ambulators-Functional ability to ambulate | able to ambulate throughout home and community, may use a more stable assitive device in community than home |
| Community ambulators-Must evaluate their ability to do all components of community ambulation safely | cross street in appropriate time, ascend and descend stairs/curb, open doors while ambulating with device |
| Thoracic -levels of funcitoning with respect to SCI (T1-T3) | STRENGTH; full use of UE, poor trunk control, GAIT PATTERN; stand with proper support, ambulate with drag to pattern Not functional, BRACING; HKAFO,body jacket, ASSISTIVE DEVICE; lofstrand crutches |
| Thoracic levels of functioning with respect to SCI (T4-T6) | STRENGTH; appropriate sitting trunk control, GAIT PATTERN; drag to (T4-5), swing to at T-6 , Not functional, BRACING, HKAFO, body jacket, ASSISTIVE DEVICE; Lofstrand crutches |
| Thoracic levels of functioning with respect to SCI (T9-T12) | STRENGTHS sitting control increased, use of secondary hip hikers (T12), Functional but not community ambulator, BRACING, HKAFO, ASSISTIVE DEVICE loftstrand cruthces |
| Lumbar levels of functioning with respect to SCI (L2-4) | STRENGTHS, sitting and standing balance, primary hip hikers (quads), GAIT PATTERN; 4 or 2 point, swing through, Functional but not community ambulator, BRACING, KAFO, ASSISTIVE DEVICE, lofstrand or axillary crutches |
| Lumbar level of functioning with respect to SCI (L4-5) | STRENGTHS, sitting and standing balance, hip hikers, partial knee flexion and extension, GAIT PATTERN,4 or 2 point, Community ambulator, BRACING, AFO, ASSISTIVE DEVICE, Lofstrand or axillary cruthces, cane |
| Ambulation training-sit to stand | pt. doesn't have functional hip strength |
| Ambualtion training sideways | lock KAFO, turn to side and push up sideways (use lofstrands) |
| Ambulation training- twist up | lock KAFO, cross legs and arms to twist to stand (will be facing w/c) |
| Ambulation training- Muscle up | lock KAFO, using lofstrands, use UE strength to push through to stand |
| Ambulation training-Hemi transfer | transfer weight to strong side and push up with strong UE and LE |
| Jackknife | use head and upper body flung forward and back to "jump" |
| Drag-To, (T1-T6) | not functional, use head and UE |
| Swing-To (T6-8) | not functional, additional assistance form trunk muscles |
| Swing-through (T9-12) | functional not likely community ambulating |
| 4-2 point (L1-5), | functional and community ambulators |
| Parallel Bars | drag-to, Swing-To, Swing-through, Jackknife |
| Walker | Drag-To, Swing-To, Swing-through |
| Lofstrand | Drag-To, Swing-To, Swing-through, Jackknife |
| Cane | 4 or 2 paint |
| Falling-Preliminary activites-kneeling on floor | static balance in tall kneeling, Dynamic balance in tall kneeling, Practice falling to floor from kneeling, utilize mat crutches) |
| Falling from standing | static balance in standing (with assistive device and braces(, Dynamic balance in standing (with assistive device and braces), Falling with Lofstands- release grasp on cruthches and throw to sides, catch weight of body on hands and roll onto forearms, Falling backwards-same as before but must twist body to land prone |
| Falling from W/C | catch weight on hands and roll to forearms |
| Return to fall to standing-Bilateral weakness | requires good HS length, spread legs and walk hands up to feet, using lofstrands, place tips at head and handgrips at greater trochanter while lying down |
| Returning from fall to standing Unilateral weakness | may use assistive device or nearby furniture, stand through a half kneel, strong leg leading |
| Returning from fall to w/c-backwards | scoot until back and rear are against wheelchair, place hands on metal frame of wheelchair, triceps push to get self back in chair |
| Returning from fall to W/C-kneeling forward | turn to face chair in tall kneeling, grasp w/c frame, place strong leg into half kneel and push to stand |
| Stair requirements | Goop UE strength and trunk balance, high thoracic lesions would likely Not be candidates for stair climbing |
| Ascending stairs-Leg Swing | shift weight to one side and swing other leg back onto the stair, Walk hands back and then swing other leg onto stair |
| Ascending stairs-Back jack | lower head quickly and forecefully to "jack" onto the stair |
| Descending stairs-Hip hiking | one foot at edge, other dangling over edge, push through hands and hike hip to step down |
| Descending stairs- Swinging off | push through crutches and swing through, land off step in postion utilizing Y-ligament |
| Descending stairs-Stepping off (T12 or lower) | hike on hip and step off then other hip repeats |
| Handrail | facing downward, jacknife up and down stairs, therapist gauards below pt is descending, when ascending (always below pt), one hand on gait belt , other on pt's shoulder |
| No handrail-Backjack | facing downward, one crutch on each side, same techniques as usuall just utilze crutches instead of rail |
| No handrail-Front jack | pt stands 45 degree angle to stairs, place one crutch up on step, jacknife and lift both feet up to the step, raise other crutch and regain balance, reverse for descending, facing forward, Therapist gaurds behind and to side with hand on belt and under axilla |
Combine with other sets
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