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progression of devices - most stabile to least stabile
II bars > walker > rolling walker > crutches > cane > none
always guard at side or behind pt. (weak side), lelow pt. on stairs or curb, hands on gait belt until SBA
4 point gait
pt. moves each crutch and each step seperately (crutch-steo-crutch-step), requires bilateral ambulation devices
3 point gait
advance both crutches/walker, then step legs to or through crutches (affected LE leads), requires bilateral ambulation devices or walker, cannot use two canes
3 point disadvantage
requires good balance and coordination, sufficient UE strangth needed, requires a good amount of energy
swing to/ swing through gait
advance both crutches simultaneously, then bring both legs through crutches, used with patients who have bilateral LE involvement and unable to adv legs. rely on UE momentum
handle comes out of center of front bar, use with only one UE, used for pt. with unilateral UE use (stroke)
unilateral or bilateral available, forearm rest on platform, good for pt with arthritis, wt. bearing restrictions of wrist
20 - 30 elbow flexion, walker handles approx. at greater trochanter level, ulnar styloid
walker gait patterns stairs and curbs
place walker sideways with 2 legs where you are and 2 legs where you are going, middle bar closest to pt, use walker as hand rail, bad leg first when coming down stairs
fitting axillary crutches
6" infront and to the side of feet, 20 - 30 elbow flexion, 2 -3 fingers between axilla and crutch, handrest at greater trochanter
fitting lofstrand crutches
20 - 30 elbow flexion, 2 - 3 fingers between cuff and elecranon fossa, hand hold at greater trochanter
place cane 6" infront of pt., 20 - 30 elbow flexion, top of can at greater trochanter
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