levels of assist &

maximal assist

-Client performs 25-49% of the task -Therapist assists with 51-75% of the task

moderate assist

-Client performs 50-74% of the task -Therapist assists with 26-50% of the task

minimal assist

-Client performs 75% or more of the task -Therapist assists with 25% or less of the task -May require a light hand for balance, steadying, minimal assistance for correction after loss of balance

dependent/total

-Client performs less than 25% or less of the task -Therapist assists with 75% or more of the task -Dependent x2 -requires two helpers

independent

-Requires no assistance -Requires no supervision -Requires no cues -Task is completed safely

contact guard assist (CGA)

-The therapist may need to give verbal cues -The therapist may need to give tactile cues -The therapist may need to hold onto the gait belt for safety but no assistance is given -May give steadying for balance -May require an assistive device

Swing Phase

40% initial swing, midswing, terminal swing

stance phase

60% heel strike, foot flat, midstance, heel off, toe off

swing to gait

Crutches are moved forward simultaneously, and the weight is transferred forward. Then swing both feet

Step length

Distance traveled in one step• Half a stride length• ~28 inches in a healthy adult

Step

Events occurring between L and R heel contacts

Stride

Events that take place between successive heel contacts of SAME foot• "Gait cycle"

A four-point gait pattern is the least stable and can be used with a walker

False

Descending a curb while using a standard walker, the following is the correct sequence: weak leg, walker, strong leg

False

The therapist should guard the patient on the strong side when the patient is WBAT.

False

The three-point NWB pattern can be performed with bilateral canes.

False

Single limb advancement

From preswing to terminal swing Clearing of the foot limb advancement

integumentary integrity

Health of the skin

modified independent

INDEPENDENT but...... -Requires assistive devices -Requires an unreasonable amount of time

supervision/setup

INDEPENDENT but...... -Therapist is in the room out of arms reach . -May require verbal cues for safety and task completion -May require an assistive device -May require set up of items prior to task completion

standby assist (SBA)

INDEPENDENT but......... -Therapist is within arms reach for safety -Therapist may need to give verbal cues -May require an assistive device

Step-to Gait Pattern

LE advances as far as the AD Increased stability with increased double stance time. increased chance for LOB

Step-through gait pattern

LE advances past the AD More like normal gait pt must demonstrate increased stability with increased swing time.

single limb support

Occurs during midstance and terminal stance phases while opposite foot is in swing phase (40% of stance phase)

2-point gait pattern: -WB status? -device? -sequence?

Slow (Reciprocal) WBAT or FWB or 2 canes or crutches, Hemi-walker

Assisted

The pt requires assistance from another person to perform the activity safely in an acceptable time frame; physical assistance, oral or tactile cues, directions, or instructions may be used.

A therapist may start gait training in the parallel bars to provide the most support and stability.

True

A two-point gait pattern can be performed with crutches and more rapidly than the four-point pattern.

True

Stair negotiation with axillary crutches requires good balance, trunk control, and strength in BUE.

True

The trendelenberg sign is an abnormal response indicating weak hip abductors on the side of the stance leg.

True

When instructing a patient in ascending stairs or curb, the stronger leg should lead up.

True

Reciprocal gait pattern

UE and contralateral LE advanced at same time Simulates normal gait pattern allowing arm swing and trunk rotation.

3-point gait pattern

all WBring statuses walker or bilateral aid may be used Aid is advanced simultaneously with affected limb

Step width

distance between the points of contact of both feet

weight acceptance

initial contact and loading response -crucial to postural adaptation through perception of ground reaction force

three point gait

pt NWB (1) Move the affected (NWB) leg and both crutches together. (2) Move the unaffected (weight-bearing) leg.

swing through gait

pt W/LE paralyzed and/or in braces crutches forward, lift both feet and swing forward

Two-point gait

pt can BW on both LE (1) Move the right leg (injured side) and left crutch together. (2) Move the left leg and the right crutch together.

4 point gait pattern: -WB status? -assistive device? -sequence?

similar to 2-point but SLOWER and offers more stability. WBAT or FWB walker or bilateral AD, contralateral affected LE, single AD, contralateral unaffected LE Reciprocal pattern

Stride length

two consecutive heel contacts of same foot• 56 inches in a healthy adult