52 Physical Therapy and Rehabilitation Lesson 2:

52 Physical Therapy and Rehabilitation Lesson 2:
Adaptive Equipment and Devices

Lesson Objectives Upon completion of this lesson, students should be able to: Define and spell the terms to learn for this chapter. List and discuss five pieces of adaptive equipment used in rehabilitation. Describe the two-point, three-point, and four-point gait in crutch walking.

Lesson Objectives Upon completion of this lesson, students should be able to: Differentiate between electromyography, evoked potential studies, and somatosensory evoked potentials. Describe proper body mechanics for transferring a patient from a wheelchair to a chair or examination table.

Adaptive Equipment and Devices
Equipment used to assist recovery from physical disorders or disabilities Includes wheelchairs, walkers, canes, crutches, special furniture, such as shower chairs and geriatric chairs Mobility aids or mobility-assistive devices designed to enable patient to ambulate

Other devices, including braces, casts, traction, prostheses, splints, and slings, used to manipulate patient's damaged bones and tissues Also includes variety of utensils Adaptive devices prescribed by physician Physical therapist may provide initial instruction of the device

FIGURE A therapist assisting an amputee patient to regain mobility and strength after amputation. Dan Porges/Getty Images

Crutches Allow patient to walk without placing weight on healing leg part Weight transferred to arms and hands Made from metal or wood Should have rubber tip at end to prevent slipping on a smooth floor surface

Axillary Crutch Tall crutch with shoulder rest and handgrip that reaches from ground to under the axilla Commonly used for patient who has suffered a fractured leg

Lofstrand (Forearm Crutch) Single aluminum tube with arm cuff that fits snugly around patient's forearm and uses a handgrip for weight bearing Allows patient to release handgrip to use the hand while still having the crutch held in place by the arm cuff for support

Lofstrand (Forearm Crutch) Canadian or Elbow Crutch Variation of Lofstrand crutch that extends further up the arm

FIGURE Three types of crutches: (A) axillary crutch; (B) Lofstrand or forearm crutch; (C) Canadian or elbow crutch.

Measuring for Axillary Crutches Determined carefully to prevent pressure damage to the axilla If crutches too long, patient may develop crutch palsy, resulting in muscle weakness in arm, wrist, and hand

Measuring for Axillary Crutches Crutches that are too short can result in patient having to bend forward while walking Back pain, nerve damage, injury to the axilla and palms of the hands can occur if crutches improperly fitted

Measuring for Axillary Crutches Have patient wear walking shoes and stand straight Place crutch tips 4 to 6 inches to the side and 4 to 6 inches in front of each foot Adjust crutch, using bolts and nuts at sides of the crutch, so that the axillary crutch bars are three finger widths below the axilla

Measuring for Axillary Crutches Measure this by inserting your own fingers between patient's axilla and crutch bar Adjust handgrips so patient can flex his or her elbows at a 30-degree angle when crutch is in place and patient's hands are on hand bars

Measuring for Axillary Crutches Instructions in writing and an actual demonstration should be provided to patient who will be using crutches

FIGURE 52-13 The correct beginning position for the patient’s feet and crutches (tripod position).

Crutch Walking Gaits Amount of weight bearing patient's leg or legs will support and his or her muscular coordination Age Overall physical condition Each foot and crutch called a point Patient encouraged to use slow gait

Four-Point Gait Slow and steady gait Used when patient can bear weight on both legs Considered safest of all gaits since patient always has three points of support in contact with the ground at all times

Four-Point Gait Used by patients who may have muscular weakness and some lack of coordination

FIGURE 52-14 Four-point gait.

Four-Point Gait First the right crutch is moved forward, followed by the left foot Then the left crutch, and then the right foot This is repeated over and over Patient must be able to move each leg separately to use this gait

Three-Point Gait Used when one leg is stronger than the other or when there is no weight bearing on one leg Patient must have good muscle coordination and arm strength To use this gait, patient must be able to support his or her full weight on one leg

Three-Point Gait Have patient move both crutches and affected leg forward and then move unaffected leg forward while weight is balanced on both crutches Requires good coordination and muscle strength

Three-Point Gait Used by patients with musculoskeletal disorders (e.g., fractures), recent leg surgery, or amputees without an artificial limb

FIGURE 52-15 Three-point gait.

Two-Point Gait Faster moving than four-point gait Used by patient who can bear some weight on both feet and maintain good balance Occurs when a crutch and the opposite foot are moved forward at the same time

FIGURE 52-16 Two-point gait.

Swing Gaits Used by patients with severe leg disabilities, such as deformities or paralysis Swing-to gait Patient moves crutches forward, lifts his or her body, and then swings legs up to the same point

Swing Gaits Swing-through gait Patient moves crutches forward, as in swing-to gait, and then swings legs past the crutches

FIGURE 52-17 Swing gaits: (A) swing-to gait; (B) swing-through gait.

Sitting with Crutches Patient should face forward and then back into a straight-back chair with arm rests until back of his or her legs touch chair seat Crutches should be placed in the hand on strong side of the body, opposite weak leg

Sitting with Crutches Patient should grasp chair arm with the other hand and lower him- or herself gently into chair

Standing with Crutches Patient should place crutches in the hand on strong side of the body to use as support Patient should move or slide his or her body forward in the chair

Standing with Crutches Patient should grasp chair arm with free hand on affected side Patient should push up to a standing position

Canes Used by patients who have muscle or bone weakness on one side or need assistance with balance Two common types: standard cane and four-point (quad) cane

Canes Several types of wooden and aluminum canes available All canes should have a rubber tip on end to prevent slipping

FIGURE 52-18 (A–B) Two types of canes.

Canes Standard cane has curved neck for ease of gripping; support for patients who need only slight assistance Tripod and quad canes have wide base with three or four points to provide steadier support; neck bent with T-shaped handle

Canes To determine correct height, patient should stand tall so handgrip is level with hip joint and elbow flexed at angle of 25 to 30 degrees Handle suitable for patient's hand size

Walkers Assistive devices made of aluminum Provide a base of support for patients who need help with balance and walking Adjusted to patient's height and reach just below patient's waistline

Walkers Stationary walker must be picked up by patient, moved forward, and then used as a base of support while patient walks into it Requires strong arm muscle development

Walker with wheels used by patients who have good coordination and balance Can be dangerous because it might move too quickly, causing patient to lose balance and fall

FIGURE 52-19 Walkers help the patient ambulate safely
FIGURE Walkers help the patient ambulate safely. Monkey Business Images/Shutterstock

Wheelchairs Hand manipulated or power driven Many patients operate their own wheelchairs Not all patients are able to (nor should they) operate their own wheelchairs

Wheelchair Transfer Patient who is paralyzed on one side of body (hemiplegia) or who has a general weakness, can be moved from a wheelchair by pivoting patient so that he or she can use the stronger leg to assist you

Wheelchair Transfer Explain to patient this transfer technique is used to prevent injury to patient and to individual assisting with transfer

PROCEDURE Wheelchair Transfer to a Chair or Examination Table FIGURE A A medical assistant helps the patient out of the wheelchair.

Braces One type of orthotic used to support weakened body parts, correct deformities, prevent joint movement May be made out of metal, plastic, or leather Customized to patient's needs and anatomy

Braces To wear this type of assistive leg device, brace is placed in patient's shoe, patient's foot is inserted, and a hook-and-loop strap used to hold brace in place

Braces Any orthotic positioned over a bony point must be padded to avoid skin breakdown Prolonged use of a brace may weaken muscles

Casts Made of plaster, plastic, or fiberglass Used to hold a bone in place after reduction of a fracture Applied over stockinette to protect skin Fiberglass and plastic casts dry quickly Plaster of Paris cast may take up to 48 hours to dry

Cast Care Casts applied for purpose of immobilizing a broken bone or muscle strain and sprain Considered to be form of nonflexible bandage Newer synthetic fiberglass materials used to form casts lighter in weight than plaster cast

Cast Care After cast has been applied, it must be left uncovered during the drying process Cast may become warm or even hot during drying process; this is normal

FIGURE 52-23 Check the edges of a cast and report any changes.

Cast Care Patient to call physician if following problems: Circulation restricted by cast Pain as a result of cast pinching skin Excessive itching under cast Numbness or tingling of fingers or toes

Cast Care Patient to call physician if following problems: Discolored toes or fingers Swelling of limb around edge of cast Discoloration soaking through cast Loosely fitting cast Foul odor coming from cast

Cast Care Physician should advise patient on amount of weight and movement that can be safely applied to cast Remind patient that nothing should be put on the edges of the cast Cast should not get wet Patient may be able to tie a strong plastic bag around the cast to take a shower

Traction Method of pulling or stretching in two directions Used to immobilize fractures Corrects deformities Reduces compression of the vertebrae or other musculoskeletal conditions

Skeletal Traction Performed on inpatients Applied by physician to patient's bone by inserting a pin or wire through the bone

Skin Traction Done by physical therapist by attaching bandages and strips of material to the skin Weights attached to the material and tension is applied to reduce painful muscle spasm Can be set up in a patient's home

Prosthesis Artificial replacement of a missing body part Immediate fitting of prosthesis involves fitting patient immediately after limb is removed

Prosthesis Benefit is that patient is able to begin ambulation the next day Specific type of fitting rests with physician Assessment of patient's overall condition, age, willingness to learn to use the new limb

Prosthesis Many recent improvements result in a limb that closely resembles the original and functions efficiently They are custom made for the patient Adjustments may be necessary to ensure a comfortable fit

Prosthesis In delayed fitting of a prosthesis, stump conditioning is needed Involves shrinking and shaping stump before a prosthesis can be fitted Amputees may feel a phantom pain, which is a normal occurrence with an unknown cause

Diagnostic Testing Muscle strength Muscle coordination
Mobility of joints Neuromuscular function Circulation and sensory function

Diagnostic Testing Neuromuscular Evaluation Tests
Electromyography (EMG) Nerve conduction studies (NCS) Evoked studies Brainstem auditory evoked response (BAER) Somatosensory evoked potentials (SEP)

Diagnostic Testing Electromyography (EMG)
Consists of using electromyograph to test electrical activity of muscles Most often performed when patient complains of muscle weakness or numbness Consists of electrodes, oscilloscope to visually produce the waves of muscle activity, amplifier, loudspeaker, electrical stimulator, and camera

Patient may receive sedation before this test is conducted since stimulation from electric current may be painful

Consists of inserting a fine-gauge needle electrode through the skin and into a muscle and then sending a small amount of electric current into the muscle Procedure permits physician to examine individual parts of muscles

Abnormal results are found in conditions such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, peripheral nerve damage Electrical activity of the muscle recorded on a graph paper or on film is known as electromyogram (EMG)

Critical Thinking Question
How do you prepare a patient for a test that may be painful and/or unpleasant?

Diagnostic Testing Surface Electromyogram (SEMG)
Involves less discomfort for patient Results less conclusive Electrodes attached to surface of the body to detect electrical activity

Diagnostic Testing Electrical Stimulation
With low-voltage current helpful to stimulate nerves that supply muscles Electrical current applied using disposable gel electrodes Passive means to stimulate muscles when patient cannot exercise due to injury or disease Used to avoid atrophy of muscle tissue

Diagnostic Testing Electrical Stimulation
Transcutaneous Electric Nerve Stimulation (TENS) TENS unit attached to patient in affected area Controlled dose of current sent to muscle to help control intractable pain when medication has not been effective May be used at home

Diagnostic Testing Evoked Potential Studies
Examine responses within brain to external stimuli such as light, sound, and touch Considered noninvasive No equipment or needle is inserted into body

Brainstem Auditory Evoked Response (BAER) Used to assess auditory nerve pathways Useful in diagnosing auditory tumors and lesions

Somatosensory Evoked Peripheral Nerves (SEP) Used for diagnosing nerve function defects in peripheral nerves, for example, in the legs

Questions? 79

52 Physical Therapy and Rehabilitation Lesson 2:

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