Ambulation (Walking)

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Types of equipment to assist Ambulation of the Resident

Gait Belts        

What is it? A gait belt is a safety device used for moving a person from one place to another. The belt is also used to help hold up a weak person while they walk. Putting this belt around a person's waist allows helpers to grip it and keep the person from falling. It also decreases the chance of a helper hurting his back while helping a person move or walk.

Why is a gait belt needed? A person may need to wear a gait belt because he is too weak to stand or walk alone. A person may need it when going from one place to another, like from the bed to a chair.

How do I use a gait belt? The following steps will guide a helper on how to use a gait belt:

1. Tell the person that the belt is used to prevent falls, and that it will be removed after the transfer.
2. Put the belt around the waist over clothing with the buckle in front. If the person wearing the belt is female, be sure the belt is not over her breasts.
3. Thread the belt through the teeth of the buckle. Put the belt through the other two openings to lock it.
4. Be sure the belt is snug with just enough room to get your fingers under it.

Parallel Bars

The use of parallel bars in rehabilitative and physical therapies is vitally important in the healthcare profession.  Parallel bars are used to help people regain their strength, balance, range of motion, and independence.  For people recovering from injuries, illnesses, and other debilitating conditions, parallel bars are important items of physical therapy, rehabilitation, and exercise equipment.

Rehabilitation therapists use parallel bars for coordination exercises.  These task-oriented procedures help people with balance and coordination problems, typically resulting from strokes or brain trauma.  Patients are required to repeat concise movements that work more than one joint and muscle.

Parallel bars are also used for ambulation exercises to improve a patient’s ability to walk independently or with assistance.  Before starting such exercises, however, some patient’s may need to develop or improve the range of motion of their joints as well as develop any lost muscle strength.  This type of training typically begins on parallel bars and then progresses to walking with mobility aides such as walkers, crutches, or walking canes.

Therapy parallel bars are also used for general conditioning exercises.  This rehabilitative therapy combines range-of-motion, muscle-strengthening, and ambulatory exercises to counteract effects from being in a wheelchair for a sustained period of time or from prolonged bed rest and immobilization. 

General conditioning exercises are used to increase heart and lung function as well assist in restoring necessary blood flow.

Parallel bars are vitally important for gait training.  On the road to recovery, preparing to walk is a monumental task requiring patience, dedication, an extraordinary amount of will power, and the assistance of a physical therapist.  Even if a patient can walk, they may find it extremely difficult without proper rehabilitative therapy.  Some injuries, such as those to the brain or spine, commonly effect motor skills and may cause spasms.  Gait training can help patients regain their normal ambulatory motion.

For people experiencing a change in their physical abilities, uneven parallel bars and rehabilitative therapy can have significant benefits.  Many people are familiar with the importance of rehabilitation following surgeries, injuries, strokes, etc.  However rehabilitative therapy has proven to have prodigious benefits for people with chronic illnesses or debilitating conditions such as arthritis, osteoporosis, and multiple sclerosis, which can fundamentally affect all areas of movement and function.  Spasticity, weakness, balance, dizziness, cognition, vision, and coordination are just some of the symptoms that can be improved through regular physical therapy.  Physical therapy also has an immense amount of psychological benefits that come along with an improvement of confidence, self image, public image, and overall sense of well-being.

Walking sticks

Walking sticks are useful if the resident needs a little extra stability when walking. Many different types are available, from simple metal or wooden sticks to sticks with a three or four pronged base for extra stability.

Many walking sticks are fairly lightweight, and some can also fold up making them easier to store and transport.

Crutches

There are two types of crutches – ones that goes under the resident arms and ones that rest under the elbows and forearms.

Underarm crutches are used to avoid putting weight on the resident legs whereas elbow crutches are used if the resident is able to put some weight on the legs.
          

Wheelchairs

The type of wheelchair the resident uses will depend upon their needs. Someone whose arthritis does not affect their hands or arms might want to use a self-propelled wheelchair whereas someone whose hands are affected might find it easier to use an electric wheelchair. For those who only need to use a wheelchair occasionally, one that can be pushed by someone else might be the best solution.              

Walkers

A Patient or Resident who has unilateral or bilateral lower-extremity weakness or can't bear weight on one leg can walk by shifting his weight to a lightweight walker. Someone with poor balance or at risk for falls can also use a walker for stability.

To prepare the resident to stand from a chair:

1. Have him slide forward in the chair and pull the walker in front of him. Tell him to place the back of his stronger leg against the chair seat and to put the weaker leg forward.
   
2. Have him put both hands on the armrests of the chair before pushing himself to a standing position.
   
3. Have him support himself with his stronger leg and his opposite hand, grasp the walker's grip with his free hand, then grasp the second grip with his opposite hand. Tell him to hold the handgrips firmly and equally as he stands.
   
4. After he's standing, make sure the walker is the correct height for your patient. His elbows should be flexed at a 15-degree angle when he stands with his hands on the grips. Ask a physical therapist to make any necessary adjustments.
   
5. If your patient has weakness in one leg, tell him to move the walker 6 to 8 inches (15 to 20 cm) ahead, step forward with the weak leg, support himself with his arms, then follow through with the stronger leg. Encourage him to take equal strides.
   
6. If he can't bear weight on one leg, show him how to advance the walker 6 to 8 inches and swing into it while supporting his weight on his arms.                       
   

Weight Bearing Status:

Before walking a resident or patient, always be sure to know how much weight he is allowed to put on either lower extremity. In most cases, the residents are able to put full weight through either leg, however, there are times when residents are assigned a weight bearing status. Abbreviations are listed below.

1. NWB - non weight bearing
2. PWB - partial weight bearing
3. WBAT - weight bearing as tolerated
4. FWB - full weight bearing

Patterns of Gait:

A person's gait is a pattern of stepping or walking that is specific to that individual. Gait training is needed to help a specific patient gain proficient and safe ambulation within and outside the home with or without an assistive device. Patients usually require gait training if there is some lower trunk or lower limb dysfunction. This dysfunction is often associated with neurological or orthopedic impairment. Complications that may require gait training include:

1. muscle weakness
2. deformity
3. spasticity (the presence of abnormal involuntary muscular contractions)
4. loss of sensation due to injury or disease that results in inaccurate sensory information and unsafe or inefficient motion
5. pain in the weight-bearing joints of the lower extremities, which causes distortion of normal gait

These complications may result from injury to or amputation of the lower extremities; surgery; osteoarthritis or other disorders of the weight-bearing joints; muscular dystrophy; muscle atrophy due to long periods of inactivity or bed rest; lesions of the brain or spinal cord; or changes in perception and other body functions that are part of the aging process.

Normal gait

In order to understand gait training, the reader may find a descriptive outline of normal human gait helpful. Human gait is measured from heel strike to heel strike, also known as the gait cycle or "one stride." The gait cycle has two phases, the stance (about 60% of the cycle)and the swing (about 40%). The point at which the body's weight is transferred from one foot to the other, when both feet are touching the ground, is called double stance or double support time. The speed of a person's walk is called the gait velocity, and the rhythm of their walk is called the cadence. Cadence is usually related to the length of the person's leg and their overall height; short people typically take smaller steps at a more rapid cadence while taller people take larger steps at a slower cadence.

Deviations in gait

Deviations from normal gait can occur in any portion of the lower extremity. Common abnormalities include:

1. Ankle/foot. Deviations of stance include foot slap and foot flat. Deviations of swing include toe drag (foot drop).
2. Knee. Abnormalities of stance include hyperextension of the knee. Abnormalities of swing include limited flexion of the knee.
3. Hip. Deviations of swing include circumduction and "hip hiking."
4. Trunk. Deviations of stance include lateral lean (Trendelenberg gait), backward lean (gluteus maximus gait), and forward lean.
5. Other. Ataxia (loss of muscular coordination) and antalgia (limping from pain).

Deviations can occur together as a group of compensations for one impairment. For example, a patient's gait may show foot drop as well as hip hiking.

Precautions

Before gait training the clinician must review all medical records and examine any pathologies or impairments that may affect the patient's ability to walk. Furthermore, through the rehabilitation evaluation, the clinician should have an understanding of the patient's present abilities and prior level of function. Once gait training begins, the clinician must choose the appropriate assistive device that will provide optimal stability and still allow the patient mobility.

The therapist should use a gait belt or similar device to help support the patient if he or she loses balance. Gait training should be done in a safe environment with few visual distractions, and with the patient wearing appropriate footwear. Some rehabilitation specialists have designed mechanical gait trainers with parachute harness systems that allow patients to practice their gait without overstraining the therapist.

Preparation

Patient assessment

In determining the patient's readiness for gait training, the therapist will evaluate the patient's physical abilities (weight-bearing, strength, stability, coordination and balance) and his or her mental and emotional readiness for gait training.

As a Restorative Aide you will closely follow the instructions of the Physical Therapist, Registered Nurse or Physician.

Go to Assignments in the Control Panel and take Unit 5 test, then proceed to Unit 6