E & D 5 ambulation, gait patterns
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| An appropriate gait pattern is determined by | the amount of weight bearing permitted and the severity of the patientʼs overall condition.
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| Commonly used gait patterns include | two-point, three-point, four-point, swing-to, and swing-through.
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| Two-point gait pattern in which a patient uses | two crutches or canes. The patient ambulates moving the left crutch forward while simultaneously advancing the right lower extremity and vice versa.
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| Two-point gait Each step is | one-point and a complete cycle is two-points.
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| Three-point gait This pattern can be seen with | a walker or crutches. It involves one injured lower extremity that may have decreased weight bearing.
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| Three-point gait | The assistive device is advanced followed by the injured lower extremity and then the uninjured lower extremity.
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| Three-point gait | The assistive device and each lower extremity are considered separate points.
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| Four-point gait | This pattern is very similar to the two-point pattern.
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| Four-point gait The primary difference between 2 point | is that the patient does not move the lower extremities simultaneously with the device, but rather waits and advances the opposite leg once the crutch/cane has been advanced.
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| Four-point gait This gait pattern may be prescribed when a patient exhibits | impaired coordination, balance or significant strength deficits.
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| Four-point gait Each advancement of the crutch or cane | as well as the bilateral lower extremities indicates a single point, thus allowing for a four-point gait pattern.
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| Swing-to gait A gait pattern where a patient with | bilateral trunk and/or lower extremity weakness, paresis or paralysis, uses crutches or a walker and advances the lower extremities simultaneously only to the point of the assistive device.
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| Swing-through gaitn A gait pattern where the patient | performs the same sequence as a swing-to gait pattern, however, advances the lower extremities beyond the point of the assistive device.
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| Guidelines for Guarding during Ambulation | A gait belt is recommended
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| Guidelines for Guarding during Ambulation Stand | to the side (usually the affected side) and slightly behind the patient
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| Guidelines for Guarding during Ambulation Grasp the gait belt | with one hand; place the other hand on the patientʼs shoulder
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| Guidelines for Guarding during Ambulation | Do not grasp the arm, as it will interfere
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| Guidelines for Guarding during Ambulation Move your lead foot | forward when the patient moves; the assistive device and your back leg should advance as the patient ambulates
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| Guidelines for Guarding during Ambulation A therapist must always consider | the size, weight, and level of impairment of the patient prior to initiating ambulation activities.
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| Guarding guidelines may require | modification and/or a second therapist may be required.
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| Guidelines for Guarding during Stair and Curb Training | A gait belt is recommended
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| Guidelines for Guarding during Stair and Curb Training When ascending stairs or curbs, | remain behind the patient (usually towards the weaker side).
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| Guidelines for Guarding during Stair and Curb Training Place the lead foot | on the same step as the patient and the other foot one step lower.
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| Guidelines for Guarding during Stair and Curb Training Hold the gait belt | in one hand and position the other hand on the patientʼs shoulder.
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| Guidelines for Guarding during Stair and Curb Training Remain | static when the patient is moving, then advance keeping your feet in stride position.
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| Guidelines for Guarding during Stair and Curb Training When descending stairs or curbs, | remain in front of the patient and usually towards the weaker side.
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| Guidelines for Guarding during Stair and Curb Training When descending stairs | Place the lead foot on the step that the patient will step on and the other foot one step lower.
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| Guidelines for Guarding during Stair and Curb Training When descending stairs Hold the gait belt | in one hand and position the other hand on the front of the patientʼs shoulder.
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| Guidelines for Guarding during Stair and Curb Training When descending stairs | Remain static when the patient is moving, then advance keeping your feet in stride position.
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| Independent: | The patient does not require any assistance to complete the task.
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| Supervision: | The patient requires a therapist to observe throughout completion of the task.
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| Contact Guard: | The patient requires the therapist to maintain contact with the patient to complete the task. Contact guard is usually needed to assist if there is a loss of balance.
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| Minimal Assist: | The patient requires 25% assist from the therapist to complete the task.
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| Moderate Assist: | The patient requires 50% assist from the therapist to complete the task.
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| Maximal Assist: | The patient requires 75% assist from the therapist to complete the task.
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| Dependent: | The patient is unable to participate and the therapist must provide all of the effort to perform the task.
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| Non-weight bearing (NWB): | A patient is unable to place any weight through the involved extremity and is not permitted to touch the ground or any surface. An assistive device is required.
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| Toe touch weight bearing (TTWB): | A patient is unable to place any weight through the involved extremity, however, may place the toes on the ground to assist with balance. An assistive device is required.
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| Partial weight bearing (PWB): | A patient is allowed to put a particular amount of weight through the involved extremity.
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| Partial weight bearing (PWB): | The amount of weight bearing is expressed as allowable pounds of pressure or as a percentage of total weight.
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| Partial weight bearing (PWB): | A therapist must monitor the amount of actual weight transferred through the involved foot during partial weight bearing. An assistive device is required.
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| Weight bearing as tolerated (WBAT): | A patient determines the proper amount of weight bearing based on comfort. The amount of weight bearing can range from minimal to full. An assistive device may or may not be required.
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| Full weight bearing (FWB): | A patient is able to place full weight on the involved extremity. An assistive device is not required at this level, but may be used to assist with balance.
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