Assistive Devices, Weight Bearing Status, and Patient Recommendations: Enhancing Mobility and Safety

QUESTION

in a zero for the assignment. 1. Discuss the following assistive devices (level of stability/patient that would benefit from each, how to properly fit each to a patient, etc.) . Walker, Axillary Crutches, Forearm/Lofstrand Crutches, Cane 2. Define and Describe each weight bearing status (NWB, TTWB, PWB, WBAT, FWB) 3. Recommend an assistive device for the following patients. . Mr. Michaels is an active 27 yo male with injured his R ankle while playing basketball. The doctor in the ER has recommended he be NWB on R LE for 1 week. He lives in a 2-story walk-up apartment with no elevator. He works out of his very small, confined apartment. o Mrs. Adele is a 78 yo female who is now 1-day s/p R TKA. She has significant pain and swelling in her R knee and requires assistance for bed mobility and transfers. She is currently WBAT. Mr. Jones is a 74 yo male who is currently being seen in outpatient PT for recent balance issues. He states he has not yet fallen, but often loses his balance just walking around the house. He comes to PT independently and does not currently use an assistive device. He enjoys walking in his neighborhood and wants to continue this but feels a bit unsteady. 4. Explain how you would instruct a patient to use a unilateral assistive device, and provide a rationale for your instructions. 5. Describe how you would guard a patient ambulating on a level surface or on stairs and when moving from a sitting to a standing position and from a standing to a sitting position. 6. Describe how you would monitor a patient’s response to ambulation activities and how you would use the findings to plan the patient’s treatment

ANSWER

Assistive Devices, Weight Bearing Status, and Patient Recommendations: Enhancing Mobility and Safety

Assistive Devices: Enhancing Mobility and Stability

Walker
Level of Stability: High stability; suitable for patients with poor balance or lower extremity weakness.
Fitting: Adjust the walker’s height to match the patient’s wrist crease when the arms are relaxed at the sides. Ensure proper grip, and have the patient stand upright, holding the walker.
Benefits:Provides wide base support for maximum stability, suitable for those who require substantial support for walking.

Axillary Crutches
Level of Stability: Moderate stability; suitable for patients who can partially bear weight on their legs.
Fitting: Ensure crutches are adjusted to about 1-2 inches below the axilla. Have the patient stand upright and bear partial weight on their hands while adjusting the fit.
Benefits: Allows for partial weight bearing while providing increased mobility compared to walkers.

Forearm/Lofstrand Crutches
Level of Stability: Moderate stability; suitable for patients who can bear weight through their arms and hands.
Fitting:Adjust the cuff height to allow two fingers between the cuff and the patient’s ulnar styloid process. Ensure the handgrips are at wrist crease level while the patient’s arms hang freely.
Benefits: Offers more mobility and freedom of movement compared to axillary crutches.

Cane
Level of Stability: Low stability; suitable for patients with mild balance issues or minor lower extremity weakness.
Fitting: The top of the cane should align with the patient’s greater trochanter. The patient should hold the cane on the opposite side of the affected limb.
Benefits: Provides minimal support and stability, making it suitable for patients who need only slight assistance.

Weight Bearing Status: Understanding and Defining

NWB (Non-Weight Bearing): The patient should not bear any weight on the affected limb.
TTWB (Toe Touch Weight Bearing): The patient can touch the affected limb’s toes to the ground for balance, but no weight should be transferred.
PWB (Partial Weight Bearing): The patient can bear a limited amount of weight on the affected limb as tolerated.
WBAT (Weight Bearing As Tolerated): The patient can bear as much weight as they can tolerate without causing pain or discomfort.
FWB (Full Weight Bearing): The patient can bear full weight on the affected limb without any restrictions.

Patient Recommendations: Enhancing Mobility and Safety

Mr. Michaels: For his NWB status, a wheelchair or knee scooter would be suitable to help him move around his apartment and perform daily tasks while keeping the RLE non-weight bearing.
Mrs. Adele:Given her WBAT status and the need for assistance, a walker with a seat could help her move around, perform transfers, and provide support for her knee.
Mr. Jones: Considering his balance issues and desire to walk independently, a single-point cane could enhance his stability while walking in his neighborhood.

Instruction, Safety, and Monitoring: Ensuring Effective Mobility Care

Instructing Unilateral Assistive Device Use: To use a cane, instruct the patient to hold the cane on the opposite side of the affected limb. Rationale: This ensures proper weight distribution, stability, and support during ambulation.

Guarding Ambulation and Transfers: During ambulation on level surfaces, stand on the weaker side of the patient, ready to assist. On stairs, the patient should ascend with the stronger leg first and descend with the weaker leg first. When moving from sitting to standing, ensure a stable base of support and monitor for signs of dizziness or imbalance.

Monitoring Patient’s Response: Observe the patient’s gait, balance, and stability during ambulation. Assess for signs of fatigue, discomfort, or instability. Use findings to modify treatment plans, adjust assistive devices, or incorporate balance exercises to address any issues and enhance patient outcomes.

By integrating proper assistive devices, understanding weight bearing statuses, making tailored recommendations, providing clear instructions, and ensuring safety during ambulation, healthcare professionals can enhance patient mobility and improve overall quality of life.