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jkelly
Instructor
| Joined: | Fri Jun 20th, 2008 |
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Posted: Mon Mar 2nd, 2009 04:02 pm |
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Great Idea on the Shoe Lift. Thanks, I'll try that.
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Darren Joffs
Instructor
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Posted: Sat Feb 28th, 2009 12:32 pm |
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| I like to think in terms of what am I trying to get out of the training. While we know that offloading that much weight, a normal gait pattern in not possible, but it wouldn't be normal with standard practice by using a FWW with UE support either. We would just get a lot less of it by limiting the training time due to fatigue without body weight support. If I am just wanting to get the leg moving forward and back, allowing the body to produce hip flex/ext and knee flex/ext, offloading that much weight will allow me to achieve this while maintaining the weight bearing limits. Something I do for the setup to help prevent "cheating" by the patients who plantar flex and get weight through their toes regardless of the amount I lift a single side is the use of a shoe lift. We have one of those inexpensive velcro strap-on, shoe lifts. The 1" lift that is strapped around the shoe on the unaffected side will help limit cheating and you won't have to tilt the pelvis to an unnatural degree to keep them off their toes in an effort to put weight on their leg.
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WebKeeper
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| Joined: | Wed Jul 5th, 2006 |
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Posted: Sun Nov 2nd, 2008 05:09 pm |
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Your technique for setting up the weight bearing restriction is absultely correct. Once you know how much weight you want LiteGait to take off of the condition that is affected. That would be in your case left stance for left leg weight bearing restriction. You setup the straps so that in that condition the BiSym (total or sum reading) is showing the desired reduction in weight bearing. The distribution of this support between right and left, though it may impact the gait patterns or patient comfort, does not change the fact that the weight bearing restriction is in effect.
Once you are supporting more than 50% of patient weight even without the assymtry, the gait patterns will no longer be "normal" That is to say the muscle firing and joint angle ranges during gait will change. Once the support gets to 80% that exaggerates the deviation from normal. In the extreme of no weight bearing, you could dorsiflex the ankle and using LG gets the affected side heel off the ground and hence not allow any weight bearing on the side. But what does that do to your "normal" patterns? Obviously not possible to have normal patterns if there is little or no weight bearing. However, with assistance the hip and the knee could go through normal range if the PT deems that useful. LiteGait will prevent the weight bearing of the affected leg that of upper limbs, but the effects of drastically reduced weight bearing remains.
The right / left lack of symmetry will decide whether the unaffected side is doing more normal work or also being assisted. If you had 50% weight bearing restriction and in single leg support 40% was coming from affected side and only 10% from the sound leg, patient's active gait patterns could be near normal. Beyond that level of support, PT assistance is needed to cause good range as permitted.
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jkelly
Instructor
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Posted: Fri Oct 24th, 2008 08:49 pm |
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Hello all,
I wanted to discuss, and hopefully confirm, that I instructed people correctly for setting up the LiteGait to maintain an ortho patients MD ordered weight bearing restriction. His MD had given him a 40 lb. weight bearing restriction on his left leg. His PT wanted him to start walking in a more normal pattern, as he had been Non-weight bearing with a knee immobilizer for some time, and had developed some bad habits, and ROM restrictions at the knee.
Using the Bisym as a scale, we weighed the patient (both legs off the ground, no hands on bars). For ease, lets say he weighed 200 lbs. We had him practice static weight shifting in stance and stride positions onto and off of the left leg, and watched the Bisym to ensure he was not bearing more than 40 lbs. on the left (So, the Bisym -on total, would read 160 lbs or more with left stance), while adjusting the amount of BWS.
While walking, with assistance at the left leg to improve the pattern, and while using the Bisym as a biofeedback, the PT and the patient ensured that the Bisym did not read LESS THAN 160 during left stance...This is the part I initially struggled with...Although with that much BWS, it was very difficult for the patient to get a normal pattern on the right. By adjusting the straps to give more support on the left than on the right, eventually we did get a more reasonable pattern, but it was still not as good as we had hoped.
So my questions are:
1. Am I setting up the Litegait/reading the Bisym correctly to ensure maintenance of the weight bearing restriction?
2. Is this too much of a weight bearing restriction to expect a reasonable gait on the contralateral limb?
3. Has anybody else had experience with partial weight bearing restrictions on ortho patients, and have any tips for getting this done?
Thanks for any insight/discussion!
John Kelly
Trainer
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