Deck 14: Navigating the Challenges of Ambulating

Question 1

Your patient is an 83-year-old man who was referred to you after he fell in his bathroom. Which of the following is the best predictor of this patient's risk of future falls?

A) His history of previous falls
B) His limited trunk strength
C) His living environment
D) His short-term memory loss

Answer 1

A

Question 2

Another way to describe forearm crutches.

Answer 2

B

Question 3

Your patient is a 72-year-old woman who fell at home and had surgery to repair a fractured left femur. The orthopedic surgeon has ordered a 25-lb. weight-bearing restriction on the left leg during gait. Which of the following methods will be most effective in ensuring compliance with this order?

A) Defer gait training until her condition is upgraded to weight-bearing as tolerated.
B) Instruct her regarding the limit by using a bathroom scale.
C) Question her frequently during gait training.
D) Use a limb-load monitor during gait training.

Answer 3

D

Question 4

Your patient is beginning to walk after a brain injury. You observe that he hikes his right hip when he advances that limb. Which of the following represents the most appropriate reason for addressing this gait deviation in your treatment plan?

A) It calls attention to his gait pattern.
B) It increases his fall risk.
C) It makes assistive device selection more challenging.
D) The resulting gait is less energy-efficient.

Question 5

Your patient is a 79-year-old woman who has just had right total hip arthroplasty because of degenerative joint changes. You are going to walk with her while she is using a walker. What is the best position for guarding this patient?

A) Standing directly behind her
B) Standing directly in front of the patient
C) Standing behind the patient and slightly to the left
D) Standing behind the patient and slightly to the right

Question 6

Your patient is a 57-year-old man who has just had undergone surgical revision of total right hip arthroplasty and is able to comply with his right lower-extremity 30-lb. weight-bearing restriction. Which of the following is the best instruction for a sit-to-stand transfer with his walker?

A) Extend the right knee and keep the foot in front of the body while rising to a standing position.
B) Extend the right knee and keep the foot off the ground completely while rising to a standing position.
C) Extend the left knee and keep the foot in front of the body while rising to a standing position.
D) Place both feet underneath the body while rising to a standing position.

Question 7

Which of the following is not a technique used to initiate a sit-to-stand transfer when the patient has lower-extremity weakness?

A) Rocking to gain momentum
B) Using hip adduction to press the knees together
C) Bracing the lower legs against the chair
D) Extending both knees to place the feet farther away from the chair

Question 8

Which of the following is true of balance?

A) It is mediated exclusively by the vestibular system.
B) It is primarily a concept related to dynamic mobility.
C) It is the ability to maintain the BoS within the CoM.
D) It is the ability to maintain the CoM within the BoS.

Question 9

Your patient is a 69-year-old man who sprained his left ankle. You are teaching him to walk with a single-point cane. He has stairs to climb at home, so you are teaching him to go up and down steps with the cane. Which instruction will you give him?

A) Place the cane on the step above, followed by the left leg, then the right leg.
B) Place the cane on the step above, followed by the right leg, then the left leg.
C) Place the right foot on the step above, followed by the cane and the left leg simultaneously.
D) Place the left foot on the step above, followed by the cane and the right leg simultaneously.

Question 10

Your patient underwent total right hip arthroplasty (posterior approach) 2 days ago. She required frequent reminders regarding movement precautions because she was getting out of bed. You are now initiating gait training with a walker. When it is time to turn around and walk back to her chair, in which direction should you instruct her to turn?

A) Toward either side is acceptable
B) Toward her dominant side
C) Toward her left side
D) Toward her right side

Question 11

Which of the following statements regarding adjustment of assistive gait devices is true?

A) Upper-extremity effort is minimized when the device the fitted so that the elbow is flexed to approximately 45°.
B) Optimal elbow angles vary from device to device.
C) The hand grip of the device should come to the level of the pelvic crest.
D) Crutches and canes should be adjusted so that they fit when the patient is standing with the tips of the devices placed about 4 to 6 in. forward and 2 in. to the side.

Question 12

Provides the greatest amount of stability for the patient in a standing position

Question 13

Which of the following is true of rollator walkers?

A) They allow patients to walk with less energy expenditure than standard walkers.
B) They are hinged in the middle to allow the walker to be advanced one side at a time.
C) The patient propels the device using the lower extremities from a seated position.
D) They are ideal for patients who have difficulty ambulating short distances.

Question 14

When selecting an assistive gait device, it is important to remember that the purpose of the device is to minimize the immobilizing effects of a patient's condition. Which statement best summarizes how this selection is made?

A) The device is chosen based on the amount of weight-bearing it will allow.
B) The device is chosen based primarily on the physician's orders.
C) The device is chosen because it provides the least amount of restriction.
D) The device is chosen based on the patient's size.

Question 15

You have been working with a patient who had a stroke 3 weeks ago. He has made excellent progress with gait recovery and is now walking on level surfaces with a single-point cane, but he occasionally loses his balance when negotiating obstacles. Which of the following represents the best guarding position for this patient while he is practicing negotiating obstacles during gait training?

A) Maintain your grasp on the gait belt with both hands at the back and center of the trunk.
B) Maintain your grasp on the gait belt with one hand hovering near the shoulder.
C) Maintain your loose overhand grasp on the gait belt with one hand.
D) Maintain your position close to the patient with neither hand on the belt.

Question 16

When guarding a patient on steps, which of the following statements is true?

A) Always guard the patient on the weaker side while ascending and descending the stairs.
B) Always stand behind the patient while descending the stairs.
C) Always stand between the patient and the direction in which the patient is most likely to fall.
D) Always stand in front of the patient while ascending stairs.

Question 17

You have just completed an evaluation of a patient in your outpatient clinic. This patient needs gait training after sustaining a stroke. Which of the following tasks would be considered "gait training" instead of "ambulating" with the patient?

A) Completing a 5-min walk with the patient
B) Facilitating advancement of the patient's hemiparetic leg during treadmill training
C) Guarding the patient during treadmill walking for endurance
D) Transporting portable oxygen for the patient during walking

Question 18

Which of the following is true of weight-bearing restrictions in general?

A) Non-weight-bearing is preferred over toe-touch weight-bearing because non-weight-bearing produces less force on the hip of the involved extremity.
B) Weight-bearing status is determined by the patient's weight rather than by injury or pathology type.
C) Weight-bearing prescriptions are commonly expressed as percentages of body weight based on a typical adult's body weight.
D) Partial weight-bearing is universally recognized to mean 25% of the patient's body weight.

Question 19

Your patient is a 15-year-old girl who has just had knee surgery following a volleyball injury, and you are fitting her with axillary crutches. Which of the following is the greatest risk for the patient if her axillary crutches are too tall?

A) The crutches will increase the energy expenditure required for ambulation.
B) The crutches will be unstable and increase the risk of falling.
C) The crutches will cause irritation of the rib cage and make using the crutches painful.
D) The crutches will cause pressure in the axilla, potentially damaging nerves and vessels.

Question 20

How much knee flexion range of motion is typically needed to descend steps?

A) From 7° to 65°
B) From 10° to 92°
C) From 20° to 87°
D) From 25° to 95°

Question 21

To stabilize a patient who is in the process of a(n) ________________fall, the clinician attempts to bring the patient's CoM back over his or her BoS.

Question 22

Cannot be used when non-weight-bearing status on one extremity is required Completion
Complete each statement.