Discover the top 7 postural abnormalities. Learn how to effectively assess mobility. Find out the best assistive devices to enhance patient care and independence.
Table of Contents
Postural Abnormalities
- Torticollis: Twisting of the neck, causing the head to rotate and tilt.
- Lordosis: Excessive inward curve of the lumbar spine; often called swayback.
- Kyphosis: Abnormally excessive convex curvature of the thoracic or sacral spine.
- Scoliosis: Abnormal lateral curve of the spine.
- Congenital Hip Dysplasia: Hip socket doesn’t fully support the ball of the joint.
- Knock-Knee (Genu Valgum): Knees tilt inward while ankles stay apart.
- Clubfoot: Foot turns inward or downward; a congenital condition.
- Foot Drop: Inability to lift the front part of the foot; caused by peroneal nerve injury.
- Pigeon Toes: Inward rotation of a child’s feet.
Contractures
- Stiffness or constriction in connective tissues, limiting movement and causing deformities.
Muscle Impairments
- Muscular Dystrophy: Muscle-wasting conditions leading to weakened skeletal muscles.
- Overuse Injuries: Result from repetitive demand on muscles, leading to conditions like tendinitis, strain, and bursitis.
Musculoskeletal Trauma
- Fractures, Sprains, Strains, Contusions: Result from direct trauma affecting bones, joints, and muscles.
Central Nervous System (CNS) Damage
- CNS and Mobility: CNS damage impairs muscle coordination, leading to mobility issues. Spinal cord injuries can cause partial or total paralysis.
Treatment Approaches
- Postural Abnormalities: Physical therapy, braces, surgery, and exercises.
- Contractures: Stretching, physical therapy, bracing, or surgery.
- Muscle Impairments: Physical therapy, rest, and sometimes surgery for overuse injuries.
- Musculoskeletal Trauma: Immobilization, physical therapy, and sometimes surgical intervention.
- CNS Damage: Rehabilitation, assistive devices, and in some cases, surgery.
Mobility and Independence Assessment
Importance of Mobility:
- Essential for maintaining independent living.
- Limited mobility can severely affect Activities of Daily Living (ADLs).
- Interventions aim to prevent immobility hazards, avoid dependent disabilities, and restore or keep mobility.
Assessment of Patient Mobility
- Functional Mobility Level:
- Level 1: Can walk indefinitely, slight breathlessness after one flight of stairs.
- Level 2: Walks one city block or 500 ft, climbs one flight slowly.
- Level 3: Walks no more than 50 ft, can’t climb a flight of stairs without stopping.
- Level 4: Experiences dyspnea and fatigue at rest.
- Activities of Daily Living (ADLs):
- 0: Completely independent.
- 1: Requires equipment or device.
- 2: Needs help from another person (assistance, supervision, or teaching).
- 3: Needs help from another person and equipment or device.
- 4: Fully dependent, does not join in activity.
- Impairments to Mobility:
- Pain, paralysis, muscle weakness, systemic disease, immobilizing devices.
- Gait Assessment:
- Evaluate walking pattern to decide mobility and fall risk.
- Range of Motion (ROM):
- Assess joint movement to find physical problems.
- Skin Integrity:
- Check for signs of pressure ulcers, especially over bony prominences.
- Pathological Conditions:
- Detect bone disorders, joint impairments, muscle development issues, postural abnormalities, trauma, and neurological damage.
- Use of Assistive Devices:
- Notice effective use of devices that support mobility, prevent deformities, and improve function.
- Physiologic Adaptation:
- Watch for orthostatic hypotension, pallor, diaphoresis, nausea, tachycardia, and fatigue.
- Neurovascular Status:
- Check immobilized extremities initially every hour, then every 4 hours, to detect potential issues.
Assistive Devices: Enhancing Patient Mobility
Assistive devices are tools designed to help individuals with activities of daily living, particularly in improving mobility and independence. These devices can significantly enhance a person’s ability to move. They allow performing tasks and maintaining independence. This is especially true for those with physical limitations.
1. Wheelchairs
- Definition: A wheelchair is a device providing wheeled mobility and seating support for those who have difficulty walking or moving.
- Types: Manual (user-propelled or pushed by another) and electric-powered. There are also advanced versions like those controlled by neural impulses.
- Use: Suitable for individuals who can’t bear weight on their lower limbs. This product offers better support over long distances compared to walkers.
2. Crutches
- Function: Crutches increase the base of support, helping to transfer weight from the legs to the upper body.
- Types of Crutches:
- Axillary Crutches: Placed under the armpits with hand grips; typically used for short-term injuries.
- Forearm (Lofstrand) Crutches: Includes a cuff and handgrip, more suitable for long-term use.
- Gutter Crutches: Feature padded forearm supports, often used by those with partial weight-bearing restrictions like rheumatoid arthritis.
3. Walking Sticks/Canes
- Function: Canes offer support by transmitting weight from the legs to the upper body. They reduce pain. They improve balance. They enhance stability.
- Types:
- White Canes: Often used by visually impaired individuals.
- Quad Canes: Feature a wider base for extra stability.
- Forearm Canes: Give extra support with forearm bracing.
4. Walking Frames/Walkers
- Definition: Walkers are metal frameworks with four legs, providing a wider base of support than canes.
- Types: Include standard walkers, rollators (with wheels), knee walkers, and walker-cane hybrids.
- Use: Ideal for individuals with poor balance or limited arm strength, offering enhanced stability.
5. Gait Belt
- Definition: A gait belt is a 2-inch-wide belt used to secure a grip on unstable patients, providing stability during transfers.
- Use: Placed around the patient’s waist over clothing. It is used in one-person or two-person pivot transfers. It can also be used with a slider board.
6. Mechanical Lift
- Definition: A hydraulic lift is often ceiling-mounted. It is used for patients who can’t bear weight. It is also for those who are unpredictable or have medical conditions preventing them from assisting in movement.
- Use: Essential for moving patients safely from one position to another without strain.
7. Slider Boards
- Definition: A slider board (transfer board) assists in transferring an immobile patient from one surface to another while lying down.
- Use: Ideal for patients who can’t use their legs or when a standing transfer is unsafe.
