Gait Patterns and Ambulation Aids

Gait patterns are determined by the patient's status ( WB restrictions, musculoskeletal/neuromuscular impairments, safety) and the environmental constraints. As we discuss weight bearing status, we will integrate specific gait patterns to address the stability, mobility and safety needs of the patient.

What is a "point" in an adaptive gait pattern?

 

Weight Bearing Status

Weight bearing status can be physician ordered, established by the PT, and/or modified during treatment based on the patient response. A physician's order for weight bearing status is in place until changed/updated by the MD/PCP. Radiographic or other diagnostic imaging, mobility status, and patient response (pain, safety) are all considered in clinical decision making for weight bearing activities.

Pre-gait activities

 

Summary Table of WB status

Weight bearing status

Description

 

Gait Pattern

Pattern description

NWB

No weight on the extremity

Three-Point

Use of walker or two crutches; Step to

Step through

Aid is advanced alternately with affected limb

PWB, also

TTWB

TDWB

Partial weight bearing

Three-One-Point or Modified Three Point

 

Use of walker or two crutches; Heel touch or flat foot with a fixed or proprioceptively-determined amount of WB in the affected limb

Aid is advanced simultaneously with affected limb

WBAT

Weight bearing As tolerated

Three-One-Point, Four point, or two point

(progress from most to least support from aid)

 

Use of walker, wheeled walker, or bilateral ambulation aids (crutches, canes); progression to more reciprocal pattern is dependent on patient safety, strength, confidence, and symptoms

FWB

Full weight bearing

Four point, or

two point

Use of walker or bilateral ambulation aid

Reciprocal pattern (slow to fast progression)

Unequal WB

Hemi pattern

Modified four-point

Modified two-point

Use of one ambulation aid (crutch, cane, hemi walker) or for patients with functional use of one upper extremity

LE and aid advance alternately (four-point) or simultaneously (two-point) ; aid is typically used on the contralateral side

 

Benefits of contralateral positioning

Bilateral Involvement Considerations

Use a patient-centered approach to critically assess which side of the body will most benefit from the cane. Specific considerations include:

 

 

 Show quiz question

Value: 1

A patient explains to a PTA that she was instructed to bear up to five pounds of weight on her involved extremity. The patient's WB status would be best described as:

 
 
 
 

 Show quiz question

Value: 1

A patient rehabilitating from a lower extremity injury has been non-weight bearing for three weeks. A recent physician entry in the medical record indicates the patient is cleared for WB up to 25 pounds. The most appropriate device to use when instructing the patient on the new WB status is:

 
 
 
 

 Show quiz question

Value: 1

An 86 year-old female is partial weight bearing on the left lower extremity after a total hip arthroplasty. Her upper extremity strength is 3+/5 and she resides alone. Which assistive device would be the MOST appropriate for the patient?