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1. Gait & Ambulation Aids Flashcards

1
Q 
# Define: Stride Length - Step Length & Width - Cadence ๐Ÿ”‘๐Ÿ”‘
What is the normal step length?
A

STRIDE

Initial contact of a limb and the subsequent initial contact of that same limb.

One gait cycle is also referred to as a stride.

STRIDE LENGTH

It is the distance measured from heel strike to heel strike of the same foot

STEP LENGTH

It is distance measured from heel strike of one foot to heel strike of the other foot.

Normally = 15 to 20 inches โ€œ1.25-1.66 Feetโ€

Step Length x 2 = Stride Length

STEP WIDTH

The distance between the center of the feet during the double limb support portion of the gait cycle when both feet are in contact with the ground.

Normal base of support (distance between heels) = 6 to 10 cm

CADENCE

The number of steps taken in 1 minute. Average is 80 to 110 steps per minute.

This corresponds to an average walking speed of 60 to 80 m/min, 5 km/h or 3mph.

Cuccurollo 4th Edition Chapter 6 P&O pg457-458

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2
Q

Gait Cycle ๐Ÿ”‘๐Ÿ”‘

List the 3 tasks of a gait cycle List the 5 periods of stance and 3 periods of swing gait

List 8 phases of gait cycle

In which phase of the gait cycle does the body have the lowest centre of gravity?

In which phase of the gait cycle does the body have the highest centre of gravity?

A

TASKS

  1. Weight acceptance
  2. Single limb support
  3. Limb advancement

STANCE PHASE 60%

Initial Contact (IC) ุจุฏุงูŠุฉ ุงู„ู…ู„ุงู…ุณุฉ

When foot comes in contact with the ground

Other limb in preswing phase.

Loading Response (LR) ุจุนุฏ ูˆุถุน ุงู„ู‚ุฏู… ุฅู„ู‰ ุฑูุน ุงู„ู‚ุฏู… ุงู„ุซุงู†ูŠุฉ

Initial contact to the time when the contralateral foot leaves the ground

Other limb in initial swing phase

๐Ÿ’ก The body has the lowest COG during loading response. (weight shift occurs)

Midstance (MSt) ู…ู† ุฑูุน ุงู„ู‚ุฏู… ุฅู„ู‰ ุฅู„ุชู‚ุงุก ุงู„ูƒุงุญู„ูŠู†

๐Ÿ’ก The body has the highest COG during midstance.

Time period from lift of the contralateral extremity from the ground to the point where the ankles of both extremities are aligned in the frontal (or coronal) plane

Terminal Stance (TSt) ู…ู† ุจุนุฏ ุฅู„ุชู‚ุงุก ุงู„ูƒุงุญู„ูŠู† ุฅู„ู‰ ู‚ุจู„ ูˆุถุน ุงู„ู‚ุฏู…

Time period from ankle alignment in the frontal plane to just prior to initial contact of the contralateral (swinging) extremity

Preswing (PSw) ูˆุถุน ุงู„ู‚ุฏู… ูˆู‚ุจู„ ุทู„ูˆุน ุงู„ู‚ุฏู… ุงู„ุซุงู†ูŠุฉ

Time period from initial contact of the contralateral extremity to just prior to lift of the ipsilateral extremity from the ground (unloading weight)

SWING PHASE 40%

Initial Swing (ISw) ุทู„ูˆุน ุงู„ู‚ุฏู… ูˆุซู†ูŠ ุงู„ุฑูƒุจุฉ

Lift of the extremity from the ground to position of maximum knee flexion

Midswing (MSw) ู…ู† ุซู†ูŠ ุงู„ุฑูƒุจุฉ ุฅู„ู‰ ูˆุถุน ุงู„ุฑุฌู„ ุนู…ูˆุฏูŠุงู‹

Immediately following knee flexion to vertical tibia position

Terminal Swing (TSw): ู…ุฏ ุงู„ุฑูƒุจุฉ ูƒุงู…ู„ุฉูŽ ุฅู„ู‰ ุจุฏุงูŠุฉ ุงู„ู…ู„ุงู…ุณุฉ

Following vertical tibia position to just prior to initial contact

Cuccurollo 4th Edition Chapter 6 P&O pg458

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3
Q

Limb Support ๐Ÿ”‘๐Ÿ”‘

A

DOUBLE LIMB SUPPORT (80%)

Time period during which both feet are in contact with the floor.

Both the beginning and end of the stance phase

SINLG LIMB SUPPORT (20%)

Time period starts when the opposite foot is lifted for the swing phase

Cuccurollo 4th Edition Chapter 6 P&O pg457

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4
Q

Seep walking vs Running effect on gait cycle ๐Ÿ”‘๐Ÿ”‘

A

Walking faster decreases the time spent in stance phase, increasing time spent in swing phase

Running have no double limb support.

Cuccurollo 4th Edition Chapter 6 P&O pg457

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5
Q

Max hip flexion, knee and ankle dorsiflexion ๐Ÿ”‘๐Ÿ”‘

A

Initial Swing

  • Max knee and ankle flexion

Mid Swing

  • Max hip flexion โ†’ to shorten the length
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6
Q

Gravity line and Centre of gravity. ๐Ÿ”‘๐Ÿ”‘

A

CENTER OF GRAVITY (COG)

Typically located 5 cm anterior to the S2 vertebra at the level of PSIS

The COG is displaced 5 cm (<2 inches) horizontally and 5 cm vertically during an average adult male step.

GRAVITY LINE

  • Behind the cervical vertebrae
  • In front of the thoracic vertebrae
  • Behind the lumbar vertebrae
  • Posterior to the hip joint and tends to passively extend the hip joint โ†’ countered by anterior ileofemoral ligament
  • Anterior to the knee joint and tends to passively extend the knee โ†’ quadriceps weakness result in genu recurvatum
  • Passes 1 to 2 inches anterior to the ankle joint and tends to dorsiflex the ankle โ†’ resisted by the soleus and gastrocnemius muscles.

Cuccurollo 4th Edition Chapter 6 P&O pg458

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7
Q

What is the normal velocity for walking?

A

NOTE: this is the walking speed that is most efficient.

Comfortable walking speed = 80 m/min or 3 mph or 4.8 kph

Cuccurollo 4th Edition Chapter 6 P&O pg458

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8
Q

List 5 determinants of gait that reduce excursion of centre of mass ๐Ÿ”‘๐Ÿ”‘ EXAM

A

๐Ÿ’ก Actual COG displacement is approximately 5 cm (2 inches)

IMPORTANCE

  1. Minimize deviation of the bodyโ€™s COG (COG follows a smooth, sinusoidal path)
  2. Minimize energy expenditure

DETERMINANTS OF GAIT

  1. Lateral pelvis displacement
    Displacement toward the stance limb, shifting COG of the body to lie above the base of support (the stance foot).
  2. Pelvic rotation
    Pelvis rotates medially (4-degree pelvic rotation) on the swinging leg side, lengthening the limb as it prepares to accept weight.
  3. Pelvic tilt
    Pelvis on the side of the swinging leg (opposite to the weight-bearing leg) is lowered 4โ€“5 degrees. This lowers the COG at midstance.
  4. Knee flexion in stance
    Lowers the COG (minimizing its vertical displacement) by early knee flexion during heel stroke or initial contact thus shortening the hip-to-ankle distance.
  5. Knee mechanisms
    Restoring leg length after midstance, knee extends as the ankle plantar flexes
  6. Foot mechanisms
    Three pivot points (rockers) at the heel, ankle, and forefoot smoothens the curve of the falling pelvis.

Cuccurollo 4th Edition Chapter 6 P&O Table 6-2 pg459

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9
Q

Prerequisites of Gait ๐Ÿ”‘๐Ÿ”‘ EXAM

A
  1. Stability in stance
  2. Clearance in swing
  3. Preposition of the swing foot
  4. Adequate step length
  5. Energy conservation
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10
Q

Foot rockers

A
  1. Heel Rocker: Initial contact & weight acceptance
    • Goal is absorbing the shock and weight descending from body to knee to foot
    • Quadriceps muscle contract to limit knee flexion moment arm
    • Tibialis anterior muscles will eccentric contract to resist planterflexion (limit foot drop)
  2. Ankle Rocker: Midstance
    • Goal is smooth tibial progression
    • Soleus contract to decelerate and control the dorsiflexion during midstance.
  3. Forefoot Rocker: Heel raise
    • To provide a rolling-like mechanism of foot during stance
    • To preserved the momentum and aid in limb advancement
    • Gastrocnemius and soleus contract to produce planterflexion
  4. Toe Rocker
    • Plantar flexors thrusts the tibia forwards moving from pre-swing to swing.
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11
Q

Muscle Activity ๐Ÿ”‘๐Ÿ”‘ EXAM

  1. Give actions of the following muscles in the mid-stance of the gait cycle
  2. List 3 muscles and their action at initial contact
  3. Is their concentric or eccentric contraction in the following muscles at loading response
  4. What lower extremity muscle group performs CONCENTRIC contraction?
  5. List the two periods of gait cycle that the ankle dorsiflexors activate and describe its function
A

Concentric

  • IP - PT - Calf

Dorsiflexors

  1. Initial Contact: eccentrically to decelerate passive plantar flexion of ankle.
  2. Initial Swing: concentrically to dorsiflex ankle to clear foot in swing.
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12
Q

What are the requirements for sufficient clearance in swing phase?

Another word: sufficient swing needs ..

A

๐Ÿ’ก One leg is stable while the other swing properly.

  1. Stability on the stance limb
  2. Adequate dorsiflexion, knee flexion and hip flexion on the swing limb
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13
Q

List 3 muscles and their action at heel strike ๐Ÿ”‘

A
  1. Tib Ant, EHL, ED, Eccentric Contraction โ†’ Preventing foor slap via controlling dorsiflexion
  2. Quadriceps, Eccentric Contraction โ†’ Controlling knee extension to prevent knee buckling
  3. Gluteus & Hamstring, Eccentric Contraction โ†’ Prevent hip flexion
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14
Q

In quiet standing, which muscles maintain the body in erect position? ๐Ÿ”‘๐Ÿ”‘ Dr. Haitham

A

Ankle planterflexors, gastrocsoleus complex

Ground reaction force is placed anterior to ankle joint forcing it into dorsiflexion, thus ankle stability is maintained by continuous contraction of the gastrocsoleus to produce a counter force (planterflexion) to stabilize ankle joint moment (torque)

PMR Secrets 3rd Edition Chapter 11 pg114 Q14

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15
Q

You are examining a 36 years old patient in the OPD. You have noticed that he has genu recurvatum during the stance phase. Mention 2 possible causes? (marks) What are the possible causes of genu recurvatum during the stance period of gait? Provide three lower extremity reasons for knee hyperextension in early stance. ๐Ÿ”‘๐Ÿ”‘

A
  1. Spastic quadriceps
  2. Compensation for weak quadriceps
  3. Weak hamstring
  4. Achilles tendon contracture
  5. Plantar flexor spasticity

Cuccurollo 4th Edition Chapter 6 P&O pg461 Table 6-4

PMR Secrets 3rd Edition Chapter 11 pg114 q18

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16
Q

When is patient with dorsiflexion weakness suspected to have foot slap? ๐Ÿ”‘๐Ÿ”‘ Dr. Abdulrazaq

A

Severely weak dorsiflexors <3/5, motor power less than โ€œanti-gravityโ€

Cuccurollo 4th Edition Chapter 6 P&O Table6-4 pg461

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17
Q

List 2 cause of Steppage gait/foot drop. List 4 DDx for foor drop ๐Ÿ”‘๐Ÿ”‘

A

BIOMECHANICAL CAUSES

  1. Severely weak dorsiflexors grade <3/5
  2. Equinus deformity (planterflexion contracture)
  3. Plantar flexor spasticity

Cuccurollo 4th Edition Chapter 6 P&O Table6-4 pg461

DEFFERENTIALS

  1. Anterior compartment syndrome of lower leg (deep peroneal neuropathy).
  2. Peroneal neuropathy at the fibular head.
  3. Sciatic neuropathy (preferential involvement of peroneal division).
  4. Lumbosacral plexopathy.
  5. L5 radiculopathy.

Preston shapiro pg 346.

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18
Q

List 3 causes of Wide base of support ๐Ÿ”‘

A
  1. Hip abductor muscle contracture
  2. Instability
  3. Genu valgum
  4. Leg length discrepancy

Cuccurollo 4th Edition Chapter 6 P&O Table6-4 pg461

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19
Q

List 2 causes Excessive foot supination ๐Ÿ”‘

A
  1. Forefoot valgus deformity (Tibialis posterior & anterior spasticity post stroke)
  2. Pes cavus
  3. Short limb

Cuccurollo 4th Edition Chapter 6 P&O Table6-4 pg461

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20
Q

List 4 causes of Increased knee flexion ๐Ÿ”‘๐Ÿ”‘

A
  1. Hamstring contracture/Spasticity
  2. Increased ankle dorsiflexion
  3. Weak plantar flexor (opposite of spastic PF โ†’ extension)
  4. Hip flexion contracture
  5. Long limb

Cuccurollo 4th Edition Chapter 6 P&O Table6-4 pg461

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21
Q

List 2 causes of Excessive trunk lateral flexion & Waddling gait ๐Ÿ”‘๐Ÿ”‘

A

Uncompensated right Trendelenburg gait

Pelvis drops on the contralateral side (excessive pelvic tilt)

Compensated Trendelenburg gait

Leans his or her trunk to the ipsilateral to prevent left pelvic drop

Causes of Excessive trunk lateral flexion

  1. Ipsilateral gluteus medius weakness, uncompensated trendelenburg
  2. Hip pain โ€œangaltic gaitโ€

Causes of Waddling gait

  1. Bilateral gluteus medius weakness, myopathic gait

Cuccurollo 4th Edition Chapter 6 P&O Table6-4 pg461

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22
Q

List 3 causes of Hip hiking ๐Ÿ”‘๐Ÿ”‘

A
  1. Quadratus lumborum shortening
  2. Long limb
  3. Stiff knee
  4. Weak hamstring โ€œlimited knee flexionโ€

Cuccurollo 4th Edition Chapter 6 P&O Table6-4 pg461

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23
Q

List 2 causes of Circumduction ๐Ÿ”‘๐Ÿ”‘

A
  1. Abductor muscle shortening or overuse
  2. Long limb
  3. Stiff knee
  4. Dropped foot

Cuccurollo 4th Edition Chapter 6 P&O Table6-4 pg461

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24
Q

What are the difference between toddler and adult gait? 4 marks ๐Ÿ”‘๐Ÿ”‘ EXAM

A
  1. Wider base support
  2. Reduced stride length with higher cadence
  3. No heel strike
  4. Little knee flexion during standing
  5. No reciprocal arm swing
  6. External rotation of entire leg during swing phase

PMR Secrets 3rd Edition Chapter 11 pg115 q22

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25
Q

At what age the child would go upstairs and down stairs with alternating feet? (2 marks)๐Ÿ”‘๐Ÿ”‘

A

Upstairs 3 years

Down stairs 4 years

PM&R secrets 2nd edition P416

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26
Q

When does an infant acquire the ability to walk supported? To walk unsupported? To run?

A
  • Walk supported by 12 months
  • Walk unsupported by 15 months
  • Run by 18 months
  • Mature gait pattern is established by 3 years old

PMR Secrets 3rd Edition Chapter 11 pg115 q21

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27
Q

Elderly gait compared to young adults? 1 mark

A

Reduced peak hip extension

PMR Secrets 3rd Edition Chapter 11 pg115 q23

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28
Q

Gait Impairment Post Stroke ๐Ÿ”‘๐Ÿ”‘ List 5 stance phase gait abnormalities in hemiplegic leg

A

HEMIPLEGIC GAIT

  1. Hip circumduction, hip hiking, and contralateral vaulting with excessive elevation of the pelvis to avoid toe drag
  2. Reduced knee flexion during swing and stance phases (spastic paretic stiff-legged gait)
  3. Knee hyperextension (dynamic recurvatum) during stance
  4. Excessive ankle plantar flexion (equinus) during swing and/or stance: ankle dorsiflexor weakness, plantar-flexor spasticity, or ankle plantar flexion contracture.
  5. Asymmetry of stepping
  6. Reduced duration of single-limb stance (SLS) on the affected side
  7. Prolonged duration of double-limb stance (DLS) on the affected side

DeLisa 5th Edition Chapter 5 Human Walking pg132

STANCE PHASE

  1. Short/absent heel strike
  2. Limited knee flexion
  3. Limited ankle dorsi-flexion
  4. Poor push off
  5. Short stance time
  6. Increased double stance

SWING PHASE:

  1. Truncal lurch towards unaffected side
  2. Hip hiking
  3. Vaulting
  4. Circumduction
  5. Hyperextension of the knee
  6. Trendelenburg gait???

Review course notes โ€“ 2010/2012 โ€“ Gait section (pg 55)

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29
Q

What are expected gait abnormalities in a patient with antalgic gait. ๐Ÿ”‘๐Ÿ”‘

A

Affected limb:

  1. Decreased stance phase time
  2. Increased swing phase time
  3. Decreased weight bearing
  4. Lateral Trunk lurch over affected hip during stance

Unaffected limb:

  1. Increased stance phase time
  2. Decreased swing phase time
  3. Decreased step length

Overall:

  1. Reduced walking speed
  2. Increased displacement of COG
  3. Increased energy expenditure

Flash Cards

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30
Q

Gait Impairment in Parkinsonโ€™s Disease ๐Ÿ”‘๐Ÿ”‘ EXAM

A

PARKINOSN GAIT

  1. Stooped posture
  2. Festinating gait
  3. Shuffling
  4. โ€œStart hesitationโ€
  5. Reduced step length
  6. Decreased arm swing
  7. Reduced trunk rotation
  8. Severe instances freezing while walking or turning (โ€œfreezing gaitโ€)

TRAPGH (CARDINAL SIGNS)

  1. Resting tremor
  2. Rigidity & Bradykinesia
  3. Stooped posture with instability
  4. Shuffling Gait
  5. Hypophonia

Cuccurollo 4th Edition Chapter 6 P&O pg462

31
Q

List 4 musculoskeletal abnormalities in crouch gait.๐Ÿ”‘๐Ÿ”‘

A
  1. Tight hip flexors
  2. Tight hamstrings
  3. Weak plantarflexors
  4. Excessive ankle dorsiflexion (over-lengthed heel cords).

Ref: European Journal of Neurology2001,8 (Suppl. 5):98ยฑ108

32
Q

Does varus or valgus knee aligment affect progression of knee OA with ambulation?

Mention one shoe modification to fix it.

A

Yes, 5 degree varus increases knee torque on medial compartment.

5 degree of lateral wedge (to force knee valgus) reduced peak knee varus torque by 6%

PMR Secrets 3rd Edition Chapter 11 pg15 q25&26

33
Q

Do high-heeled shoes increase the risk for OA of the knee? What about moderate-heeled shoes? ๐Ÿ”‘๐Ÿ”‘

A

High-heel shoes 2.5 inch or 6 cm increases force across patellofemoral joint and greater compressive force on medial compartment of the knee (23% greater).

Moderate-heel shoes 1.5 inch or 4 cm increase varus torque 14% and knee flexor torque 19%

PMR Secrets 3rd Edition Chapter 11 pg116 q27&28

34
Q

Gait Impairment With Hip Flexion Contracture

A
  1. Decreased hip extension range of motion (ROM)
  2. Increased anterior pelvic tilt
  3. Decreased contralateral step length
  4. Increased knee flexion.

Cuccurollo 4th Edition Chapter 6 P&O pg462

35
Q

Gait Impairment in Duchenne Muscular Dystrophy ๐Ÿ”‘๐Ÿ”‘

A

๐Ÿ’ก Maintain a weight line posterior to the hip and anterior to the extended knee

  1. Increased lumbar lordosis โ†’ compensating for weak hip extensors
  2. Waddling gait โ†’ hip abductor weakness.
  3. Toe walking โ€œPlantar flexionโ€ โ†’ compensating for weak knee extensors

Cuccurollo 4th Edition Chapter 6 P&O pg462

36
Q

How many degrees does a knee flexion contracture significantly interfere with gait? ๐Ÿ”‘๐Ÿ”‘

A

At 30 degrees due to inducing limb length discrepancy

PMR Secrets 3rd Edition Chapter 11 pg115 q24

37
Q

Gait Impairment in Plantar Flexion (PF) Weakness, List 4 causes of weak PF.

A

Gait

  1. Decreased or absent heel rise and lack of propulsion
  2. Excessive ankle dorsiflexion
  3. Persistent knee flexion during stance phase
  4. Increased energy expenditure
  5. Decreased stride length
  6. Decreased walking speed
  7. Ipsilateral pelvic drop in preswing, causing a lower COG then increased energy consumption since the pelvis rises again during the stance phase of the normal contralateral leg

Causes

๐Ÿ’ก Can also think as UMN (TBI, stroke, SCI) and LMN (Peripheral nerve) or MSK

  1. Achilles tendon rupture
  2. Tibial nerve injury
  3. S1 radiculopathy
  4. Poliomyelitis
  5. Charcotโ€“Marieโ€“Tooth disease

Cuccurollo 4th Edition Chapter 6 P&O pg462

38
Q

What is the gait pattern in a person with weak hip extensors? ๐Ÿ”‘

A

Trunk hyperextension (extensor larch) to prevent rapid forward fall at initial contact.

PMR Secrets 3rd Edition Chapter 11 pg115 q20

39
Q

Patient with OA knee want to use assistive device.

What kind of device you want to give? What consideration? ๐Ÿ”‘

A

Device:

Quadrapod cane

Consideration:

  1. Use it on the sound limb
  2. High adjustment: Elbow should be bent approximately 15-20 degrees.
  3. Placed approximately 15-20cm from the outside of the foot
40
Q

UE gait aids โ€“ crutches, cane, forearm crutch โ€“ list % of weight off-loaded for each ๐Ÿ”‘๐Ÿ”‘

A

When compared to normal unassisted gait the energy expenditure per unit distance is about 18-36% greater for partial wt bearing gaits using either axillary or forearm crutches.

  1. Cane : 25% off
  2. Forearm crutches : 40-50% off
  3. Crutches : 80% of wt off

Ref: Tan p295

41
Q

Components of Cane. 5 marks. ๐Ÿ”‘

A
  1. Handle
  2. Adjusting knob for handle
  3. Shaft
  4. Adjustable mechanism for height
  5. Rubber tip

Cuccurollo 4th Edition Chapter 6 P&O pg506

42
Q

Cane. List 4 benefits - Measurement - Gait Pattern - How To Use ๐Ÿ”‘๐Ÿ”‘

What are the functions of gait aids? List 4 functions of ambulation aids?

A

Benefits

  1. Increase base of support (parkinson, ataxia, stroke)
  2. Decrease loading on lower limbs (injury, arthritic)
  3. Muscle weakness (excessive knee or hip flexion)
  4. Provide additional sensory feedback (neglect)
  5. Assist acceleration/deceleration (hiking)

Measurement

  • 20-degree to 30-degree elbow flexion
  • Height: base of the heel to the upper border of the greater trochanter

Gait Pattern

  • Three-point: Cane and affected limb advance together, bearing more weight to the cane via upper bodyุŒ then unaffected limb follow forward

How to Use

  1. Up Stairs (stronger) leg first, down stairs reverse pattern
  2. Stroke: less-affected hand
  3. Joint paint: opposite side

Cuccurollo 4th Edition Chapter 6 P&O pg506

DeLisa 5th Edition Chapter 74 U & LL Prosthetics pg2078

43
Q

Compare types of canes

A

Cuccurollo 4th Edition Chapter 6 P&O pg507

44
Q

Crutch vs Cane in term of contact with body? ๐Ÿ”‘๐Ÿ”‘

A

Cane has one point of contact with the body.

Crutch has two points of contact with the body

Cuccurollo 4th Edition Chapter 6 P&O pg507

45
Q

Advantages of different types of Crutches ๐Ÿ”‘๐Ÿ”‘

46
Q

Muscles that need strengthening in preparation for crutch walking? 4 marks ๐Ÿ”‘๐Ÿ”‘

A
  1. Latissimus dorsi
  2. Triceps
  3. Pectoralis major
  4. Quads
  5. Hip extensors
  6. Hip abductors

Cuccurollo 4th Edition Chapter 6 P&O pg462-463

47
Q

Axillary Crutch. Components - Measurement - Drawbacks ๐Ÿ”‘๐Ÿ”‘

A

Components

  1. Padded axillary piece (on top)
  2. Two upright shafts
  3. Hand piece (in middle)
  4. Extension piece (adjustable)
  5. Rubber tip.

Measurement

  • Elbow flexed 30 degrees
  • Wrist in maximal extension
  • Fingers forming a fist
  • 6 inches (15 cm) lateral to the fifth toe

Drawbacks

  1. Heavy weight
  2. Restriction of hand use
  3. Trouble coordinating gait
  4. Axillary nerve palsy (Crutch palsy)

Cuccurollo 4th Edition Chapter 6 P&O pg507

DeLisa 5th Edition Chapter 76 LL Orthotics, Shoes & Aids

48
Q

Lofstrand Forearm Crutches. Measurement - Advantages ๐Ÿ”‘๐Ÿ”‘ EXAM 2021

A

Measurement

  • Forearm piece: 2 inch below the elbow
  • Handgrip: 30 degree flexion in elbow
  • Placement: 6 inches (15 cm) in front of the body
  • Length: level of greater trochanter

Advantages

  1. Weight bearing across your entire forearm rather than concentrating it on wrist
  2. Allow the hands to be free without disengaging the crutch from the forearm.
  3. Reduce the pressure on the axillary nerve and possibly avoid nerve damage
  4. More lightweight than underarm crutches
  5. Require a little bit more upper body strength and also help build and promote such strength.
  6. Improved cardiovascular functionality

Practical Manual of PM&R 1st Edition

49
Q

Gait patterns in crutches. 3 marks. ๐Ÿ”‘๐Ÿ”‘ EXAM 2021 Gait pattern in paraplegic patient.

A

TWO POINT GATE

  • Advancement of right crutch, left foot and left crutch with right foot simultaneously
  • Used for ataxic patients, faster than 4 point gait pattern

FOUR POINT GATE

  • Right crutch, left foot, left crutch, right foot sequence to be repeated
  • Patient bearing on all four points while limb advance simultaneously
  • Used fot ataxia, lower limb weakness
  • Slow and hard to learn

THREE POINT GATE โ†’ Complete off-loading of the limb

  • Three points of support that requires good balance (healthy young patients)
  • Both crutches advance together with affected limb advance is same time or swing after stepping on unaffected leg.
  • Used for lower limb injuries (fracture, amputation)

PARAPLEGIC GAIT PATTERN (POLIO, CP) โ†’ Complete off-loading of the limb

  1. Swing to gait
    Both crutches advance, arms pushed down, both lower limb swing to level of crutch
  2. Swing through gait
    Both crutches advance, arms pushed down, both lower limb swing beyond level of crutch

Practical Manual of Physical Medicine and Rehabilitation 1st Edition

50
Q

Weight bearing status or levels.

A

1. Full weight bearing (FWB)

No restrictions and client can bear 100% body weight on the lower extremities (LE).

2. Weight bearing as tolerated (WBAT)

Weight bearing is limited by patient tolerance of weight borne on extremity.

3. Partial weight bearing (PWB):

No restrictions and client can bear 20-70% body weight on the lower extremities (LE).

4. Toe touch weight bearing (TTWB)

Only the toes of the affected extremity contact the floor to improve balance

5. Non-weight bearing (NWB)

No weight is borne on the involved limb

51
Q

Weight bearing status or levels.

A

1. Full weight bearing (FWB)

No restrictions and client can bear 100% body weight on the lower extremities (LE).

2. Weight bearing as tolerated (WBAT)

Weight bearing is limited by patient tolerance of weight borne on extremity.

3. Partial weight bearing (PWB):

No restrictions and client can bear 20-70% body weight on the lower extremities (LE).

4. Toe touch weight bearing (TTWB)

Only the toes of the affected extremity contact the floor to improve balance

5. Non-weight bearing (NWB)

No weight is borne on the involved limb

52
Q

Indication of platform walker/crutches ๐Ÿ”‘๐Ÿ”‘

A
  1. Arthritic patient (OA, RA)
  2. Flexion contracture of elbow
  3. Weak grip due to pain
  4. Deformities of hand

Practical Manual of Physical Medicine and Rehabilitation

53
Q

Walker. Indications - Measurement - Advantages - Disadvantages ๐Ÿ”‘๐Ÿ”‘

A

INDICATIONS

  1. 1 Leg: Unilateral weakness (stroke, OA, fracture)
  2. 2 Legs: Bilateral weakness and/or incoordination (SCI, Polio)
  3. Aging: Improve quality of life and confidence (i.e., deconditioned elderly)
  4. Balance: Increase balance (i.e., multiple sclerosis [MS] or parkinsonism)
  5. To relieve weight bearing either fully or partially on a LE (allow the upper extremities to transfer body weight to the floor).
  6. Fear of falling

MEASURMENT

  • Shoulders relaxed and the elbows flexed 20 degrees
  • 12 inches - 30 cm - Double of usual gait aids

ADVANTAGES

  1. Provide a wider base of support
  2. More stable base of support
  3. Provide a sense of security for patients fearful of ambulation

DISADVANTAGES

  1. More conspicuous in appearance
  2. Stooped posture
  3. Interferes with development of a smooth reciprocal gait pattern with slow cadence
  4. Interferes with stair negotiation
  5. Difficult to maneuver through doorways or bathrooms
  6. Patient become too reliant or emotionally dependent on the stability provided by the walker

Cuccurollo 4th Edition Chapter 6 P&O pg508

54
Q

Types of walker

55
Q

Gait in walker

A

Full weight bearing

Walker is lifted/moved forward, one foot move forward and other foot move past it.

Partial weight bearing

Walker is lifted/moved forward, affected limb move forward, weight is shifted by upper body, unaffected limb step past affected limb.

Non weight bearing

walker is lifted/moved forward while bearing the weight on upper body, affected limb advance and follow the walker without bearing weight, then unaffected limb step forward.

56
Q

List 4 Indications of Kaye Walker ๐Ÿ”‘๐Ÿ”‘ EXAM 2021

A
  1. Cerebral Palsy (Diaplegic)
  2. Parkinson
  3. Ataxia
  4. Multiple Sclerosis
  5. Progressive Supranuclear Palsy (PSP)
  6. Multiple System Atrophy (MSA)
  7. Poliomyelitis
  8. Paraplegic SCI

Dr. Ali & Dr. Maitham Answers

57
Q

Advantages of Scooter ๐Ÿ”‘๐Ÿ”‘ EXAM 2020

58
Q

Toe off of the floor as the patient stands, or knee flexed too Much

In this trans-tibial gait deviation, name the prosthetic causes and solutions.

A

Prosthetic causes: foot too dorsiflexed

Solution: plantarflex the foot

Ref: Braddom p301

59
Q

Q1: BKA with Excessive knee flexion. List 4 Causes๐Ÿ”‘๐Ÿ”‘

Q2: Knee too forcefully and rapidly flexes after heel strike; high pressure against the anterior-distal tibia and heel strike and/or prolonged discomfort at this point. In this trans-tibial gait deviation, name the prosthetic causes and solutions.

A

EXCESSIVE FLEXION

  1. Weak knee extension
  2. Knee flexion contracture
  3. Anterior displacement of the socket
  4. Posterior displacement of the foot
  5. โ†‘ Ankle dorsiflexion
  6. Too hard heel cushion
  7. Excessive heel high

Cuccurollo 4th Edition Chapter 6 P&O pg501

60
Q

Q1: A man with a transtibial amputation has recently got a new prosthesis and new shoes. He complains it feels like his knee is being pushed back when he walks. The patient complains of feeling as if they are walking uphill. You observe him walking: his knee is fully extended at initial contact and remains extended for 20% of the stance phase. List 4 common causes of this problem? ๐Ÿ”‘๐Ÿ”‘

Q2: โ€œHill-climbingโ€ sensation toward the end of stance phase In this trans-tibial gait deviation, name the prosthetic causes and solutions.

A

Excessive knee extension

  • Quad weakness
  • Distal anterior tibial discomfort
  • โ†‘ Ankle plantar flexion
  • Posterior displacement of the socket
  • Anterior displacement of the foot
  • Too soft heel cushion
  • Habit

Cuccurollo 4th Edition Chapter 6 P&O pg501 Table 6-12

61
Q

Transtibial Prosthetics. List 4 Gait Deviations. Draw the problems.

A

EXCESSIEV FLEXION

  1. Knee flexion contracture
  2. โ†‘ Ankle dorsiflexion
  3. Anterior displacement of the socket
  4. Posterior displacement of the foot
  5. Too hard heel cushion
  6. Excessive heel high
  7. Weak knee extension

EXCESSIEV EXTENSION

  1. Quad weakness
  2. Distal anterior tibial discomfort
  3. โ†‘ Ankle plantar flexion
  4. Posterior displacement of the socket
  5. Anterior displacement of the foot
  6. Too soft heel cushion
  7. Habit

EXCESSIEV VARUS

  • Pain on proximal-medial or distal-lateral aspect
  1. Socket Too Wide
  2. Lateral placement of socket
  3. Brim of the socket tilted medially
  4. Medial placement of prosthetic foot
  5. Knee Valgus
  6. Collateral ligament instability
  7. MCL Tear
  8. Prosthetic foot inversion
  9. Short prosthetic length

EXCESSIEV VALGUS

  • Pain proximal-lateral or distal-medial aspect
  • Lateral placement of prosthetic foot
  • Medial placement of socket

Cuccurollo 4th Edition Chapter 6 P&O pg501

62
Q

Dragging prosthetic foot, list 4 causes.

63
Q

Transfemoral Gait Deviations. Abducted gait. 4 causes.

A

Abducted gait

Very wide-based gait with prosthesis held away from midline at all times

Patient will complain of medial pain and poor balance

Cuccurollo 4th Edition Chapter 6 P&O Table 6-14 pg503

64
Q

Transfemoral amputation presented to the clinic with circumduction gait.
Give 3 possible causes & 2 modifications / treatment ๐Ÿ”‘๐Ÿ”‘

A

Causes

  1. Inadequate knee flexion
  2. Knee too stiff
  3. Prosthesis too long
  4. Inadequate suspension
  5. Poor gait pattern
  6. Habitual
  7. Abductor muscle shortening or overuse

Modifications

  1. Adjust knee friction or damping
  2. Adjust prosthesis length
  3. Physical therapy focusing on gait training and corrective gait pattern.

Cuccurollo 4th Edition Chapter 6 P&O Table 6-14 pg503

65
Q

Transfemoral amputation presented to the clinic with circumduction gait.
Give 3 possible causes & 2 modifications / treatment ๐Ÿ”‘๐Ÿ”‘

A

PROSTHETIC

  1. Prosthesis too long
  2. Knee too stiff
  3. Inadequate suspension

AMPUTEE

  1. Abduction contracture of residual limb
  2. Muscle weakness
  3. Fear of stubbing toe and falling
  4. Habit

Modifications

  1. Adjust knee friction or damping
  2. Adjust prosthesis length
  3. Physical therapy focusing on gait training and corrective gait pattern.

Cuccurollo 4th Edition Chapter 6 P&O Table 6-14 pg503

66
Q

List 3 gait deviations that commonly occur when a prosthetic leg is too long ๐Ÿ”‘๐Ÿ”‘

A
  1. Circumduction
  2. Hip vaulting
  3. Hip hiking
67
Q

Lateral Bending Trunk Gait in AKA. List 3 prosthetic and 3 non-prosthetic cause. ๐Ÿ”‘๐Ÿ”‘

Give 4 prosthetic and 4 patient causes of ipsilateral lateral trunk lurch in AKA

A

๐Ÿ’ก Lateral bending of trunk: Excessive bending occurs laterally from midline, generally to prosthetic side

PROSTHETIC CAUSES

  1. High medial wall
  2. Prosthesis aligned in abduction
  3. Prosthesis may be too short

AMPUTEE CAUSES

  1. Habit pattern
  2. Poor balance
  3. Hip abduction contracture
  4. Oversensitive and painful
  5. Very short residual limb

Cuccurollo 4th Edition Chapter 6 P&O pg503 Table 6-14

68
Q

Vaulting Gait in AKA. List 3 prosthetic and 3 non-prosthetic cause. ๐Ÿ”‘๐Ÿ”‘

A

PROSTHETIC CAUSES

  1. Prosthesis may be too long
  2. Too much friction in knee
  3. Inadequate suspension

AMPUTEE CAUSES

  1. Fear of stubbing toe and falling
  2. Residual limb discomfort
  3. Habit

Cuccurollo 4th Edition Chapter 6 P&O pg503 Table 6-14

69
Q

Abducted Gait in AKA. List 3 prosthetic and 3 non-prosthetic cause. ๐Ÿ”‘๐Ÿ”‘

A

PROSTHETIC CAUSES

  1. Prosthesis may be too long
  2. Lateral (abduction) displacement of the prosthesis
  3. High medial wall
  4. Improperly shaped lateral wall
  5. Pelvic band placed too far away

AMPUTEE CAUSES

  1. Hip abduction contracture
  2. Habit

Cuccurollo 4th Edition Chapter 6 P&O pg503 Table 6-14

70
Q

Knee instability in AKA. List 3 prosthetic and 3 non-prosthetic cause. ๐Ÿ”‘๐Ÿ”‘

A

PROSTHETIC CAUSES

  1. Socket is mounted with excess flexion
  2. Knee joint may be too far ahead
  3. Excessive dorsiflexion due to hard plantar flexion bumper (resistance)

AMPUTEE CAUSES

  1. Hip extensor weakness (canโ€™t resist flexion moment arm)
  2. Hip flexion contracture (limit extension, more flexion moment arm)

Cuccurollo 4th Edition Chapter 6 P&O pg504 Table 6-14

71
Q

Foot Slap in AKA. List the case and how to fix it. ๐Ÿ”‘

A

FOOT SLAP

The foot plantar flexes too rapidly and strikes the floor with a slap

PROSTHETIC CAUSES

  1. Plantar flexion bumper is too soft (insufficient resistance)

Cuccurollo 4th Edition Chapter 6 P&O pg504 Table 6-14

72
Q

60 M, Right AKA, trauma 25 years ago. Walks into the office with hip hiking.

Describe gait deviation. ๐Ÿ”‘๐Ÿ”‘

List 3 prosthetic and three non-prosthetic causes.

A

Which side is the deviation? Prosthetic side

Swing or stance phase? Swing phase

What do you see? Elevation of the pelvis at the midpoint of swing phase on the residual limb side

Prosthetic reasons:

  1. Foot in plantarflexion
  2. Inadequate suspension
  3. The prosthesis is just too long
  4. Socket too small
  5. Limited knee flexion (excessive knee friction or tight extension aid)

Patient reasons:

  1. Weak hip flexors, cannot initiate knee flexion in swing phase
  2. Pain
  3. Habit

Ref: Review notes 2012 (Dudek)

73
Q

Q1: BKA with Excessive knee flexion. List 4 Causes Q2: Knee too forcefully and rapidly flexes after heel strike; high pressure against anterior-distal tibia and heel strike and/or prolonged discomfort at this point. In this trans-tibial gait deviation, name the prosthetic causes and solutions.

74
Q

Drop off at end of stance phase. In this trans-tibial gait deviation, name the prosthetic causes and solutions.

A

Prosthetic causes: Keel too soft

Solution: Stiffer keel foot

Ref: Braddom p301

PassPMR - 08 Prosthetics & Orthotics (9 decks)

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