1. Gait & Ambulation Aids

Question 1

# Define: Stride Length - Step Length & Width - Cadence 🔑🔑
What is the normal step length?

Answer 1

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 “1.25-1.66 Feet”

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

Question 2

Gait Cycle 🔑🔑

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?

Answer 2

TASKS

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

STANCE PHASE 60%

Initial Contact (IC) بداية الملامسة

When foot comes in contact with the ground

Other limb in preswing phase.

Loading Response (LR) بعد وضع القدم إلى رفع القدم الثانية

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

Other limb in initial swing phase

💡 The body has the lowest COG during loading response. (weight shift occurs)

Midstance (MSt) من رفع القدم إلى إلتقاء الكاحلين

💡 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) من بعد إلتقاء الكاحلين إلى قبل وضع القدم

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

Preswing (PSw) وضع القدم وقبل طلوع القدم الثانية

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) طلوع القدم وثني الركبة

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

Midswing (MSw) من ثني الركبة إلى وضع الرجل عمودياً

Immediately following knee flexion to vertical tibia position

Terminal Swing (TSw): مد الركبة كاملةَ إلى بداية الملامسة

Following vertical tibia position to just prior to initial contact

Cuccurollo 4th Edition Chapter 6 P&O pg458

Question 3

Limb Support 🔑🔑

Answer 3

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

Question 4

Seep walking vs Running effect on gait cycle 🔑🔑

Answer 4

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

Question 5

Max hip flexion, knee and ankle dorsiflexion 🔑🔑

Answer 5

Initial Swing

• Max knee and ankle flexion

Mid Swing

• Max hip flexion → to shorten the length

Question 6

Gravity line and Centre of gravity. 🔑🔑

Answer 6

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 → countered by anterior ileofemoral ligament
• Anterior to the knee joint and tends to passively extend the knee → quadriceps weakness result in genu recurvatum
• Passes 1 to 2 inches anterior to the ankle joint and tends to dorsiflex the ankle → resisted by the soleus and gastrocnemius muscles.

Cuccurollo 4th Edition Chapter 6 P&O pg458

Question 7

What is the normal velocity for walking?

Answer 7

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

Question 8

List 5 determinants of gait that reduce excursion of centre of mass 🔑🔑 EXAM

Answer 8

💡 Actual COG displacement is approximately 5 cm (2 inches)

IMPORTANCE

1. Minimize deviation of the body’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 4–5 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

Question 9

Prerequisites of Gait 🔑🔑 EXAM

Answer 9

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

Question 10

Foot rockers

Answer 10

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.

Question 11

Muscle Activity 🔑🔑 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

Answer 11

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.

Question 12

What are the requirements for sufficient clearance in swing phase?

Another word: sufficient swing needs ..

Answer 12

💡 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

Question 13

List 3 muscles and their action at heel strike 🔑

Answer 13

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

Question 14

In quiet standing, which muscles maintain the body in erect position? 🔑🔑 Dr. Haitham

Answer 14

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

Question 15

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. 🔑🔑

Answer 15

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

Question 16

When is patient with dorsiflexion weakness suspected to have foot slap? 🔑🔑 Dr. Abdulrazaq

Answer 16

Severely weak dorsiflexors <3/5, motor power less than “anti-gravity”

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

Question 17

List 2 cause of Steppage gait/foot drop. List 4 DDx for foor drop 🔑🔑

Answer 17

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.

Question 18

List 3 causes of Wide base of support 🔑

Answer 18

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

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

Question 19

List 2 causes Excessive foot supination 🔑

Answer 19

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

Question 20

List 4 causes of Increased knee flexion 🔑🔑

Answer 20

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

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

Question 21

List 2 causes of Excessive trunk lateral flexion & Waddling gait 🔑🔑

Answer 21

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 “angaltic gait”

Causes of Waddling gait

1. Bilateral gluteus medius weakness, myopathic gait

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

Question 22

List 3 causes of Hip hiking 🔑🔑

Answer 22

1. Quadratus lumborum shortening
2. Long limb
3. Stiff knee
4. Weak hamstring “limited knee flexion”

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

Question 23

List 2 causes of Circumduction 🔑🔑

Answer 23

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

Question 24

What are the difference between toddler and adult gait? 4 marks 🔑🔑 EXAM

Answer 24

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

Question 25

At what age the child would go upstairs and down stairs with alternating feet? (2 marks)🔑🔑

Answer 25

Upstairs 3 years Down stairs 4 years PM&R secrets 2nd edition P416

Question 26

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

Answer 26

* 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

Question 27

Elderly gait compared to young adults? 1 mark

Answer 27

Reduced peak hip extension PMR Secrets 3rd Edition Chapter 11 pg115 q23

Question 28

Gait Impairment Post Stroke 🔑🔑 List 5 stance phase gait abnormalities in hemiplegic leg

Answer 28

**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 – 2010/2012 – Gait section (pg 55)

Question 29

What are expected gait abnormalities in a patient with antalgic gait. 🔑🔑

Answer 29

**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

Question 30

Gait Impairment in Parkinson’s Disease 🔑🔑 EXAM

Answer 30

**PARKINOSN GAIT** 1. Stooped posture 2. Festinating gait 3. Shuffling 4. “Start hesitation” 5. Reduced step length 6. Decreased arm swing 7. Reduced trunk rotation 8. Severe instances freezing while walking or turning (“freezing gait”) **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

Question 31

List 4 musculoskeletal abnormalities in crouch gait.🔑🔑

Answer 31

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):98±108

Question 32

Does varus or valgus knee aligment affect progression of knee OA with ambulation? Mention one shoe modification to fix it.

Answer 32

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

Question 33

Do high-heeled shoes increase the risk for OA of the knee? What about moderate-heeled shoes? 🔑🔑

Answer 33

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

Question 34

Gait Impairment With Hip Flexion Contracture

Answer 34

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

Question 35

Gait Impairment in Duchenne Muscular Dystrophy 🔑🔑

Answer 35

💡 Maintain a weight line posterior to the hip and anterior to the extended knee 1. Increased lumbar lordosis → compensating for weak hip extensors 2. Waddling gait → hip abductor weakness. 3. Toe walking “Plantar flexion” → compensating for weak knee extensors Cuccurollo 4th Edition Chapter 6 P&O pg462

Question 36

How many degrees does a knee flexion contracture significantly interfere with gait? 🔑🔑

Answer 36

At 30 degrees due to inducing limb length discrepancy PMR Secrets 3rd Edition Chapter 11 pg115 q24

Question 37

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

Answer 37

**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** 💡 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. Charcot–Marie–Tooth disease Cuccurollo 4th Edition Chapter 6 P&O pg462

Question 38

What is the gait pattern in a person with weak hip extensors? 🔑

Answer 38

Trunk hyperextension (extensor larch) to prevent rapid forward fall at initial contact. PMR Secrets 3rd Edition Chapter 11 pg115 q20

Question 39

Patient with OA knee want to use assistive device. What kind of device you want to give? What consideration? 🔑

Answer 39

**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

Question 40

UE gait aids – crutches, cane, forearm crutch – list % of weight off-loaded for each 🔑🔑

Answer 40

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

Question 41

Components of Cane. 5 marks. 🔑

Answer 41

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

Question 42

Cane. List 4 benefits - Measurement - Gait Pattern - How To Use 🔑🔑 What are the functions of gait aids? List 4 functions of ambulation aids?

Answer 42

**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 body، 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

Question 43

Compare types of canes

Answer 43

Cuccurollo 4th Edition Chapter 6 P&O pg507

Question 44

Crutch vs Cane in term of contact with body? 🔑🔑

Answer 44

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

Question 45

Advantages of different types of Crutches 🔑🔑

Answer 45

Question 46

Muscles that need strengthening in preparation for crutch walking? 4 marks 🔑🔑

Answer 46

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

Question 47

Axillary Crutch. Components - Measurement - Drawbacks 🔑🔑

Answer 47

**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

Question 48

Lofstrand Forearm Crutches. Measurement - Advantages 🔑🔑 EXAM 2021

Answer 48

**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

Question 49

Gait patterns in crutches. 3 marks. 🔑🔑 EXAM 2021 Gait pattern in paraplegic patient.

Answer 49

**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 → 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) → 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

Question 50

Weight bearing status or levels.

Answer 50

**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

Question 51

Weight bearing status or levels.

Answer 51

**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

Question 52

Indication of platform walker/crutches 🔑🔑

Answer 52

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

Question 53

Walker. Indications - Measurement - Advantages - Disadvantages 🔑🔑

Answer 53

**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

Question 54

Types of walker

Answer 54

Question 55

Gait in walker

Answer 55

**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.

Question 56

List 4 Indications of Kaye Walker 🔑🔑 EXAM 2021

Answer 56

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

Question 57

Advantages of Scooter 🔑🔑 EXAM 2020

Answer 57

Question 58

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.

Answer 58

Prosthetic causes: foot too dorsiflexed Solution: plantarflex the foot Ref: Braddom p301

Question 59

Q1: BKA with Excessive knee flexion. List 4 Causes🔑🔑 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.

Answer 59

**EXCESSIVE FLEXION** 1. Weak knee extension 2. Knee flexion contracture 3. Anterior displacement of the socket 4. Posterior displacement of the foot 5. ↑ Ankle dorsiflexion 6. Too hard heel cushion 7. Excessive heel high Cuccurollo 4th Edition Chapter 6 P&O pg501

Question 60

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? 🔑🔑 Q2: “Hill-climbing” sensation toward the end of stance phase In this trans-tibial gait deviation, name the prosthetic causes and solutions.

Answer 60

**Excessive knee extension** * Quad weakness * Distal anterior tibial discomfort * ↑ 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

Question 61

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

Answer 61

**EXCESSIEV FLEXION** 1. Knee flexion contracture 2. ↑ 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. ↑ 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

Question 62

Dragging prosthetic foot, list 4 causes.

Answer 62

Question 63

Transfemoral Gait Deviations. Abducted gait. 4 causes.

Answer 63

**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

Question 64

Transfemoral amputation presented to the clinic with circumduction gait. Give 3 possible causes & 2 modifications / treatment 🔑🔑

Answer 64

**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

Question 65

Transfemoral amputation presented to the clinic with circumduction gait. Give 3 possible causes & 2 modifications / treatment 🔑🔑

Answer 65

**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

Question 66

List 3 gait deviations that commonly occur when a prosthetic leg is too long 🔑🔑

Answer 66

1. Circumduction 2. Hip vaulting 3. Hip hiking

Question 67

Lateral Bending Trunk Gait in AKA. List 3 prosthetic and 3 non-prosthetic cause. 🔑🔑 Give 4 prosthetic and 4 patient causes of ipsilateral lateral trunk lurch in AKA

Answer 67

💡 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

Question 68

Vaulting Gait in AKA. List 3 prosthetic and 3 non-prosthetic cause. 🔑🔑

Answer 68

**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

Question 69

Abducted Gait in AKA. List 3 prosthetic and 3 non-prosthetic cause. 🔑🔑

Answer 69

**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

Question 70

Knee instability in AKA. List 3 prosthetic and 3 non-prosthetic cause. 🔑🔑

Answer 70

**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 (can’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

Question 71

Foot Slap in AKA. List the case and how to fix it. 🔑

Answer 71

**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

Question 72

60 M, Right AKA, trauma 25 years ago. Walks into the office with hip hiking. Describe gait deviation. 🔑🔑 List 3 prosthetic and three non-prosthetic causes.

Answer 72

**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)

Question 73

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.

Question 74

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

Answer 74

Prosthetic causes: Keel too soft Solution: Stiffer keel foot Ref: Braddom p301