2] Mgmt Of Gait Deviations For Prosthetic Users

Question 1

What contractures does TFA have

Answer 1

Hip flex contracture

Question 2

What contracture does TTA have

Answer 2

Knee flex and hip flex contracture

Question 3

How much flexion should there be for TTA with no ROM issues?

Answer 3

5-10 deg of flexion normal

Question 4

If someone has a contracture, how do you account for the ROM?

Answer 4

Add whatever they are losing + 5-10 degrees they should normally have

Question 5

Would you do an eval if they have pain?

Answer 5

No because pain could be the reason why they have compensations

Question 6

Alignment for TTA

Answer 6

Socket should be in flexion
Foot inset in relation to socket
Socket translated anterior to foot

Question 7

TFA prosthetic alignment?

Answer 7

Socket placed in flex and ADD
Foot inset in relation to socket
Knee posterior to socket

Question 8

Possible prosthetic causes of early heel rise in stance phase

Answer 8

Excessive socket extension
Excessive ankle PF
Foot too anterior
DF bumper too stiff

Question 9

Possible PATIENT causes of early heel rise during stance phase

Answer 9

Knee or hip flex contracture not accommodated in alignment

Question 10

Possible prosthetic causes of decreased toe clearance during swing phase

Answer 10

Inadequate suspension/pistoning
Long prosthesis
Excessive ankle PF

Question 11

Possible PATIENT causes of decreased toe clearance during swing phase

Answer 11

Didn’t put it on correctly
Contra glute med weak
Not enough hip and knee flex

Question 12

Common gait deviations related to decreased WB (6)

Answer 12

1] Midline shift to intact side
2] Intact limb ADDucts 
3] Decreased step length of intact limb 
4] Decreased stance time on prosthesis 
5] Limited weight shift on prosthesis 
6] Increased UE support

Question 13

Interventions for decreased WB

Answer 13

Parallel bars
Use mirror to enforce midline
Gradually decrease UE support

Question 14

Possible causes of decreased stride length on intact side during swing phase

Answer 14

Pain
Socket toe extended
Foot to forward
Foot too PF
Anterior bumper too stiff 
SACH heel too soft 
Fear
Hip flex contracture on prosthetic side

Question 15

Interventions for prosthetic knee control

Answer 15

Parallel bars 
Orient COM
Restore pelvic motion 
Forward and backward stepping with prosthetic limb 
Verbal cues

Question 16

Interventions to address balance and proprioceptive loss

Answer 16

Closed environment first
Visual feedback
Reflex hammer during WB on prosthesis 
SL balance with hip strategy and intact foot rolls a ball
Perturbations 
Stable —> compliant surfaces