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PTA 220 > 6.PTA 220-Pathological gait and amputations/prosthetics > Flashcards

6.PTA 220-Pathological gait and amputations/prosthetics Flashcards

1
Q

heel strike of one foot to the next heel strike of the same foot.
Always measured as same side, same portion of gait phase. (May not always be heel strike!)
Stance phase (60%), swing phase (40%), and two periods of double support (heel strike-toe off)

A

Gait cycle

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2
Q

distance covered during the gait cycle

A

Stride

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3
Q

point of heel strike of one LE to the point of heel strike of the other LE.

A

Step length

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4
Q

number of steps taken in a given period of time

A

Cadence

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5
Q

just anterior to S2 (or ~ 55% of total stature as measured from ground up.)
COG undergoes a natural rise and fall of approx 2 inches when walking. (Picture heads bobbing in a crowd)
COG undergoes natural lateral shift of 1 ¾ inches when walking.

A

COG

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6
Q 
Pelvic Rotation
Pelvic Tilt
Pelvic lateral displacement
Knee flexion
Hip flexion
Knee and ankle interaction
A

Six Gait Determining Factors

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7
Q

weakness of anterior tibialis; foot slaps ground due to no eccentric control

A

Foot slap

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8
Q

leg length discrepancy, heel cord contracture, heel pain

A

Toes first/lack of heel strike

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9
Q

lack of DF; toes never clear ground due to lack/weakness of anterior tibialis

A

Toe drag

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10
Q

weakness in quads, flexion contracture, muscle guarding with knee pain, leg length discrepancy

A

Excessive knee flexion

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11
Q

knee hyperextension due to lack of joint stability; locked into hyperextension by ligamental and bony support

A

Genu recurvatum

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12
Q

used with foot drop to try to avoid toe drag

A

Excessive hip flexion (steppage)

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13
Q

weak iliopsoas, weak anterior tibialis; circumducts rather than forward advancement

A

Hip circumduction

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14
Q

weak hamstrings, weak anterior tibialis, fused or braced knee

A

Hip hiking

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15
Q

excessive trunk lateral flexion to compensate for weak glute meds on stance side, and prevent pelvic drop on swing through side; or protect a painful hip

A

Trendelenburg gait

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16
Q

protective of painful area, shortened step length; uneven cadence; may coincide with additional abnormal patterns

A

Antalgic

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17
Q

unsteadiness due to lack of control of proprioception

A

Ataxic

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18
Q

repetitive tip toe pattern for patients with Parkinson’s Disease. Uncontrollable gait, comes to an abrupt halt at an object.

A

Festinating

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19
Q

circumduction of hip for momentum to advance the flaccid extremity

A

Hemiplegic

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20
Q

flexed knees and trunk, shuffling gait (with occasional festination)

A

Parkinsonian

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21
Q

leg crosses midline during swing through

A

Scissor

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22
Q

excessive hip flexion (like you’re trying to step over something)

A

Steppage

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23
Q

Cerebral Palsy “controlled fall” pattern. (40-50% of patients with CP) Typically with hip add, hip IR, hip flexion, knee flexion, PF. Momentum and velocity maintain upright posture with gait

A

Spastic diplegia

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24
Q

leading cause for LE amputations, especially when coupled with smoking and diabetes

A

PVD

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25
Q

amputations - most commonly from MVA or gunshot/military trauma

A

Trauma

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26
Q

levels of amputation

A

Partial toe- excision of any part of one or more toes
Toe disarticulation- disarticulation at the metatarsal halangeal joint
Partial foot/ray resection- resection of the 3rd, 4thl 5th MTs and digits
Transmetatarsal- Amputation through the midsection of all MTs
Syme’s- Ankle disarticulation with attachment of heel pad to distal end of tibia. May include removal of malleoli and distal tibial/fibular flares
Long transtibial (below knee)- More than 50% tibial length
Transtibial (below knee)- Between 20 and 50% of tibial length
Short transtibial (below knee)- Less than 20% tibial length
Knee disarticulation- Amputation through the knee joint; femur intact
Long transfemoral- More than 60% femoral length
Transfemoral (above knee)- Between 35 and 60% femoral length
Short transfemoral (above knee)- Less than 35% femoral length
Hip disarticulation- Amputation through hip joint; pelvis intact
Hemipelvctomy- Resection of lower half of the pelvis
Hemicorporectomy- Amputation both lower limbs and pelvis below L4-L5 level

27
Q

Leaves a horizontal scar at midline of the limb

A

Equal length anterior/posterior closures

28
Q

Leaves a scar line anteriorly across the limb. Often used in dysvascular transtibial amputations because the posteriortissues have a better blood supply than anterior skin.

A

Posterior flap

29
Q
  • Infection
  • DVT
  • Neuroma- a bundle of nerve tissue. Painful if compressed. Must sufficiently pad the area.
A

Post-Surgical Complications

30
Q

to maintain AROM and avoid contractures.

A

Early PT intervention

31
Q

education on positioning, ther ex, transfers, re-establishing static and dynamic balance, wheelchair mobility, and ambulation.

A

Post-Surgical Phase

32
Q

plaster casting molded to keep limb in desired shaped. Not removable.
Advantages of these styles: decreased edema, decreased pain, earlier ambulation, earlier transition to permanent prosthesis.

A

Rigid

33
Q

plaster or plastic that can be removed to check healing/signs of infection/wounds.
Advantages of these styles: decreased edema, decreased pain, earlier ambulation, earlier transition to permanent prosthesis.

A

Removable rigid

34
Q

Unna boot style. Provides medicinal protection against infection, not as much support as rigid.

A

Semi-rigid

35
Q

elastic wraps or shrinker sock.

  • advantages: inexpensive, light weight, clean
  • disadvantages: poor edema control, can cut off circulation if wrapped incorrectly or slips with movement, frequent reapplication needed.
A

Soft

36
Q

tingling, burning, itching, pressure or numbness in an area that no longer exists.

A

Phantom sensations

37
Q

cramping, squeezing, shooting/burning pain in an area that no longer exists.

A

Phantom pains

38
Q

Position prone, no pillow in supine.

A

positioning- Avoid hip and knee flexion contractures.

39
Q

prone/sidelying hip extension, supine/sidelying abd, supine hip flexion, sidelying adduction, SAQ (transtibial), glute squeezes, quad sets, hip rotation stretches.

A

Bed Exercise

40
Q

a replacement for all or part of a limb

A

Prosthetic device

41
Q

brace down the anterior lower leg, with a rigid plate that extends the normal length of the foot. Allows increased stance time. The socket helps to protect the metatarsalsals .

A

Partial Foot

42
Q

Due to the nature of the amputation, the limb may be asymmetrical. Can have medial flap to allow better donning/doffing. Must be secured after donned.

A

Syme’s Prosthesis

43
Q

uses a central metal shank covered with soft plastic or foam rubber “skin-like” substance. More natural appearance. Easier to adjust. Most commonly used as final prosthesis.

A

Endoskeleton

44
Q

“crustacean” shell. Made of hard, shiny plastic. Obvious external hardware at knee joint. Most durable cover, but least cosmetic. Most commonly used as training leg prior to final prosthesis.

A

Exoskeleton

45
Q

the area that contains the actual residual limb. Created by molding to patient’s shape by either casting or computer aided design.

A

Socket

46
Q

concave surfaces that allow decreased pressure over bony areas.

A

Reliefs

47
Q

convex surfaces that allow increased pressure to more tolerant areas, such as muscle, tendon, and less prominent bony areas.

A

Buildups

48
Q

how the limb stays in place during non-weight bearing activity.

A

Suspension

49
Q

leather strap that surrounds the distal thigh.

A

Cuffs

50
Q

leather or flexible plastic attachment that laces up the thigh. Can be problematic due to pressure atrophy.

A

Corsets

51
Q

liner has pin attachment that locks into place on prosthesis.

A

Distal pin

52
Q

medial and lateral edges extend above the femoral epicondyles; also uses removable medial wedge.

A

Supracondylar brim

53
Q

also extends anteriorly above patella. Good for short transtibial amputations.

A

Supercondylar/suprapatellar brim

54
Q

removes all air molecules between liner, limb and socket. Allows consistent shape of limb, good for wound healing, decreases shearing forces of movement, assists proprioception.

A

Vacuum-Assisted

55
Q

lower posterior and medial shelf for ischial tuberosity and gluteals, higher lateral and anterior wall to direct forces to the posterior.

A

Quadrilateral socket

56
Q

narrower med/lat borders, weight is shifted to med/lat sides and distal limb instead of ischial tuberosity

A

Ischial containment

57
Q

no liner needed, provides greatest amount of volume control. Pressure gradient too high for natural forces to overcome.

A

Total suction

58
Q

requires liner and straps. Lesser pressure gradient inside/outside.

A

Partial suction

59
Q

suspended entirely by pelvic straps

A

No suction

60
Q

hardware attached to bone that fits to prosthesis.

A

Osseointegration

61
Q

modify speed of motion so not as robotic and loud.

A

Friction mechanism (knee joint option)

62
Q

Levels of Amputations for UE

A

Levels of upper extremity amputations include:

Fingers or partial hand (transcarpal)
At the wrist (wrist disarticulation)
Below the elbow (transradial)
At the elbow (elbow disarticulation)
Above the elbow (transhumeral)
At the shoulder (shoulder disarticulation)
Above the shoulder (forequarter)
62
Q

Computerized leg; very expensive but highest quality of mobility

A

C-leg (knee joint option)

PTA 220 (6 decks)

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