6.PTA 220-Pathological gait and amputations/prosthetics Flashcards
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)
Gait cycle
distance covered during the gait cycle
Stride
point of heel strike of one LE to the point of heel strike of the other LE.
Step length
number of steps taken in a given period of time
Cadence
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.
COG
Pelvic Rotation Pelvic Tilt Pelvic lateral displacement Knee flexion Hip flexion Knee and ankle interaction
Six Gait Determining Factors
weakness of anterior tibialis; foot slaps ground due to no eccentric control
Foot slap
leg length discrepancy, heel cord contracture, heel pain
Toes first/lack of heel strike
lack of DF; toes never clear ground due to lack/weakness of anterior tibialis
Toe drag
weakness in quads, flexion contracture, muscle guarding with knee pain, leg length discrepancy
Excessive knee flexion
knee hyperextension due to lack of joint stability; locked into hyperextension by ligamental and bony support
Genu recurvatum
used with foot drop to try to avoid toe drag
Excessive hip flexion (steppage)
weak iliopsoas, weak anterior tibialis; circumducts rather than forward advancement
Hip circumduction
weak hamstrings, weak anterior tibialis, fused or braced knee
Hip hiking
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
Trendelenburg gait
protective of painful area, shortened step length; uneven cadence; may coincide with additional abnormal patterns
Antalgic
unsteadiness due to lack of control of proprioception
Ataxic
repetitive tip toe pattern for patients with Parkinson’s Disease. Uncontrollable gait, comes to an abrupt halt at an object.
Festinating
circumduction of hip for momentum to advance the flaccid extremity
Hemiplegic
flexed knees and trunk, shuffling gait (with occasional festination)
Parkinsonian
leg crosses midline during swing through
Scissor
excessive hip flexion (like you’re trying to step over something)
Steppage
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
Spastic diplegia
leading cause for LE amputations, especially when coupled with smoking and diabetes
PVD
amputations - most commonly from MVA or gunshot/military trauma
Trauma
levels of amputation
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
Leaves a horizontal scar at midline of the limb
Equal length anterior/posterior closures
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.
Posterior flap
- Infection
- DVT
- Neuroma- a bundle of nerve tissue. Painful if compressed. Must sufficiently pad the area.
Post-Surgical Complications
to maintain AROM and avoid contractures.
Early PT intervention
education on positioning, ther ex, transfers, re-establishing static and dynamic balance, wheelchair mobility, and ambulation.
Post-Surgical Phase
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.
Rigid
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.
Removable rigid
Unna boot style. Provides medicinal protection against infection, not as much support as rigid.
Semi-rigid
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.
Soft
tingling, burning, itching, pressure or numbness in an area that no longer exists.
Phantom sensations
cramping, squeezing, shooting/burning pain in an area that no longer exists.
Phantom pains
Position prone, no pillow in supine.
positioning- Avoid hip and knee flexion contractures.
prone/sidelying hip extension, supine/sidelying abd, supine hip flexion, sidelying adduction, SAQ (transtibial), glute squeezes, quad sets, hip rotation stretches.
Bed Exercise
a replacement for all or part of a limb
Prosthetic device
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 .
Partial Foot
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.
Syme’s Prosthesis
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.
Endoskeleton
“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.
Exoskeleton
the area that contains the actual residual limb. Created by molding to patient’s shape by either casting or computer aided design.
Socket
concave surfaces that allow decreased pressure over bony areas.
Reliefs
convex surfaces that allow increased pressure to more tolerant areas, such as muscle, tendon, and less prominent bony areas.
Buildups
how the limb stays in place during non-weight bearing activity.
Suspension
leather strap that surrounds the distal thigh.
Cuffs
leather or flexible plastic attachment that laces up the thigh. Can be problematic due to pressure atrophy.
Corsets
liner has pin attachment that locks into place on prosthesis.
Distal pin
medial and lateral edges extend above the femoral epicondyles; also uses removable medial wedge.
Supracondylar brim
also extends anteriorly above patella. Good for short transtibial amputations.
Supercondylar/suprapatellar brim
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.
Vacuum-Assisted
lower posterior and medial shelf for ischial tuberosity and gluteals, higher lateral and anterior wall to direct forces to the posterior.
Quadrilateral socket
narrower med/lat borders, weight is shifted to med/lat sides and distal limb instead of ischial tuberosity
Ischial containment
no liner needed, provides greatest amount of volume control. Pressure gradient too high for natural forces to overcome.
Total suction
requires liner and straps. Lesser pressure gradient inside/outside.
Partial suction
suspended entirely by pelvic straps
No suction
hardware attached to bone that fits to prosthesis.
Osseointegration
modify speed of motion so not as robotic and loud.
Friction mechanism (knee joint option)
Levels of Amputations for UE
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)
Computerized leg; very expensive but highest quality of mobility
C-leg (knee joint option)
