Dynamic Assessments: Lower Extremity Amputation Flashcards
What are prosthetic causes of excessive knee flexion?
Heel height too high, stiff heel cushion, excessive ankle dorsiflexion, socket too far anterior/foot too posterior, socket excessively flexed, prosthesis too long.
what phases of gait is excessive knee flexion a problem?
stance phase
IC, LR, MS, TS
Which of the following is NOT a prosthetic cause of excessive knee flexion?
a) Heel height too high
b) Socket positioned too far posteriorly
c) Excessive ankle dorsiflexion
d) Stiff heel cushion
Answer: b) Socket positioned too far posteriorly
A stiff ________ is a prosthetic cause of excessive knee flexion.
heel cushion
What anatomical factors contribute to excessive knee flexion?
Knee and/or hip flexion contracture, weakness of quadriceps, pain anteriorly in residual limb, poor balance.
Which anatomical cause is likely to increase excessive knee flexion in a patient with a prosthesis?
a) Strong quadriceps
b) Knee or hip flexion contracture
c) Heel height too low
d) Socket excessively extended
b) Knee or hip flexion contracture
What is the functional significance of excessive knee flexion?
Impaired shock absorption and increased demand on quadriceps to prevent further knee flexion
if the prosthetic ankle is aligned in _____ or ________, it will cause an anterior shift of the knee joint
DF
neutral with too high heel or too stiff
your patient is an amputee with increased heel height which causes him to compensate with a forward trunk lean. what are reasons this patient would compensate in that way?
decreased moment arm –> decreased torque –> decreased quad activation needed
which phase of gait is insufficient knee flexion problematic?
swing phase
What are prosthetic causes of insufficient knee flexion?
low shoe heel
soft heel cushion
excessive ankle PF
socket too far post./foot too far ant.
socket insufficiently flexed
Which of the following is NOT a prosthetic cause of insufficient knee flexion?
a) low shoe heel
b) stiff heel cushion
c) Excessive ankle PF
d) socket too far posterior
b - stiff heel cushion
What anatomical factors contribute to insufficient knee flexion?
weakness of quads
anterior-distal pain
inadequate gait training
Which anatomical cause is likely to lead to insufficient knee flexion in a patient with a prosthesis?
a) Strong quadriceps
b) anterior-distal pain
c) Heel height too low
d) proper gait training
b- anterior-distal pain
What is the functional significance of insufficient knee flexion?
reliance on body structures stance stability
insufficient shock absorption
if the prosthetic ankle is aligned in _____ or the AFO is aligned in _____w/___, it will cause knee hyperextension
PF
PF with too short heel or too soft
What are prosthetic causes of lateral/varus thrust at midstance?
excessive foot inset
low trim lines
poor M-L stability
Which of the following is NOT a prosthetic cause of lateral/varus thrust at midstance?
a) excessive foot inset
b) low trim lines
c) good M-L stability
c) good M-L stability
what are anatomical causes of latera/varus thrust at midstance?
proximal weakness
short residual limb
poor M-L stability
which of the following can be both a prosthetic and anatomical cause of lateral/varus thrust at midstance?
a) excessive foot inset
b) short residual limb
c) proximal weakness
d) poor M-L stability
d) poor M-L stability
what is the functional significance of lateral/varus thrust at midstance?
narrow BOS
increased stress on medial knee joint –> could lead to early degenerative changes
What are prosthetic causes of medial/valgus thrust at midstance?
excessive foot outset
low trim lines
poor M-L stability
Which of the following is NOT a prosthetic cause of medial/valgus thrust at midstance?
a) excessive foot inset
b) low trim lines
c) poor M-L stability
a) excessive foot inset
what are anatomical causes of medial/valgus thrust at midstance?
proximal weakness
short residual limb
poor M-L stability
do anatomical causes differ between lateral/varus thrust at midstance and medial/valgus thrust at midstance?
no
what is the functional significance of medial/valgus thrust at midstance?
increased stress on lateral knee joint –> could lead to early degenerative changes
the socket lateral to foot or foot inset will lead to an increase in knee ______ moment
the socket medial to foot or foot outset will lead to an increase in knee _____ moment
varus
valgus
what are prosthetic causes of excessive abduction in stance for TFA?
long prosthesis
abducted socket
sharp or high medial wall
inadequate suspension
Which of the following is NOT a prosthetic cause of excessive abduction in stance?
a) long prosthesis
b) inadequate suspension
c) abducted socket
d) low medial wall
d)
what are anatomical causes of excessive abduction in stance in TFA?
abduction contracture
lateral/distal pain
weakness of hip flexors or hip adductors ipsilaterally
adductor roll
Which anatomical cause is likely to lead to excessive abduction in a patient with a TFA?
a) adduction contracture
b) medial/proximal pain
c) weakness of hip flexors
d) abductor roll
c)
what is the functional significance of excessive abduction in stance in TFA?
widens base of support for stability
what are prosthetic causes of excessive forward trunk flexion in stance in TFA?
socket too big
poor suspension
unstable knee unit
short walker or crutches
Which of the following is NOT a prosthetic cause of excessive forward trunk flexion in stance?
a) socket too big
b) inadequate suspension
c) stable knee unit
d) short walker or crutches
c)
what are anatomical causes of forward trunk flexion in stance in TFA?
instability
hip flexion contracture
pain with ischial tuberosity WBing
Which anatomical cause is likely to lead to excessive forward trunk flexion in a patient with a TFA?
a) stability
b) knee flexion contracture
c) hip flexion contracture
d) pain in supine
c)
what is the functional significance of excessive forward trunk flexion in stance in TFA?
forward displacement of COM
increased energy expenditure
you assess gait in your TFA patient. You notice an ipsilateral trunk lean in stance phase. What is the most likely reason for this compensation?
reduction in hip adduction and knee varus moments –> less activity needed from hip abductors
what are prosthetic causes of a lateral whip in swing in TFA?
faulty socket contour
knee internally rotated
foot malrotated
prosthesis donned in malrotation
Which of the following is NOT a prosthetic cause of lateral whip in swing?
a) faulty socket contour
b) foot malrotated
c) prosthesis donned in malrotation
d) knee externally rotated
d)
what is an anatomical cause of lateral whip in swing?
weakness of hip rotators
what is the functional significance of a lateral whip in swing?
assists with foot clearance
what are prosthetic causes of foot rotation at loading response in TFA?
stiff heel cushion (rigid SACH foot)
malrotated foot
loose fitting socket
Which of the following is NOT a prosthetic cause of foot rotation at loading response?
a) soft heel cushion
b) stiff heel cushion
c) loose fitting socket
d) malrotated foot
a)
what are anatomical causes of foot rotation at loading response in TFA?
poor muscle control
improper training
weak hip medial rotators
Which anatomical cause is likely to lead to foot rotation at loading response in a patient with a TFA?
a) good muscle control
b) proper training
c) strong hip medial rotators
d) weak hip medial rotators
d)
what is the functional significance of foot rotation at loading response?
poor stance stability
alters forward progression
which of the following is the most likely cause of excessive forward trunk lean during the stance phase of gait?
a) weakness of hip extensors
b) hip flexion contracture
c) poor eccentric quadriceps control
d) locked prosthetic knee
b) hip flexion contracture
a patient uses an ischial containment socket, which of the following deviations is most likely to be observed in static standing due to the socket design?
a) elevated ASIS on prosthetic side
b) backward trunk lean
c) decreased anterior pelvic tilt
d) increased anterior pelvic tilt
d) increased anterior pelvic tilt
