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Orthotics > Exam > Flashcards

Exam Flashcards

1
Q

Anatomical position (5)

A
  • standing
  • feet together
  • arms to the side
  • head and eyes facing forwards
  • palms of the hands facing forwards
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2
Q

Medial (1)

A

Closer to the midline

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3
Q

Lateral (1)

A

Further from the midline

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4
Q

Superior (1)

A

Closer to the head

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5
Q

Inferior (1)

A

Closer to the feet

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6
Q

Proximal (1)

A

Closer to the origin of a structure

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7
Q

Distal (1)

A

Further away from the origin of a structure

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8
Q

Posterior/dorsal (1)

A

Closer to the posterior surface of the body

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9
Q

Anterior/ventral

A

Closer to the anterior surface of the body

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10
Q

Supine (1)

A

Face or palm up

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11
Q

Prone (1)

A

Face or palm down

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12
Q

Flexion (2)

A
  • in non-anatomical language this is bending

- flexion usually means the angle between the body segments on either side of the flexion joint is decreased

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13
Q

Extension (1)

A

This is the opposite motion to flexion

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14
Q

Range over flexion vs range of extension (1)

A

For most joints range of flexion is greater than range of extension

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15
Q

Abduction (1)

A

Moving away from the midline of the body or segment

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16
Q

Adduction (1)

A

Moving closer to the midline of the body or segment

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17
Q

Internal rotation (2)

A
  • rotation towards the midline

- the anterior aspect of the segment rolls towards the midline

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18
Q

External rotation (1)

A

The opposite motion to internal rotation

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19
Q

Supination (1)

A

Rotating the arm and wrist so that the palm faces up

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20
Q

Pronation (1)

A

Rotating the arm and wrist so that the palm faces down

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21
Q

Valgus (1)

A

Turned outwards, away from the midline of the body

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22
Q

Varus (1)

A

Turned inward, towards the midline of the body

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23
Q

Gait cycle (2)

A
  • a reference framework for the walking process

- defines terms for the different phases and events of gait

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24
Q

Stance percentage (1)

A

60 percent

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25
Q

Swing percentage (1)

A

40percent

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26
Q

Loading qualities (3)

A
  • shock absorption
  • stabilisation of limb
  • preservation of progression
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27
Q

Mid stance qualities (1)

A

-progression of com to level with the supporting foot

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28
Q

Terminal stance qualities (1)

A

Progression of com to beyond the supporting foot

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29
Q

Pre-swing qualities (2)

A
  • preparation of the limb for swing

- assist with balance as weight is transferred

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30
Q

Initial swing qualities (2)

A
  • clearance of the floor

- advancement of the swinging limb to level with the supporting foot

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31
Q

Mid swing qualities (2)

A
  • clearance of the floor

- advancement of the swinging limb to beyond the supporting foot

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32
Q

Terminal swing qualities (1)

A

-preparation of the limb for weight acceptance

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33
Q

Cadence (2)

A
  • the number of steps (not strides) per minute

- also known as step rate

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34
Q

Step width (2)

A
  • the distance between the centres of the right and left heels measured perpendicular to the direction of progression
  • also known as walking base
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35
Q

Toe-out angle (2)

A
  • the angle between the direction of progression and a line drawn from the centre of the heel running between the 2nd and 3rd toes
  • also known as foot progression angle
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36
Q

Kinematics (3)

A
  • the study or description of motion, without regard to the forces which produce it
  • the displacements and velocities of the body segments
  • the angular displacements and velocities at the joints
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37
Q

Joint angles (1)

A

-measured in degrees from the neutral position

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38
Q

Kinetics (3)

A
  • the study or description of the forces, moments and masses which bring about the motion
  • forces bring about accelerations
  • moments bring about angular accelerations
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39
Q

Ground reaction force (4)

A
  • measured with a force platform
  • gives the magnitude of the force (Newtons)
  • the direction of the force
  • and also the point of origin under the foot
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40
Q

Moment (3)

A
  • a turning force
  • moment = magnitude of force x shortest distance between line of force and joint centre
  • the ground reaction force acts to produce a moment at each of the joints
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41
Q

Moment =

A

Force x distance

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42
Q

External moment

A

arises outside the body

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43
Q

Kinematics and kinetics (3)

A
  • if we know the external moment acting at a joint
  • and we know how the joint is moving
  • therefore we can usually make some inferences about what the muscles are doing
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44
Q

Concentric muscle action (1)

A

Muscle length decreases as the muscle generated tension ie muscle contracts

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45
Q

Eccentric muscle action (1)

A

-muscle length increases as the muscle generates tension

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46
Q

Concentric muscle action quantities (2)

A
  • high energy cost, ie muscles fatigue quickly

- mainly concerned with propulsion

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47
Q

Eccentric muscle action quantities (2)

A
  • much lower energy cost than concentric action

- mainly concerned with control in walking

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48
Q

Concentric muscle action motion (1)

A

-muscle activity causing motion which opposes the external moment

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49
Q

Eccentric muscle action motion (1)

A

-muscle activity controlling motion which is in the same direction ad the external moment

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50
Q

Negatives about observational gait analysis (3)

A
  • in real time the eye is not fast enough to observe some gait events
  • it may not be quantitive and may not even be objective
  • subjects may fatigue if much walking is required
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51
Q

Gait features feet sagittal plane (7)

A
  • initial contact by heel, flat or forefoot
  • does the foot slap down
  • does the heel contact the floor
    • if so when does it lift
  • are the toes dragging in swing
  • can you estimate the peak dorsiflexion in stance
  • can you estimate the plantarflexion in swing
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52
Q

Gait features feet coronal (3)

A
  • are the forefeet pronated
  • is the hind foot in valgus or varus
    • in stance and in swing
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53
Q

Gait features knees (7)

A
  • what is the peak knee extension in stance
    • too much or too little
  • what is the peak of flexion in swing
  • what is the position at initial contace
  • are the knees rotated in the transverse plane
    • relative to the direction of progression
    • relative to the pelvis
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54
Q

Gait features hips (5)

A
  • what is the peak knee extension in stance
    • too much or too little
  • what is the peak of flexion in swing
    • too much or too little
  • are these related to the position of the pelvis
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55
Q

Gait features pelvis sagittal (3)

A
  • is the pelvis more anteriorly or posteriorly tilted than normal
  • is there a marked lordosis
  • does the pelvis tilt through a greater range than normal through the gait cycle
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56
Q

Gait features pelvis coronal and transverse (2)

A
  • is the pelvis higher/more retracted on one side than the other
  • does the pelvis move through a greater range than normal through the gait cycle
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57
Q

Gait features upper body (3)

A
  • is there any forward or backward lean
  • is there any lateral tilting or flexing
  • is arm swing normal
58
Q

Muscle activity and emg (2)

A
  • when a muscle is active it produces a very low level electrical signal
  • this signal can be detected on the surface of the skin and is known as the electromyogram or emg
59
Q

Normal gait initial contact (1)

A

By heel

60
Q

Loading response ankle (3)

A
  • tibialis anterior is active in loading
  • it controls the plantarflexor moment and moderates plantarflexion as the foot moves to plantargrade
  • also active in swing to lift the foot, ensuring that it clears the ground
61
Q

Loading response knee (2)

A
  • quads are active in loading

- controlling the external flexor moment to prevent collapse as the knee flexes to absorb shock

62
Q

Loading response hip (2)

A
  • hip extensors are active in loading

- generating power to extend the hip and progress the body centre of mass forward

63
Q

Loading response summary (3)

A
  • dorsiflexors acting eccentrically to control motion of foot
  • quads acting eccentrically to control motion of the knee
  • hip extensors acting concentrically to assist with forward propulsion of centre of mass
64
Q

Mid stance ankle (2)

A
  • the plantarflexors are active throughout mid and terminal stance
  • they oppose the dorsiflexor moment and control dorsiflexion and tibial progression
65
Q

Mid stance knee (3)

A
  • the quads are still active in midstance
    • but activity tails off in terminal stance as the moment crosses over to extensir
  • they oppose the external flexor moment to effect extension of the knee
66
Q

Mid stance hip (3)

A
  • the hip extensors are also still active in mid stance
    • and activity also tails off in terminal stance as the moment crosses over to extensor
  • they oppose the external flexor moment to continue the extension of the hip
67
Q

Mid stance summary (3)

A
  • plantarflexors acting eccentrically to control progression of tibia
  • quads acting concentrically to effect extension of knee against flexor moment
  • hip extensors still acting concentrically to assist with forward propulsion of centre of mass
68
Q

Pre swing ankle (2)

A
  • the planarflexors are active in the early part of pre swing
  • they generate power which plantarflexes the foot against the dorsiflexor moment, and helps to propel the leg forward to initiate the swing phase
69
Q

Pre swing knee

A
  • the quads are active in pre swing

- even though the knee is starting to flex rapidly, this muscle action is required to moderate the rate of flexion

70
Q

Pre swing hip (2)

A
  • the hip flexors are active in later preswing

- they generate power to flex the hip at the beginning of swing

71
Q

Pre swing summary (3)

A
  • plantarflexors acting concentrically in early preswing to plantarflex the foot
  • quads acting eccentrically to control rate of flexion of knee
  • hip flexors acting concentrically to flex hip in prep for swing
72
Q

Ways to analyse energy in gait (4)

A
  • mechanical energy
    • calculations using kinematic and kinetic data
  • metabolic energy
    • measurements related to metabolic energy expenditure
73
Q

Mechanical energy in gait (6)

A
  • pe/ke energy exchange at com
  • calculations suggest that energy is transferred between segments during the gait cycle
  • may give us insight into the mechanism behind an energy efficient gait
  • energy calculations involve motion
    • cocontraction?
    • isometric contraction?
74
Q

Metabolic energy in gait (3)

A
  • o2 consumption is an indicator of metabolic energy expenditure
    • millimetres of o2 consumed per kilogram body mass per minute (ml/kg/min)
  • o2 cost = o2 consumption / speed
75
Q

Attributes of normal gait (5)

A
  • stability in stance
  • adequate foot clearance in swing
  • pre-positioning of foot for initial contact
  • adequate step length
  • energy conservation
76
Q

Stability in stance (3)

A
  • poor balance
  • poor trunk and lower body control
  • abnormal foot position
77
Q

Adequate foot clearance in swing (4)

A
  • loss of dorsiflexion in swing due to
    • weakness of the dorsiflexors
    • spasticity or shortness in the plantarflexors
  • inadequate knee flexion in swing
78
Q

Pre-positioning of foot for initial contact (4)

A
  • this allows efficient transfer of weight during loading
  • compromised by
    • poor control of swinging limb
    • possibly because of poor stability in stance on the contralateral side
79
Q

Adequate step length (3)

A
  • poor knee extension in stance
  • poor stance stability on the contralateral side
  • poor propulsive effort to the swinging limb (poor push off)
80
Q

Energy conservation in gait (4)

A
  • increased vertical excursion of the centre of mass
  • poor control of momentum
  • poor control of energy transfer between the body segments
  • energy efficiency summaries the degree of severity of all gait deviations
81
Q

Functional interpretation of the foot (3)

A
  • shock absorption
  • weight bearing stability
  • progression
82
Q

Shock absorption mechanisms in gait (7)

A
  1. Plantarflexion of foot
    • eccentric action of dorsiflexors
  2. Flexion of knee
    • eccentric action of quads
  3. Adduction of hip
    • eccentric action of abductors
      - plus functions within the foot
83
Q

Shock absorption mechanisms of foot (2)

A
  • heel fat pad

- subtalar and mid-tarsal joint motion

84
Q

What planes are important in gait? (3)

A
  • sagittal plane
  • coronal/frontal
  • transverse
85
Q

Spina bifida (5)

A
  • a neural tube defect
    • involves incomplete development of the brain, spinal cord, and/or their protective coverings
    • caused by failure of the foetus’s spine to close properly during he first month of pregnancy
    • infants born wit sb may have an open lesion on their spine where significant damage to the nerves and spinal cord has occured
  • although the spinal opening can be surgically repaired shortly after birth, the nerve damage is permanent, resulting in varying degrees of paralysis of the lower limbs
86
Q

S2 knee and foot (7)

A
  • peroneus brevis
  • peroneus longus
  • Flexor digitorum longus
  • flexor hallucis longus
  • gastroc
  • soleus
  • intrinsics
87
Q

S2 hip and knee (4)

A
  • gluteus maximus
  • medial hamstrings
  • lateral hamstrings
  • external rotators
88
Q

S3 (4)

A

Knee and foot:

  • flexor digitorum longus
  • flexor hallucis longus
  • intrinsics

Hip and knee: none

89
Q

L5 knee and foot (6)

A
  • peroneus brevis
  • peroneus longus
  • tibialis anterior
  • extensor digitorum longus
  • extensor hallucis longus
  • tibialis posterior
90
Q

L5 hip and knee (5)

A
  • gluteus maximus
  • medial hamstrings
  • lateral hamstrings
  • abductors
  • external rotators
91
Q

S1 knee and foot (8)

A
  • peroneus brevis
  • peroneus longus
  • extensor digitorum longus
  • extensor hallucis longus
  • flexor digitorum longus
  • flexor hallucis longus
  • gastroc
  • soleus
92
Q

S1 hip and knee (5)

A
  • gluteus maximus
  • medial hamstrings
  • lateral hamstrings
  • abductors
  • external rotators
93
Q

L1 (1)

A

Knee and foot: none

Hip and knee: hip flexors

94
Q

L2 (4)

A

Knee and foot: none

Hip and knee:

  • hip flexors
  • adductors
  • internal rotators
  • quads
95
Q

L3 (5)

A

Knee and foot: none

Hip and knee:

  • hip flexors
  • quads
  • adductors
  • internal rotators
  • external rotators
96
Q

L4 knee and foot (2)

A
  • tibialis anterior

- tibilalis posterior

97
Q

L4 hip and knee (3)

A
  • adductors
  • external rotators
  • quads
98
Q

Knee and foot muscles (11)

A
  • gastroc
  • soleus
  • peroneus brevis
  • peroneus longus
  • tibialis anterior
  • tibialis posterior
  • extensor digitorum longus
  • extensor hallucis longus
  • flexor digitorum longus
  • flexor hallucis longus
  • instrinsics
99
Q

Hip and knee muscles (5)

A
  • gluteus maximus
  • lateral hamstrings
  • medial hamstrings
  • abductors
  • external rotators
100
Q

Weak hip extensors (5)

A
  • hip extensors are active during terminal swing, loading and mid-stance
  • hamstrings and gluteus maximus
  • a backwards upper body lean will redirect the grf further back
  • extension of the hip progresses the trunk forward
  • if this is not possible pt may rotate pelvis in the transverse plane
101
Q

Weak hip abductors (5)

A
  • hip abductors are active during terminal swing, loading and midstance
  • in loading and midstance they act to balance the external adductor moment at the hip
  • a lateral upper body lean to the stance side will redirect the grf more laterally
  • using a stick on the opposite side will produce an opposing moment to assist the hip abductors
  • an alternative strategy to lateral lean
102
Q

Weak dorsiflexors (3)

A
  • the dorsiflexors are active during swing and loading
  • in swing they lift the foot to ensure that the toes do not drag along the ground
  • in loading they resist the external plantarflexor moment at the ankle and prevent the forefoot from slapping onto the ground
103
Q

Weak plantarflexors (1)

A

-the plantarflexors are active during mid and terminal stance

104
Q

Cerebral palsy (6)

A
  • a group of chronic conditions affecting body movement and muscle coordination
  • caused by damage to one or more specific areas of the brain
    • usually occuring during foetal development; before during or shortly after birth or during infancy
    • not caused by problems in the muscles or nerves
    • faulty development or damage to motor areas in the brain disrupt the brains ability to adequately control movement and posture
  • not progressive (ie brain damage does not get worse) however secondary conditions, such as muscle length and spasticity and bony deformity and may change over time
105
Q

3 main types of cp (3)

A
  • spastic cp
  • athetoid cp
  • ataxic cp
106
Q

Spastic cp (2)

A
  • muscles become very stiff and weak, especially under effort
  • leads to poor control of movement
107
Q

Athetoid cp (2)

A
  • some loss of control of their posture

- unwanted movements

108
Q

Ataxic cp (2)

A
  • poor coordination and balance

- maybe also shaky hand movements and irregular speech

109
Q

Spasticity (1)

A

Lance definition: spasticity is a motor disorder characterised by a velocity dependent increase in tonic stretch reflexes, with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex, as one component of the upper motorneurone syndrome

110
Q

Results from muscle spasticity (6)

A
  • muscle shortness
  • joint contracture
  • bony deformation
    • femoral antevertion
    • tibial torsion
    • foot deformity
111
Q

Spasticity cp appearance (3)

A
  • poor selective motor control
  • abnormal reflex activity
  • weakness
112
Q

Muscles frequently affected in spastic cp (5)

A
  • gastroc
  • soleus
  • hamstrings
  • rectus femoris
  • psoas
113
Q

Gastroc (3)

A
  • 2 joint
  • knee flexor
  • plantarflexor
114
Q

Soleus (2)

A
  • single joint

- plantarflexor

115
Q

Hamstrings (3)

A
  • 2 joint
  • hip extensor
  • knee flexor
116
Q

Rectus femoris (3)

A
  • 2 joint
  • hip flexor
  • knee extensor
117
Q

Psoas (2)

A
  • single joint

- hip flexor

118
Q

Spasticity in psoas (5)

A
  • psoas is a single joint muscle which stretches when the hip extends
  • maximal stretch on psoas therefore occurs at max hip extension ie during terminal stance
  • shortness and/or spasticity in psoas will cause limited peak hip extension
  • also an anteriorly tilted pelvis and lordosis
    • but beware this is not the only cause for these
119
Q

Spasticity in rectus femoris (4)

A
  • maximal stretch on rectus femoris occurs when the knee is flexed and the hip is extended
  • max hip extension does not happen at the same time as max knee flexion but they do become close in pre-swing and initial swing
  • maximally stretched in pre and initial swing
  • shortness and/or tone causes decreased and delayed knee flexion in swing
120
Q

Spasticity in hamstrings (5)

A
  • maximal stretch on the hamstrings occurs when the hip is maximally flexed and the knee is maximally extended
  • this happens around ic ie terminal swing and loading
  • flexed knee in terminal swing and loading
    • not always because of short hamstrings
    • there are several causes for this
121
Q

Spasticity in gastroc/soleus (1)

A

-maximal stretch on these muscles occurs during terminal stance

122
Q

Initial contact (2)

A
  • beginning if gait cycle

- heel strike can not be used for all pathological gait

123
Q

Foot off (2)

A

-foot that made ic at beginning of cycle lifts from ground and begins to swing forward

124
Q

Loading (2)

A
  • starts with ic and finishes with opposite foot off

- period during which weight is transferred from one limb to the other ie when the new stance limb is loaded

125
Q

Pre-swing (3)

A
  • starts with opposite foot contact and finishes with foot off
  • this interval is called preswing because it is the period during which the reference side prepares for the swing phase
  • it necessarily corresponds to loading on the opposite side
126
Q

Loading and pre-swing phases (2)

A
  • both feet are in contact with the ground

- so are called double support phases

127
Q

One limb in swing and one foot on ground (1)

A

-known as single support phases

128
Q

Mid and terminal stance (5)

A
  • single support period between opposite foot off and opposite foot contact
  • long interval in a typical gait cycle in which the body’s com progresses from behind the supporting stance foot to infront of it
  • therefore divides phase into 2 parts
  • first com is behind the stance foot and during second it is infront
  • first is called mid stance and 2nd terminal stance
129
Q

Midstance (6)

A
  • first phase of single support
  • finishes when the body weight is aligned over the stance foot
  • in nonpathological gait this will correspond to the maximum height attained by the centre of mass
  • in practice these events can be difficult to discern by eye and the point at which the feet cross is often taken as a marker of convenience for the end of midstance
  • for typical nonpathological gait this will also correspond with the alignment of the com over the stance foot but is not necessarily the case in pathological gait
  • note: midstance can sometimes be used to refer to an event rather than a phase
130
Q

Swing phase (3)

A
  • initial swing
  • mid swing
  • terminal swing
131
Q

Initial swing (2)

A
  • phase in which the swing limb accelerates forwards

- finishes when feet cross

132
Q

Mid swing (4)

A
  • starts when initial swing ends
  • the end of midswing is defined by perry as the point at which the swinging limb is forward and the tibia is ivertical
  • can not always be used for pathological gait eg crouch gait
  • an alternative def for pathological gait is point of maximum hip flexion
133
Q

Terminal swing (2)

A
  • final phase of the cycle between the end of midswing and initial contact
  • in nonpathological gait this is the phase in which advancement of the swinging limb is achieved solely via the extension of the knee
134
Q

Speed (1)

A

-usually measured in metres per second (ms-1)

135
Q

Stride length (1)

A

-the distance from the point of initial contact of one side to the next point of initial contact of the same side. Usually measured in metres (m)

136
Q

Step length (3)

A
  • the distance from the point of initial contact of one side to the next point of initial contact of the opposite side
  • this step length is attributed to the side which made the second initial contact
  • also usually measured in metres (m)
137
Q

Cadence (2)

A
  • the number of steps (not strides) taken in a given time period
  • sometimes called step rate and usually measured in steps per minute
138
Q

Step width (3)

A
  • the distance between the centres of the right and left heels measured perpindicular to the direction of progression
  • also known as walking base
  • may be measured in metres (m) centimetres (cm) or millimetres (mm)
139
Q

Stance and swing times (2)

A
  • the time spent in the stance phase or the swing phase for one or other side
  • may be measured in seconds(s) or may be divided by the total time taken for the entire gait cycle and expressed as a percentage (%gait cycle)
140
Q

Double support time (2)

A
  • the total time spent in double support
  • may be measured in seconds (s) but more usually divided by the total time taken for the entire gait cycle, and expressed as a percentage (% gait cycle)
141
Q

Single support time (2)

A
  • the total time spent in single support
  • as for double support may be measured in seconds (s) but more usually expressed as a percentage of the total gait cycle time (% gait cycle)
142
Q

Toe out angle (3)

A
  • the angle between the direction of progression and a line drawn from the centre of the heel running between the 2nd and 3rd toes
  • also known as foot progression angle
  • measured in degrees

Orthotics (3 decks)

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