Exam 5: Transfemoral Gait Deviations Flashcards
Gait deviations you are likely to see intial contact to loading response
- Rotation of prosthetic foot at initial contact
- instability of prosthetic knee
- Foot slap
Problem with amputee that may lead to rotation of prosthetic foot at initial contact
too vigorous extension of knee by amputee
Problems with prosthesis that may lead to rotation of prosthetic foot at IC (2)
- heel cushion too firm/ too hard PF bumper
- loose socket
Problems with amputee that may result in instability of P.knee during IC and LR
- weak hip extensors
- significant flexion contracture- the more severe the contracture, the earlier in stance it cause instability; therefore most contractures cause problems in or near mid-stance
Problems with prosthetic that may result in instability of P.knee during IC and LR (4)
- unstable knee (too far anterior to Tr-Kn-An line)
- too firm heel cushion or PF bumper
- insufficient flexion in socket
- heel too high or excessive dorsiflexion
Reasons foot slap may occur (2)
Prosthetic: Posterior bumper too soft
Amputee: forceful driving of prosthesis into ground to ensure knee stability
Gait Deviations you are likely to observe in Mid-stance
- Ipsilateral bending of trunk
- Contralateral bending of trunk
Problems with the amputee that may cause I-lat trunk leaning during mid-stance
- very short RL
- habit/fear/poor balance
- weak abductors
- abduction contracture
- habit or poor gait training (inadequate weight shifting)
Problems with the prosthesis that may cause I-lat trunk leaning during mid-stance (4)
- too short
- lateral wall allows too much abduction of femur
- foot outset
- distal lateral RL pain
Problem causing contralateral trunk lean during
mid-stance
cotch pressure
Gait Deviation likely to be observed terminal stance to pre-swing
Drop-off at end of stance
Problems that may cause drop-off at end of stance
Amputee: nothing
Prosthesis:
- inadequate limitation of DF
- too soft DF bumper
- toe break too far posterior
- socket too anterior on pilon
- foot too posterior
Gait deviations you are likely to see dring intial swing (4)
- excessive heel rise
- excessive pistoning
- lateral whip
- medial whip
Problems with amputee that may cause excessive heel rise during initial swing
forcible hip flexion
Problems with prosthesis that may cause excessive heel rise during initial swing (3)
- insufficient friction at knee
- inadequate extension aid
- improper knee selection
Problems that may cause excessive pistoning during intial swing
Amputee: may occur w/ lg. flabby RL w/ poor muscle control
Prosthesis: pt. not seated in socket (socket too big or improperly donned)
Problem with amputee that may cause lateral whip during initial swing
improper donning
Problem with prothesis that may cause lateral whip during initial swing
too much IR at knee
Problem with amputee that may cause medial whip during initial swing
improper donning
Problems with prothesis that may cause medial whip during initial swing (2)
- too much ER at knee
- socket too loose
Gait deviations that may be observed during mid-swing (3)
- vaulting
- circumduction
- abducted gait
Where is the pressure focused during an abducted gait deviation?
abducted gait causes excessive distal. lateral pressure
Problems with the amputee that may cause vaulting during mid-swing (4)
- habit
- poor balance/ poor knee control, ex: weak hip extensors
- fear of stubbing prosthetic toe
- weak hip flexors or improper gait training for intiation of flexion
Problems with prothesis that may cause vaulting during mid-swing (4)
- too long
- inadequate suspension
- too much knee friction leading to insufficient knee flexion
- excessive built-in knee stability (such as knee joint too far posterior to TKA line)
Problems with amputee that may cause circumduction during mid-swing (3)
- habit
- weak hip extensors
- insecurity regarding knee control
Problem with prosthesis that may cause circumduction during mid-swing
too much stability at knee joint (too much friction or knee posterior to TKA line)
Problems with amputee that may cause an abducted gait during mid-swing (4)
- abduction contracture
- habit
- fear (such as results from weak hip extensors)
- RL pain (crotch pressure)
Problems with prosthesis that may cause an abducted gait during mid-swing (3)
- too long
- too high medial wall
- too much foot outset or valgus alignment between shank and socket may mimic this
Gait deviations that may be observed during terminal swing and in general (3)
Terminal Swing
- terminal impact
General
- uneven timing (short prosthetic stance)
- uneven arm swing
What is terminal impact?
The prosthetic shank comes to a sudden stop with a visible and possibly audible impact as the knee reaches full extension
Problems with amputee that may cause terminal impact during terminal swing (2)
- intentional- to get audible cue
- too vigorous hip flexion followed by strong hip extension
Problems with prosthesis that may cause terminal imact at terminal swing (2)
- insufficient friction at knee
- too strong extension aid
Problems with amputee that may cause uneven timing (3)
- weakness/unstable knee
- poor balance/insecurity
- pain
Problems with prosthesis that may cause uneven timing (5)
- socket fits poorly causing pain
- alignment instability
- excessive DF
- poor suspension
- unaccommodated hip flexion contracture
Problems with amputee that may cause uneven arm swing (3)
- habit
- poor balance
- insecurity
Problems with prosthesis that may cause uneven arm swing (2)
- occassional due to stump pain (that’s what Mincer has on the sheet- seems weird)
- inadequate suspension
Some sage advice
What gait deviations might you observe in a transfem amputee with weak hip extensors? (3)
- instability of prosthetic knee during IC to LR phase
- circumduction during mid-swing
- abducted gait during mid-swing (fear component with this)
What gait deviations might you see in a transfem amptee with an abduction contracture? (2)
- ipsilateral bening of trunk during mid-stance
- abducted gait during mid-swing
What gait deviations might you see in a transfem amputee with poor balance and/or fear? (5)
- ipsilateral trunk bending during mid-stance
- vaulting during mid-swing
- abducted gait during mid-swing
- uneven timing (short prosthetic stance)
- uneven arm swing
What gait deviations might you see if the transfem prosthesis has too much DF? (3)
- instability of prosthetic knee during IC to LR
- drop-off at end of stance during terminal swing to mid-stance
- uneven timing (short prosthetic stance)
What gait deviation might you see in a transfem amputee with a significant hip flexion contracture?
instability of the prosthetic knee during IR to LR
What gait deviation are you likely to see in a transfem amputee with weak hip flexors?
Vaulting during mid-swing
What gait deviations might you see in a transfem prothesis if the socket is too loose? (2)
- rotation of prosthetic foot at IC
- medial whip
What gait deviations might you see if the transfem prosthesis has a heel cushion that is too firm or PF bumper is too hard? (2)
- rotation of prosthetic foot at IC
- instability of prosthetic kneeduring IC to LR
What gait deviation might you see in transfem prothesis if the posterior bumper is too soft
foot slap during IC to LR
What gait deviation might you see of the transfem prosthesis is too short?
ipsilateral trunk bending during mid-stance
Gait deviations you are likely to see due to lack of or poor gait training according to Mincer (3)
- instability of prosthetic knee during IC-LR
- I-lat trunk bending during midstance
- vaulting during mid-swing
Gait deviation that have nothing to do with the amputee and we can only blame the prosthesis (1)
Drop-off
