Final Exam Flashcards
task related determinant
element of a task that is critical to successful performance
framework for observational task analysis
general observations
deviations
hypothesized causes
testing hypotheses
Steps in observational gait analysis
general observations
gait deviations
hypothesize problems
test hypotheses
12 critical events
heel contact heel rocker controlled knee flexion hip/pelvic stability ankle rocker forefoot rocker hip extension rapid plantar flexion passive knee flexion peak knee flexion ankle DF to neutral peak hip flexion knee extension to neutral
Overall trend in activity related to occupation
increase in low activity levels and decrease in high activity levels
molecular changes that occur that can alter mechanics of joints
increased structural protein cross linkages
decreased proteoglycan size
fragmentation of collagen
cellular changes that occur that can alter mechanics of joints
decreased proliferation
altered control of apoptosis
decreased response to growth factors
altered response to loading
structural changes
increased stiffness decreased water content decreased strength decreased cross-sectional area and/or volume ROM and load transmission changes
What is the order of decline in magnitude in trunk ROM
extension
lateral flexion
rotation
flexion
order of loss of ROM in hip
extension, rotation, abduction
main loss in ROM at ankle w/ aging
dorsiflexion
ROM loss order in shoulder
flexion, external rotation, abducation
posture involved w/ aging
forward head, thoracic kyphosis, flattened lumbar curve, hip/knee flexion, wide base of support
postural control alterations w/ aging
increased postural sway
decreased limits of stability
altered motor strategies
limited response capacity
gait variabilities w/ aging
gait speed decreased decreased stride length decreased SLS time step width variability energy expenditure
sit to stand phases
- weight shift
- momentum transfer from upper to lower body
- extension
- stabilization
What is the most commonly injured location in running?
knee followed by shin and foot
PFPS most common injury
Running gait cycle
stance phase- absorption
stance phase- generation
swing phase- generation=
swing phase- reversal/absorption
What changes with an increase in slower speeds vs an increase in faster speeds?
at slower speeds, increase comes mostly from stride length, while it comes mostly from stride frequency at faster speeds
What is the most common foot strike pattern for recreational runners?
rear-foot strike
What are some changes that are influenced by barefoot running?
shorter contact time
shorter stride length
greater stride frequency
vertical ground reaction force differences
How is power absorption distribution different in RFS vs FFS/Midfoot?
Midfoot/forefoot strike leads to decreased power absorption at the knee and hip and increased power absorption at the ankle
achilles tendon effects with FFS/MFS
higher achilles tendon average loading rate and impulse
does BF training help to increase postural stability and balance?
yes- deflect load and redistributes it to the digits
What happens to the medial longitudinal arch w/ barefoot running?
significantly shortened
How does BF running help with force absorption
may help the LE to attenuate impact forces- may be helpful for any runner
injuries corresponding to rear foot
anterior leg injuries: knee pain, quad strains, hip injuries
injuries related to mid-foot/forefoot
posterior leg injuries: achilles tendonopathy, hamstring, foot injuries
When transitioning to barefoot running, how should they progress?
1/4 mile and increase by 10% per week
cadence manipulation
increase preferred cadence by 10%- decreases peak forces and decreases overstrike,
Difference between phantom limb pain vs phantom limb sensation
phantom limb pain is more of a feeling or sensation that the limb is present (can be helpful) while phantom pain is considered abnormal and is treated aggressively with medication, and guided imagery
types of UE prostheses
IPOP: immediate post-operative prosthesis passive body-powereed/cable operated electrically powered hybrid adaptive/recreational
Orientation to prosthetic wearing
wear for
how to open the terminal device of body control prosthesis
scapular abductio nand shoulder flexion
elbow flexion/extension w/ body control
use forearm lift device which responds to scapular abduction and chest expansion when elbow is locked
***elbow lock/unlock
shoulder depression, extension and abduction - “down, back, out”
benefits of electric powered/myoelectric prosthesis
imporoved cosmesis, increased grip force, minimal to no harnessing, ability to use overhead, minimal effort to control, more similar to human control
myoelectric disadvantages
cost
frequency of maintenance/repair
fragile nature of gloves requiring frequency replacement
less proprioceptive feedback
slowness in response and increased weight
UCBL
exceptional control of calcaneal deviation
fits easily into most shoes
SMAFO
provides medial/lateral ankle control and allows full dorsi flexion/plantar flexion
flexible calcaneal deformities
metal AFO
free motion DF, PF assist or double action
used for patients who are reluctant to change to plastic or fluctuating volume present due to edema
dorsi-flexion assist
offers plantar flexion resistance at heel strike and DF resistance at toe off
holds foot in neutral position during swing
mild med/lat instability
dynamic carbon fiber AFO
absorb force at heel strike and help propel at toe off
management of drop foot due to DF paralysis/weakness, and neuro conditions including CVA, charcot marie tooth, MS and mild medial/lateral instability
solid ankle AFO
custom fabricated for individual patient needs
provides anterior/posterio and med/lat stability
loss of gastroc/soleus strength and mild instability of the knee
varus/valgus at ankle
anterior floor reaction
ant/post and med/lat stability
crouch gait, weak quads
hinged ankle AFO
allows full/limited DF/FP
med/lat ankle instability
mild genu recurvatum or drop foot
2 stage AFO
leather AFO reinforced w/ plasticsoft inner boot reinforced by semi rigid outer plastic AFO
boney pronators, sensation inssues, spinabifida
AZ AFO
patient comfort, adjustability for edema management
post tib tendon dysfunction
ankle arthritis
naturopathic walker
soft inner liner, rocker bottom sole diabetic ulcers, fracture management
plastic KAFO
M/L instability
A/P instability
hamstring/quad wakness
4 aspects of care involved pre-operatively w/ amputation
education
rapport
function
meet w peer
types of dressings for shrinnkage
rigid non-removable
rigid removable
soft dressings
RIGID= IPOP
advantages of IPOP
provide more protection if paint falls, but makes dressing change more difficult, limits knee ROM, increased likelihood of dehiss of incision while weight bearing due to rigidity
advantages/disadvantages soft dressings
advantage to be able to take off soft dressing if uncomfortable, less protection is fall
more superior option between IPOP/soft?
IPOP showed no further surgical intervention, fewer post op complications, and shorter times to custom prostheses
what is the purpose of the first prosthesis?
to condition the residual limb, shrink/shape residual limb, is meant to be adjustable, a reduce contractors,
K2, K3, K4
K2 walk at one speed
K3, can increase speed- community ambulatory
k4- increased demand on prosthetic- athletic active
what factors is energy expenditure related to for gait?
level of amputation
stride length
asymmetry
more energy expenditure shown to be involved w/ vascular or non-vascular
vascular
what measurements are the c-leg sensors detecting?
knee anlge change
knee angle rate of change (acceleration/deceleration)
ankle plantar flexion moment
ankle dorsiflexion moment
what two factors must be met so that c-leg will aloow the knee to flex?
dorsiflexion moment >66% of body weight
knee is fully extended
(if not reached, stays in extension)
what three parameters are required to release stance in the rhea knee?
20% maximum toe load
knee in full extension
no knee movement
OR unloading of prosthesis
power knee
power for concentri and eccentric- helps with sit to stand/stand to sit, transition from level to stairs/ramps
powered swing flexion and powered swing extension
powered stair ascent
genium knee
next generation of c-leg- allows for walking backwards, multi direction motion, immersible
built in runner mode
who is a candidate for the c-leg, reheo, power knee, or genium?
K3 and K4 range (some argue 2)
frequently walk w/ inclines or uneven terrain
frequenclty vary cadence
needs complete hip extension
genium more specifically?
user’s condition demands high degree of safety
predominant reason for prescribing foot orthoses?
motion control- includes providing support to longitudinal and transverse arches of the foot
-control the amount and rate of foot motion, especially foot pronation
orthotics for motion control
cobra pad, functional foot orthosis, MASS device
most effect for motion control?
posted and molded
important uses for foot orthoses considering alignment
not as important to align skeleton, but rather permit return to preferred motor pattern
