Final Exam - Gait Deviations, Aquatic, Vestibular Flashcards
Characteristic of circumducted gait
Prosthesis swings laterally in a wide area during swing phase
Potential prosthetic cause of circumducted gait
Prosthesis is too long
Prosthesis has too much alignment stability or friction in the knee, making it difficult to bend the knee
Potential patient causes of circumducted gait
Abduction contracture of the residual limb
Lack of confidence for flexing the prosthetic knee because of muscle weakness or fear of stubbing toe
Habit
Characteristic of vaulting gait
Rising on toe of the sound foot permits the individual to swing the prosthesis through with little knee flexion
Potential prosthetic causes of vaulting
Prosthesis is too long
Inadequate socket suspension
Excessive stability in the alignment or some limitation of knee flexion such as a knee lock or a strong extension aid
Potential patient causes of vaulting
Fear of stubbing toe
Habit
Discomfort in residual limb
Potential prosthetic causes for rotation of prosthesis upon heel strike
Too much resistance to plantarflexion by plantarflexion bumper or heel wedge
Too much toe out build into prosthesis
Socket too loose
Potential patient causes for rotation of prosthesis upon heel strike
Extend residual limb too vigorously at heel strike
Poor muscle control of residual limb
Characteristic of uneven arm swing
Arm on prosthetic side is held close to body during locomotion
Potential patient causes of uneven arm swing
Poor balance
Fear and insecurity
Habit
Characteristics of uneven timing
Unequal duration steps with usually a very short stance phase on the prosthetic side
Potential prosthetic causes for uneven timing
Improperly fitting socket may cause pain
Weak extension aid or insufficient friction in prosthetic knee can cause excessive heel rise with prolonged swing through
Potential patient causes for uneven timing
Weak residual limb
Poor balance
Fear and insecurity
Characteristics of long prosthetic step
Individual takes longer step with the prosthesis than with the uninvolved LE
Potential prosthetic causes of long prosthetic step
Initial flexion in socket is insufficient when an irreducible flexion contracture is present
Potential patient causes of long prosthetic step
Flexion contracture that cannot be accommodated prosthetically
Characteristics of excessive trunk extension
Individual creates an active lumbar lordosis during stance phase
Potential prosthetic cause of excessive trunk extension
Improperly shaped posterior wall causing forward rotation of pelvis to avoid full weight bearing on ischium
Insufficient initial flexion built into socket
Potential patient causes of excessive trunk extension
Hip flexor tightness Hip extensor weakness Weak abdominals Habit Move shoulders back to gain balance
Characteristics of uneven heel rise
Prosthetic heel rises quite markedly and rapidly when the knee is flexed at beginning of swing phase
Potential prosthetic cause of uneven heel rise
Insufficient knee joint friction
Inadequate extension aid
Potential patient cause of uneven heel rise
Use more power than necessary to force knee into flexion
Characteristics of terminal swing impact
Rapid forward movement of the shin piece allows the knee to reach maximum extension with too much force before heel strike
Potential prosthetic cause of terminal swing impact
Insufficient knee friction
Too strong knee extension aid
Potential patient cause of terminal swing impact
Deliberate, forceful extension of residual limb to ensure knee in full extension
Characteristics of instability of prosthetic knee
Unstable knee creates danger of falling when knee flexes
Potential prosthetic cause of instability of prosthetic knee
Knee joint too far anterior of TKA line
Insufficient initial flexion built into socket
PF resistance too great, causing knee to buckle at heel strike
Failure to limit DF can lead to incomplete knee control
Potential patient cause of instability of prosthetic knee
Hip extensor weakness
Severe hip flexion contracture
Characteristics of medial or lateral whips
Medial whip is present when the heel travels medially on initial flexion and the beginning of swing phase; a lateral whip exists when the heel moves laterally
Potential prosthetic causes of medial/lateral whips
Lateral: excessive IR of prosthetic knee Medial: excessive ER of prosthetic knee Overly tight socket Excessive valgus of prosthetic knee toe break in conventional foot malaligned
Characteristics of foot slap
Too rapid descent of the anterior portion of the prosthetic foot
Potential prosthetic causes of foot slap
PF resistance too sfot
Potential patient causes of foot slap
Drive prosthesis into walking surface too forcibly to assure extension of knee
Characteristics of dropoff at the end of stance phase
Downward movement of trunk as the body moves over prosthesis
Potential prosthetic causes of dropoff at the end of stance phase
Inadequate limitation of DF in prosthetic foot
Too short heel in SACH
Characteristics of lateral bending of trunk
Excessive bending occurs laterally from midline, generally to prosthetic side
Potential prosthetic cause of lateral bending of trunk
Prosthesis too short
Improperly shaped lateral wall failing to provide adequate support for femur
Prosthetic aligned in abduction, causing wide-based gait
Potential patient cause of lateral bending of trunk
Inadequate balance
Abduction contracture
Oversensitive, painful residual limb
Habit
Characteristics of abducted gait
Very wide based gait with prosthesis held away from the midline at all times
Potential prosthetic causes of abducted gait
Prosthesis too long
Too much adduction built into prosthesis
High medial wall, causing ramus pressure
Improperly shaped lateral wall failing to provide support for femur
Potential patient causes of abducted gait
Abduction contracture
Habit
Thermoneutral
93-95
Convection
Movement of water across the skin or movement of body through water
Conduction
Physical contact between water and body
Radiation
Exchange of thermal energy between body and air
Four phases of Halliwick
Mental adaptation to being in the water
Restore balance from all positions in the water
Inhibit unwanted movement and remain stable in water
Swim from stabilized position
Shaw swimming
Combines swimming technique with Alexander technique
Feldenkrais pool conditions
86-94 degrees in chest deep water
Bad ragaz pool conditions
92-98 and in three to four feet in depth
Watsu pool conditions
92-96
What does Jahara mean
Third arm
What are the purposes of vestibular rehab
Stabilize visual images on fovea of retina during head movements
Postural stability
Spatial orientation
What are the otolith organs
Saccule
Utricle
What is the tonic firing rate
80 pulses per second
Rotation of head to the side depolarizes the hair cells and causes increased firing rate. Hyperpolarization occurs on the opposite labyrinth
Vestibulo-ocular reflex
Maintains gaze stability during rapid head movements
Operates from 60-400 degrees/second
What maintains gaze stability when the head is moving at less than 60 degrees per second?
Smooth pursuit
Meniere’s disease
Low frequency hearing loss and episodic vertigo, may have tinnitus
Related to endolymph fluid build-up
Perilymphatic fistula
Rupture of the oval or round windows causing fluid to leak into the middle ear
