Gait Assessment

Question 1

What to asses in Residual Limb

Answer 1

is skin free from abrasions, sores, and other problems

Question 2

potential issues with residual limb

Answer 2

areas that may not tolerate socket pressure

Question 3

What to assess/ potential issues with prosthesis

Answer 3

general condition, changes, broken components, wear and tear

Question 4

What to assess/potential issues with liner

Answer 4

does liner fit with socket? Improper fir may cause pain, skin breakdown, or gait deviations

Question 5

Assessing seated posture in transtibial amputation

Answer 5

knees flexed to 90, feet flat on floor

Question 6

Posterior flaring in seated position in transtibial

Answer 6

pressure on hamstrings when patient is seated? if pain is present pt will keep leg extended

Question 7

Residual limb position in seated position in transtibial

Answer 7

does stump rise out of socket when seated? socket may be too small or pt wearing too many socks

Question 8

Pain on Weightbearing

Answer 8

assess limb interface with socket at bony prominence, excesive pressure will cause skin problems and gait diviations

Question 9

Knee stability in standing

Answer 9

socket aligned in 5-8 deg of flexion

Question 10

Equal leg length in standing

Answer 10

PSIS, ASIS, iliac crests level? Too long or short = gait deviations

Question 11

Base of support

Answer 11

How wide is it? greater than 2-4 inches is problematic

Question 12

Standard socket alignment

Answer 12

5 deg flexion, 5 deg adduction

Question 13

4 Goals of prosthetic alignment

Answer 13

1. facilitating heel strike at initial contact
2. Providing adequate single limb stability during stance phase
3. creating smooth forward progression during transition from early to late stance phase (rollover)
4. insuring adequate swing phase toe clearance

Question 14

Pylon in standing (assessment and potential issues)

Answer 14

is pylon vertical, if not will lead to gait deviations, uneven pressure on one side or the other

Question 15

Shoe position on floor (assessment and potential issue)

Answer 15

foot fully on floor when standing? Could lead to plantarflexion or dorsiflexion while walking, shortens lever, less efficient gait

Question 16

Brim of socket (what to assess, potential issues)

Answer 16

are there excessive rolls of tissue? Gaps? Socket may be too tight, too big, or not properly molded

Question 17

Assessment of Liner When standing (what to assess and potential issues)

Answer 17

Does the stump and liner have good interface? Worn out liners –> skin breakdown

Question 18

Suspension (what to assess and potential issues)

Answer 18

Does prosthesis move too much when leg is off the ground? Too much movement = skin breakdown

Question 19

Static Observations of transfemoral amputation/prosthesis

Answer 19

Interior of socket- is inside of socket smooth?
component function- is knee joint providing 5-8 degrees of flexion? If too little hyperextension can occur, and problems in stance can lead to falls.

Question 20

Transfemoral Observation: Fit of socket sitting (What to assess and potential issues)

Answer 20

Is the socket fitting securely? Socket should fit securely in all positions

Question 21

Transfemoral Sitting observation: bilateral shin and thigh length

Answer 21

Are the knees level when sitting with knees flexed to 90? A high prosthetic knee –> misaligned knee joint and poor swing through

Question 22

Transfemoral Sitting observation: burning/pinching

Answer 22

Is there a smooth, thin socket or liner layer on the posterior wall? If not –> sciatic nerve pressure

Question 23

Transfemoral Sitting observation: Reach Shoes

Answer 23

Can the patient lean forward and reach shoes? Ant. wall may block forward lean

Question 24

Transfemoral Standing Observation: Socket fit

Answer 24

Is the patient comfortable in the socket? Gait deviations, non-compliance, skin breakdown

Question 25

Transfemoral standing observation: knee stability

Answer 25

Is the knee in line with or just behind the trochanter to knee axis? If the knee is anterior to this line it will be unstable leading to gait deviations

Question 26

Transfemoral Standing Observation: Level of Pelvis

Answer 26

Are the ASIS, PSIS, and Iliac crests level?

Question 27

Transfemoral Standing Observation: Socket contact with residual limb

Answer 27

Is there good contact between the socket and residual limb? If loose or tight, skin breakdown and discomfort can occur.

Question 28

Transfemoral Standing Observation: Adductor Roll

Answer 28

Is there an adductor roll? Pain if adductor roll over medial wall is pinched between socket and pubic ramus?

Question 29

Transfemoral standing observation: Pressure on pubic ramus

Answer 29

Is there pressure on pubic ramus from socket? Pain–> abducted gait