Gait Assessment Flashcards
What to asses in Residual Limb
is skin free from abrasions, sores, and other problems
potential issues with residual limb
areas that may not tolerate socket pressure
What to assess/ potential issues with prosthesis
general condition, changes, broken components, wear and tear
What to assess/potential issues with liner
does liner fit with socket? Improper fir may cause pain, skin breakdown, or gait deviations
Assessing seated posture in transtibial amputation
knees flexed to 90, feet flat on floor
Posterior flaring in seated position in transtibial
pressure on hamstrings when patient is seated? if pain is present pt will keep leg extended
Residual limb position in seated position in transtibial
does stump rise out of socket when seated? socket may be too small or pt wearing too many socks
Pain on Weightbearing
assess limb interface with socket at bony prominence, excesive pressure will cause skin problems and gait diviations
Knee stability in standing
socket aligned in 5-8 deg of flexion
Equal leg length in standing
PSIS, ASIS, iliac crests level? Too long or short = gait deviations
Base of support
How wide is it? greater than 2-4 inches is problematic
Standard socket alignment
5 deg flexion, 5 deg adduction
4 Goals of prosthetic alignment
- facilitating heel strike at initial contact
- Providing adequate single limb stability during stance phase
- creating smooth forward progression during transition from early to late stance phase (rollover)
- insuring adequate swing phase toe clearance
Pylon in standing (assessment and potential issues)
is pylon vertical, if not will lead to gait deviations, uneven pressure on one side or the other
Shoe position on floor (assessment and potential issue)
foot fully on floor when standing? Could lead to plantarflexion or dorsiflexion while walking, shortens lever, less efficient gait
Brim of socket (what to assess, potential issues)
are there excessive rolls of tissue? Gaps? Socket may be too tight, too big, or not properly molded
Assessment of Liner When standing (what to assess and potential issues)
Does the stump and liner have good interface? Worn out liners –> skin breakdown
Suspension (what to assess and potential issues)
Does prosthesis move too much when leg is off the ground? Too much movement = skin breakdown
Static Observations of transfemoral amputation/prosthesis
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.
Transfemoral Observation: Fit of socket sitting (What to assess and potential issues)
Is the socket fitting securely? Socket should fit securely in all positions
Transfemoral Sitting observation: bilateral shin and thigh length
Are the knees level when sitting with knees flexed to 90? A high prosthetic knee –> misaligned knee joint and poor swing through
Transfemoral Sitting observation: burning/pinching
Is there a smooth, thin socket or liner layer on the posterior wall? If not –> sciatic nerve pressure
Transfemoral Sitting observation: Reach Shoes
Can the patient lean forward and reach shoes? Ant. wall may block forward lean
Transfemoral Standing Observation: Socket fit
Is the patient comfortable in the socket? Gait deviations, non-compliance, skin breakdown
Transfemoral standing observation: knee stability
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
Transfemoral Standing Observation: Level of Pelvis
Are the ASIS, PSIS, and Iliac crests level?
Transfemoral Standing Observation: Socket contact with residual limb
Is there good contact between the socket and residual limb? If loose or tight, skin breakdown and discomfort can occur.
Transfemoral Standing Observation: Adductor Roll
Is there an adductor roll? Pain if adductor roll over medial wall is pinched between socket and pubic ramus?
Transfemoral standing observation: Pressure on pubic ramus
Is there pressure on pubic ramus from socket? Pain–> abducted gait
