gait deviations Flashcards
BK
Prosthesis
Vaulting, Pelvic Hike, Circumduction (3)
- prosthesis is too long
- insufficient suspension: pistoning and dropping down lengthens it
- foot set in too much PF: lengthen it
BK
Patient
Vaulting, Pelvic Hike, Circumduction (3)
- knee extension contracture: cannot shorten
- weak hip and knee flexors: need to compensate with trunk or pelvis
- Lack pre-ambulation training
BK
Rapid and Excessive Knee Flexion in Early Stance (6)
- BK socket tilted too far anteriorly
- foot set too far posteriorly
- hard cushion heel: if cannot compress for FF need to bring forward tib and fib –knee flexion
- knee flexion contracture
- pain in residual limb –protective knee flexion
- inability to compress heel
BK
prosthesis
Rapid and Excessive Knee Flexion in Early Stance (3)
- BK socket tilted too far anteriorly
- foot set too far posteriorly
- hard cushion heel: if cannot compress for FF need to bring forward tib and fib –knee flexion
BK
patient
Rapid and Excessive Knee Flexion in Early Stance (3)
- knee flexion contracture
- pain in residual limb –protective knee flexion
- inability to compress heel: if cannot compress for FF need to bring forward tib and fib –knee flexion
BK
Insufficient Knee Flexion In Early Stance (6)
- insufficient anterior tilt of socket
- foot set too far anteriorly = not far enough posteriorly
- Heel is too soft
- knee extension contracture
- Quadriceps weakness–lock knee in extension and lean forward with trunk to create biomechanical extension moment at knee–dont want a flexion moment because of weak quads so lack flexion
- Residual Limb Pain
BK
Prosthesis
Insufficient Knee Flexion In Early Stance (3)
- insufficient anterior tilt of socket
- foot set too far anteriorly = not far enough posteriorly
- Heel is too soft
BK
Patient
Insufficient Knee Flexion In Early Stance (3)
- knee extension contracture
- Quadriceps weakness–lock knee in extension and lean forward with trunk to create biomechanical extension moment at knee–dont want a flexion moment because of weak quads so lack flexion
- Residual Limb Pain
BK
Excess Valgus at Midstance (4)
- foot set too far laterally
- poorly fitting socket
- Genu Valgum
- MCL Laxity
BK
Prosthesis
Excess Valgus at Midstance (2)
- foot set too far laterally
2. poorly fitting socket–prosthesis is thrusting in medially as a result crating a valgus moment
BK
Patient
Excess Valgus at Midstance (2)
- Genu Valgum
2. MCL Laxity
BK
Excess Varus at Midstance (4)
- foot set too far medially
- poorly fitting socket
- genu varum
- LCL laxity
BK
Prosthesis
Excess Varus at Midstance (2)
- foot set too far medially
2. poorly fitting socket
BK
Patient
Excess Varus at Midstance (2)
- genu varum
4. LCL laxity
BK
Medial and Lateral Whips (2)
medial whip: heel turns in medially
lateral whip: heel turns out laterally
- poorly fitting socket
- insufficient accommodation of hamstring tendon
- —(hamstring tendon pushes into the posterior wall and creates the rotation)
BK
Asymmetrical Step Lengths and Times (7)
- decreased prosthetic stance time: decreased SLS on the prosthetic leg- quicker shorter steps with contralateral leg
- quick and short step with intact LE
- Residual limb pain: WB less on painful side
- poor prosthetic fit/alignment
- lack preambulation training
- weakness
- fear
How much does AK need to allow in knee flexion to sit?
115 degrees
if limb is neutral but prosthesis is IR
adductor tendon may be on anterior wall
if limb is neutral but prosthesis is ER
adductor tendon may be on medial wall
Allow LLD
no more than 1/2 inch
AK
Lateral Trunk Bend During Prosthetic Stance (5)
- prosthesis is too short
- medial wall is too high–pubic area
- lateral wall is not adducted–not efficient glut medius
- weak gluteus medius
- hip pain-bring weight to prosthetic side to decrease compressive force in SLS on that side
AK: why lateral wall is not adducted of AK cause lateral trunk bend during prosthetic stance
lateral wall is supposed to be 10 degrees angle relative to the vertical, trandelenburg–if it is adducted it locks the femur in so it doesnt abduct when go into stance
if not adducted and femur abducts in stance it shortens gluteus medius which cannot generate as much tension causing the opposite side of the pelvis to drop and then the person uses lateral trunk flexion to bring COG over the weak gluteus medius
AK: why would hip pain cause lateral trunk bend to prosthetic side in SLS on that side?
hip pain-bring weight to prosthetic side to decrease compressive force in SLS on that side
AK
Prosthesis Abducted (5)
- prosthesis is too long
- medial wall is too high : pubic area
- abduction contracture
- patient fear
- lack preambulation training
AK
vaulting, pelvic hiking, circumduction (5)
- prosthesis is too long
- insufficient suspension–causes pistoning
- too much knee friction (or locked knee unit)
- insufficient hip flexion
- lack pre-ambulation training
AK
Terminal Impact (3)
—at the end of swing when getting ready to HS: there is an abrupt and quick uncontrolled knee extension where the knee extends out faster than it should, snaps out in extension
- insufficient knee friction:
- -need it to act like eccentric hamstrings - too string extension aide
- -external: elastic band in front stretches and then snaps back too much into extension because too tight or too strong
- -internal: too much of a spring effect in the spring - too forceful hip flexion followed by extension
- -strong quick hip flexion followed by abrupt hip extension, ie in a hurry
- -cases a whiplash effect
Terminal Impact
what is it?
—at the end of swing when getting ready to HS: there is an abrupt and quick uncontrolled knee extension where the knee extends out faster than it should, snaps out in extension
AK
how does too strong an extension aide cause terminal impact?
–external: elastic band in front stretches and then snaps back too much into extension because too tight or too strong
–internal: too much of a spring effect in the spring
AK
Excess Heel Rise (3)
- insufficient knee friction
- -not enough friction at knee to control movement of lower part of prosthesis back - insufficient knee extension aide
- -doesnt resist knee flexion/heel rise (supposed to resist flexion and help extension) - too forceful hip flexion
- -gets too much knee flexion
Why does insufficient knee friction cause excess heel rise in AK?
not enough friction at knee to control movement of lower part of prosthesis back
Why does insufficient knee extension aide cause excess heel rise in AK?
doesnt resist knee flexion/heel rise (supposed to resist flexion and help extension)
AK
Rotation of Prosthetic Foot at Heel Strike (2)
person brings foot down into HS and the prosthesis either rotates out or rotates in
heel is supposed to allow for a nice foot flat without the prosthesis rotating
- heel cushion too firm
–cushion should be compressed and allow a nice FF witout the prosthesis rotating, cannot get the WB down through the hind foot–they go into FF with rotation
more likely to rotate outward than inward - inability to compress cushioned heel
- -this is part of training, AK has less ability to press down and need to work harder because less residual limb connected to the prosthetic foot
AK: why heel cushion too firm cause rotation of prosthetic foot at HS?
cushion should be compressed and allow a nice FF witout the prosthesis rotating, cannot get the WB down through the hind foot–they go into FF with rotation
more likely to rotate outward than inward
AK
Foot slap at HS (2)
- cushion is too soft
2. pushing down too hard
AK
Anterior Pelvic Tilt in Terminal Stance (3)
when getting to heelrise and toe off get an increased lumbar lordosis and anterior pelvic tilt
- insufficient posterior tilt of socket
- tight hip flexors
- discomfort around the ischial tuberosity: they anterior pelvic tilt to take pressure off the IT on the shelf
AK: why insufficient posterior tilt of socket causes Anterior Pelvic Tilt in Terminal Stance??
posterior socket tilt allows flexors to be more short and allows shank/foot to get back in terminal stance
=do not need to elongate hip flexors as much to get flexed attitude prosthesis
if not enough posterior tilt socket and tight hip flexors: hip flexors pull on the pelvis into an anterior pelvic tilt
psoas on spine into lordosis (L1-L5 VB) increase anterior convexity
AK
Asymmetrical Step Length and Stance Time (7)
- decreased prosthetic stance time
- quick and short steps with intact LE
- residual limb pain
- poor prosthetic fit or alignment
- lack of pre-ambulation training
- weakness
- fear
