Gait Deviations Flashcards
What are two primary causes of gait deviations?
- Prosthetic
2. Organic (related to the user)
What makes up a pre-gait assessment? (6)
Prosthetic Fit/Comfort Suspension (pistoning test) Static/Bench Alignment -Iliac Crest Height -Prosthetic foot position -Pylon position
What are characteristics of a normal TT gait (5)
Little trunk sway (less than 2.5 cm)
Mild VARUS moment at the knee in midstance is normal
Knee flexion throughout gait; assess symmetry
Ankle movement during stance will depend on type of ankle
Intact knee (TT) improves proprioceptive feedback
What are normal characteristics of TF gait?
Energy expenditure; oxygen consumption
-Unilateral amputation - 49%
-Bilateral amputation - 280%
(more people being denied for TF ambulating prosthesis due to co-morbidities like DM and CHF)
Increased step width, BOS
Increased movement in CORONAL PLANE!
Why might foot slap occur in a person with a prosthesis?
Lack of anterior tib
How does the pelvis rotate during gait?
Pelvis rotates forward on swing side while it rotates backwards on the stance side (goes backwards relative to the swing side; does not actually move backwards in normal gait).
Must initiate first, then translate pelvis thru transverse plane (arm swing helps!)
According to the lecturer, what is the most common thing prosthetic ambulators lack?
Pelvic translation thru the transverse plane (anterior translation)
What is a Ground Reaction Force?
The force exerted by the ground on a body in contact with it (For example, a person standing motionless on the ground exerts a contact force on it (equal to the person’s weight) and at the same time an equal and opposite ground reaction force is exerted by the ground on the person).
*alignment will directly affect the Ground Reaction Force and where the joints fall in relationship to the GRF
Where is the GRF in the sagittal plane during normal gait?
Posterior to ankle (PF moment)
Posterior to knee (flexion moment)
Anterior to hip (flexion moment)
- Keep GRF in mind during assessment of gait. Patients will utilize this GRF and compensate by moving the joint to the opposite side of the GRF.
Where is the GRF in the frontal plane during the loading response?
Lateral to subtalar axis
Medial to knee
Medial to hip axis
What is prosthetic alignment?
Alignment is the relationship between the prosthetic socket and pylon and the foot and the pylon.
Directly affects the ground reaction force (GRF) and where joints fall in relationship to the GRF.
Will Affect the patients gait and also the forces acting within the socket.
-Moments cause pressure inside the socket
What is the difference between translational, rotational, and angular alignment movements?
Translational - Movement does not change the angle of the socket; only
changes the forces (moments) acting on the socket.
Rotational - May affect timing and during of GRF through stance phase of gait
Angular - Will change the angle of the socket
therefore effect the angle of the knee/hip
joint in addition to changing the
forces (moments) acting on the joint.
Translational, angular, and rotational transtibial movements?
Translational - the position of the knee does not change
Angular - flexion ext named by the position the socket then places the knee into
-Foot inv/ev typically only used to bring foot level with the ground
Rotational Movement - toe-in (int rot) / out (ext rot)
Translational, angular, and rotational transfemoral movements?
Translational - does not change the position of the hip, just the forces on the hip (GRF)
Angular - flex/ext/add/abd named by the position the socket then places the hip into
-Foot inv/ev typically only used to bring foot level with the ground
Rotational movements - toe-in (int rot) / out (ext rot)
Knee-in (int rot) / out (ext rot)
What are common deviations with the Stance Phase (7)?
Foot slap Knee instability Excessive knee flexion Excessive knee extension Lateral trunk bend Excessive trunk extension Abducted (wide base) gait
What causes foot slap in a TT amp? (2)
Prosthetic: heel counter too soft
PF resistance too soft
*an inc. of knee ext - dec. rollover of the foot
User (organic) causes: none.
What causes foot slap in a TF amp? (2)
Same as TT
Prosthetic: heel counter too soft
PF resistance too soft
*an inc. of knee ext - dec. rollover of the foot
User (organic) causes: none.
What are prosthetic causes of knee instability/buckling in a TT amp? (3)
Lever arm too short
Socket too ant on pylon
Excessive DF in ankle
What are user (organic) causes of knee instability/buckling in a TT amp? (3)
Decreased quad strength / timing
Knee flexion contracture
Pain due to excess any limb forces
What are prosthetic causes of knee instability/buckling in a TF amp? (3)
Knee join ahead of TKA line
Heel counter too firm (need to flex knee to get foot flat)
Excessive DF in ankle
What are user (organic) causes of knee instability/buckling in a TF amp? (2)
Weak hip ext
Hip flexion contracture
What are prosthetic causes of excessive knee flexion in a TT amp? (3)
Excessive DF of foot
Too firm heel height
Increased heel height of shoe (compared with the one the prosthesis was made for)
What are prosthetic causes of excessive knee flexion in a TF amp? (3)
Same as TT but causes immediate instability
Excessive DF of foot
Too firm heel height
Increased heel height of shoe (compared with the one the prosthesis was made for)
What are user causes of excessive knee flexion in a TT amp? (1)
Knee flexion contracture
What are user causes of excessive knee flexion in a TF amp? (1)
Hip flexion contracture
What are prosthetic causes of excessive knee extension in a TT amp? (5)
Excessive PF of foot
Soft heal
Lever arm too long
Pylon too far post. on foot (forces knee into hyperext.)
Decreased heel height of the shoe compared to the one the prosthesis was made for
What are prosthetic causes of excessive knee extension in a TF amp? (5)
Same as TT
Excessive PF of foot
Soft heal
Lever arm too long
Pylon too far post. on foot (forces knee into hyperext.)
Decreased heel height of the shoe compared to the one the prosthesis was made for
What are user causes of excessive knee extension in a TT amp? (2)
Weak quads
Habit
What are user causes of excessive knee extension in a TF amp? (1)
Habit (for security)
What are prosthetic causes of lateral trunk bend in a TT amp? (2)
Prosthetic too short
Foot too outset
(Lateral trunk bend is usually towards the proshtetic side!!
Usually see some degree of this as individuals can’t fully make up for loss of skeletal fixation to the ground
Excess of 5cm is less common with TT then TF
More common in bilateral TT)
What are prosthetic causes of lateral trunk bend in a TF amp? (4)
Prosthesis too short
Short lateral wall
High medial wall (pain)
Excessive abduction of socket (wide stance)
What are user causes of lateral trunk bend in a TT amp? (2)
Weak abductors
Weak core
What are user causes of lateral trunk bend in a TF amp? (5)
Poor balance and control over prosthesis
Abd contracture
Weak abductors
Short residual limb (lever arm too short for pelvic stability)
Is lateral trunk bend more common in TF or TT?
TT (see notes in slide 22)
What are prosthetic causes of excessive trunk extension in a TT amp? (1)
Typically not seen
What are prosthetic causes of excessive trunk extension in a TF amp? (3)
Insufficient socket flex
Discomfort on ischial wall
Poor posterior wall shape
What are user causes of excessive trunk extension in a TT amp? (1)
Typically not seen
What are user causes of excessive trunk extension in a TF amp? (5)
Hip flex tight (APT) Weak hip ext (compensate by extending trunk) Weak abduction Balance issues Habit
What are prosthetic causes of excessive abduction (WBOS) in a TT amp? (1)
Prosthesis too long
What are prosthetic causes of excessive abduction (WBOS) in a TF amp? (5)
Prosthesis too long
Too much abduction in socket
Medial wall too high
Lateral wall too short (opposite of lateral trunk bend)
Pelvic band, if used, is improperly positioned
What are user causes of excessive abduction (WBOS) in a TT amp? (3)
Abduction contracture
Poor balance
Habit
What are user causes of excessive abduction (WBOS) in a TF amp? (3)
Abd contracture
Poor balance
Habit
What is the optimal amount of abduction?
2-4 inches at mid-stance
What is it called when excessive abduction occurs in both the swing and stance phases?
Circumduction
What are eight deviations seen in the swing phase?
Uneven heel rise Medial and lateral heel whips Insufficient knee flexion Pistoning Circumduction Vaulting Terminal swing impact Multiple asymmetries (uneven arm swing, step length, and/or step time)
What are prosthetic causes of uneven heel rise in a TT amp? (1)
N/A
What are prosthetic causes of uneven heel rise in a TF amp? (3)
Insufficient knee flexion
Excessive knee friction
Inadequate knee extension aide
What are user causes of uneven heel rise in a TT amp? (1)
N/A
What are user causes of uneven heel rise in a TF amp? (1)
Using too much force to flex the knee
What are prosthetic causes of heel whips (medial/lateral) in a TT amp? (1)
N/A - TF descriptor only
What are prosthetic causes of heel whips (medial/lateral) in a TF amp? (2)
Excessive ER of knee (medial)
Excessive IR of knee (lateral)
What are user causes of heel whips (medial/lateral) in a TT amp? (1)
N/A
What are user causes of heel whips (medial/lateral) in a TF amp? (2)
Weak IR at hip (medial)
Weak ER at hip (lateral)
Where are heel whips best seen?
Seen best from behind the patient
A medial heel whip is best observed from:
Behind the patient at initial swing
Whip describes the movement of the heel at the very end of stance, beginning of swing with initial knee flexion. May see what looks like a heel whip at times however this is rotation
What are prosthetic causes of insufficient knee flexion in a TT amp? (2)
Posterior comfort due to:
- Posterior wall too high
- Too many socks making it bulky behind the knee
What are prosthetic causes of insufficient knee flexion in a TF amp? (1)
Excessive knee friction
(In friction knees, when the friction in the knee is increased, there will need to be an increase in hip flex force. Patient may complain of difficulty bending knee to sit)
What are user causes of insufficient knee flexion in a TT amp? (1)
Weak hamstrings
What are user causes of insufficient knee flexion in a TF amp? (2)
Weak hip flexors
Decreased confidence
What are prosthetic causes of pistoning in a TT amp? (3)
Improper donning (too few socks)
Socket too large
Insufficient suspension
What are prosthetic causes of pistoning in a TF amp? (3)
Improper donning (too few socks)
Socket too large
Insufficient suspension
What are user causes of pistoning in a TT amp? (1)
N/A
What are user causes of pistoning in a TF amp? (1)
N/A
What are prosthetic causes of circumduction in a TT amp? (1)
Prosthesis too long
What are prosthetic causes of circumduction in a TF amp? (2)
Knee friction too high
Prosthesis too long
What are user causes of circumduction in a TT amp? (1)
Insufficient knee flexion
What are user causes of circumduction in a TF amp? (3)
Hip abduction
Contracture
Habit
What are prosthetic causes of vaulting (rising up on forefoot of sound side to initiate swing) in a TT amp? (4)
Prosthesis too long
Prosthesis improperly donned (too many socks)
Socket too large
Insufficient suspension
What are prosthetic causes of vaulting in a TF amp? (4)
Same as TT
Prosthesis too long
Prosthesis improperly donned (too many socks)
Socket too large
Insufficient suspension
What are user causes of vaulting in a TT amp? (2)
Insufficient knee flexion
Fear of stubbing toe/Habit
What are user causes of vaulting in a TF amp? (3)
*Weak hip flexors!
Insufficient knee flexion
Fear of stubbing toe/habit
What are prosthetic causes of terminal wing impact (rapid forward movement of shaft of transfemoral prosthesis) in a TT amp? (1)
N/A
What are prosthetic causes of terminal wing impact (rapid forward movement of shaft of transfemoral prosthesis) in a TF amp? (2)
Insufficient knee flexion friction
Knee extension side too strong
What are user causes of terminal wing impact (rapid forward movement of shaft of transfemoral prosthesis) in a TT amp? (1)
N/A
What are user causes of terminal wing impact (rapid forward movement of shaft of transfemoral prosthesis) in a TF amp? (2)
Forceful hip flexion
Habit/fear
(Patients will do this so they know the knee is extended (fear))
What are prosthetic causes of asymmetries in a TT amp? (1)
N/A
What are prosthetic causes of asymmetries in a TF amp? (1)
N/A
What are user causes of asymmetries in a TT amp? (3)
Generalized weakness
Progressed assistive device too soon
Balance issues
What are user causes of asymmetries in a TF amp? (3)
Generalized weakness
Progressed assistive device too soon
Balance issues
What should you look at during a gait assessment?
The WHOLE person.
PT assessment should reveal weakness or ROM or sensory issues.
Look at symmetry between the intact and the prosthetic side.
Assess gait in variable settings and on variable surfaces.
Trial changes to the prosthesis with the prosthetist and reassess gait.
