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
