Gait & Gait Deviation for Prosthetics Flashcards
What is each part of the stance phase and the definition for each part?
- Initial Contact: instant heel contacts the ground
- Loading Response: Heel contact to foot flat
- Midstance: Foot flat until contralateral extremity lifts off the grounds
- Terminal Stance: From midstance through heel off of the WB extremity
What is each part of the swing phase and the definition for each part?
- Preswing: Heel off until toe off of the WB extremity
- Initial Swing: From toe off until max knee flexion
- Midswing: From max knee flexion until tibia is in vertical position
- Terminal Swing: From vertical tibia until just before initial contact
Where are the ground reaction forces during initial contact?
- Posterior to ankle
- Anterior to knee
- Anterior to the hip
What is velocity?
Rate of linear forward motion of the body (m/sec)
What is cadence?
Number of steps taken per unit of time (steps/min)
What is stride length?
Heel strike to ipsilateral heel strike
What is step length?
Heel strike to contralateral heel strikeWha
What is step width?
Width of base of support
What is stance?
- Weight acceptance
- Single limb support
What is swing?
- Foot clearance
- Swing limb advancement
What items should be considered in TT static standing alignment eval?
- Equal weight distribution
- Level pelvis
- ASIS, PSIS, IT
- Foot position
- Knee position
- Hip position
- Position of pylon
- Pain
What can occur when setting the knee socket in slight flexion?
- Accommodate knee flexor contracture
- Increase exposure to patellar tendon for WB
- Prevent genu recurvatum
- Help resist tendency of residual limb to piston
What occurs with TT medial displacement of foot?
- Maintain fairly normal BOS
- Loads more pressure on medial aspect
- Decreased pressure on fibular head
- Slight varus force created at knee
- Medial displacement of GRF
What does foot insert refer to?
Displacement of prosthetic foot toward the midline of the body
What does foot outset refer to?
Displacement away from the midline
What are some common gait deviation for patients with transtibial amputation?
- Excessive knee flexion in loading response
- Insufficient knee flexion in loading response
- Lateral/ varus thrust at midstance
- Medial/valgus thrust at midstance
- Ipsilateral lateral trunk bending during prosthetic limb stance
- Sound side vaulting
What are some prosthetic causes of excessive knee flexion in loading response after TTA?
- Heel height to high
- Stiff heel cushion
- Excessive ankle DF
- Socket too far anterior or tilted forward
- Foot too posterior
- Socket excessively flexed
- Prosthesis too long
What are some anatomical causes of excessive knee flexion in loading after TTA?
- Knee and/or hip flexion contracture
- Weakness of quads
- Pain in residual limbs
- Poor balance
What is the functional significance of excessive knee flexion in loading after TTA?
- Impaired shock absorption
- Increased demand on quadriceps to prevent further knee flexion
What are the prosthetic causes of insufficient knee flexion in loading response after TTA?
- Low shoe heel
- Soft heel cushion
- Excessive ankle PF
- Socket too far posterior or tilted posterior
- Foot too far anterior
- Socket insufficiently flexed
What are some possible anatomical causes of insufficient knee flexion in loading response after TTA?
- Extensor spasticity
- Weakness of quads
- Anterior-distal pain
- Arthritis
What is the functional significance of insufficient knee flexion in loading response after TTA?
- Reliance on bony structures stance stability
- Insufficient shock absorption
What are the prosthetic causes of lateral/varus thrust at midstance after TTA?
- Excessive foot inset
- Poor M-L stability
What is the anatomical cause of lateral/varus thrust at midstance after TTA?
Proximal weakness
What is the functional significance of lateral/varus thrust at midstance after TTA?
Increased stress on medial knee joint, which could lead to early degenerative changes
What are the prosthetic causes of medial/valgus thrust at midstance after TTA?
- Excessive foot outset
- Poor M-L stability
What is the anatomical cause of medial/valgus thrust at midstance after TTA?
Proximal weakness
What is the functional significance of medial/valgus thrust at midstance after TTA?
Increased stress on lateral knee joint- could lead to early degenerative changes
What is the prosthetic cause of ipsilateral trunk bending during prosthetic limb stance after TTA?
Prosthetic length too short
What are the anatomical causes of ipsilateral trunk bending during prosthetic limb stance after TTA?
- Poor gait training
- Poor proprioception
- Weak ipsilateral hip abductors
What are the prosthetic causes of sound side vaulting after TTA?
- Prosthesis too long
- Inadequate prosthetic suspension
- Prosthetic positioned in too much PF
What are the anatomical causes of sound side vaulting after TTA?
- Poor proprioception
- Poor gait training
- Lack of confidence
What is the functional significance of sound side vaulting after TTA?
- Deviation to assist w/ foot clearance
- Increased energy expenditure
Is more stance time observed on prosthetic or intact limb after TTA?
Stance time on prosthetic < intact
Is longer step length observed on prosthetic or intact limb after TTA?
Step length prosthetic > intact
What are contributing factors to step length/single stance time asymmetries?
- Patient confidence
- Pain
- Improper weight shifting
If short step length is observed on prosthetic side what is the possible cause?
Knee flexion contracture
What occurs if the TFA prosthetic socket is set in flexion?
- Accommodates hip flexion contracture
- Weight line shifts posterior to knee joint center
What are some control mechanisms for knee stability for patients with TFA?
- Alignment of knee joint axis in sagittal plane
- Inherent mechanical stability of the knee
- Voluntary control swing muscular power
- Microprocessor controlled
What are common gait deviations for patients with transfemoral amputation?
- Excessive abduction in stance
- Excessive ipsilateral trunk bend in stance
- Excessive forward trunk flexion in stance
- Contralateral vaulting, hip hike, circumduction
- Medial whip in swing
- Lateral whip in swing
- Foot rotation at loading response
What are some prosthetic causes of excessive abduction in stance in patients after TFA?
- Long prosthesis
- Abducted socket
- Sharp or high medial wall
- Inadequate suspension
What are some anatomical causes of excessive abduction in stance in patients after TFA?
- Abduction contracure
- Lateral/ distal pain
- Weakness of hip flexors or hip adductors ipsilaterally
- Adductor roll
What is the functional significance of excessive abduction in stance after TFA?
Widens BOS for stability
What is the prosthetic causes of excessive ipsilateral trunk bend in stance after TFA?
- Short prosthesis
- Sharp or high medial wall
- Prosthesis aligned in abduction
What is the anatomical causes of excessive ipsilateral trunk bend in stance after TFA?
- Abduction contracture
- weak abductors
- hip pain
- instability
- Short residual limb
- Lack of proprioception
- Poor balance
- Hypersensitive or painful residual limb
What is the functional significance of excessive ipsilateral trunk bend in stance after TFA?
Increased energy expenditure
What are the prosthetic causes of excessive forward trunk flexion in stance after TFA?
- Socket too big
- Poor suspension
- unstable knee unit
What are the anatomical causes of excessive forward trunk flexion in stance after TFA?
- Instability
- Hip flexion contracture
- Pain w/ ischial WB
What is the functional significance of excessive forward trunk flexion in stance after TFA?
- Forward displacement of COM
- Increased energy expenditure
What are some other causes of excessive forward trunk flexion in stance after TFA?
Short walker or crutches
What are the prosthetic causes of contralateral vaulting, hip hiking, & circumduction after TFA?
- Long prosthesis
- Locked knee
- Inadequate suspension
- Loose socket
- Foot PF
What is the functional significance of contralateral vaulting, hip hiking, & circumduction after TFA?
- Assists with foot clearance
- Increased energy expenditure due to displacement of COM
What are the anatomical causes of contralateral vaulting after TFA?
- Residual limb discomfort
- Fear of stubbing toe
- Short residual limb
- Painful hip/residual limb
What are the anatomical causes of hip hike after TFA?
- Weakness of hip flexors
- Difficult initiating knee flexion
What are the anatomical causes of circumduction after TFA?
- Abduction contracture
- Poor knee control - inability to initiate knee flexion
- Weakness of hip flexors
- Painful anterior distal residual limb
What are the prosthetic causes of medial whip in swing after TFA?
- Faulty socket contour
- Prosthesis donned in malrotation (ER)
- Poor socket fit
- Knee axis in excessive ER
What is the anatomical cause of medial whip in swing after TFA?
Weakness of hip rotators
What is the functional significance of medial whip in swing after TFA?
Assists with foot clearance
What are the prosthetic causes of lateral whip in swing after TFA?
- Faulty socket contour
- Foot malrotated
- Prosthesis donned in malrotation (IR)
- Knee in IR
What is the anatomical cause of lateral whip in swing after TFA?
Weakness of hip rotators
What is the functional significance of lateral whip in swing after TFA?
Assists with foot clearance
What are the prosthetic causes of foot rotation at loading response after TFA?
- Stiff heel cushion (rigid SACH foot)
- Malrotated foot
- Loose fitting socket
What are the anatomical causes of foot rotation at loading response after TFA?
- Poor muscle control
- Improper training
- Weak hip medial rotators
What is the functional significance of foot rotation at loading response after TFA?
- Poor stance stability
- Alters forward progression
