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Prosthetics and Orthotics > Gait implications for Prosthetics and orthotics > Flashcards

Gait implications for Prosthetics and orthotics Flashcards

1
Q

ankle-knee interaction: stance

A
  • static stance: ankle position indirectly controls knee position
  • DF ankle: GRF vector posterior to knee axis-flexion moment at knee
  • with PF ankle: GRF vector anterior to knee axis- extension moment at knee strengthen HS
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2
Q

GRF AFO

A
  • ankle can dorsiflex: GRF vector posterior to knee axis creates flexor moment
  • ankle held in neutral: GRF vector anterior to knee axis - creates extensor moment
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3
Q

Biomechanical Objectives of transtibial prostheses

A
  1. Maximize WB
  2. improve medial/lateral stability
  3. encourage knee flexion
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4
Q

Biomechanical Objectives of transtibial prostheses

Maximize WB

A
  • distribute forces to pressure tolerant areas (patellar tendon, medial tibial flare)
  • to pressure-sensitive areas (tibial crest)
  • set socket in flexion
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5
Q

Biomechanical Objectives of transtibial prostheses

improve medial/lateral stability

A
  • inset prosthetic foot (medial to knee) to mimic slight knee varus at midstance
  • more lateral to knee = knee valgus
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6
Q

Biomechanical Objectives of transtibial prostheses

encourage knee flexion

A
  • move prosthetic socket anterior in relation to foot
  • use firm heel bumper
  • SACH: solid ankle cushioned heel to give some DF/PF motion
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7
Q

Biomechanical Objectives of transfemoral prostheses

A
  1. full, comfortable WB on residual limb
  2. medial/lateral stability of hip/pelvis during stance
  3. A/P knee stability during stance
  4. Permit normal step length with non amputated limb
  5. control of prosthetic knee during swing
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8
Q

Biomechanical Objectives of transfemoral prostheses

full comfort weight bearing on residual limb

A
  • total contact force distribution
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9
Q

Biomechanical Objectives of transfemoral prostheses

Medial/lateral stability of hip and pelvis during stance

design features

A

Design features:

  • inset prosthetic foot
  • lateral wall of socket adducted
  • narrow medial/lateral dimension of socket to stabilize femur
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10
Q

Biomechanical Objectives of transfemoral prostheses

Anterior/posterior stability during stance

A

knee joint set posterior to GRF vector

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11
Q

Biomechanical Objectives of transfemoral prostheses

permit normal step length with non-amputated limb

A
  • socket set in slight flexion
  • decreases amount of hip extension needed in non-amputated limb to take full step on prosthetic side
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12
Q

Biomechanical Objectives of transfemoral prostheses

control of prosthetic knee during swing

A
  • want knee to flex in early swing, then extend fully in preparation for heel strike during late swing
  • depends on gait speed, type of knee
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13
Q

excess knee flexion: initial contact into loading response (step off)

A
  • foot goes to foot flat quickly into excess knee flexion during early stance
  • transtibial prosthesis: socket in too much flexion, heel bumper too frim
  • ankle-foot orthosis: solid ankle to heel rocker for bottom shoe
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14
Q

excess knee extension midstance to terminal stance

A
  • transtibial prosthesis: socket not flexed enough, heel bumper too soft => delays tibial advancement
  • ankle-foot orthosis: ankle permits plantarflexion => knee can hyperextend
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15
Q

transtibial prosthetic sock issues

too many ply

A

residual limb not seated down into socket

findings:

  • too long on prosthetic side (iliac crest heights)
  • redness below patellar tendon
  • may see pistoning
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16
Q

transtibial prosthetic sock issue

insufficient ply

A

residual limb too far down in socket

findings:

  • discomfort distal end of tibia
  • redness above patellar tendon
  • may see pistoning
17
Q

Transfemoral gait deviations:

lateral trunk bending

A
  • during stance on affected side

prosthetic causes

  • prostheisis too short
  • lateral wall of socket not stabilizing femur: insuffcient hip abductor torque
  • medial wall of socket too high: lateral trunk bend to decrease medial pressure

Patient causes

  • hip abductor weakness
18
Q

Transfemoral gait deviations:

abducted gait

A
  • during stance on affected side

Prosthetic causes:

  • prosthesis too long
  • medial wall of socket too high

Patient causes:

  • hip abductor weakness => increase BOS => no need to stabilize pelvis
19
Q

Transfemoral gait deviations:

circumduction

A
  • during swing on affected side

prosthetic causes:

  • prosthetic too long
  • prosthetic foot in PF
  • insufficient suspension
  • medial shelf too high
  • excess knee friction (transfemoral)

Patient causes:

  • inability to shorten leg for swing
20
Q

Transfemoral gait deviations:

vaulting

-

A
  • during stance on unaffected side

prosthetic causes:

  • prosthesis is too long
  • prosthetic foot in PF
  • insufficient suspension
  • medial shelf too high

Patient causes:

  • inability to shorten leg for swing
21
Q

Transfemoral gait deviations:

uneven step length

short step on affected side

A
  • short step on affected side

prosthetic causes:

  • socket in excess flexion
  • pistoning
  • excess knee fricition

Patient causes

  • ineffective swing affected leg
22
Q

Transfemoral gait deviations:

uneven step length
short step on unaffected side

A

prosthetic causes:

  • socket in insuffcient flexion
  • prosthetic foot in PF

patient causes:

  • inability to achieve hip extension during terminal stance on affected side
  • spasticity ankle PF => restricts forward inclination of tibia
23
Q

Transfemoral gait deviations:

uneven heel raise

A

prosthetic cause

  • insufficient knee friction

Patient cause:

  • weakness knee flexors
  • spasticity knee and ankle extensors
24
Q

Transfemoral gait deviations:

rotation of prosthetic foot at initial contact

A
  • heel cushion too hard
  • foot set in excess ER
  • especially with Transfemoral
25
Q

Transfemoral gait deviations:

Terminal swing impact

A
  • insufficient knee friction
26
Q

Lateral whip

A
  • occurs during swing on prosthetic limb
  • knee joint axis aligned in excessive internal rotation
27
Q

Transfemoral gait deviations:

foot slap

A
  • soft heel bumper
  • prosthetic foot set in PF
28
Q
A

Prosthetics and Orthotics (8 decks)

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