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NPTE Final Frontier > GAIT: P & O > Flashcards

GAIT: P & O Flashcards

1
Q

Levels of Amputation:

Name them

A
  • Involving the foot
  • BKA aka Transtibial
  • Knee disartic (thru knee)
  • AKA – Transfemoral
  • Hip disartic (thru hip)
  • Hemi-pelvectomy

Why?–> DM, Trauma, Infx, Military, underserved pops**

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2
Q

Practice!
Pt has LEFT BKA. Black dot is COM BEFORE amp, what happens AFTER amp?

A

Moves HIGHER on the RIGHT side
(Yellow dot)
- COM is going to travel towards HEAVIER part of body (where most body mass is) after amputation==> UP and OPP side if U/L LE amputation

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3
Q

COM is going to travel towards HEAVIER part of body (where most body mass is) after amputation==> UP and OPP side if U/L LE amputation
- Amp’d limb becomes LIGHTER

A

COM always goes to where there is MORE body mass
- UE amp==> COM goes LOWER
- LE amp==> COM goes HIGHER
- If U/L==> Always on oPP side of amputation
- If B/L==> COM is in middle

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4
Q

Care AFTER Amp.
Things WE do

A
  1. Wound care
  2. Pain control
  3. Limb shaping (swollen @ first)
  4. Initial prosthetic fitting
  5. Balance
  6. Strengthening
  7. Gait training!
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5
Q

Analyzing the prosthesis:

A
  • Gait devs can be prosthetic OR anatomical in nature (KNOW BOTH!)
  • If need to adjust prosthetic–> prosthetist
  • Some need further PT tx
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6
Q

Ex. Right trunk lean w/ AKA

A

Could be LONG prosthetic
OR
Magnet theory– STANCE ONLY–Trunk leans TOWARDS weak mm’s
Here we have weak R hip ABDs==> ANATOMICAL CAUSE

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7
Q

How can the Walls of prosthetics be considered similar to **Normal l

Above Knee Prosthesis (AKA)
Low walls vs High walls
FIRST thing to remember…

A

LOW walls
- think Weak mm’s

HIGH walls
- think TIGHT mm’s

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8
Q

Prosthetic vs Normal mm’s

Above Knee Prosthesis (AKA)
Low walls vs High walls

A

LOW Walls–> Weak mm’s
- Ex. Low anterior thigh wall==> weak quads
- Ex. Low lateral wall==> weak abd’s

HIGH Walls–> TIGHT mm’s
- Ex. High anterior thigh wall==> tight hip flexors, which pulls pelvis ANT

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9
Q

Gait Deviations
AKA in Stance Phase

Whole table first

A

see table

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10
Q

Gait Deviations: AKA; Stance Phase

Deviation: Lateral bend

A

Anatomic==> Weak (LOW) abductors, short amp limb
Prosthetic==> Short prosthesis, inadequate lateral wll (LOW (weak mm’s) lateral wall

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11
Q

Gait Deviations: AKA; Stance Phase

Deviation: ABduction

A

Anatomic: Abd contracture, Knee INstab
Prosthetic: Long prosthesis, ABD’d hip joint

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12
Q

Gait Deviations: AKA; Stance Phase

Deviation: Lordosis

A

Anatomic: Hip flexion contracture, WEAK (think LOW walls) extensors
Prosthetic: Anterior socket wall discomfort

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13
Q

Gait Deviations: AKA; Stance Phase

Deviation: Forward flexion

A

Anatomic: WEAK (think LOW walls) Quads (MAGNET THEORY)
Prosthetic: Unstable knee jt, short walker

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14
Q

Practice!
Pt w/ AKA is displaying R lateral trunk bending while ambulating (MAGNET is only in stance). Which of following would be MOST likley cause?

A

A: Right lateral WALL too LOW (LOW WALLS==weak muscles)– same as Lat mm’s too weak!
- Weak R. abd’s == LOW lateral WALL on R.

*Also stick to your plane!!– this question says Lateral trunk lean so obv asking about FRONTAL PLANE problem!

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15
Q

Gait Deviations: AKA; Swing phases + Stance heel off + Heel contact

Phase: EARLY Sw
Deviation: High heel rise

A

Anatomic: nada
Prosthetic: Inadequate friction, slack (loose) Ext aid (Ext aid helps keep knee in Ext), if Slack==> knee will flex too early==high heel rise

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16
Q

Gait Deviations: AKA; Swing phases + Stance heel off + Heel contact

Phase: LATE Sw
Deviation: Terminal impact (landing on forefoot)

A

Anatomic: Forceful hip flexion (bc knee stuck in EXT)
Prosthetic: Inadequate friction, Taut (tight) Ext aid–
- Now knee stuck in EXT bc EXT aid taut==> knee stuck in EXT so Term impact & forceful hip flexion

17
Q

Gait Deviations: AKA; Swing phases + Stance heel off + Heel contact

Phase: Stance Heel off
Deviation: Heel whip (aka knee rotated)

Heel Whip–> think LIME

Lateral=> IR @ knee; Medial=> ER @ knee

A

Anatomic: Fast pace
Prosthetic: Knee bolt rotated; prosth. donned in MALrotation

Heel Whip== LIME; Lateral-IR; Medial-ER @ knee

18
Q

Gait Deviations: AKA; Swing phases + Stance heel off + Heel contact

Phase: Heel contact
Deviation: Foot rotation

A

Anatomic: nada
Prosthetic: STIFF heel cushion (too stiff so not absorbing shock==foot rotation); MALrotated foot

19
Q

Practice!
28 yo male w/ LEFT AKA. PT observes medial heel whip (LIME) during heel off on LEFT side. MOST likely cause?

LIME= Lateral-IR; Medial-ER

A

ER @ L knee
A: Prosthetic knee bolt is externally rotated

Heel Whip== LIME

20
Q

Hard and Soft Bumpers
What would cause restricted PF or could say leads to excessive DF?

Bumpers… think HEEL CUSHION

Think David in his Red High Heels

A

STIFF heel cushion OR HARD PF bumper

STIFF heel cushions gonna push foot into DF

21
Q

Hard and Soft Bumpers
If PF of foot is restricted by stiff heel cushion or hard PF bumper…

A
  • Amps knee may have to flex thru more than normal ROM to allow sole of foot to reach floor
  • Bumper will NOT absorb the impact of heel striking floor, thus tending to produce abrupt and excessive knee FLEX—–> bc PF restricted, SO foot goes into DF AND
  • EXCESS DF assocd w/ knee flexion
22
Q

Hard and Soft Bumpers
What will cause excessive compressibility of heel cushion and thus causing excessive PF==knee hyperEXT?

“PE class”

A

Too soft heel cushion OR soft PF bumper

23
Q

Hard and Soft Bumpers
Too soft heel cushion OR soft PF bumper will allow excessive compressibility of heel cushion…

Gonna push foot into excess PF

A
  • Excess PF==knee hyperEXT (PE class)
  • GRF passes ANTERIOR to knee bw heel strike and MSt
  • ==> HyperEXT of knee jt
24
Q

Hard and Soft Bumpers
Just remember….basically diff bw 2

A
  • HARD PF bumper or STIFF heel cushion== excessive DF–> knee flexion (gonna push foot into DF)
  • SOFT PF bumper or SOFT heel cushion== excessive PF–> knee hyperEXT (gonna push foot into PF)
25
Q

Practice!
PT observing gait of pt w/ R. transfemoral amp. PT notices excessive R PF @ heel (soft heel cushion) strike. possible cause for foot slap?

PE Class (PF assoscd w/ hyperEXT

A

A: PF bumper (HEEL cushion) too SOFT (so its not STOPPING PF)
Others
- PF bumper too rigid would == excess DF
- Heel cushion too rigid== excess DF (same as bumper too rigid)
SUMMARY:
- PF stop too soft== too much Pf== knee hyperEXT
- PF stop too hard== no PF, will go into DF== knee flexion
- DF stop too soft== too much DF== knee flexion
- DF stop too hard==NO DF, will go into PF== knee hyper EXT

26
Q

Quick diff bw Prosthetics vs Orthotics

A

Prosthetics REPLACE body part
Orthotics ADDED to body

27
Q

Toe Drag and talking about orthotic causes
Here we focus on the key word ASSIST

A
  • inadequate ASSIST– similar to weak mm’s
  • inadequate STOP– similar to spastic mm’s
28
Q

Toe Drag and talking about Orthotics
Anatomic vs Orthotic causes

A

Anatomic: Weak (think weak assist) DFs
Orthotic: inadequate DF ASSIST (same as saying WEAK DFs)– foot slap or drop bc NOT enough assist!
Anatomic: PF spasticity (here we’re thinking someting wrong w/ Stop)
Orthotic: inadequate PF STOP–causes too MUCH PF==toe drag

29
Q

Practice!
PT observing gait and notices pt slap forefoot on ground during early Stance phase. Which impairment of orthotic could contribute?

A

A: Inadequate DF assist (assist we think WEAK mm’s)
Slaps foot== inadeq. DF assist–> SAME as saying** weak DFs!!**

Bumbers (heel cushions) think Prosthetics– **Stop/Assist= orthotics

30
Q

YOU WILL FUCKING CRUSH BOARDS JOSH!!!!!!!!!!

A

YOU KNOW THIS!!!! YOU FUCKING GOT THIS SHIT!!!

31
Q

PRACTICE!
58yo w/ AKA. PT examining wound site and sees exudate. Which of following findings indicates infection?

A

Viscous (thick) yellow exudate
Others:
- Dark red or bright red blood== Inflamed wound
- Serosanguinous== clear w/ little blood= wound healing

32
Q

Practice!
Pt w/ transfem amp unable to wear total contact prosthesis for past 4d. Pt reports shooting pain @ end of resid limb. NO erythema. Most likely?

A

Neuroma bc nerve endings @ end of RL not happy!
Others:
- Cellulitis/dermatitis (both “itis’s”== more inflamm, would be erythema
- Impetigo== infx of skin

remember if 2 similar answers then BOTH likely wrong!

33
Q

Practice!
To prevent contractures in pt w/ AKA (transfem), emphasis placed on des. positioning program maintains ROM in HIP:

Flex and ABD contractures MOST common!!!

A

EXT and ADD
want to preserve EXT and ADD–put them in PRONE!
Want to PREVENT flex/abd contractures (most common)–this is common bc LE goes into Flex/ABD to stay close to home (body)

34
Q

Inspection
Always inspect Res. Limb!!!

Pressure Tolerant (FAT FAT) vs Pressuer Sensitive (M-DPT)

A

Pressure Tolerant:
- Transient redness is to be expected after use (ok for pressure)

Pressure Sensitive:
- NO redness should be observed

see chart

35
Q

Pressure SENSITIVE areas

FAT FAT–think FAT people are SENSITIVE

A

FAT FAT
- Fibular nerve
- Ant Tib
- Fibular head/neck
- Ant Tibial crest

36
Q

Pressure TOLERANT areas

M-DPT

A

M-DPT
- Medial tibial plateau
- Distal end (rare)
- Patellar tendon (strong WB)
- Tib/fib shafts

37
Q

Practice!
After gait training pt w/ new BKA prosth. you notice redness along patellar tendong and medial tibial flare– indicates?

A

A: Pressure tolerant WB during St.
Pressure TOLERANT== M-DPT– Medial tibial plateau, Distal end, Patellar tendon, Tib/fib shafts
Pressure SENSITIVE== FAT FAT (FAT people are sensitive)– Fibular nerve, Ant Tib; Fibular head/neck, Ant Tibial crest

38
Q

DO GAIT QUESTIONS!!!!

A

!!!!!!!

NPTE Final Frontier (19 decks)

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