GAIT: P & O Flashcards
Levels of Amputation:
Name them
- 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**
Practice!
Pt has LEFT BKA. Black dot is COM BEFORE amp, what happens AFTER amp?
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
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
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
Care AFTER Amp.
Things WE do
- Wound care
- Pain control
- Limb shaping (swollen @ first)
- Initial prosthetic fitting
- Balance
- Strengthening
- Gait training!
Analyzing the prosthesis:
- Gait devs can be prosthetic OR anatomical in nature (KNOW BOTH!)
- If need to adjust prosthetic–> prosthetist
- Some need further PT tx
Ex. Right trunk lean w/ AKA
Could be LONG prosthetic
OR
Magnet theory– STANCE ONLY–Trunk leans TOWARDS weak mm’s
Here we have weak R hip ABDs==> ANATOMICAL CAUSE
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…
LOW walls
- think Weak mm’s
HIGH walls
- think TIGHT mm’s
Prosthetic vs Normal mm’s
Above Knee Prosthesis (AKA)
Low walls vs High walls
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
Gait Deviations
AKA in Stance Phase
Whole table first
see table
Gait Deviations: AKA; Stance Phase
Deviation: Lateral bend
Anatomic==> Weak (LOW) abductors, short amp limb
Prosthetic==> Short prosthesis, inadequate lateral wll (LOW (weak mm’s) lateral wall
Gait Deviations: AKA; Stance Phase
Deviation: ABduction
Anatomic: Abd contracture, Knee INstab
Prosthetic: Long prosthesis, ABD’d hip joint
Gait Deviations: AKA; Stance Phase
Deviation: Lordosis
Anatomic: Hip flexion contracture, WEAK (think LOW walls) extensors
Prosthetic: Anterior socket wall discomfort
Gait Deviations: AKA; Stance Phase
Deviation: Forward flexion
Anatomic: WEAK (think LOW walls) Quads (MAGNET THEORY)
Prosthetic: Unstable knee jt, short walker
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: 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!
Gait Deviations: AKA; Swing phases + Stance heel off + Heel contact
Phase: EARLY Sw
Deviation: High heel rise
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
Gait Deviations: AKA; Swing phases + Stance heel off + Heel contact
Phase: LATE Sw
Deviation: Terminal impact (landing on forefoot)
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
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
Anatomic: Fast pace
Prosthetic: Knee bolt rotated; prosth. donned in MALrotation
Heel Whip== LIME; Lateral-IR; Medial-ER @ knee
Gait Deviations: AKA; Swing phases + Stance heel off + Heel contact
Phase: Heel contact
Deviation: Foot rotation
Anatomic: nada
Prosthetic: STIFF heel cushion (too stiff so not absorbing shock==foot rotation); MALrotated foot
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
ER @ L knee
A: Prosthetic knee bolt is externally rotated
Heel Whip== LIME
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
STIFF heel cushion OR HARD PF bumper
STIFF heel cushions gonna push foot into DF
Hard and Soft Bumpers
If PF of foot is restricted by stiff heel cushion or hard PF bumper…
- 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
Hard and Soft Bumpers
What will cause excessive compressibility of heel cushion and thus causing excessive PF==knee hyperEXT?
“PE class”
Too soft heel cushion OR soft PF bumper
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
- Excess PF==knee hyperEXT (PE class)
- GRF passes ANTERIOR to knee bw heel strike and MSt
- ==> HyperEXT of knee jt
Hard and Soft Bumpers
Just remember….basically diff bw 2
- 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)
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: 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
Quick diff bw Prosthetics vs Orthotics
Prosthetics REPLACE body part
Orthotics ADDED to body
Toe Drag and talking about orthotic causes
Here we focus on the key word ASSIST
- inadequate ASSIST– similar to weak mm’s
- inadequate STOP– similar to spastic mm’s
Toe Drag and talking about Orthotics
Anatomic vs Orthotic causes
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
Practice!
PT observing gait and notices pt slap forefoot on ground during early Stance phase. Which impairment of orthotic could contribute?
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
YOU WILL FUCKING CRUSH BOARDS JOSH!!!!!!!!!!
YOU KNOW THIS!!!! YOU FUCKING GOT THIS SHIT!!!
PRACTICE!
58yo w/ AKA. PT examining wound site and sees exudate. Which of following findings indicates infection?
Viscous (thick) yellow exudate
Others:
- Dark red or bright red blood== Inflamed wound
- Serosanguinous== clear w/ little blood= wound healing
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?
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!
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!!!
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)
Inspection
Always inspect Res. Limb!!!
Pressure Tolerant (FAT FAT) vs Pressuer Sensitive (M-DPT)
Pressure Tolerant:
- Transient redness is to be expected after use (ok for pressure)
Pressure Sensitive:
- NO redness should be observed
see chart
Pressure SENSITIVE areas
FAT FAT–think FAT people are SENSITIVE
FAT FAT
- Fibular nerve
- Ant Tib
- Fibular head/neck
- Ant Tibial crest
Pressure TOLERANT areas
M-DPT
M-DPT
- Medial tibial plateau
- Distal end (rare)
- Patellar tendon (strong WB)
- Tib/fib shafts
Practice!
After gait training pt w/ new BKA prosth. you notice redness along patellar tendong and medial tibial flare– indicates?
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
DO GAIT QUESTIONS!!!!
!!!!!!!
