Gait Review and Normal Amputee Gait Flashcards
Forces applied by prosthetic and orthotic devices are ________ forces.
external
The gait cycle is from initial contact of one foot to initial contact of the ________ foot.
same
- _______ is synonymous with a gait cycle.
- ______ is sequence of events that occur within heel contacts of opposite feet.
- Stride
- Step (2 in 1 gait cycle)
- Gait cycle is __% stance phase, and __% swing phase.
- Gait cycle is __% single-limb support and __% double-limb support.
- 60% stance, 40% swing
- 80% single, 20% double
Describe:
- Stride length
- Step length
- Degree of toe-out
- Step width
Stride Length
-distance between 2 successive heel contacts of same foot
Step Length
-dstance between successive heel contacts of different feet
Degree of Toe-Out (5-7° normal)
-Angle between line of progression of the body and a line intersecting the center of the heel and second toe
Step width (8-10cm)
-lateral distance between heel centers of 2 consecutive foot contacts
An asymmetric ____ length is often observed in prosthetic users. Why?
- Step
- Potentially due to spending less time in stance phase of involved side. Results in shortening swing time and step length on noninvolved side.
A prosthetic on the L side results in a decreased __________ on the L side and a decreased ________ on the R side.
- stance phase
- step length
What are the temporal descriptors of gait?
- Stride time- time for a full gait cycle
- Step time- time for completion of a R or L step
- Cadence (step rate)- number of steps/min
What is the spatial-temporal descriptor?
Gait speed- distance covered in a specific amount of time
What is a normal walking speed?
1.37m/sec (3mph)
Gait speed decreases when either ________ or ______ is reduced.
step length or cadence
What are some common reasons for decreased gait speed in this population?
- decreased confidence
- poor gait training
- may not have had normal gait speed before
What are the 4 phases of stance phase?
- Loading Response (IC/LR)
- Midstance (MSt)
- Terminal Stance (TSt)
- Preswing (PSw)
What are the 3 phases of swing phase?
- Initial Swing (ISw)
- Midswing (MSw)
- Terminal Swing (TSw)
What are the key features of IC/LR?
- ) Shock absorption through
- Plantarflexion
- Knee flexion
- Pronation
- Hip Adduction - ) Forward propulsion through hip extension
What are the key features of MSt?
- ) Shock absorption
- ) Stabilize in single limb support
- ) Forward progression of tibia
What are the key features of TSt?
- ) Continued stabilization in single limb support
- ) Forward propulsion through plantarflexion
- ) Forward progression
What are the key features of PSw?
- ) Continued forward propulsion through plantarflexion
2. ) Continued forward progression
What are the key features of ISw?
- ) Forward propulsion of swing leg through hip flexion
- ) Foot clearance through
- dorsiflexion
- knee flexion
What are the key features of MSw?
1.) Forward propulsion of swng leg through hip flexion
What are the key features of TSw?
- ) Prepare for initial contact through
- controlled knee extension
- ankle positioned into less supination
Key Muscle Activity - Hip:
Hip Extensors
-Activated in ___________ prior to initial contact to initiate hip extension and prepare the LE for weight acceptance at the beginning of stance.
Hip Flexors
-Advance lower extremity forward during ________ and lift lower extremity to allow for toe clearance during swing.
Hip Abductors
-Control the slight lowering of the ________ pelvis on the side of the swing limb.
Hip Adductors
-Assist with initiation of hip flexion after _______.
- terminal swing (TSw)
- initial swing (ISw)
- contralateral
- toe-off
How do transfemoral ambulators initiate knee extension?
hip extension
Key Muscle Activity - Knee:
Knee Extensors
-___________ control knee flexion in LR then act __________ to extend the knee and support body in midstance.
Knee Flexors
-Deccelerate knee _________ in preperation for placement of the foot on the ground.
- Eccentrically, concentrically
- extension
Key Muscle Activity - Ankle
Ankle Dorsiflexors
-Eccentric activation to control ___________ of the ankle at initial contact until foot comes in contact with the ground
Ankle Plantarflexors
-Eccentric contraction moving into midstance to control ______ advancement and concentric contraction at _________ and ______ to propel forward (“push-off”)
Ankle invertors
-Eccentrically contracts to control ________ until midstance then concentrically contracts to ________ the foot for push-off in terminal stance/preswing
Ankle evertors
-Also active as co-contraction to counter strong ________ occurring during loading response to midstance
- plantarflexion
- tibial, terminal stance (TSt) and preswing (PSw)
- pronation, supination
- inversion
GRFV
- If torque needed is in direction of movement: __________ contraction
- If torque needed is opposite to direction of movement: ________ contraction
- concentric
- eccentric
- The loss of plantarflexors in amputees results in what?
- What phase(s) of gait will this be most noticeable?
- shorter contralateral step length
- reduced gait speed
- impaired balance
-Most noticeable in MSt, this is when the gastroc is the most active
Activity at the ____ and _____ produces majority of force for knee flexion during swing phase. This is the principle utilized in prosthetic design for individuals with transfemoral amputation.
hip and ankle
No prosthetic mechanism is needed to produce knee flexion given the individual can do what?
- flex the hip
- ambulate fast enough to produce momentum
PROSTHETIC GAIT
PROSTHETIC GAIT
Do trauma patients or dysvascular patients tend to walk faster?
Trauma
________ and __________ efficiency both decrease as the level of the amputation moves more proximal.
energy and biomechanical
What is the key alignment issue in transtibial prosthetic gait?
socket-foot relationship (too far anterior/posterior)
Transtibial Prosthetic Gait:
IC/LR
- _____ stride length
- _______ knee flexion
MSt
- _____ position (close to _______ during MSt)
- _____ step width
TSt
- smooth progression over the _____
- smooth _______ of the limb
PSw
-______,_____, and _____ position to maintain stability
Swing Phase
-Prosthetic _____
- equal
- controlled
- pylon (vertical)
- normal (2-4in)
- foot
- flexion (equal to intact)
- pelvic, trunk, and head
- path
_______ and __________ is a common cause for many TTA deviations and is caused by poor __________.
- pistoning and bellclapping
- suspension
What does pistoning and bellclapping result in?
- decreased stability
- decreased confidence
- excessive pressure/shearing forces
Transfemoral patients have an overall decrease in gait speed of around ___%.
40%
What is the key alignment issue in transfemoral prosthetic gait?
- socket-knee
- knee-foot
Transfemoral Prosthetic Gait:
IC/LR
- _______ stride length
- ______ gait cycle
- knee joint _______
MSt
- weight shift over _______
- _______ to propulsion
- ______ position
TSt
- SLS time _______
- _______ progression of COM over foot
- _______ lumbar lordosis
PSw
- ______ heel rise
- adequate _______
Swing phase
-______
- decreased
- shorter
- stability
- prosthetic
- braking
- pylon
- decreased
- normal
- normal
- normal
- suspension
-velocity
Energy Expenditure:
- For normal individuals, the energy cost of walking and gait speed are ______.
- For transtibial amputees, they have a __-__% increase in O2 consumption.
- For transfemoral amputees, they have a ___-___% increase in O2 consumption.
- linear
- 16-28%
- 60-110%
Prosthetic Gait: Main Takeaways
- A solid foundation in normal gait lends itself well to prosthetic gait analysis
- Development of gait __________ and __________, as well as increased metabolic cost, is unavoidable
- “Normal” prosthetic gait is a function of ______ fit, __________ alignment, components, and ____ ability
- No matter the cause or level, amputees have increased ________ costs for ambulation
- abnormalities and compensations
- socket fit, prosthetic alignment, components, and user ability
- metabolic
