L5: TFA_TTA Gait Training Part 1 Flashcards
Functional capacity of amputees
TTA
- Can resume prev activities
- amb on lvl surfs, inclines, stairs
Functional capacity of amputees
TTA
Rely on ________ to push or lift heavy load
intact limb/balance
Functional capacity of amputees
TTA
Bilateral kneeling uncomfortable….what should you do?
Teach them to WB thru patellar tendons
Functional capacity of amputees
TTA
Amb _______ SLOWER why?
15-40% slower to conserve energy
Functional capacity of amputees
TFA
- Can amb and maint prolonged standing w/ occ. breaks
- Can lift/push light to med loads
Functional capacity of amputees
TFA
Stairs: Step TO pattern…..why?
No Ecc. quad control, but depends on the knee prescribed
Functional capacity of amputees
TFA
Walking speed is _________ SLOWER
40-55%
Functional capacity of amputees
TFA
Shorter the limb===________==_________
Shorter the limb==shorter lever arm==inc’d fatigue
Functional capacity of amputees
In General…..
Energy Req’s
- INCd energy req’s and cardiac output to walk WITH prosth.
- TTA→ O2 costs 16-28% more than controls
- TFA→ 60-110% inc
GET THEM ON UBE IMMEDIATELY!!!!
TTA: Static WB Eval
2 tips
- Look @ prosth. separate
- Look @ pt as a whole
*best in standing
TTA: Static WB Eval
General…
- Part of initial eval assess ROM, suture healing, strength, functional abilities
- Provide pt w/ info on how skin tension may feel and have them distinguish bw skin tension and pain
- **manual stretch to simulate !!!
TTA: Static WB Eval
Educate on what ?
*Wearing schedule
*Amt of socks
*Cleaning socket + interface
TTA: Static WB Eval
Assessing pt w/out prosth donned and why??
- Assess whether pt can stand indep. w/out prosth donned
- Gives info on type of interface and suspension most approp.
TTA: Static WB Eval
Wearing Schedule Flow Chart
PRINT!!!
TTA: Static WB Eval
Don/Doff should be done in ______
SITTING!!!
TTA: Static WB Eval
Should be done in sitting…..but if in standing these are the guidelines:
- Pt wt shifts onto prosth and pulls wrinkles from socks
- Tighten suspension system→ should be snug
- ***Ensure prosth has NOT rotated during STS or tightening process
TTA: Static WB Eval
HOW SHOULD IT FIT????
KNOW THIS!!!!!!!!!!!!!!!!!
KEY INFO!
- Pt may need to shift wt or take a few steps to accurately assess comfort and alignment
- Remember→ check redness
- Pts will often NOT put full wt onto newly fitted prosth device
- *TIP: use Biodex to educate
- Look for obv compensations @ trunk, prox LE and contralat limb
TTA: Static WB Eval
COM shifts which way?
COM shifts contralat & Sup. to prosth
TTA: Static WB Eval
Manual assessment by PT includes:
- Good proximal fit
- If PTB-SC
- Approx ⅓ to ½ of patella should be w/in socket*****
-
Med and Lat flares should be superior to condyles and snug
- **Test in sitting
TTA: Static WB Eval
In the case of PTB-SC
how much of patella should be w/in socket??
⅓ to ½ of patella should be within socket
TTA: Static WB Eval
Medial and lateral flares
Superior to condyles and snug
TTA: Static WB Eval
More on manual assessment by PT:
- Include:
-
Total contact fit distally
- *should be able to see and touch tissue in valve
- Re-assess alignment including:
- foot
- pylon and socket relationship
- ALL from anterior, lateral, and posterior views*****
-
Total contact fit distally
TTA: Static WB Eval
How should they LOOK?
Once prosth fit is correct…. begin what?
Postural assessment
TTA: Static WB Eval
How should they LOOK?
Once prosth fit is correct begin Postural Assessment including:
- Observation all three planes (@ least two)
- Assess alignment of bony landmarks: Symmetry
- Iliac crests
- PSIS, ASIS
- Greater trochs
- Superior patella border
- Overall leg length should be no more than ½ inch diff
TTA: Static WB Eval
How should they LOOK?
Bony landmarks for checking symmetry
Iliac crests
PSIS, ASIS
Greater trochs
Sup patella border
TTA: Static WB Eval
How should they LOOK?
Overall leg length should be NO MORE than _______ diff
½ inch
TTA: Static WB Eval
Checking EQUAL WB
MUST HAVE
- Biodex
- sheet of paper under toe, heel and med/lateral aspect
TTA: Static WB Eval
Checking PAINFUL WB
AVOID!!!
- Clay, lipstick, marker in socket
- determines where they are WB
TTA: Static WB Eval
IF more than ½ inch leg length diff, must determine what?
Whether oirigin is intrinsic (anatomical) OR extrinsic (prosthesis)
TTA: Static WB Eval
Intrinsic vs. Extrinsic cause for leg length difference (greater than ½ inch)
-
Intrinsic
- Correct w/ approp interventions
-
Extrinsic
- Consult CPO
TFA: IRC Socket Static Eval
Manual assessment by PT includes:
- Good proximal fit→ sitting AND standing
-
Sitting:
- should have LESS anterior hip discomfort when sitting
-
Standing:
- In IRC: ischial tube and pelvic ramus should be resting WITHIN socket
- Min. adductor roll present→ due to design
- In IRC: ischial tube and pelvic ramus should be resting WITHIN socket
TFA: IRC Socket Static Eval
Sitting:
Should have LESS anterior hip discomfort
TFA: IRC Socket Static Eval
Standing:
In IRC socket→ Isch tube and pelvic ramus should be resting WITHIN socket
*MIN adductor roll present due to design
TFA: Quadrilateral (Quad) Socket Static Evaluation
what is KEY?
EDUCATION!
TFA: Quadrilateral (Quad) Socket Static Evaluation
Manual assess by PT includes:
- Good proximal fit in BOTH sitting and standing
- tell them this!
-
Sitting:
- Discomfort common in groin/anterior hip due to higher ant. wall
-
Standing:
- Palpate isch tubes by having them flex forward
- When they return to standing→ should be pressure bw IT and post. shelf
- *INFORM pt→ may feel “intense pressure @ ITs and in Ant hip== normal and needed
TFA: Quadrilateral (Quad) Socket Static Evaluation
Sitting:
Discomfort common in groin/anterior hip due to higher ant. wall
TFA: Quadrilateral (Quad) Socket Static Evaluation
Standing:
Palpate isch tubes by having them flex forward→ when they return to standing there should be pressure bw IT and post. shelf
*Pt may feel intense pressure @ ITs and anterior hip== Normal and Needed!!!
TFA: Static Eval
Talk about the fit distally
-
TOTAL CONTACT fit distally
- Should be able to see/touch tissue in valve
- Unable to easily fit fingers in socket proximally
TFA: Static Eval
Re-assess alignment what/where?
- Re-assess alignment:
- foot
- pylon and socket relationships
- ALL from ant, lateral, posterior views
-
*NOTE: Ensure 50/50 WB!!!
- inset vs outset ****
TFA: Static Evaluation
- If they have pain in WB they will inherently want to add cotton plys to increase comfort….
- Sometimes this is NOT approp!!!
-
Need to assess origin of pain and alignment BEFORE adding socks
- *REMEMBER: Intrinsic vs. Extrinsic origin
TFA:
If pain in WB….why is it NOT approp to add cotton plys right away?
must assess origin of pain and alignment and determine intrinsic vs extrinsic origin
TFA: Static Eval
How should they LOOK?
- Once prosth fit is correct→ Postural assessment:
- Observe all three planes
- Alignment bony landmarks
- Iliac crests
- PSIS, ASIS
- Greater trochs
- Overall leg length should be NO MORE than ½ in. difference******
Overall leg length diff no more than _______
½ inch difference
At the end of evaluation…..
TAKE EVERYTHING OFF!!!!
- Re-inspect skin
- Re-take vitals
- Borg RPE???
Key factors that contribute to changes in gait in Transtibial amputees (TTAs):
4:
- Length of RL
- Suspension and socket→ alignment
- Fit of prosth.
-
Foot componentry
- Stability vs. Mobility
- Maybe they are better w/ more stable foot
- REMEMBER: More mobility === LESS stability
- Maybe they are better w/ more stable foot
- Stability vs. Mobility