L5:TFA_TTA Gait Training Part 2: Deviations and Causes*** Flashcards
WRITE ALL OF THIS!!!
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ALL CARDS PRESENTED AS FOLLOWS:
TALKING ABOUT SPECIFIC DEVIATIONS IN GAIT @ SPECIFIC TIMES IN GAIT CYCLE
Type of prosth:
Phase of gait:
Deviation:
Intrinsic (w/in body) vs. Extrinsic (prosth. or environment)
Type of prosth: TTA
Phase of gait: IC→MSt
Deviation: EXCESSIVE KNEE FLEXION
INSTRINSIC
- Knee flex contracture
- Hip flex contracture
- Hip and/or knee strength or timing deficits
Type of prosth: TTA
Phase of gait: IC→MSt
Deviation: EXCESSIVE KNEE FLEXION
EXTRINSIC
- Excessive DF of foot (remember prosth foot!)
- Excessive socket flexion (ant. tilt)
- aka have to flex knee more to fit in socket
- Socket anterior to foot
- Excessive heel cushion stiffness (SACH)
- durometer mods this
- too stiff→ pylon follows= knee flexion
- Prosth too long
- Walking downhill (environ.)
Type of prosth: TTA
Phase of gait: IC→MSt
Deviation: KNEE HYPEREXTENSION
INSTRINSIC
- Cruciate lig insuff.
- Quad weakness
- Distal RL pain
- Excessive popliteal tissue
*see video slide 63
Type of prosth: TTA
Phase of gait: IC→MSt
Deviation: KNEE HYPEREXTENSION
EXTRINSIC
- Excessive PF of foot
- PF assocd w/ knee EXT ***
- Excessive socket EXT (posterior tilt)
- Ext knee more to put in socket
- Excessively soft heel cushion (SACH) (opp of excess. knee flex)
- BW shifts over too quickly
- Prosth TOO SHORT
- Inadeq. cuff suspension
- Walking uphill (environ.)
Type of prosth: TFA
Phase of gait: IC→ MSt
Deviation: KNEE INSTABILITY
INTRINSIC
- SIGNIFICANT hip flexion contracture (>25-30degs)
- Weakness of hip EXTs
- forces more knee flexion
Type of prosth: TFA
Phase of gait: IC→ MSt
Deviation: KNEE INSTABILITY
EXTRINSIC
- Prosthetic Knee axis (TKA) aligned too far anterior to the wt line→ GRF/ext moment line***
- Socket may not have been preflexed→ decd biomech. adv of hip EXTs
- Excessive DF of prosth. foot → TTA as well
- SACH heel of PF bumper (PF– Posterior) too stiff→ TTA as well
- wont allow PF
Type of prosth: TFA or TTA
Phase of gait: IC→ MSt
Deviation: FOOT SLAP
INTRINSIC
- NONE → no mm’s
Type of prosth: TFA or TTA
Phase of gait: IC→ MSt
Deviation: FOOT SLAP
EXTRINSIC
- Heel cushion too soft (exactly what it sounds like)
- PF bumper (posterior) too soft/worn
Type of prosth: TFA or TTA
Phase of gait: IC→ MSt
Deviation: EXTERNAL ROTATION OF PROSTH. FOOT
INTRINSIC
- Tight hip ERs
- Weak hip mm’s
- Fear of knee instab. extending knee too vigorously, ER to compensate
- Shoe too tight on prosth.—– NOT ON TEST
*SEE VIDEO SLIDE 66
Type of prosth: TFA or TTA
Phase of gait: IC→ MSt
Deviation: EXTERNAL ROTATION OF PROSTH. FOOT
EXTRINSIC
- Excessively firm heel cushion
- PF bumper (posterior) too firm
- Poor fit in socket allowing rotation→ fluctuating edema
Type of prosth: TTA
Phase of gait: Midstance→ (SLS, glutes, ABDs)
Frontal plane
Deviation: VALGUS MOMENT @ KNEE
INTRINSIC
- Collateral lig insuff. @ knee
- Medial distal RL pain
Type of prosth: TTA
Phase of gait: Midstance (SLS, glutes, ABDs)
Frontal plane
Deviation: VALGUS MOMENT @ KNEE
EXTRINSIC
- Excessive outset of foot (you’ll see this in another deck)
- Inadeq. socket fit or suspension
- Walking on uneven surfaces (environ.)
Type of prosth: TTA
Phase of gait: Midstance (SLS, glutes, ABDs)
Frontal plane
Deviation: VARUS MOMENT @ KNEE
INTRINSIC
- Collateral lig insuff @ knee
- Lateral distal RL pain
- Weakness of hip ABDs ***
Type of prosth: TTA
Phase of gait: Midstance (SLS, glutes, ABDs)
Frontal Plane
Deviation: VALGUS MOMENT @ KNEE
EXTRINSIC
- Excessive inset (you’ll see this in other deck) of foot
- Inadeq. socket fit or susp.
- Walking uneven surfs (environ.)