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Prosthetics&Orthotics > L5:TFA_TTA Gait Training Part 2: Deviations and Causes*** > Flashcards

L5:TFA_TTA Gait Training Part 2: Deviations and Causes*** Flashcards

1
Q

WRITE ALL OF THIS!!!

A

*********

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2
Q

ALL CARDS PRESENTED AS FOLLOWS:

TALKING ABOUT SPECIFIC DEVIATIONS IN GAIT @ SPECIFIC TIMES IN GAIT CYCLE

A

Type of prosth:

Phase of gait:

Deviation:

Intrinsic (w/in body) vs. Extrinsic (prosth. or environment)

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3
Q

Type of prosth: TTA

Phase of gait: IC→MSt

Deviation: EXCESSIVE KNEE FLEXION

INSTRINSIC

A
  • Knee flex contracture
  • Hip flex contracture
  • Hip and/or knee strength or timing deficits
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4
Q

Type of prosth: TTA

Phase of gait: IC→MSt

Deviation: EXCESSIVE KNEE FLEXION

EXTRINSIC

A
  • 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.)
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5
Q

Type of prosth: TTA

Phase of gait: IC→MSt

Deviation: KNEE HYPEREXTENSION

INSTRINSIC

A
  • Cruciate lig insuff.
  • Quad weakness
  • Distal RL pain
  • Excessive popliteal tissue

*see video slide 63

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6
Q

Type of prosth: TTA

Phase of gait: IC→MSt

Deviation: KNEE HYPEREXTENSION

EXTRINSIC

A
  • 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.)
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7
Q

Type of prosth: TFA

Phase of gait: IC→ MSt

Deviation: KNEE INSTABILITY

INTRINSIC

A
  • SIGNIFICANT hip flexion contracture (>25-30degs)
  • Weakness of hip EXTs
    • forces more knee flexion
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8
Q

Type of prosth: TFA

Phase of gait: IC→ MSt

Deviation: KNEE INSTABILITY

EXTRINSIC

A
  • 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
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9
Q

Type of prosth: TFA or TTA

Phase of gait: IC→ MSt

Deviation: FOOT SLAP

INTRINSIC

A
  • NONE → no mm’s
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10
Q

Type of prosth: TFA or TTA

Phase of gait: IC→ MSt

Deviation: FOOT SLAP

EXTRINSIC

A
  • Heel cushion too soft (exactly what it sounds like)
  • PF bumper (posterior) too soft/worn
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11
Q

Type of prosth: TFA or TTA

Phase of gait: IC→ MSt

Deviation: EXTERNAL ROTATION OF PROSTH. FOOT

INTRINSIC

A
  • 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

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12
Q

Type of prosth: TFA or TTA

Phase of gait: IC→ MSt

Deviation: EXTERNAL ROTATION OF PROSTH. FOOT

EXTRINSIC

A
  • Excessively firm heel cushion
  • PF bumper (posterior) too firm
  • Poor fit in socket allowing rotation→ fluctuating edema
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13
Q

Type of prosth: TTA

Phase of gait: Midstance→ (SLS, glutes, ABDs)

Frontal plane

Deviation: VALGUS MOMENT @ KNEE

INTRINSIC

A
  • Collateral lig insuff. @ knee
  • Medial distal RL pain
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14
Q

Type of prosth: TTA

Phase of gait: Midstance (SLS, glutes, ABDs)

Frontal plane

Deviation: VALGUS MOMENT @ KNEE

EXTRINSIC

A
  • Excessive outset of foot (you’ll see this in another deck)
  • Inadeq. socket fit or suspension
  • Walking on uneven surfaces (environ.)
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15
Q

Type of prosth: TTA

Phase of gait: Midstance (SLS, glutes, ABDs)

Frontal plane

Deviation: VARUS MOMENT @ KNEE

INTRINSIC

A
  • Collateral lig insuff @ knee
  • Lateral distal RL pain
  • Weakness of hip ABDs ***
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16
Q

Type of prosth: TTA

Phase of gait: Midstance (SLS, glutes, ABDs)

Frontal Plane

Deviation: VALGUS MOMENT @ KNEE

EXTRINSIC

A
  • Excessive inset (you’ll see this in other deck) of foot
  • Inadeq. socket fit or susp.
  • Walking uneven surfs (environ.)
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17
Q

Type of prosth: TTA

Phase of gait: Midstance to Late Stance

Deviation: DROP-OFF (PREMATURE ROLLOVER)→ earlier knee flex/excessive but @ diff stage

INTRINSIC

A
  • Hip and/or knee flexion contracture
  • Weak hip EXTs
  • Anterior distal RL pain
  • Timing of rollover is off (too early)
    • should occur bw TSt and PSw→ instead occurring bw MSt and TSt

*see video slide 69

18
Q

Type of prosth: TTA

Phase of gait: Midstance to Late Stance

Deviation: DROP-OFF (PREMATURE ROLLOVER)→ earlier knee flex/excessive but @ diff stage

EXTRINSIC

A
  • Poor prosth. foot alignment, too much DF
    • Ecc, excessive DF assocd w/ flexion
  • DF bumper (anterior) too soft or worn out
  • Heel cushion too soft (SACH)
  • Keel too short***
  • Socket too far anterior
  • Walking downhill (environ.)
19
Q

Excessive DF assocd w/——

Excessive PF assocd w/——-

A

Excess DF== knee flexion

Excess PF== knee EXT

20
Q

Type of prosth: TTA

Phase of gait: Midstance

Deviation: INSUFFICIENT WB

INTRINSIC

A
  • RL pain OR hypersensitivity
  • Excess. UE reliance on AD
  • Knee jt instab.
  • Decd strength
  • FOF/decd confidence
21
Q

Type of prosth: TTA

Phase of gait: Midstance

Deviation: INSUFFICIENT WB

EXTRINSIC

A
  • Prosth. too long
  • Poor socket fit→ discomf.
  • Walking on rugged terrain (environ.)
  • Walking uphill (environ.)
22
Q

Type of prosth: TTA

Phase of gait: Midstance→ Preswing

Deviation: DELAYED KNEE FLEXION

INTRINSIC

A
  • Posterior/distal RL pain
  • Pt locking knee due to knee instab.
23
Q

Type of prosth: TTA

Phase of gait: Midstance → Preswing

Deviation: DELAYED KNEE FLEXION

EXTRINSIC

A
  • Excessive PF of foot
    • remember: excess PF coupled w/ more EXT, so this == delayed knee flexion!! make the connection!!!
  • Socket pos’d post. to foot
  • Excessively long keel of foot
  • Walking uphill
24
Q

Type of prosth: TFA

Phase of gait: Midstance to Late Stance

Deviation: LATERAL TRUNK BENDING (TOWARDS PROSTH. SIDE)

INTRINSIC

A
  • Short RLs: diff to make socket w/ adeq. lateral stability
  • Groin/ADD discomf., pinching

**see video slide 72

25
**Type of prosth:** TFA **Phase of gait:** Midstance to Late Stance **Deviation:** LATERAL TRUNK BENDING (TOWARDS **PROSTH. SIDE)** **EXTRINSIC**
* Initial socket **set in too much ABD** * **RL too deep in socket/socks** * Prosth. foot excessively **outset**
26
**Type of prosth:** TFA **Phase of gait:** Stance **Deviation:** ABDUCTED GAIT PATTERN (only a **stance** **phase** thing) **INTRINSIC**
* Pain in groin/pinching * Decd **pelvic stab/weak ABDs** * Lateral distal RL pain * FOF/Wide BOS \*\*see video slide 73
27
**Type of prosth:** TFA **Phase of gait:** Stance **Deviation:** ABDUCTED GAIT PATTERN (only a **stance** **phase** thing) **EXTRINSIC**
* Prosth. too long * Socket aligned in **excessive ABD** * Medial wall too high
28
**Type of prosth:** TFA **Phase of gait:** Stance **Deviation:** UNEVEN STEP LENGTH **INTRINSIC**
* Pain _anywhere_ in RL * Hip flex contracture→ **limits hip EXT in late stance** * **FOF** **\*\*see video slide 74**
29
**Type of prosth:** TFA **Phase of gait:** Stance **Deviation:** UNEVEN STEP LENGTH **EXTRINSIC**
Mechanical knee instab.
30
**Type of prosth:** TTA **Phase of gait:** Swing **Deviation:** INADEQUATE CLEARANCE OF FOOT **INTRINSIC**
* Decd knee or hip ROM * Decd hip or knee strength or motor control * FOF/decd confidence
31
**Type of prosth:** TTA **Phase of gait:** Swing **Deviation:** INADEQUATE CLEARANCE OF FOOT **EXTRINSIC**
* Prosth **too long** * **Excess PF of prosth foot== EXT** * Walking uneven surfs.
32
**Type of prosth:** TFA **Phase of gait:** Swing **Deviation:** EXCESSIVE LUMBAR LORDOSIS **INTRINSIC**
* Sig hip flexion contracture * **so they use lordosis to kickstart motion to swing LE** * Core and hip (flexion) weakness * **Short RL/ineffective lever**
33
**Type of prosth:** TFA **Phase of gait:** Swing **Deviation:** EXCESSIVE LUMBAR LORDOSIS **EXTRINSIC**
* Insuff. socket pre-flexion
34
**Type of prosth:** TFA **Phase of gait:** Right BEFORE Swing→ more like TSt→PSw **Deviation:** MEDIAL AND LATERAL WHIPS OF HEEL \*COMMON \*REMEMBER FERRARO DOING IT **INTRINSIC**
* **Lateral→** when donning, RL **internally rotated in socket** * **Medial→** “ ” **externally rotated in socket** * DECd ROM @ hip rotators
35
**Type of prosth:** TFA **Phase of gait:** Right BEFORE Swing→ more like TSt→PSw **Deviation:** MEDIAL AND LATERAL WHIPS OF HEEL \*COMMON \*REMEMBER FERRARO DOING IT **EXTRINSIC**
* **Lateral whip→** knee positioned in **too much IR** * **Medial whip→** knee pos'd in **too much ER** * **Medial whip→** Silesian/TES belt **too tight=pulls socket into ER**
36
**Type of prosth:** TFA **Phase of gait:** Swing **Deviation:** VAULTING/CIRCUMDUCTION/HIP HIKING **INTRINSIC**
* Anxiety about catching toes during swing (poor clear) * Anticipated anxiety about **knee instab during upcoming stance** **\*see video slide 78**
37
**Type of prosth:** TFA **Phase of gait:** Swing **Deviation:** VAULTING/CIRCUMDUCTION/HIP HIKING **EXTRINSIC**
* Insuff. suspension/pistoning * Too much knee resist. * Foot set in excessive PF * Locked knee * Prosth **too long**
38
Gait Deviations ## Footnote **Cheat sheet slide w/ videos**
SLIDE 79 WATCH IT!!!!!!!!! \*\*\*\*\*
39
MAX DF @ which phase?
MSt→ TSt
40
DO THIS EXERCISE: ## Footnote **TFA vs. Normal Gait comparison (subphases)** **\*use all knees/feet**
SEE SLIDE 80\*\*\* WRITE IN NOTEBOOK\*\*\*\* YOU FUCKING GOT THIS SHIT JOSH!!!! YAAAAAAA!!!!

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