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6 Prosthetics & Orthotics > L9 Amputee Gait > Flashcards

L9 Amputee Gait Flashcards

1
Q

Gait is determined by

A

-level of amputation
-technical capabilities of prosthetic
-strength of muscles
-ROM

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2
Q

IC to LR Forces (NORMAL)

A

GRF originates at heel, passes post to ankle and knee joints

produces knee flexion, ankle pf

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3
Q

Midstance through preswing (NORMAL)

A

GRF moves ant to ankle and knee
produces ankle DF, then will PF
forward tibial incline lets heel rise and GRF fall behind knee, causing swing

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4
Q

IC TT Gait

A

Knee should be flexed
Pelvis/trunk should be erect

heel lever allows smooth descent, controlled knee flexion

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5
Q

LR TT Gait

A

controlled flex of knee
controlled lowering of prosthetic foot
knee flexes more for shock absorption
heel should compress to simulate pf
quads are active
BOS shouldn’t be more than 5 cm

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6
Q

Midstance TT Gait

A

full WB on prosthesis
slight varus thrust
upright trunk
reciprocal arm swing
pylon is perpendicular
foot is flat
degree of df is dependent on foot

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7
Q

Terminal Stance/Preswing TT Gait

A

unloading of prosthetic leg
loading of contralateral leg
transition is affected by type of foot
toe lever helps to promote smooth roll over
knee should begin to flex as heel rises

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8
Q

Swing Phase TT Gait

A

knee should flex during swing
toe clears floor
socket remains suspended
step length should be equal
pelvis is level
minimal transverse plane rotation of heel

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9
Q

TT Excessive Knee Extension at IC causes

A

Prosthesis = toe lever too long, foot too anterior, insufficient socket flexion, heel to soft, faulty suspension

patient = weak quads, reduced confidence

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10
Q

TT Knee too flexed at IC causes

A

faulty suspension
knee flexion contracture > 40 °

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11
Q

TT Unequal Stride Length

A

inadequate suspension
foot too posterior or anterior
pain
reduced confidence

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12
Q

TT Rotation of Foot at IC

A

no enough contact/loose contact
stiff heel compression
put on wrong
excessive toe out
excessive DF or big heel lever
pain
decreased stability
weakness of ER/IR

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13
Q

TT Knee instability at LR

A

toe lever arm too short
heel too hard
DF
higher heel shoe
too much socket flexion
weak quads

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14
Q

TT Pylon leans medially

A

(top of pylon is medial to bottom)

too much socket adduction
foot too outset

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15
Q

TT Pylon leans laterally

A

(top of pylon lateral to bottom)

not enough adduction
foot too inset

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16
Q

TT Valgus THrust

A

foot is excessively outset

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17
Q

TT Varus thrust

A

foot is excessively inset
slight is normal

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18
Q

TT Drop off in terminal stance/preswing

A

socket is too loose
short toe lever
too much DF
too much socket flexion
high heel of shoe
hip/knee flexion contracture

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19
Q

Causes of Pistoning

A

suspension too loose
inadequate number of sock ply

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20
Q

“I feel like I’m walking uphill/can’t bend my knee/I’m falling backwards”

A

socket too extended
foot too pf
long toe lever/foot too ant
heel bumper too soft
shoe heel too soft or too low

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21
Q

“I feel like I’m walking downhill, my knee feels like it wants to buckle, I can’t straighten my knee, I’m being thrown forward”

A

socket flexion
too much DF
short toe lever/long heel lever/foot post
too firm heel
too high of heel

22
Q

Ideal TF Gait

A

equal step length
symmetric in pattern
even cadence
BOS with 2-3 in separation
pelvis is level

23
Q

IC to Midstance TF

A

IC is most unstable
knee should be in extension from hc to midstance

24
Q

Swing Phase TF Gait

A

initiate swing with enough hip flexion to achieve knee flexion

knee in extension in prep for IC

25
Q

TF Knee instability at IC

A

high heel height
excessive DF
too far ant knee
inadequate socket flexion
prosthesis too long
hip flexion contracture
weak hip extensors

26
Q

Foot Slap TF

A

pf resistance is too soft
heel lever is too short
heel cushion is too soft
pt grinding heel into ground

27
Q

Foot rotation at LR TF

A

Foot bumper too firm
loose socket
foot aligned in ER
poor muscular control
weakness of hip muscles
not enough WB at IC

28
Q

Forward Trunk Flexion TF

A

socket too big
poor suspension
knee instability
knee axis too far anterior
hip flexion contracture
weak hip extensors
pain with ischial WB

29
Q

Abducted Gait TF

A

lateral wall of socket has space
prosthesis too long
high medial wall
prosthesis aligned in abduction
weakness
abduction contracture
adductor roll
reduced balance
pain on ramus
lack of confidence

30
Q

Lateral Trunk Lean to prosthetic side TF

A

prosthesis too short
space within socket
medial wall of socket is too high
inadequate socket adduction
prosthesis in abduction
pain on ramus
pain of lateral distal femur
short residual limb
weak hip abductors
poor balance

31
Q

Excessive Lumbar Lordosis TF

A

insufficient socket flexion
ppor shaping of post wall of prosthesis
flexion contracture
weak hip ext
weak abd
pain on ischial WB

32
Q

Medial Whips

A

occurs when heel travels medially at beginning of swing phase

prosthetic knee ER, socket donned in ER, inadequate suspension

33
Q

Lateral Whip

A

heel moves laterally at IC
prosthetic knee IR, socket donned in IR, inadequate suspension

34
Q

Circumduction TF

A

excessive PF
positioning
decreased knee flex
lack of weight shift
weak hip flex
lack of confidence
socket posterior
increased pf

35
Q

Vaulting TF

A

excessive mechanical resistance to knee flex
prosthesis alignment too stable
prosthesis too long
excessive pf
inadequate suspension
lack of training
fear of catching toe during swing
fear of knee flexion
weakness of hip flexors for swing

36
Q

Microprocessor knee transfers

A

keep weight through prosthetic leg and push weight down through the heel as they sit

37
Q

Non-microprocessor knee transfers

A

move prosthetic foot slightly behind to get toe load to unlock the knee

38
Q

Preswing knee flexion depends on

A

use of hip flexors
initiation of forward pelvic rotation
timing of heel rise
controlled shifting of weight from prosthesis to intact side

39
Q

Gait Training for Manual lock knee

A

locked for both swing and stance
stable, doesn’t allow for normal gait
swing is done through hip hike/circumduction
shorter prosthesis, causes lateral trunk lean

40
Q

Gait Training for Single Axis Knee

A

free moving hinge from flexion to extension
knee stability is acheived based on GRF
GRF should be ant to knee in stance
focus on heel strike and strong hip ext
knee doesn’t allow for change in speed

41
Q

Gait training for Weight activated friction knee

A

mechanical friction during stance
free swing when its not WB
has a risk for buckling
practice weight shift off and hip ext
knee doesn’t allow for change in speed

42
Q

Gait training for polycentric knee

A

very stable
need to practice heel strike with strong hip ext for stability
need to practice weight shift for swing

43
Q

Gait training for Microprocessor Knee

A

can rapidly adapt to changes in gait, including cadence or incline

44
Q

Transtibial advanced gait trainig

A

progress to activities that demand varied cadence and transitional gait liked sidestepping, turning

practice dynamic gait activities like crossing the street

45
Q

Ascending stairs TT

A

step over step requires quads and med to long residual limb

the more limited df, the harder it is to go up

46
Q

Descending stairs TT

A

toes of prosthetic foot hang over edge of step to allow knee to bend

47
Q

TF Ascending stairs

A

technique varies on knee
usually step to pattern leading with intact

should practice weight shift and stabilization with hip extensors, hip abductors

most likely will need to abduct prosthetic limb to avoid toes catching

48
Q

TF Descending stairs

A

step to pattern leading with prosthetic

can do step over step depending on knee. Should place heel only on step to create flexion at knee. C-leg is best for this

side-stepping can also be used

49
Q

Ascending Ramps TF

A

step to pattern to allow hip extension

avoid DF limit by ER the foot and roll over instep

steep hills require side stepping or figure S

50
Q

Descending Ramps TF

A

safest is to lead with prosthetic side and take short step with sound side

sidestepping can be used, leading with prosthetic

6 Prosthetics & Orthotics (11 decks)

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