L9 Amputee Gait Flashcards
Gait is determined by
-level of amputation
-technical capabilities of prosthetic
-strength of muscles
-ROM
IC to LR Forces (NORMAL)
GRF originates at heel, passes post to ankle and knee joints
produces knee flexion, ankle pf
Midstance through preswing (NORMAL)
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
IC TT Gait
Knee should be flexed
Pelvis/trunk should be erect
heel lever allows smooth descent, controlled knee flexion
LR TT Gait
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
Midstance TT Gait
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
Terminal Stance/Preswing TT Gait
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
Swing Phase TT Gait
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
TT Excessive Knee Extension at IC causes
Prosthesis = toe lever too long, foot too anterior, insufficient socket flexion, heel to soft, faulty suspension
patient = weak quads, reduced confidence
TT Knee too flexed at IC causes
faulty suspension
knee flexion contracture > 40 °
TT Unequal Stride Length
inadequate suspension
foot too posterior or anterior
pain
reduced confidence
TT Rotation of Foot at IC
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
TT Knee instability at LR
toe lever arm too short
heel too hard
DF
higher heel shoe
too much socket flexion
weak quads
TT Pylon leans medially
(top of pylon is medial to bottom)
too much socket adduction
foot too outset
TT Pylon leans laterally
(top of pylon lateral to bottom)
not enough adduction
foot too inset
TT Valgus THrust
foot is excessively outset
TT Varus thrust
foot is excessively inset
slight is normal
TT Drop off in terminal stance/preswing
socket is too loose
short toe lever
too much DF
too much socket flexion
high heel of shoe
hip/knee flexion contracture
Causes of Pistoning
suspension too loose
inadequate number of sock ply
“I feel like I’m walking uphill/can’t bend my knee/I’m falling backwards”
socket too extended
foot too pf
long toe lever/foot too ant
heel bumper too soft
shoe heel too soft or too low
“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”
socket flexion
too much DF
short toe lever/long heel lever/foot post
too firm heel
too high of heel
Ideal TF Gait
equal step length
symmetric in pattern
even cadence
BOS with 2-3 in separation
pelvis is level
IC to Midstance TF
IC is most unstable
knee should be in extension from hc to midstance
Swing Phase TF Gait
initiate swing with enough hip flexion to achieve knee flexion
knee in extension in prep for IC
TF Knee instability at IC
high heel height
excessive DF
too far ant knee
inadequate socket flexion
prosthesis too long
hip flexion contracture
weak hip extensors
Foot Slap TF
pf resistance is too soft
heel lever is too short
heel cushion is too soft
pt grinding heel into ground
Foot rotation at LR TF
Foot bumper too firm
loose socket
foot aligned in ER
poor muscular control
weakness of hip muscles
not enough WB at IC
Forward Trunk Flexion TF
socket too big
poor suspension
knee instability
knee axis too far anterior
hip flexion contracture
weak hip extensors
pain with ischial WB
Abducted Gait TF
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
Lateral Trunk Lean to prosthetic side TF
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
Excessive Lumbar Lordosis TF
insufficient socket flexion
ppor shaping of post wall of prosthesis
flexion contracture
weak hip ext
weak abd
pain on ischial WB
Medial Whips
occurs when heel travels medially at beginning of swing phase
prosthetic knee ER, socket donned in ER, inadequate suspension
Lateral Whip
heel moves laterally at IC
prosthetic knee IR, socket donned in IR, inadequate suspension
Circumduction TF
excessive PF
positioning
decreased knee flex
lack of weight shift
weak hip flex
lack of confidence
socket posterior
increased pf
Vaulting TF
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
Microprocessor knee transfers
keep weight through prosthetic leg and push weight down through the heel as they sit
Non-microprocessor knee transfers
move prosthetic foot slightly behind to get toe load to unlock the knee
Preswing knee flexion depends on
use of hip flexors
initiation of forward pelvic rotation
timing of heel rise
controlled shifting of weight from prosthesis to intact side
Gait Training for Manual lock knee
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
Gait Training for Single Axis Knee
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
Gait training for Weight activated friction knee
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
Gait training for polycentric knee
very stable
need to practice heel strike with strong hip ext for stability
need to practice weight shift for swing
Gait training for Microprocessor Knee
can rapidly adapt to changes in gait, including cadence or incline
Transtibial advanced gait trainig
progress to activities that demand varied cadence and transitional gait liked sidestepping, turning
practice dynamic gait activities like crossing the street
Ascending stairs TT
step over step requires quads and med to long residual limb
the more limited df, the harder it is to go up
Descending stairs TT
toes of prosthetic foot hang over edge of step to allow knee to bend
TF Ascending stairs
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
TF Descending stairs
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
Ascending Ramps TF
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
Descending Ramps TF
safest is to lead with prosthetic side and take short step with sound side
sidestepping can be used, leading with prosthetic
