Lever Arms, Rockers & GRF Flashcards

1
Q

How can you remember the 3 rockers?

A

HAM! Heel, ankle, metatarsals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 transitional rocker periods and how it relates to stance phase?

A
  1. Heel: transition from swing into early stance, controlled lowering forefoot occurs, with fulcrum at heel
  2. Ankle: controlled forward progression of the tibia over foot occurs, with motion of talocrural joint of ankle
  3. Metatarsals: transition from stance toward swing occurs as heel rises, with DF of MTP joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe 1st Rocker Phase

A

Heel Strike: During the first (heel) rocker, there is a controlled lowering of the foot from neutral ankle position at initial contact to a plantarflexed foot flat, as well as acceptance of body weight on the limb during loading response. When motor control and muscle performance is efficient, eccentric contraction of the quadriceps and anterior tibialis prevents “foot slap” and protects the knee as GRF is translated upward toward the knee.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

1st rocker is lost with:

A
  • heel pain
  • fixed equinus (foot lacks DF, toe walker)
  • true or apparent LLD (lower limb discrepency)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does the foot do during 1st rocker phase

I don’t know how else to ask this

A

Foot is lowered onto ground under control of eccentrically acting tibialis anterior
Foot pronates with flattening of medial arch, and hind foot in valgus to allow shoe absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe 2nd Rocker Phase

A

n the second (ankle) rocker, the tibia begins to rotate over the weight-bearing foot, from its initial 10 degrees of plantarflexion at the end of loading response, then through vertical into dorsiflexion as mid-stance is completed. Eccentric contraction of the gastrocnemius and soleus muscles “puts on the brakes” to control the speed of the forward progression of the tibia over the fixed foot throughout mid-stance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

During 2nd Rocker-is it PF or DF happening?

A

Progressive DF of ankle allows tibia and COG to progress over foot
This was a quiz question

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe 3rd Rocker phase

A

Toe Off
At the start of the third (toe) rocker, the forefoot has converted from its mobile adaptor function of early stance to a rigid lever for an effective late stance, and the heel rises off the ground so that body weight has to roll over the first metatarsophalangeal joint through push-off in terminal stance. During fast walking and running, acceleration occurs as active contraction of the gastrocnemius-soleus complex propels the foot and leg into swing phase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3rd Rocker phase Description

A

Foot rotates over MT heads
Foot moves into supination, heel into varus
Tib Post locks midfoot so foot can act as rigid lever
Concentric contraction of triceps surae and FHL provides pushoff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3rd Rocker is lost with:

A
painful forefoot (hallux valgus/hallux rigidus) excessively stiff toe of prosthesis
-Loss of PF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Function of Prosthetic feet

A
  • provide controlled PF at Loading response
  • provide easy movement from hindfoot to forefoot
  • control large DF moment at Terminal stance to prevent collapse over ankle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are movements that prosthetic feet have not been able to eliminate

A

A loss of PF during pre-swing and Loss of DF during swing phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Soft heel=Short/Long heel lever=Stable/unstable at the knee

A

Soft heel=shorter heel lever=stability at the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe soft heel

A
Early Loading response
more loading but still low
easy PF movement of foot 
quick to foot flat
quick shortening of heel lever=low PF movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Firm Heel=long/short lever arm =more flexion/extension but potential for instability

A

Firm heel=longer lever arm= more flexion or ease of mobility but a potential for instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe Firm Heel

A
Instability at the knee at loading response can occur due to longer heel lever however this longer heel lever preserves more momentum and creates a better first rocker (the heel “rocker”)
Harder heels (firmer durometer of heel), a hard plantar flexor bumper,  dorsiflexing the foot, anterior tilting of the socket, or sliding the foot back, or higher heels creates knee flexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lever arms are determined by what?

A

the perpendicular distance between the action of the vector and the center of joint rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The rotational potential of the forces that act on a joint is called ______.

A

Torque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Torque moments = ________ x ________

A

the product of the force; the lever arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is ground reaction force?

A

It is the mean load bearing line.

- It takes into consideration forces acting in all three planes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a moment?

A

Tendency for a movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where does the ground reaction force need to be?

A

Behind the knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When you move the foot behind/posterior the knee, where does the ground reaction force move?

A

Moves to behind the knee = flexion tendency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When you move the foot in front of/anterior to the knee, where does the ground reaction force move?

A

Moves in front of the knee = extension tendency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
In a BK, where do you want the ground reaction force to be in relation to the body? Why?
Behind the knee - to promote knee flexion, so they do not hyperextend & ruin knee capsule and/or ligaments
26
In a AK, where do you want the ground reaction force to be in relation to the body? Why?
In front of the knee - to promote extension so they are more stable
27
When your foot is dorsiflexed what happens to the ground reaction force/physiological movement?
The ground reaction force causes an increased knee flexion moment
28
What ankle movement stops hyperextension?
dorsiflexion
29
At heel strike the socket has a tendency to tip forward & the knee is trying to go forward, causing pressure where?
Anterior distal & Posterior proximal
30
What is the limit of heel height adjustability?
3/8 inch
31
What is the prosthetic foot size like compared to the patient's sound size?
The prosthetic foot needs to be a 1/2 size smaller.
32
What is the term that describes the density of the material used for the foot prosthesis?
Heel durometer
33
What is the desired position of the pylon once the shoe is attached and the foot is on the floor?
Vertical
34
What happens if the heel on a shoe is too high? Too low?
Too high - knee tends to gives out | Too low - knee tends to hyperextend
35
What NORMALLY happens at the knee and ankle during mid-stance?
Ankle valgus, genu varum at the knee
36
If you inset the foot on a prosthetic device, what happens to the knee? Where is the pressure inside the socket?
Inset the foot = the knee want to go into valgus (can be a problem) Pressure = Lateral distally, medial proximal
37
How do you judge where the ABD/ADD alignment should be?
Put the patella tendon level
38
At mid-stance the socket causes pressure where?
Posterior distal and Anterior Proximal
39
What would be different about a runner's foot compared to a patient who is having increased difficulty with mid-stance/toe-off?
Runner's foot - wants a longer toe to load a longer toe lever Patient - since they have trouble getting over foot and loading prosthesis they will need a shorter toe-lever
40
The socket needs to be flexed to what degree? Why?
- 5 degrees | - Prevents hyperextension & increases weight bearing area
41
What is the reference point to measure height on the uninvolved/sound side?
Patella tendon
42
Even though it is mostly done for cosmetic purposes, the foot is abducted to what degree?
5 - 7 degrees
43
When you put the foot to increased toe-out, what happens to the toe lever?
Shortens
44
From initial contact through loading response we have a Plantar flexion moment, why?
Because the force vector is behind ankle. Then, the ground reaction force vector moves from heel towards to forefoot after mid-stance creating a dorsiflexion moment
45
Results of Flexible MP toe lever (4):
easier to initiate knee flexion at preswing; COP will be near MP joint; shorter toe lever; smaller DF and knee extension moments
46
Results of inc. ankle stiffness in regards to rollover:
The stiffer the ankle the more resistance met when moving forward at midstance. If the ankle is too free then the lower leg continues moving forward at midstance and the foot feels too short to slow them down.
47
Describe toe lever, COP, and DF/knee extension moments in relation to solid ankle foot (K1 foot) during rollover.
While moving into DF, toe lever increases rapidly -- COP moves forward quickly, and DF and extension moments rapidly increase
48
K1 foot provides what?
Used for those who need STABILITY
49
Describe toe lever, COP, knee flexion moment, and DF/knee extension moments in relation to Single/Multi-axis (K2, K3) foot use during rollover
While moving into DF, toe lever increases slowly -- COP moves forward slowly, DF/knee extension moments slowly, knee flexion moment is smaller.
50
K4 amputee - describe ideal foot type
K4 may actually want something between a solid ankle and a multiaxis ankle such as a dynamic pylon that creates a semi-stiff ankle. This allows them to walk fast b/c they need a long enough lever to push off w/ energy during running but enough knee mobility to initiate swing easily.
51
Functions of prosthetic knees (7):
- Provide stance stability early in stance phase - Control heel rise during initial swing - Control extension during terminal swing to prevent terminal impact - Provide shock absorption at loading response - Provide easy initiation of knee flexion at terminal stance - Provide easy flexion during pre-swing - Loss of transverse and coronal plane motions in prosthetic knee joints
52
Name type of knee choice used if pt has enough muscular control to be able to vary his/her cadence
Fluid control knee | May also use hydraulic, polycentric, microprossor knees
53
Knee type best choice for aggressive ambulators
Hydraulic knee; has a greater range for cadence control
54
Types of knees used for pts who have limited muscular control.
locking knee, friction knee
55
Gait training protocol: Sound Limb Stepping (PWB)
- introduces patient to gait biomechanics | - heel rise to heel strike
56
Gait Training Protocol: Prosthetic Limb Stepping (PWB)
- posterior pelvic rotation may occur - facilitate forward rotation and block prosthetic foot movement rhythmic initiation active quick stretch and resistive techniques
57
Gait Training Protocol: Prosthetic Limb Stepping (FWB)
- begin with prosthetic limb back - if motion becomes uncontrolled, return to PWB/UE support * watch for circumduction*
58
Gait Training Protocol: Sound Limb Stepping (FWB)
- begin with sound leg back * increased speed of step, decreased step length, lateral trunk lean can occur as a result of inability or unwillingness to WB or balance over prosthesis
59
Gait Training Protocol: Stride Length and Prosthetic Control
- step forward & back with prosthetic limb - alter step length - long, medium, short - repeat with sound limb * give feedback on good step length & monitor sound limb for crossing over BOS
60
Gait Training Protocol: Ambulating with Prosthesis
- begin in parallel bars | - progress to other assistive devices as appropriate
61
Gait Training Protocol: Assistive Device Progression
- progression is P-bars to crutches (axillary to Lofstrand) to canes - walker use only recommended if you feel this will be AD for long term home use
62
Advanced Gait Drills: Trunk Rotation/Arm Swing
- important for balance, momentum & symmetry - directly influenced by speed (increased speed = increased arm movement) - amputees often w/decreased arm swing on prosthetic side - facilitate by using rhythmic initiation or passive cueing or trunk as patient walks
63
Advanced Gait Drills: Sidestepping
- to sound side first - resistance applied to sound side hip to facilitate contralateral hip abd - repeat on prosthetic side
64
Advanced Gait Drills: Treadmill Ambulation
- normal cadence is 2.5 mph
65
Functional Activities: Stairs - Step-To Technique
- up with the good down with the bad | - used by hemi-pelvectomy, hip disartic, most AKA and short BKA or any frail elderly, or falls risk patient
66
Functional Activities: Stairs - Step-Over Technique
- faster, but more dangerous - timing and coordination are critical - use by BKA and select AKA
67
Functional Activities: Stairs - Sidestepping Approach
- if necessary and hand rails are available
68
Functional Activities: Ramps
- can be difficult due to lack of adequate PF/DF - AKA must maintain greater force on posterior wall to maintain extension - most ascend/descend w/shorter, even steps or step to pattern leading w/sound limb
69
Functional Activities: Hills
- difficult d/t lack of PF/DF - most use sidestepping approach - microprocessor knees are changing the landscape for these activities
70
Functional Activities: Other Activities you can work on
- curbs - getting up from chair - pick up objects/stepping over objects - floor to stand transfers - car transfers - turning to sound & prosthetic side - amb. on grass/uneven terrain or busy area - Recreational activities - work-related skills
71
Examples of Advanced Balance Drills
- toe & heel pivoting - 90 degree balance - squatting limb balance - tandem walking - playing catch - kicking a ball - tennis ball drills - foam activities - braiding - braiding with catching - sidestepping with catching - multiple plane stepping - obstacle course - Wii-Fit
72
What may cause excessive knee flex?
contractures, habit, pain, alignment, socket fit
73
What may cause excessive knee ext?
most often alignment
74
What may cause knee varus/valgus?
alignment, length of prosthetic, instability inside socket
75
What is a habit some amputees develop?
Hyperextension that occurs when statically standing
76
Causes of excessive PF
correlates with knee hyperext
77
Causes of excessive DF
correlate with increased knee flex
78
Causes of increased lumbar lordosis
hip flexion contracture; insufficient socket flexion; weak hip extensors; weak abdominals; insufficient support from ant or posterior walls, pnfl ischial WB
79
What is equal stride length in males vs females?
Males: 80 cm Females: 65 cm
80
What leads to efficient gait?
normalization of trunk, pelvic, and limb biomechanics
81
Optimal single leg stance time for amputee
5 seconds
82
What is the goal for standing balance?
orienting COG over BOS
83
What are 3 gait deviations that occur without adequate single limb WB?
1. decreased stance time on prosthetic side 2. decreased stride length on sound side 3. lateral trunk bending over prosthetic limb