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Kin 4W03 > Midterm 2 > Flashcards

Midterm 2 Flashcards

1
Q

What is Postural Control of balance?

A

adjusting our posture in order to maintain the COM inside of the margins of the BOS

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2
Q

What are the three processes of postural control?

A

Detect -> Adjust -> Feedback

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3
Q

What happens in Detection?

A

telling us about our current position and state of motion

send this info to CNS

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4
Q

What Happens in Adjust and Feedback?

A
  • CNS adjusts, and sends out commands to muscular system
  • When adjustments made, sensors give feedback
  • constantly going thru this process
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5
Q

What are the Three Sensory Inputs that are involved in Detection?

A

vestibular system within inner ear

visual system

somatosensory system (sensors in the tissues like muscles, ligaments, capsules of the joints body (proprioceptors), GTO’s, muscle spindles)

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6
Q

Why is the Cerebellum important in terms of postural control and balance?

A

master controller, makes decisions about the info it gets, drives the commands to make the corrections

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7
Q

What is a Motor Output?

A

muscles that will make postural adjustment

cerebellum has to coordinate the timing of those contractions

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8
Q

What are Two Motor Output Factors?

A

Strength: how much strength/force can that muscle acc produce in order to create a postural adjustment

Rate of Force Development: can have a strong muscle, but might not be able to produce that force quickly and hence might not be effective at preventing you from falling

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9
Q

What two forces do we need to consider in Postural Analysis? (idk abt this one)

A
  1. Gravity
  2. Muscular Effort force
    GRF reacts to both ^
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10
Q

What is Centre of Pressure?

A

a point location within BOS and it’s the point where we can calculate where the GRF is going to act (GRF acts up thru COP)

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11
Q

Where do GRF aim when they go through COP

A

GRF acts up and aims for the COM

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12
Q

Explain how the forces are interacting If a person is swayed forward

A
  1. Gravity: gravity would want more dorsiflexion
  2. Plantar flexors will active to counteract this (plantar flexion moment)
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13
Q

How will the COP change depending on what muscles we use?

A

If using Plantar flexors: COP moving forward to reflect that you are using your plantar flexors to control COM

If using Dorsiflexors: COP moving backward to reflect that you are using your dorsiflexors to control COM

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14
Q

What is COP useful for?

A

COP - Useful for quantifying Sway and
by dividing path length by trial time you can find COP velocity

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15
Q

Differences in COP between The Youth and Adult?

A

anterior posterior direction quite similar (Forward/backward)

less medial lateral (side to side) movement in young adult (and less variability)

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16
Q

What role does Foot Dimensions play in Balance?

A

Change COP within BOS reflecting effort to balance COM

COP has lots of room front to back to contain COM

COP can only move so much side to side

Thus, More stable in front to back direction

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17
Q

Why is it easier to fall backward than forward?

A

Because the COP has more room to move forward relative to the talocrural joint so you can manage forward pressure easily
but if the COM sways posteriorly, you have a shorter opportunity to work within

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18
Q

What is the strategy that we use to respond to perturbations

A

specific pattern of muscle activations that are executed in response to the perturbation w/ purpose of keeping COM in BOS

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19
Q

What are the two types of Postural Adjustments?

A

Compensatory Postural Adjustment

Anticipatory Postural Adjustment

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20
Q

What is the difference between CPA and APA

A

CPA: compensating for some kind of perturbation coming in that we didn’t know was happening (surprise)

APA: anticipatory postural adjustment meaning we knew it was going to happen

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21
Q

Explain the Ankle Strategy

A

Low muscular effort

Easy to perform; low motion of hips, everything moves like big stick

As COM moves posteriorly, activate dorsiflexors to pull forward

As COM moves anteriorly, activate plantar flexors

great for quiet standing, but may not be enough sometimes

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22
Q

What is the Hip Strategy?

A

When Ankle Strategy fails or insufficient, we use Hip strategy

Requires friction b/w feet and floor for it to be effective

Hips put us closer to COM, potentially allowing to manage COM better

Situation: feet going forward relative to body (like bus accelerates) need a CPA - would flex at the hip
nervous system thinking feet are going to far forward, need to take the COM and move it back

Situation: feet feel like they’ve slipped backward like if bus stopped quickly - hips will extend, and trunk tips posteriorly

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23
Q

What do we do if there is a BIG perturbation?

A

Take a step

instead of managing the COM which is no longer able to be done effectively, you change your BOS instead

Can even reach forward with arm and put hand on a wall to open up BOS to maintain COM

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24
Q

What are some Tests that can be conducted to test balance?

A

Force plates: Not accessible by many physicians

Balance Error Scoring System (BESS)

Timed up-and-go (TUG)

Functional Reach Test (FRT)

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25
Q

What is BESS?

A

Balance Error Scoring System

tests 3 position on 2 surfaces (Total 6 tests)

6 errors to look for

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26
Q

How do you perform BESS

A

series of 20 second trials in a variety of different test conditions/positions

Overall: end up with 6, 20 second trials

Count the number of errors person performs in each trial and add them up

The higher the number, the higher the score = lower balance rating

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27
Q

What are the conditions of BESS test?

A

3 test position all with EYES CLOSED and hands on iliac crests:
1. Feet side by side
2. Standing on non-dominant foot with other leg in 30 degrees hip flexion and 45 degrees knee flexion
3. Tandem Position (Dominant foot forward non-dominant behind)

2 test surfaces:
Surface 1: the floor
Surface 2: Foam pad or unstable surface etc

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28
Q

What are the errors to look for in a BESS test

A
  1. hands come off iliac crests,
  2. person opens eyes,
  3. person has to take a step/stumbles,
  4. abduct or flex their hip beyond 30 degrees,
  5. forefoot or heel lifts off surface (no longer maintaining full foot contact with ground),
  6. come out of their test position for more than 5 seconds
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29
Q

How do you perform the Timed Up and Go test?

A

Start with model seated, feet just at a line of tape on floor

Another piece of tape on floor 3 meters away that they walk towards and then they need to walk back

stop the timer once they return to seated position

individual who takes longer to complete this task would be scoring more poorly in terms of their postural control of this dynamic skill

job at this point with the observations is to just take note, not to try and solve it at the moment

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30
Q

How is TUG different from BESS

A

TUG is a Dynamic, functional test while BESS is Static

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31
Q

Are gait aids allowed in a TUG test?

A

Trying to replicate what a person does at home, so it is allowed to be used (e.g. walker, cane, etc.)

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32
Q

What observations should you make in a TUG test

A

Time

Quality of the movement
- short strides,
- appear to be shuffling/dragging one foot or both
- compare right and left arm swings

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33
Q

what is the average TUG time for healthy older adults, age 60-85 years old?

A

10-15 seconds

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34
Q

How to perform FRT?

A

Stand beside wall, shoulder flexed 90 degrees, hand closed into a fist

On the wall is a meter stick or tape measure aligned at the level of their shoulder

Mark their start position - head of third metacarpal

From there, functional reach - lean forward, reach as far forward as they can before the moment they step or start to fall
- mark how far they went
- Take the difference bw start and finish

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35
Q

What is something client should avoid during FRT

A

Leaning against a wall. Don’t want them having that extra postural stability

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36
Q

What does FRT test give insight to?

A

Anticipatory Postural Adjustment

They know they’re going to have to go to the edge of their stability and we wanna see what they could do to control that in anticipation

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37
Q

What are the average FRT values for older adults (community dwelling and non-community dwelling)

A

~27cm for Community-dwelling older adults (older adults who are living independently in their own home, etc )

~15 cm for non-community dwelling
( in a care facility, require assistance, etc )

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38
Q

What are some Limitations to FRT

A

Mobility of Shoulder & Spine

Safety Risk

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39
Q

How long do the Swing and Stance phase last

A

Swing Phase - 40% of gait cycle

Stance Phase - 60% of gait cycle

40
Q

What positions is the gait cycle composed of? edit maybe

A

Initial Contact
Opposite Toe off
Heel Rise
Opposite initial Contact
Toe Off
Foot Adjacent
Tibia Vertical
Initial Contact

IC - OTO - HR - OIC - TO - FA - TV - IC

41
Q

What are the different Phases of Gait?

A

Loading Phase
Mid-stance
Terminal Stance
Pre-swing
Early Swing
Mid-swing
Terminal Swing

42
Q

What happens in the Loading phase of Gait

A

Loading phase is from IC - OTO

Purpose: making movement away from double support state into single support phase (2 feet on ground to 1 foot)

Transferring body weight from rear leg and accepting it into front leg

Takes up 10% of overall gait cycle

43
Q

What happens in the Mid-stance phase of Gait

A

Mid-stance is from OTO - HR
Single Support through entire phase

Primary goal is to allow body’s COM to travel all the way over the fixed foot (starts from back and moves forward)

40% of overall gait cycle

44
Q

What happens in the Terminal stance phase of Gait

A

Terminal Stance is from HR - OIC
“Falling phase”

COM of body moves forward beyond forefoot

Start in Single Support, End in Double Support

45
Q

What happens in Pre-Swing Phase of Gait

A

Pre-Swing is from OIC - TO

Load up opposite limb
Transferring weight to opposite limb to life the foot and get into single support

46
Q

What is Happening in the Swing Phase?

A

Prep to catch the “fall”
Dual Pendulum motion
- Hip: legs swing forward from the hip joint as we move through hip flexion
- Knee: knee swings through extension at the same time

Need to make sure for minimum foot clearance (MFC)

47
Q

What is happening in the Early Swing Phase

A

Early Swing is from TO - FA
All about accelerating through great hip pendulum motion

foot will reach its peak forward velocity or peak anterior velocity around the time of FA

48
Q

What is happening in the Mid-Swing Phase

A

Mid-Swing is from FA - TV
Still some forward motion but not as much

Forward motion is from knee - this motion tends to be very passive and overall progression

49
Q

What is Happening in Terminal Swing Phase

A

Terminal Swing is from TV - IC
Decelerating in this Phase

Preparing to set the foot down
- need to get the foot and limb ready for solid contact w/ the ground and to prepare to transfer all the weight from left limb into right limb (loading phase)

50
Q

What are some Temporal-Spatial Parameters (TSP) we should think about

A

Stride Length (avg 1.4m)
Toe out Angle (avg 5-10 degrees)
Step Width (avg 10-15cm but very variable)

51
Q

Describe the movement and joint/muscle stuff at the hip, knee, and ankle during LOADING

A
  • At initial contact, hip flexed at 30, knee extended, ankle neutral at 90 if not slightly dorsiflexed
  • After contact, knee flexes a bit by 15 degrees – gravity wants this flexion, so quads acting eccentrically
  • Foot also hits the ground entirely (plantarflexes), meaning dorsiflexors acting eccentrically
  • Foot also pronates, meaning supinators acting eccentrically (like tib ant)
52
Q

Describe the movement and joint/muscle stuff at the hip, knee, and ankle during MID-STANCE

A

absorption then propulsion (Body behind foot = absorption; Body infront of foot = propulsion)
* Hip extension concentrically done
* Knee extending through this process, largely done passively
* Ankle dorsiflexes through this process by about 10 degrees, plantarflexors resist this eccentrically
* Through absorption – pronation so supinators still eccentrically contracting ; through propulsion – concentric contraction of supinators

53
Q

Describe the movement and joint/muscle stuff at the hip, knee, and ankle during TERMINAL STANCE

A
  • Still propulsive
  • Hip reaches peak extension at about 20 degrees
  • Knee softens a bit
  • Ankle plantarflexes for propulsion
  • MTP joints still in contact with the ground, will see toe flexors eccentrically contract
54
Q

Describe the movement and joint/muscle stuff at the hip, knee, and ankle during PRE SWING

A
  • Hip flexes concentrically thru flexion of hip flexors
  • Knee flexes a bit by 30-40 degrees (passive, happens as the hip flexes)
  • Ankle reaches peak plantarflexion (20 degrees)
  • Arch supinated (tib post big-time player, soleus too bc of the bent knee)
55
Q

Describe the movement and joint/muscle stuff at the hip, knee, and ankle during EARLY SWING

A
  • Hip flexes concentrically (continues from pre swing)
  • Knee flexes concentrically (up to 60 degrees) – knee flexors to concentrically create that position/movement (e.g. hamstrings, sartorius)
  • Ankle dorsiflexes to neutral position
  • So hip, knee and ankle dorsi FLEXORS will help clear our feet from hitting the ground
56
Q

Describe the movement and joint/muscle stuff at the hip, knee, and ankle during MID SWING

A
  • Hip flexes a bit, but not much compared to early swing
  • Big part of the dual pendulum coming from the knee now, largely passive but some low- level activation of quads (knee extensors)
  • Ankle stays steady in neutral position
57
Q

Describe the movement and joint/muscle stuff at the hip, knee, and ankle during TERMINAL SWING

A
  • Goal is deceleration
  • Hip reaches peak flexion at 30 degrees (limited by eccentric hip extensors)
  • Knee flexors ecc contract, but allow knee to reach full extension for initial contact
  • Foot still supinated and ankle neutral, ready for contact
58
Q

Describe the vertical movement of the COM as you walk

A

When foot catches a fall, COM at lowest point and as COM travels over top of foot it will reach peak height (when it is directly over top of foot )

59
Q

describe the arm swing while you walk and HAT

A
  • Right arm swings with left leg and left arm swings with right leg – this is reflection of HAT rotation
    • HAT makes up 2/3 of body mass – going along for the ride when we walk
60
Q

Describe pelvic and HAT rotation

A

As we walk, our legs force our pelvis to rotate, allowing us more length in our stride
when this happens the spine will rotate to counteract that pelvic rotation and turns the HAT

61
Q

List the 5 Gait Detours

A
  1. Foot Drop/Slap
  2. Vaulting
  3. Trendelenburg
  4. Hemiplegic Gait (hemiplegia/hemiparesis)
  5. Parkinsonian Gait
62
Q

What is happening in a Foot drop/slap gait detour?

A

Damage to the peroneal nerve that feeds the dorsiflexors

affected leg: increased hip flexion bit of knee flexion to help foot clear

Foot also placed in the ground in a flat position (steppage gait)

Compensations: Steppage or Pelvic Hike

63
Q

What is happening in a Vaulting gait detour?

A

Stiff Knee and Hip, cant get into flexion that is needed
- cant activate hamstrings as knee flexors
particularly well, or could have an
arthritic knee
Will show up in Swing Phase

Compensation:
normal leg plantarflex to give some vertical motion for the affected leg to swing thru (lifts COM a little higher which gives space for leg to swing through)

Circumduction can be seen with vaulting (Semi circular pathway to swing leg forward); might externally rotate hip first, brings adductors of hip forward, making them act like hip flexors

64
Q

What is happening in a Trendelenburg gait detour?

A

Caused by Weakness of Glute Medius resulted from:
- neurological pathology at the superior gluteal nerve that feeds those abductors
- osteoarthritic hips
- Patellofemoral Pain Syndrome

Role of Abductors in Gait: manage pelvic tilt whenever in a single leg stance position

If abductors are weak, person’s pelvis will go into tilt when in single leg position

Compensation:
shift their COM to try and compensate for those weak abductors
* if shift COM closer to the hip then the hip abductors don’t have to work as hard

Seen in mid-stance when the foot is adjacent

65
Q

What is happening in a Hemiplegic gait detour?

A

They experience weakness or paralysis in half the body (right ore left)
There is also Hypertonia in muscles (too much muscle tone) which will affect posture

Commonly associated w/ CNS pathologies - stroke, cerebral palsy, TBI’s (traumatic brain injury)

UPPER EXTREMITY: FLEXION & PRONATION
- elbow, wrist and finger flexion
- arm in pronation
- Shoulders adduct close to body

LOWER BODY: EXTENSION AND PLANTARFLEXION
- Knee extension
- Foot Plantarflexion

66
Q

What is Parkinsons?

A

Parkinson’s is a Degenerative condition that leads to the loss of dopamine producing cells in mid-brain

67
Q

What is Dopamine?

A

Dopamine is a NTSM – regulates mood, appetite, sleep, role in motor control

Lack of Dopamine causes tremors, shaking, move in a stiff way, involuntary muscle contractions

68
Q

What is happening in Parkinsonian gait detour?

A

overall appearance - stooped shuffling, person looks like they’re hunched over

Limited motion in lower extremity and in arm swing

Tendency to Freeze when they encounter anything that interrupts the rhythm of their gait pattern: Just suddenly stop, can’t keep going
- happen when they approach a doorway or attempt to change direction or encounter obstacle they need to navigate around etc

Can overcome this by listening to another rhythm (e.g. metronome)

69
Q

What is prosthetics

A

Providing individuals w/ limb loss w/ artificial limbs catering to their individual needs/goals

70
Q

How early would you give someone prosthetics?

A

You’d need to look at developmental milestones so if they aren’t pulling to stand or crawling then you’d consider it
Also (w/ upper body) you’d see if they’re able to balance while sitting

71
Q

Is there one prosthesis for everything?

A

No, often there’s an everyday prosthesis then one for specific sports/needs (like a running one or swimming or skating, etc)

72
Q

Most prevalent type of amputation?
Most commonly seen in clinic for prosthesis?

A

Prevalent – partial foot (42.9%)
Clinic – Transtibial (30.9%)

73
Q

How do you assess for prosthetics?

A

Subjective and Objective Assessment
Subjective: look at their goals and living/social environment
Objective: Skin integrity, muscle strength, ROM
Skin integrity – bc there may be a lot of scarrign from amputation make sure there’s no skin breakdown or ulcers

74
Q

Is there a difference in prosthetics for stability and ROM? Explain.

A

Yes, SACH for stability and the dynamic response one for more ROM

SACH - The heel is cushioned to imitate plantarflexion
good for young and geriatric patients

Dynamic – Carbon fibre ; More ROM; Acts like a spring
* If you don’t have proper muscle strength and balance to control this foot they have greater chance of falling

75
Q

What are some causes of limb amputation?

A

trauma, diabetes and vascular reasons, cancer (osteosarcomas), or congenital reasons

76
Q

Describe how a prosthetic gait differs from a normal one (generally)

A

Require a lot more energy to walk with prosthesis compared to without one (Higher level of amputation = greater energy required)

  • Cause of amputation plays an effect in how much energy you need to expend too

Typically have bias to their sound side as opposed to prosthesis side (COM shift to one side)
○ Longer stance phase on non-prosthetic side

77
Q

How might someone with a transtibial amputation have a different gait ? (discuss frontal plane and saggital plane observations)

A

Frontal plane :
they may have greater toe out to increase their BOS and increase stability
Slightly more bias toward medial side of foot
Slight varus moment at mid-stance within normal means
Sway between left and right possibly bc large/wide BoS
Sagittal Plane:
Different foot position on initial contact (prosthesis side = heel strike to toe very clearly // unaffected side = hitting the ground with a flat foot)
Knee stays more hyperextended than what you’d normally see (on prosthetic side)
Toe clearance at propulsion?– much less than 60% of knee flexion – foot functionally longer – perhaps that’s why we saw the toe-out walk

* Compare step length on both sides 
* Compare mid-stance -- whether there's a hyperextension moment or early flexion moment 
* is there Toe clearance?
78
Q

Discuss Prosthetic gait for double trans-tibial prosthesis

A
  • sway b/w two sides – balance thing
    • Smaller steps
    • Valgus moment in knee to create larger BoS to help with balance (often seen in bilateral prosthesis)
      ○ Early stages so you’d let him practice a little more before accommodating to ‘fix’ the problem
      ○ If it causes issues – accommodate to adjust prosthesis
    • Not confident – can tell by looking at head, arms, trunk
    • Knees bent to lower COM to keep balance - bias COM forward a bit too
79
Q

What are some trans-femoral gait deviations?

A

Circumduction
Vaulting
Lateral Trunk Bending (Trendelenburg)

80
Q

Describe Circumduction w/ a prosthetic limb
What plane would you see it in
What might the causes be

A

Prosthesis swings in laterally curved line
May see this with a Locked prosthetic knee
For patients with weaker muscles around hip so wouldn’t have a lot of control over knee flexion and they’d have more risk of falling
In swing, prosthetic leg is functionally long
Seen in frontal plane, throughout swing phase

Prosthetic Causes: Manual locking knee, Inadequate suspension

Individual Causes: Weak hip flexors, lack of confidence in bending knee or weak flexors

81
Q

Describe Vaulting w/ a prosthetic limb
What plane would you see it in
What might the causes be

A

early/ excessive plantar flexion of sound foot raises entire body

Seen in sagittal plane, initial to mid swing

Prosthetic Causes:
Prosthesis too long, poor suspension, delayed knee flexion in swing

Individual Causes:
Poor habit, lack of confidence

82
Q

Describe Lateral Trunk Bending w/ a prosthetic limb

What plane would you see it in

What might the causes be

A

leans towards the amputated side when prosthesis is in stance phase
Seen in frontal plane, stance phase

Prosthetic Causes:
prosthetic too short
pain in perineum region

Individual Causes:
Poor gait habit
Weak abductors

83
Q

Non-motor symptoms of Parkinsons

A

Lack of motivation
Apathy
depression

84
Q

Symptoms of Parkinsons

A

Slow Movements (bradykinesia) – can take 10 sec for info to go through brain and reply
○ Impacted by medication – helps to overcome –> exercise can help too but have to do it in tandem w/ meds
Small Movements (hypokinesia) – typing, taking glasses off, etc. would be difficult
Postural Changes – curve in back,
○ W/ exercise try change that (Pilates pr good for this)
Non-Motor Symptoms
* Freezing of gait – figure out why they’re freezing in the first place and work on that

85
Q

What walking and balance issues do people with parkinsons face

A
  • Freezing of Gait
    • Start Hesitation – like if they’re sitting somewhere, they’re stuck – can’t get themselves to move
    • Balance – major contrib. to falls
    • Weakness – a lot of people have the STRENGTH to do smt but with bradykinesia and hypokinesia they feel weak bc they can’t functionally do smt
      ○ Not a muscle issue, but a movement issue
      ○ Get them moving bigger and stuff
    • Poor toe extension - if cant get toe up (even in sitting first) need to clear it before you get to standing to improve their gait
    • Poor postural reactions – can’t react fast enough so they can’t regain balance (like in response to a push or smt)
    • Those ON meds can make it seem like they have a more normal gait, but they will fatigue quicker than the average person - there’s only a certain time/duration of the day that this medication will work for (LEVADOPA)
    • Tend to have floppy feet
    • Typically lean toward the stronger side as the weaker side fatigues quicker
86
Q

What role does deep brain stimulation play in Parkinsons

A
  • On max doses of meds, can also have DBS (deep brain stimulation) - pack that sits somewhere in the chest, leads down the neck from the brain - the device in the chest can be turned on and off w controller (advised not to do that tho)
    • when have DBS, some ppl have issues w their gait afterwards (not all ppl have issues tho)
    • his meds were at a point where he got dyskinesia (side effect of meds, moving so much cant even hold a cup, couldn’t function enough just on meds alone so he went on the DBS route)
    • DBS patients get bare psych assessments, taken off their meds and sat around for 4 hours to assess them when on and off their meds - psych testing is long, takes 4-6 hours to complete, look at everything to ensure ppl fully aware of the procedure and what’s going to happen afterwards
    • Can freeze and get stuck, hard to turn as he cant react quick enough and he’ll fall

W/ Parkinson’s, still get facial expressions and stuff (they have emotions, their face tends to look flat tho), mouth open meaning a little later into Parkinson’s - DBS side effect is activating facial muscles randomly

87
Q

How does treadmill walking play a role in working with parkinsons people

A
  • Need to get posture higher so that their COM moves up and back to get them walking upright and not hunched over leaning forward
    • Can include a target to make them kick their foot forward and land on their heel instead of not clearing the ground - will help them to get their good stride - I think you can also have them reach for something to get arm swing?
      Slowest you would go in Parkinson’s patients is 0.5 MPH - slow to be intentional about their steps
88
Q

How does technology play a role with people w/ parkinsons

A
  • When someone gets stuck or freeze – device that cues you to step and walk over smt (e.g. the laser) – cues you to take bigger steps
    • Pole of some sort - stick it behind them to help with extension to prevent forward lean – now COM is above feet and not over toes
    • Use a ladder so people walk through the ladder thingies – helps clear their toes
89
Q

What new interventions help someone with parkinsons

A

Smovey Rings – more arm swing and helps create dopamine??
Rock steady Boxing helps hypokinesia and stuff
Pilates, yoga too

90
Q

What is a Pedorthist and how does it difffer from Pediatrist

A

Health care individual who is trained in assessment of lower limb

Pediatrist: This is 4 year program post diploma, They deal with foot issues can do minor surgeries They do not have training to make orthotic like a pedorthist

91
Q

What are the 4 main Determining factors for an Orthotic?

A
  1. Pain
    a. Do you have pain?
    i. Two Categories: Are you
    painful? Are you not Painful?
    b. These categories will have diff
    treatment
  2. Function
    a. Is pain/are you limited in
    anything that you want to do
  3. Alignment
    a. The way a person is put together when they are standing in a position (The flat footed thing kinda)
    b. Ideally you want to see ‘straight’ lines (no valgus no varus etc)
    c. If there is something that is not ideal then its ok its just 1 thing to look at
  4. Biomechanics
    a. How do you walk
    b. How do muscles interact
    c. How do joints interact etc

The More ‘Yes’ you have to these then you would benefit from an orthotic

92
Q

What is involved in an Orthotic Assessment?

A

History
○ Try to get understanding of what brings the person in

Biomechanical Analysis
○ See how a person moves/how theyre put together
○ Does foot move well, is ankle restricted, etc

Postural Analysis
○ Get an idea of how a person looks like when they are standing

Functional tests
○ Start to test where that pain is, and look for muscle strengths and weaknesses
○ Squats: Show ROM
○ Balance: —

Gait/ Run Analysis
○Take everything and put it together
○ Watch how the run/walk/skate (through video maybe) etc

93
Q

How is an Orthotic Made?

A
  1. Make Mold (Foam, Plaster, 3D Scan)
    - Has to be proper or rest of orthotic will be bad
  2. Get Positive Image so you can start making orthotic
  3. Get materials, heat it up in the mold, vaccuum press comes down and molds it into the positive foot mold
94
Q

Why are some orthotics made of diff materials and have diff design?

A

Dependent on Person, Condition, Activities, Shoes

The more specific you can design an orthotic for a purpose, the better it will work.

95
Q

Explain Computer Generated Orthotics

A
  1. Still need a Mold
  2. 3D printing improves accuracy of the fit of these devices, and saves time
  3. 3d Orthotics more dynamic and can be thinner (2.5mm)
  4. Additive manufacturing. Others are subtractive
  5. 0 Waste production
96
Q

What are other factors to consider for someones foot (not just orthotics)?

A

Footwear

Bridge Gap between Strengthening appropriate muscles

Specific run training (for runnings)

Recovery orthotic is diff than run orthotic cause of the spring (more spring in the run orthotic)

Kin 4W03 (2 decks)

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