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Movement Analysis > Movement Analysis Test 2 > Flashcards

Movement Analysis Test 2 Flashcards

1
Q

Ipsilateral trunk lean most commonly occurs during reference limb ___.

Possible causes?

A

Stance

Ipsilateral hip ABD weakness, hip joint pain, IT band tightness, or scoliosis

Examine for: Ipsilateral glut med weakness;
trunk ROM

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2
Q

6 goals of post surgical management phase? (Amputation)

A
  1. Promote healing residual limb
  2. Protect intact limb
  3. Maximize functional independence
  4. Prevent motion loss
  5. Educate in the process of prosthetic rehab
  6. Facilitate psychological adjustment
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3
Q

ISw- the ___ continues to ___, which in turn ___ of the transfemoral prosthesis.
The femur has migrated to _____.

A

Hip flexors continue to flex, which in turn forces the knee.

Femur migrated to anterior
distal aspect of socket - this causes high pressure to the area.
Be mindful of this location when observing this phase of gait.

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4
Q

MSt- ankle

A

DF from neutral -> 5*

GRF moves forward through ankle joint to create increasing DF moment

Ankle PF contract eccentrically to provide controlled motion of tibia
“Ankle rocker”

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5
Q

TSt- pelvis

A

Rotates 5* backward as contralateral stance limb extends forward

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6
Q

Transfemoral gait deviations -MSt

Abducted gait

A

Prosthetic causes:

  1. Pubic ramus pressure- medial brim too high
  2. Prosthesis too long
  3. Improper relief for distal femur in lateral wall
  4. Foot excessively outset

Patient cause:

  1. Hip joint ABD contracture
  2. Weak glut med
  3. Fear or habit
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7
Q

Transfemoral gait deviations in Swing phase - Knee/Foot whip

A

Cause:
Prosthesis was donned in rotation
Knee is incorrectly rotated

Remedy:
Re-donn limb in correct rotation
Check landmarks
Have prosthesis adjust if not resolved

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8
Q

4 essential factors for efficient prosthetic gait

A
  1. Accept the weight of the body on each leg
  2. Balance on 1 foot in single-limb support
  3. Advance each limb forward and prepare for the next step
  4. Adapt to environmental demands
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9
Q

What are the primary phases of rehabilitation for LE amputees?

A

Post-surgical management
Preprosthetic management
Prosthetic management

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10
Q

Transtibial gait deviations -LR
Rapid knee flexion
Causes?

A

Prosthetic causes:

  1. Prosthetic heel too firm
  2. Socket set too far anterior over foot
  3. Socket is excessively flexed (>7*)

Patient cause:

  1. Quad weakness
  2. Heel of shoe too high (pt changed shoes)
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11
Q

Transfemoral
IC
Common gait deviations

A

Knee not fully extended

Unequal step length

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12
Q

MSt- knee

A

Extends to 5* by end of MSt

GRF passes across knee joint from anterior-> posterior, changing knee flex moment to knee ext moment

Quads remain active while knee flex moment in effect

Knee stabilized by ankle PF and knee ext moment in latter half of MSt

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13
Q

LR primary goals….
The knee is positioned ___
The GRF at the knee …
muscles?

A

Knee remains stable
Foot remains in line of progression

Knee flexed to 15* throughout LR

GRF lies posterior to knee , creating Flex moment

Quads eccentrically contract to provide controlled flex and shock absorption
Hamstrings concentrically contract to extend femur and pull body over stance leg

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14
Q

3 critical places when residual limb is stressed (transtibial prosthesis)

A

LR (distal- anterior / proximal- posterior)

TSt (distal- Posterior/ proximal-anterior)

PSw (distal- anterior / proximal- posterior)

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15
Q

Pros and cons of soft dressings during post-surgical management phase? (Amputation)

A

Pros:
Easy to apply
Inexpensive
Easy access to incision

Cons:
Little edema control
Minimal protection
Requires frequent rewrapping

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16
Q

PACT program lessons learned- successful out outcomes from what?

A
  1. Regular clinical follow up
  2. Proper professional footwear
  3. Patient education
  4. Prescription RX
  5. Proper prosthetic care and training
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17
Q

TSw- continues to use ___ to support weight of transtibial prosthesis.

____ contract to stabilize limb prior to ___.

Tibia at __.

A

Knee extension

Hamstrings contract to stabilize limb prior to IC

Tibia at anterior distal socket

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18
Q

WB regions of the transfemoral limb

A 
Ischial tuberosity 
Femoral triangle 
Circumference 
Lateral shaft of the femur 
Soft tissue circumference
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19
Q

CARF

A

Commission for accreditation of rehabilitation facilities

Offers a Amputation specialty accreditation
42 programs currently accredited
12 VA facilities accredited

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20
Q

Ipsilateral pelvic drop
Swing phase
Possible cause

A

Contralateral hip ABD weakness, hip ADD spasticity, or hip ADD contracture

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21
Q 
IC- knee
Transtibial Prosthesis 
COP?
GRF?
Muscles?
A

COP: corner heel of foot

GRF: little consequence

Co-contraction of quads and hamstrings

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22
Q

Most common contracture for transfemoral amputee

Post-op recommendations

A

Hip FLEX, ER, ABD

Can begin to develop as soon as 72 hours after amputation/immobilization

Proper body positioning should begin immediately after surgery.
Encourage to lay prone (preferred) or supine with pelvis level and hips in neutral position for 5-10 min 3x/day

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23
Q

Principles to begin fitting prosthetic for amputee

A

Wound closure
Tolerant to force couple pressures
Circumference reduction
Sound side WB ability

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24
Q 
LR- knee
Transtibial Prosthesis 
COP?
GRF?
Muscles?
A

COP: moves slightly anterior as prosthetic heel compresses

GRF: moves posterior to knee, inducing knee flexion moment

Concentric contraction of quads - extends tibia in attempt to slow progression
B/C tibia not completely stabilized w/in socket it will migrate anteriorly

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25
Q

TSt- knee

A

Remains at max ext (5* flex) throughout most of TSt then flexes slightly (15*) prior to PSw

GRF remains anterior to knee, moving posterior as knee begins to flex

Knee ext peaks mid-TSt before decreasing and changing to flex for PSw

Ankle DF concentrically contract to stabilize knee throughout this phase

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26
Q

PACT program

A

Preservation-Amputation Care and Treatment Program

EST by VA in 1993 to prevent/delay amputation by identifying those at risk of limb loss

Prior to PACT 9k amputations annually, in 2095 5500, 40% decline

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27
Q

IC is described as____.

The pelvis is positioned ___

A

The moment the foot touches the ground

5* forward rotation

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28
Q

WB regions of the transtibial limb

A 
Patella tendon 
Medial tibial flare 
Pre-tibial region 
Fibular shaft 
Popliteal fossa 
Gastroc-Soleus muscle belly
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29
Q

How is phantom limb pain treated?

A

Medical: surgical, pharmacological

Psychological: counseling, biofeedback

Acupuncture

TENS

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30
Q

Which program elements are key in the continued rehabilitation of the LE amputee? (9)

A
  1. Donning
  2. ROM/flexibility training
  3. Strength training
  4. CV training
  5. Balance and coordination training
  6. Gait training
  7. Functional training
  8. Advanced training
  9. Activity-specific training
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31
Q

IC is described as____.
The knee is positioned ___
The GRF at the knee …
muscles?

A

The moment the foot hits the ground

Knee neutral
GRF anterior to knee, creating ext moment

Quads remain contracted in prep for LR
Hamstrings briefly contract to counter knee ext moment and stabilize knee

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32
Q

Transfemoral gait deviations -MSt

Lateral bending of trunk

A

Prosthetic cause:

  1. Foot excessively outset leading to wide BOS
  2. Prosthesis too short
  3. Socket aligned in hip ABD
  4. Distal femur pain

Patient cause:

  1. Weak hip ABD or ABD contracture
  2. Very short residual limb
  3. Inability to WB
  4. Fear or habit
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33
Q

TSt - hip

A

Femur extends to max 20* ext
Pelvic rotation back contributes

GRF moves posterior, creating small ext moment that peaks and begins to diminish as limb unloaded

Weak hamstring action may act to control ext

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34
Q

Excess sock

BK prosthesis

A

Patient reports pressure at tibial tuberosity

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35
Q

What are the goals for the prosthetic management phase?

A
  1. Attain smooth, energy efficient gait
  2. Allow the individual to perform ADLs
  3. Maximize participation in employment activities
  4. Facilitate participation in desired recreational activities
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36
Q

Positioning

Post-surgical (Amputation)

A

Avoid extended sitting and supine sitting in bed propped with pillow
To prevent hip flexion contracture

Good:
Prone and Sidelying with pillow between legs

Keep hip and knee in extension

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37
Q

Transfemoral gait deviations in Swing phase - terminal impact

A

Prosthetic cause-
Insufficient extension resistance
Mechanical extension assist too strong

Patient cause-
Too strong hip flexion
Patient may practice hip extension to speed knee extension

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38
Q

Pt feels distal end pressure (BK)

A

Excess contact

Distal gapping and lack of contact

Do a distal contact test

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39
Q

Transfemoral
IC- knee not fully extended

Causes?

A

Prosthetic-
Excessive knee extension resistance

Patient-
Weak hip flexion in early swing initiation
Weak hip extensors

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40
Q

Pros and cons of IPOP during post-surgical management phase? (Amputation)

A 
Pros: 
Excellent edema control 
Excellent protection 
Pain control 
Early WB

Cons:
No access to incision
More expensive than other dressings
Requires proper training for use

(IPOP- immediate post-op prosthetic)

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41
Q

Gait observation in transtibial

Plane and focus

A

Sagittal plane:
Tibia progression
Knee stability

Frontal/Coronal plane:
Varus/Valgus knee
Pelvic shift
Trunk lean

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42
Q

TSt

Muscles used

A

Calf (peak)

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43
Q

LR - pelvis

A

Remains in forward rotation throughout LR

Hamstrings contract to stabilize pelvis

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44
Q

DM national stats

A

> 50% increase in most states
100% increase in 18 states

(MS highest; MT lowest)

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45
Q

Transfemoral socket- correct rotational position

A

Adductor longus : anterior medial corner
(contained w/ no impingement or roll present anterior and medial brim)

Ischial tuberosity
Have pt flex forward- palpate IT and have pt extend back into socket
IT matches the seat on the socket

  • pubic ramus free of pressure (medial brim)
  • ample ASIS clearance sitting and bending forward (anterior brim)
  • trochanter free of pressure and no gapping- esp when weight shift laterally (lateral brim)
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46
Q

One of the most common deviations seen in a coronal plane of individuals with transfemoral prosthetics.

A

Lateral trunk lean toward prosthetic side during MSt.

Causes:
Hip ABD weakness
Short limb length
Poorly fitted socket (lack of femoral ADD in socket)

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47
Q

Too few socks

BK prosthesis

A

Pt reports distal patella and end pressure

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48
Q

Transfemoral
LR- rapid toe descent
Causes?

A

Prosthetic- excessive heel compression

Patient- forcing extension to ensure knee stability

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49
Q

Psychological factors in phantom limb pain

A

Not causal
May contribute to course and severity
Coping strategies related to functional interference
Psychological variables and support prior to amputation may influence pain experience

50
Q

LR: the concentric action of the ____ as the knee is ____ controls the progression of the transtibial prosthesis.
Eccentrically the ___ are active in this phase of gait

A

Quads controls as the knee extends to control progression of the prosthesis

Hip extensors and hamstrings

51
Q 
PSw- knee
Transtibial Prosthesis 
COP?
GRF?
Muscles?
A

BW transferred to sound leg

COP: continues to migrate anteriorly to whatever portion of foot still in contact with the ground

GRF: moves back, posterior to knee and causes significant knee flexion moment

Quads extend limb w/in socket (anterior tibia position)
Pelvic rotation and hip flexion assist in moving limb forward

52
Q

Contralateral pelvic drop
Stance phase
Possible causes

A

Ipsilateral hip ABD weakness, hip ADD spasticity, or hip ADD contracture

53
Q

Transtibial amputee
PSw
Muscle to overcome induced knee flexion moment and to prevent dropping off of toe?

A

Quadriceps

54
Q

To slow down the (LR) flexion moment at the knee, the ___ used to ___ and control progression of the limb.

(Amputee biomechanics- transtibial)

A

Quads to extend tibia

55
Q

LR primary goals….
The ankle is positioned ___
The GRF at the ankle …
muscles?

A

Knee remains stable
Foot remains in line of progression

Ankle rapidly PF to 10* before returning to neutral at end of LR

GRF lies posterior to ankle, creating PF moment

Pretibial eccentrically contract to provide controlled PF and initial tibial progression
“Heel rocker”’

56
Q 
MSt- knee
Transtibial Prosthesis 
COP?
GRF?
Muscles?
A

S/B most stable position in gait

COP: moves anteriorly towards center of foot

GRF: should move through or slightly anteriorly to the knee and NOT produce unwanted flex or ext moments

Tibia s/b in neutral position

57
Q

LR primary goals….
The hip is positioned ___
The GRF at the hip …
muscles?

A

Knee remains stable
Foot remains in line of progression

Femur extends slightly throughout LR to 20* flex

GRF remains anterior to hip, hip flex moment maintained through LR

Hamstrings concentrically contract to extend femur and pull body over stance leg

58
Q

Transtibial gait deviations -LR
Knee extension
Causes?

A

Prosthetic causes:

  1. Heel too soft
  2. Socket set too posterior over foot
  3. Foot excessively PF

Patient cause:

  1. Weak Quads
  2. Habit
  3. Pt changes to lower heel (shoes)
59
Q

Transtibial gait deviations -MSt

Varus moment at knee

A

Prosthetic cause:

  1. Foot excessively inset
  2. Excess varus angulation alignment
  3. Looseness in socket fitting

Patient cause:

  1. Short residual limb
  2. Ligament laxity with coronal instability
60
Q

MSt - hip

A

Femur extends throughout MSt to 10* ext

GRF moves to hip joint throughout MSt
By end of MSt the small hip flex moment is eliminated

No hip flex/ext muscle activity

61
Q

Rigid dressing and IPOP difference in outcomes over other dressings

A

Rigid:
Accelerated rehab times
Reduced edema

IPOP:
Fewer post-surgical complications
Fewer higher-level revisions

62
Q

Transfemoral gait deviations - TSt

Causes?

A

Exaggerated lordosis

Prosthetic causes: insufficient socket flexion build into limb

Patient cause:

  1. Hip flexion contracture
  2. Weak hip extensors
  3. Weak abdominal muscles
63
Q

Transtibial deviation in TSt and cause?

A

Rapid knee flexion
(Pelvic drop off)

Prosthetic causes:

  1. Socket too anterior over foot
  2. Excessive knee flexion in socket
  3. Foot too DF
  4. Foot too soft

Patient cause- changes shoes to higher heel (will also be seen in LR)

64
Q

What defines post-surgical management phase? (Amputation)

A

Surgery to discharge from hospital

65
Q

Transfemoral
LR
Common gait deviations

A

Knee instability

ER of foot

Rapid toe descent

66
Q

Incidence of amputation

A

1998- 185k annually

2000- 82k due to DM

Nearly 2 million live with major limb loss

67
Q

MSw muscles?

A

Small amount of iliopsoas (decreasing from ISw peak)

Hamstrings (midway starts- increases peaking in TSw)

Small amount of Tibialis anterior

68
Q

Pelvic hike during swing phase

Possible causes

A

Quadratus lumborum assists with limb clearance when hip flex, knee flex and/or ankle DF are inadequate

69
Q

Preparing for first prosthesis

A

Don’t deny based on current presentation

Set goals of independence w/o prosthesis

Primary factors that can be overcome with PT:
Contractures
Sound side weakness 
UE weakness 
Excess weight
70
Q

IC is described as____.
The hip is positioned ___
The GRF at the hip …
muscles?

A

The moment at which the foot hits the ground

Femur flexed 25*

GRF anterior to hip, creating large flex moment

Hip extensors contract to resist the flex moment

71
Q

Transfemoral
IC - unequal step length

Causes?

A

Prosthetic-
Excessive or insufficient socket flexion
Unstable knee

Patient-
Poor balance
Muscle weakness
Fear of knee stability

72
Q

The first PT sessions after prosthesis - 2 goals

A
  1. Don’t compromise session with poor fitting limbs that cause you more problems
  2. Solve issues within your scope without the prosthetist
73
Q

Graded motor imagery

A

Left/Right discrimination
Explicit motor imagery
Mirror therapy

74
Q

ISw- the knee ___ in preparation to clear the floor.

Thus will cause the ___ to lift transtibial prosthesis, and may increase pressure on ___.

A

Knee flexed in preparation to clear floor
Will cause tibia to flex w/in the socket to lift prosthesis off floor and may increase pressure on the posterior distal aspect of residual limb

75
Q

“Other” factors that influence phantom limb pain

A

Pre- and Post- operative pain may influence occurrence

Mow frequent in adolescents and adults (compared to young children)

Unclear relationship w/ regard to mechanism of amputation

May be provoked or worsened by physical or psychological factors

76
Q 
TSt- knee
Transtibial Prosthesis 
COP?
GRF?
Muscles?
A

COP: moves anteriorly toward metatarsal area/toe region

GRF: anterior to knee, causing posteriorly directed knee extension moment

Hamstrings flex residual limb w/in socket- pulling body forward and overcomes the knee ext moment

77
Q

LR: Transfemoral Prosthesis
COP?
GRF?
Muscles?

A

COP: moves slightly anterior as prosthetic heel compresses

GRF: moves posterior to knee, inducing knee flexion moment on limb

Concentric contraction of hip extensors extensors femur to overcome effect of induced knee flexion moment
N/c femur not stabilized- pulled toward posterior wall of socket (concentrated pressure)

78
Q

Deviation: backward trunk lean

Primary phase?
Cause?

A

Stance or swing

Hip extensor weakness - particularly glut max
Hip flexor weakness
Limited hip flexion

79
Q

Transfemoral gait deviations in Swing phase - Excessive heel rise

A

Prosthetic cause- insufficient resistance to knee flexion

Patient cause- flexing hip too aggressively

80
Q 
PSw- knee
Transtibial Prosthesis 
COP?
GRF?
Muscles?
A

BW transferred to sound leg

COP: continues to migrate anteriorly to whatever portion of foot still in contact with the ground

GRF: moves back, posterior to knee and causes significant knee flexion moment

Knee flexion initiated with hip flexion and pelvic rotation

81
Q 
Average stride (m)
Average velocity (m/s)
Average cadence (steps/min)
A
  1. 41 m
  2. 37 m/s

113 steps/min

82
Q

Transfemoral gait deviations -MSt

A
  1. Lateral bending of trunk

2. Abducted gait

83
Q

Transtibial gait deviations -LR

A
  1. Rapid knee flexion
  2. Knee extension
  3. Excessive toe out
84
Q

MSt: Transfemoral Prosthesis
COP?
GRF?

A

S/B most stable position in gait

COP: anteriorly to center of foot

GRF: through or slightly anterior to knee

Femurs s/b in a neutral position w/in socket

Knee unit can be positioned slightly posterior to add more stability during stance

85
Q

Prosthetic related causes of gait

Correctable by PT

A 
Prosthetic causes:
Heel height 
Sock ply
Donning technique 
Limb edema 
Non-prosthetic causes: 
Limits in ROM and strength 
Muscular asymmetries (common in transfemoral) 
Co-morbidities 
Fear of falling 
Previously developed habits
86
Q

Key elements in post-surgical assessment? (Amputation)

A 
General systems review 
Post surgical status 
Pain 
Functional status 
ROM

ROM- emphasis on active ROM only initially
Avoid knee flex/ext following transtibial
Avoid vigorous hip ABD/ADD following transfemoral

87
Q

Pros and cons of semi-rigid dressings during post-surgical management phase? (Amputation)

A

Pros:
Better edema control than soft dressing
Improved protection

Cons:
Needs frequent changing
Cannot be applied directly by patient
No access to incision

88
Q

MSw- as the pt stops ____, the transfemoral knee will begin to __.

As the foot passes the floor, therapist may need to cue “_____”
This requires coordination of the ___ on sound side, and ___ on affected side.

If the foot doesn’t clear the floor in MSw, it is usually due to ___.

A

As stop additional hip flex, the knee will begin to swing into ext.

As the foot passes the floor, may need to cue:
Stabilization of pelvis, not allow pelvis to tilt in coronal plane

This requires coordination:
Sound side- hip ABD
Affected side- Quadratus lumborum

If toe doesn’t clear in MSw- is usually training issue (NOT prosthetic too long)

89
Q

DM and vascular disease amputations

“Good news stats”

A

65% decline in DM amputations

Improvement in blood sugar control, foot care, diabetes management

90
Q

Transfemoral gait deviations in Swing phase - Circumduction

A

Prosthetic cause:

  1. Prosthesis too long (more likely to cause abducted gait)
  2. Knee too stable and difficult to flex

Patient cause:

  1. ABD tightness
  2. Knee control insecurity
91
Q

Pros and cons of shrinkers during post-surgical management phase? (Amputation)

A

Pros:
Easy to apply
Inexpensive

Cons:
Not used until sutures removed
Requires changing as residual limb shrinks

92
Q

B/c the ground reaction force vector is ____ to the knee in LR,
a(n) _____ directed moment will induce knee ____.

A

GRF Posterior to knee

Anterior directed moment induces knee flexion

93
Q

Transfemoral gait deviations in Swing phase

A
  1. Circumduction
  2. Vaulting
  3. Excessive heel rise
  4. Knee/foot whip
  5. Terminal impact
94
Q

Transtibial gait deviations -LR
Excessive toe out
Causes?

A

Prosthetic cause: foot aligned in excessive ER

Patient cause: External hip rotation (weak internal rotators)

95
Q

IC: Transfemoral Prosthesis
COP?
GRF?
Muscles?

A

COP: corner of heel

GRF: little effect on knee

Hip extension used to control the limb progression and placement

Femor is still in relatively neutral position w/in socket, until flexion moments begin moving toward LR

96
Q

What spinal mechanisms contribute to phantom limb pain?

A 
Hyperexcitability 
Disinhibition 
Unmasking 
Sprouting
Neuropeptide expression

^ all these contribute to:
Central sensitization

97
Q

IC is described as____.
The ankle is positioned ___
The GRF at the ankle …
muscles?

A

The moment the foot hits the ground

Ankle joint neutral
GRF Posterior to ankle, creating small PF moment

Pretibial muscles contract to support weight of foot and control PF

98
Q

Prosthesis preparation- contracture reduction

A

Progresses slowly
Measure and give pt a goal

Passive stretching

Active stretching when ambulation gets with a prosthesis

> 25* not advised to fit

99
Q

Force couple pressures on residual limb - transfemoral

MSt

A

Proximal medial

Distal lateral

100
Q

What supraspinal mechanisms contribute to phantom limb pain?

A

Cortical reorganization:
Somatosensory cortex
Motor cortex

Subcortical reorganization:
Brain stem
Thalamus

101
Q 
TSt- knee
Transfemoral Prosthesis 
COP?
GRF?
Muscles?
A

COP: moves anteriorly toward metatarsal/toe area

GRF: anterior to knee, causing posteriorly directed knee ext moment

Femur moves anteriorly as hip flexors activates, begins flex at socket and thus the knee

Pelvic rotation and hip flexion work together to overcome knee ext moment and begins prosthetic knee flexion

102
Q

DM and vascular disease- amputation- highest risk?

A

Men > Women (6 per 1000 vs 1.9)

Black folks (4.9 per 1000 vs 2.7)

75+ years old (6.2 per 1000)

103
Q

First transfemoral leg

A

Confirm the flexion of prosthetic socket:
Match the patient flexion +5*

Eval WB regions:
Ischial tuberosity- healthy skin coverage
Quads and hamstrings 
Lateral shaft of femur 
Tolerance to circumferential tightness
104
Q

What peripheral mechanisms contribute to phantom limb pain?

A
  1. Ectopic discharges from Neuroma in residual limb
  2. Ectopic discharges from Dorsal root ganglion
  3. Maintenance by sympathetic nervous system
  4. Peripheral influence on central reorganization
105
Q

TSw- stabilizing ____ and may employ some ___.

___ will act to rapidly accelerate ____.

For most transfemoral knees, it is important to ____ before of IC.

A

Stabilize femur and may employ some hip ext

Hip ext will act to rapidly accelerate knee into ext

For most transfemoral knees, important to fully extend knee prior to placing foot in ground for IC

106
Q

Transtibial gait deviations -MSt

Valgus moment at knee

A

Prosthetic cause:

  1. Foot excessively outset
  2. Excess Valgus angulation alignment
  3. Fibular head pain
  4. Looseness in socket fitting

Patient cause:

  1. Short residual limb
  2. Ligament laxity with coronal instability
  3. Wide BOS
107
Q

Transtibial gait deviations - MSt

A
  1. Valgus moment at knee

2. Varus moment at knee

108
Q

MSw- the limb progresses, accelerated by ____, which will cause the tibia to move ___.

Most deviations in this phase are related to:

(Transtibial prosthesis)

A

Accelerated by knee extension, moving tibia anteriorly toward anterior socket wall

Most deviations related to the suspension aspect of the prosthesis- the weight of the prosthesis must be suspended to allow for proper toe clearance

109
Q

5 elements of functional training are key in prosthetic management?

A
  1. Transfers
  2. Stairs, ramps and curbs
  3. Advanced training
  4. Activity/Sport specific
  5. Fall management
110
Q

Transfemoral amputee

Cue to improve knee stability in LR

A

Push thigh into back of socket

111
Q

MSt- pelvis

A

Rotates to neutral by end of MSt

Hip ABD contract concentrically to stabilize hip

112
Q

Causes of amputation and %

A

54% vascular disease
45% trauma
>2% cancer related

113
Q

Key elements in preprosthetic and prosthetic management phases assessments (10)

A 
History 
Systems review 
Skin
Residual limb 
Vascularity 
ROM 
Muscle strength 
Neurological 
Functional status 
Emotional status
114
Q

Contralateral trunk lean most commonly occurs during reference limb ___.

Possible causes?

A

Swing

Contralateral hip ABD weakness,
Hip joint pain, IT band tightness, or scoliosis

Contralateral glut med strength
Limited knee flex or excess PF during ISw
Leg length discrepancy

115
Q

DM and vascular disease amputation
2nd amputation and mortality
“Bad news stats”

A

55% require a 2nd amputation within 3-5 years

5 year mortality rate for 50% of those with vascular disease related amputation

2010- est 50% of DM amputations were preventable

116
Q

Deviation: forward trunk lean

Primary phase?
Cause?

A

Primarily stance phase

Quad weakness
Hip or knee flexion contractures

117
Q

On transfemoral amputation, which muscles are most affected

A

ADD and extensor muscles

Weakness and limited ability to extend hip

118
Q

TSt - ankle

A

Continues to DF to 10*

GRF moves to toes, MTP joints extend to 30*
DF moment reaches max by end of TSt

Ankle DF concentrically contract to lift heel off ground
“Forefoot rocker”

119
Q

Prosthesis preparation-

Performance goal

A

Measurable performance goals

Independent use of walker for stated distance (100’)

Must incorporate good mechanics in preparation for the prosthesis

Assisted (contact guard -> stand by -> supervision) -> Modified independent

120
Q

4 goals of preprosthetic management phase? (Amputation)

A
  1. Independent in residual limb care
  2. Independent in mobility, transfers and functional activities
  3. Demonstrate HEP accurately
  4. Care of remaining LE if amputated for vascular reasons
121
Q

Criteria used in selecting dressings during post-op (amputation)

A 
Level of amputation 
Surgical technique 
Healing requirements 
Patient compliance 
Surgeon preference

Movement Analysis (2 decks)

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