P&O Flashcards

1
Q

What is stride length?

A

Linear distance b/w corresponding successive points of contact of the same foot

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2
Q

What is step length?

A

Linear distance in plane of progression b/w corresponding successive contact points of opposite feet

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3
Q

How much time percent wise in gait cycle are you in stance vs. swing? What about double-limb vs. single-limb support in normal gait cycle?

A

60 stance, 40 swing;

20 double-limb vs 80 single-limb

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4
Q

Center of gravity typically located

A

5 cm anterior to the S2 vertebra

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5
Q

Subdivisions of stance phase?

A
  1. Initial contact (heel strike)
  2. Loading response (Foot flat); lowest COG
  3. Midstance (Midstance); highest COG
  4. Terminal stance (Heel off)
  5. Preswing (Toe off)
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6
Q

Subdivisions of swing phase?

A
  1. Initial swing (Acceleration)
  2. Midswing (Midswing)
  3. Terminal swing (Deceleration)
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7
Q

6 determinants of gait?

A
  1. Pelvic rotation
  2. Pelvic tilt
  3. Knee flexion in stance
  4. Foot mechanisms (ankle flexion/extension mechanisms)
  5. Knee mechanisms
  6. Lateral displacement of pelvis
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8
Q

When is iliopsoas active during gait cycle?

A

Concentric with terminal stance, preswing, initial swing, midswing

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9
Q

When is glute max active during gait cycle?

A

Initial stance, eccentric

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10
Q

When is glute med active during gait cycle?

A

Eccentric during initial stance, loading response, midstance, terminal stance

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11
Q

When are hamstrings active during gait cycle?

A

Eccentric during initial stance and loading response (similar to pretibial muscles); also during swing phase

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12
Q

When are quads active during gait cycle?

A

Eccentric during initial stance and loading; also during preswing and initial swing

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13
Q

When are pretibial muscles active during gait cycle?

A

Eccentric during initial stance and loading response; concentric during swing phase

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14
Q

When are calf muscles active during gait cycle?

A

Eccentric during mid stance;

concentric during terminal stance and pre-swing

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15
Q

What does excessive trunk lateral flexion b/w loading response and preswing suggest?

A

Ipsilateral glute med weakness (compensated Trendelenburg gait)

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16
Q

Primary disturbance in Parkinson’s gait? Other key features?

A

Reduced step length;

Stooped posture, festinating gait, shuffling, freezing, decreased arm swing

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17
Q

Consequences of hip flexion contracture on gait?

A

Increased anterior pelvic tilt, increased knee flexion, also increased energy consumption

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18
Q

Compared to ambulation in normal patients, those propelling WC showed ______ increase in energy expenditure

A

9%

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19
Q

Muscles needed for crutch walking?

A

UE:
Latissimus dorsi, triceps, pec major;
LE:
Quads, hip extensors, hip abductors

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20
Q

Major risk factor for LE amputations?

A

Diabetes

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21
Q

Leading cause of UE amputations?

A

Trauma

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22
Q

When to do amputation for mangled hand?

A

Irreparable damage to four of the following:

  1. Skin
  2. Vessels
  3. Skeleton
  4. Nerves
  5. Extensor tendons
  6. Flexor tendons
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23
Q

Percentile ranges for transradial amputation?

A

Very short: residual limb less than 35%;
Short: 35-55
Long: 55-90

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24
Q

Percentile ranges for transhumeral amputation?

A

Humeral neck: Residual limb less than 30%;
Short transhumeral: 30-50;
Standard transhumeral: 50-90

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25
Q

What is the most common and practical type of terminal device?

A

Body-powered voluntary opening device

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26
Q

In prosthetic wrist unit, what does wrist flexion unit allow with terminal device?

A

To be in flexed position, facilitating ability to perform activities close to the body. Important for b/l UE amputees

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27
Q

Two types of wrist units?

A

Friction wrists, locking wrists

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28
Q

What does transradial amputation prosthesis require?

A
  1. Harness and control system
  2. Upper arm cuff/pad
  3. Elbow hinge
  4. Socket
  5. Wrist unit
  6. Terminal device
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29
Q

What transradial prosthetic socket can be used with a figure-9 harness for control purposes?

A

Muenster socket

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30
Q

What is the most commonly used trans-radial harness?

A

Figure-8 (O-ring) harness

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31
Q

When is the single-control vs. dual-control cable system used?

A

Single-control for transradial single-control cable system;

Dual-control for transhumeral and very short transradial split-socket prosthesis

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32
Q

What is the harness used most frequently for transhumeral prostheses?

A

Modifications of the basic figure-8 and chest strap patterns used with transradial prostheses

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33
Q

How does the dual-control cable system operate?

A

One cable with two functions:

  1. Flex elbow unit when elbow is unlocked
  2. Operate terminal device when elbow locked
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34
Q

For body-powered vs myoelectric control systems, what are advantages to both?

A

Body-powered: less expensive, lighter, more durable, easier to repair, sensory feedback;
myoelectric: better cosmesis, stronger grasp force, less harnessing

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35
Q

For body-powered vs myoelectric control systems, what are disadvantages to both?

A

Body-powered: Mechanical appearance, depends on your motor strength, difficult to use;
Myoelectric: More expensive, heavier, decreased durability due to other components

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36
Q

Myoelectric transradial prostheses use _______ ______ to activate the prosthesis

A

muscle contractions

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37
Q

Most common causes of LE amputations per age group

A

0-5: congenital
5-15: Cancer, trauma
15-50: Trauma
Over 50: Vascular, infection

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38
Q

Define myodesis vs myoplasty?

A

Myodesis: Muscles and fasciae sutured directly to bone;
myoplasty: Opposing muscles sutured to each other and to periosteum

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39
Q

Where does Lisfranc amputation happen? Chopart? Consequence of these amputations?

A

Tarsometatarsal junction;
tarsals and metatarsals;
can get equinovarus deformity with excessive anterior weight bearing with breakdown

40
Q

Advantages of Syme’s?

A
  1. Maintains length of limb
  2. Preserves heel pad
  3. Early fitting of prosthesis
  4. Partial weight bearing possible
41
Q

In elderly, approximately _____ of patients have worse functional ability after BKA

A

50%

42
Q

When is one instance when knee disarticulation would be the procedure of choice?

A

Severe flexion contracture (over 50 degrees) and limb ischemic

43
Q

Ideal shape for transtibial residual limb is _________, and ideal transfemoral limb is ___________

A

cylindrical;

conical

44
Q

Ideal dressing for post-op residual limb management? How long should a shrinker be worn daily? Contractures to worry about?

A

Removable rigid dressing;
24 hours a day except bathing;
hip flexion, hip abduction, and knee flexion contractures

45
Q

Prosthetic feet available for Syme’s amputation?

A
  1. Solid ankle cushion heel (SACH)
  2. Stationary ankle flexible endoskeleton (SAFE)
  3. Energy-storing carbon fiber foot
46
Q

What is the standard socket used for the average BK amputee? What is it characterized by?

A

Total-contact patellar tendon bearing socket;

bar in the anterior wall designed to apply pressure on the patellar tendon

47
Q

Pressure-tolerant areas?

A
  1. Patellar tendon
  2. Pretibial muscles
  3. Popliteal fossa (gastroc-soleus muscles)
  4. Lateral shaft of fibula
  5. Medial tibial flare
48
Q

Pressure-sensitive areas?

A
  1. Tibial crest, tubercle, condyles
  2. Patella
  3. Fibular head
  4. Distal tibia and fibula
  5. Hamstring tendons
49
Q

Which suspension design includes silicone or other gel insert or liner with use of one-way expulsion valve?

A

Suction suspension

50
Q

Key features of SACH foot?

A

Compressible heel, wooden keel;

can get motions of ankle in normal walking without actual ankle movement occurring

51
Q

Difference in motion for single-axis vs multiaxis?

A

Single-axis moves in DF and PF; K1

multi-axis for PF, DF, inversion, eversion, rotation; K2

52
Q

Two examples of flexible-keel foot?

A

SAFE (stationary ankle flexible endoskeleton);

STEN (stored energy)

53
Q

Example of energy-storing foot/dynamic response?

A

Flexfoot, good for K3 and K4 users

54
Q

Difference in polycentric vs single-axis knee?

A

Polycentric has instantaneous center of rotation that changes, prox and posterior to knee unit itself;
allows greater knee stability, more symmetrical gait, and equal knee length when sitting

(PPP)

55
Q

Ischial containment socket is also known as _________; what position does it keep the femur in?

A

Narrow medio-lateral socket;

keeps femur in adduction to keep hip abductors in more stretched and efficient position

56
Q

What is characteristic of the quadrilateral transfemoral socket?

A

Narrow AP, wide ML;

reliefs for adductor longus, hamstring, greater trochanter, gluteus maximus, rectus femoris

57
Q

Manual locking knee provides what benefit?

A

Ultimate knee stability in stance phase (knee kept extended throughout gait cycle); for geriatric patients

58
Q

What is the mechanism of the constant friction knee?

A

Uses friction mechanisms, ultimately decreasing incidence of high heel rise in early swing and decrease terminal impact in late swing

59
Q

Key disadvantages with stance-control knee?

A

Have to unload fully to flex, so can’t use in b/l AKA;

activities requiring knee motion under weight bearing, like step-over-step descent, not possible with this knee

60
Q

What can polycentric/four-bar knee be used for?

A

Knee disarticulation and long residual limb; provides excellent knee stability

61
Q

What do fluid-controlled knee units allow for? Advantages?

A

Allows for either swing phase, or swing and stance phase control;
variable cadence, smoothest gait, also stable

62
Q

Key difference with microprocessor-control hydraulic knee compared to fluid-controlled knee units?

A

Computer-programmed custom settings for each individual; re-calibrates stability of the knee 50 times per second

63
Q

What is choke syndrome?

A

Proximal prosthetic socket too tight and lack of total contact b/w residual limb and socket impairing venous return

64
Q

What is verrucous hyperplasia?

A

Wartlike skin overgrowth, usually of residual distal limb, due to inadequate socket wall contact with subsequent edema formation

65
Q

Causes of excessive knee flexion with transtibial amputee?

A
  1. Increased ankle DF
  2. Excessive anterior displacement of socket over foot
  3. Excessive posterior displacement of foot relative to socket
  4. Heel cushion too hard
  5. Knee flexion contracture
66
Q

Causes of excessive knee extension with transtibial amputee?

A
  1. Increased ankle PF
  2. Moving socket posteriorly relative to foot
  3. Moving foot anteriorly relative to socket
  4. Too soft heel cushion
  5. Quad weakness, distal anterior tibial discomfort
67
Q

Causes of lateral trunk bending to prosthetic side in transtibial amputee?

A

Prosthesis too short, prosthesis in abduction; amputee with hip abduction contracture, very short residual limb

68
Q

Causes of abducted gait in transtibial amputee?

A

Prosthesis too long, too much abduction; amputee with hip abduction contracture

69
Q

Causes of circumducted gait?

A

Prosthesis too long, inadequate suspension, abduction contracture of residual limb

70
Q

How frequently to replace prostheses in pediatric amputee?

A

First 5 years of age: Yearly;
Ages 5-12: every 18 months;
ages 12-21: every 2 years

71
Q

Who is more likely to experience bony overgrowth after an acquired amputation, kids or adults?

A

Kids more so than adults

72
Q

Cane measurement/prescription?

A

20- to 30-degree elbow flexion, or height of greater trochanter of hip for cane height

73
Q

What is a University of California Biomechanics Lab orthosis useful for?

A

Controlling flexible calcaneal deformities (rearfoot valgus or varus) and transverse deformities of the midtarsal joints (forefoot abduction or adduction); provides effective longitudinal arch support and re-aligns a flexible flat foot

74
Q

What is a rocker bar and what is it used for?

A

Strip placed posterior to metatarsal heads;

can relieve metatarsal pain, quicken gait cycle, or assist DF

75
Q

What is a heel wedge used for?

A

Place medially to rotate hindfoot into inversion, or laterally to rotate hindfoot into eversion

76
Q

Heel lift useful for

A

compensation of fixed pes equinus deformity, or leg length discrepancy more than 1/4 to 1/2 inch.

77
Q

Where does the line of gravity pass through in LE?

A
  1. Just posterior to hip joint to passively extend hip joint
  2. Just anterior to knee joint to passively extend the knee
  3. Anterior to ankle joint to dorsiflex ankle
78
Q

What are options for single channel ankle joints for AFO’s with hinged ankle joints?

A
  1. Spring in channel for dorsiflexion assist
  2. Inserting steel pin for plantar flexion stop
  3. Pin and spring for dorsiflexion assist and plantar flexion stop
79
Q

What is characteristic of dual channel ankle joints?

A

Posterior channel functions exactly as a single channel joint;
anterior channel provides option of adjustable steel pin for dorsiflexion stop or to lock joint in fixed position

80
Q

What LE orthosis would be good for an obese patient with quads weakness?

A

KAFO with double metal uprights and posterior offset knee joint

81
Q

Scott-Craig orthosis designed for who? What does it allow for?

A

Ambulation in adults with paraplegia (neuro level at L1) who want to stand and ambulate;
Unsupported standing

82
Q

What is the RGO?

A

Special design of HKAFO; used for upper lumbar paralysis where active hip flexion is preserved

83
Q

What can be added to a knee immobilizer to decrease rotational instability of the knee?

A

Footplate

84
Q

What is purpose of an opponens orthosis?

A

Immobilize the thumb and first MCP joint to promote tissue healing and/or protection or for positioning of weak thumb in opposition to other fingers

85
Q

Purpose of long opponens orthosis? Classic examples?

A

Similar to short opponens orthosis but will cross the wrist;
long opponens splints and thumb spica splints

86
Q

When is wrist-driven prehension orthosis used?

A

C6 complete tetraplegia; need wrist extensors at least 3+ or better to use body-powered tenodesis

87
Q

What is a balanced forearm orthosis?

A

Shoulder-elbow-wrist-hand orthosis (SEWHO) with forearm trough and mount;
supports forearm and arm against gravity, allowing patients with weak shoulder and elbow muscles to move arm horizontally and flex elbow to bring hand to mouth

88
Q

What type of orthosis is a sterno-occipital mandibular immobilizer?

A

Cervicothoracic orthosis (CTO)

89
Q

When is the Minerva CTO useful?

A

Management of unstable cervical spine

90
Q

When is the Halo vest CTO used? Risks?

A

Management of unstable C-spine fx;

pressure ulcers with bedrest

91
Q

TLSO can help increase

A

intra-abdominal pressure

92
Q

Purpose of Taylor brace?

A

Flexion/extension control TLSO

93
Q

Purpose of Knight-Taylor Brace?

A

Similar to Taylor brace; for post-surgical or non-surgical management of stable T- or L- fx

94
Q

Purpose of Jewett brace?

A

Permit upright position and prevent flexion after compression fx of TL spine;
also for TL Scheuermann’s disease and thoracic osteoporotic kyphosis

95
Q

Purpose of CASH TLSO brace?

A

Similar to Jewett; has cross picture

96
Q

When to use CTLSO?

A

Milwaukee brace good for scoliosis, when apex located superior to T8;
also for thoracic Scheuermann’s disease kyphosis