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Assistive Tech > P - Prosthetic Gait Training > Flashcards

P - Prosthetic Gait Training Flashcards

1
Q

what is the name of the typical guideline for amputee strengthening

A

“rule of ten”

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2
Q

what is the Rule of Ten

A

10 second exercise
- 2sec upward
- 6sec hold
- 2sec downward

10 second rest
10 reps

should still be individualized, modify prn to individualize to pt

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3
Q

hip extension strengthening

ms activated
exercise set up
phases of gait

A

gluts, HS

bridge (pressing into residual limb)
- glut sets, trying to get hips up
- BL bridge, towel under residual limb
- progress to single limb bridge on residual

phases of gait:
- terminal swing
- initial contact
- loading response

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4
Q

hip ABD strengthening

ms activated
exercise set up
phases of gait

A

glut med, glut min

side plank (on amp side)
- start isometric
- BL, push down w both limbs and hips go up
- progress to single limb on residual, keeping sound limb elevated, pressin hips up

phases of gait: SL support (for balance and stability)
- mid stance
- terminal stance

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5
Q

hip flexor strengthening

ms activated
exercise set up
phases of gait

A

iliopsoas, rectus fem

prone, reverse bridge
- pressing limbs down to lift hips up

phases of gait:
- mid stance
- entire swing phase
- loading response

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6
Q

what is a consideration of hip flexion strengthening in amputees

A

iliopsoas tightness is common in almost amps, spend more time stretching and not strengthening bc pts will need hip ext for gait

prone is a good place to start for stretching

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7
Q

back extension strengthening

ms activated
exercise set up
phases of gait

A

back ext, glut max, hip ADDs

prone, towel roll b/w legs
- lifting chest/head/legs up like a superman

phases of gait:
- initial contact
- loading response
- mid swing
- terminal swing

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8
Q

who should you take caution with for a back extension strengthening exercise? how can you modify for that pt pop?

A

LBP

avoid end range, use ab pillow, glut sets

he doesn’t do a lot of this, focuses more on bridges

common to have LBP in amps bc using different ms for stability

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9
Q

hip ADD strengthening

ms activated
exercise set up
phases of gait

A

hip ADD

side lying on sound side
- have residual limb propped on a step, they push down into it and lift hips up

phases of gait:
- mid swing
- terminal swing
- initial contact

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10
Q

bridging for sound limb strengthening

ms activated
exercise set up
phases of gait

A

glut max, back ext, sound side IRs

bridging (typical setup)

phases of gait:
- loading response
- mid stance
- terminal stance

will help dec LBP bc dec stress in bridging vs the prone back ext

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11
Q

sit-ups

ms activated
exercise set up
phases of gait (& why?)

A

abdominals

typical sit up
- can progress to lift legs at same time when you crunch up

phases of gait: mid stance
- for lumbo pelvic stabilization

he doesn’t do sit ups a lot
- he thinks you can get more stabilization from leg lowering
- more appropriate for advanced pts

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12
Q

what pt pop should you be cautious of doing sit ups with

A

LBP

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13
Q

knee extension strengthening

ms activated
exercise set up
phases of gait

A

quads

in prone, towel roll under tibial tub - leg presses down into it to straighten knee
- can incorporate different positions

phases of gait:
- initial contact
- loading response
- mid stance

in prone will work on iliopsoas flexibility

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14
Q

what is the significance of knee extension strengthening

A

need TKE for ambulation

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15
Q

knee flexion strengthening

ms activated
exercise set up
phases of gait

A

HS

supine, towel roll inferior to popliteal fossa & leg presses down to bend knee
- can progress to have leg off table and bending knee there

phases of gait:
- initial swing
- mid swing

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16
Q

what is a consideration of knee flexion strengthening

A

important to have full HS ms length
- will likely spend more time working on HS flexibility rather than strength

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17
Q

how can having the prosthesis on for exercises alter the activity

A

can inc activation and control of residual limb musculature

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18
Q

how can exercises be performed to inc activation and control of residual limb ms

A

pt places pressure on each part of socket to engage ms for stability
- pt needs to feel engaged ms bc affects pressure against various parts of socket –> engages different ms
- want to engage entire socket

start in sitting or standing pending fatigue and standing abilities

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19
Q

what are examples of general stabilization exercises

A

abdominal stabilization:
- supine: TrA, UE/LE mvmt
- seated: mat, ball, UE/LE mvmt

hip stabilization:
- half kneeling (w pro)
- tall kneeling (w pro)
- Q-ped (w pro)
- planks

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20
Q

what was the key to functional activities and their progression with amputee strengthening

A

hip flexor and extensor/glut strength

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21
Q

what were differing characteristics in TTA fallers and non-fallers

A

fallers = walk faster

non-fallers = ext support, hip ABD and knee ext eccentric training, proper socket fit

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22
Q

how often should the amputee perform a skin inspection

A

every time doff prosthesis

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23
Q

managing a prosthesis: how do you work on increasing wearing tolerance

A

gradual inc thru duration and activities the prosthesis is worn

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24
Q

when and why do you need to adjust sock ply

A

as volume of residual limb will change throughout the day

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25
Q

at what point w the # of sock ply is a new socket indicated

A

if >10-15 sock ply, talk to prosthetist about a new socket bc this is a lot of sock

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26
Q

what is a concern with sweating in the residual limb w a prosthesis

A

sweating can lead to skin maceration –> once you get skin breakdown, it all slows down and you have to change gait training

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27
Q

how do you monitor the fit of the prosthesis

A

in sitting
standing
- look at pelvic landmarks to check alignment

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28
Q

when you do skin checks what do you look for

A

ID areas of skin concerns: redness, abrasions
- short term redness is fine bc there is a certain amt of compression w a prosthesis
- if longer than short term - there is too much compression or force on the residual limb

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29
Q

what environment do you often start gait training w a prosthesis

A

in parallel bars

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30
Q

what is the purpose of establishing a wearing schedule and how do you create one

A

gradually inc wearing time and wt bearing

30min 3x/day to start
inc by 30min each day if no issue
- concerned if redness lasts >15-20min

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31
Q

tolerant vs intolerant pressure areas

A

tolerant: load bearing areas
- designed for WBing and can accept weight from prosthesis

intolerant: not meant to bear weight
- these are the areas to assess

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32
Q

what are tolerant vs intolerant areas in a TTA

A

tolerant:
* patellar tendon
* medial tibia
* lateral fibula
* gastrocs

intolerant:
* tibial crest
* fibular head
* distal ends
* HS tendons

33
Q

what are tolerant vs intolerant areas in the TFA

A

tolerant:
- ischial tub
- soft tissues (protective)

intolerant:
- distal femur
- pubic ramus (superior medial portion of socket)

34
Q

what is a common complaint of pts w a TFA prosthesis

A

pain by pubic ramus if too high up in the groin

35
Q

what are pre-gait activities to promote ambulation

A
  • stretching - hip flexors, HS
  • strengthening - sound, residual, lumbopelvic region
  • WBing
  • trunk rotation - dissociate trunk from pelvis
  • balance activities - challenge systems and improve confidence
36
Q

what is there a loss of in TFA which impacts ambulation

A

lose distal HS attachment & ability for post pelvic tilt

37
Q

what is there a loss of in TTA which impacts ambulation

A

dec HS length d/t 5-10deg knee flexion w gait

38
Q

what are benefits to pre-gait weight bearing

(5)

A
  1. dec phantom pain
  2. inc strength/stability
  3. dec edema
  4. inc joint compression
  5. dec forces on sound limb - more WBing in prosthesis promotes symmetrical WBing
39
Q

how does BOS and COG change after an amputation

A

BOS is much smaller
- COG moves laterally and slightly superiorly
- have to work on balance w new BOS and moved COG

40
Q

how big should their standing BOS be roughly after an amputation

A

2-4’’

41
Q

what are strategies to improve proprioception pre-gait

(4)

A
  • tapping & vibration
  • reflex hammer vs prosthetic foot - (A/P) vibratory sensation and feedback
  • sensation in socket - (A/P) feel limb in socket for more awareness and control
  • EO -> EC
42
Q

what is the goal of sit to stand transfers

A

equal body weight on both limbs
- pts have a tendency to shift wt to should side

43
Q

how can a PT facilitate equal WBing during a STS transfer

A

apply lateral and anterior force on same side as amputation during the STS
- facilitates WBing on prosthetic limb

44
Q

what is the goal of weight-shifting

A

equal body weight on both limbs

45
Q

how do you facilitate a weight shift and what cues do you give

A

cue hip and shoulders to go together
- find balance point (marble) and feel for change in ms activation

46
Q

what is the progression of weight shifting in pre-gait training

A
  1. lateral
  2. A/P
  3. diagonal
  4. no UE support on sound side
  5. no UE support at all
  6. stool stepping with sound limb
47
Q

what is the importance of diagonal weight shifting practice

A

more functional for amb
- mimics gait and swing phase

48
Q

how is diagonal weight shifting introduced and how do you progress it

A

shift from prosthetic side to sound side
- heel to toe

shift from sound side to prosthetic side
- toe load unlocks knee

49
Q

how do you remove UE support progressively with weight shifting

A

remove UE support on sound side first
- inc WBing on prosthesis

progress to remove UE support on prosthetic side when stable

50
Q

what is the rational for tool taps w the sound limb

(3)

A
  1. promotes single leg balance on prosthetic side
  2. facilitates ms within socket
  3. assists w kinesthetic awareness of prosthetic foot in space
51
Q

what are the pre-gait requirements to “graduate” to a gait training program

A

good ROM/ms length
strength
balance
lumbopelvic stabilization

52
Q

what is the progression of gait training activities

A
  1. sound limb stepping
  2. prosthetic limb stepping
  3. sidestepping
  4. resisted gait training
  5. amb outside parallel bars
53
Q

what is the pre-gait counterpart to sound limb stepping

A

diagonal weight shift

54
Q

what are critical components to look for with sound limb stepping

A

normal 2-4’’ BOS
no crossover

55
Q

where do you facilitate for both sound and prosthetic limb stepping

A

tactile cues at anterior pelvis

56
Q

what is crossover or “scissoring” gait pattern often a compensatory habit from

A

following amb w crutches

57
Q

what do you look for in prosthetic limb stepping

A

can they advance leg from pelvis forward and back w/ good anterior pelvic rotation in transverse plane

58
Q

what compensations do you watch for to avoid with prosthetic limb stepping

A
  • kicking leg forward
  • posterior pelvic rotation
  • leaning trunk back
59
Q

how do you progress prosthetic limb stepping

A

start w rhythmic initiation at ant pelvis
- progress from PWB to FWB

60
Q

sidestepping:

set up
facilitation

A

to sound side first
resistance at swing limb
- facilitates glut med
- activating ms inside the socket

61
Q

how is resisted gait training facilitated and what is the rationale for this intervention

A

resist at ASIS
encourages anterior pelvic rotation in transverse plane
- help w pelvic dissociation from trunk

62
Q

how is ambulation outside parallel bars introduced and progressed

A
  1. pt puts UE on PT’s shoulders, PT provides resistance at ASIS to facilitate transverse plane motion
  2. progress to facilitate trunk rotation & arm swing
  3. rhythmic initiation w PT behind pt and tactile cues at shoulders for facilitating trunk rotation
63
Q

do we use an AD w the pt when they first start outside the parallel bars and why?

A

goal: no AD
- depends on pt and safe functional mobility
- if cane start w it on sound side (normal)
- discourage ASAP

64
Q

why do we care about fine tuning ambulation outside of parallel bars w trunk rotation and arm swing

A

key for energy expenditure as ambulate
- normal arm swing helps w balance and ability to amb

65
Q

stair training

ascent and descent pattern in TTA

A

ascent - step over step
descent - step over step

66
Q

stair training

ascent and descent pattern in TFA and why

A

ascent - step to
* knee “locked” by pushing back into the socket

descent - step over step
- take advantage of resistance in knee to lower the body weight down

67
Q

stair training

why is the prosthetic foot placement important in the descent for both TTA and TFA

A

foot forward on step d/t loss of DF/PF
- allows knee flex and PF

68
Q

what is the “safe” technique to teach amps first when starting to use ramps

A

side step technique

69
Q

ramp training

ascent and descent body mechanics

A

ascent
* lean forward
* lead with sound limb

descent
* lean backward
* lead with prosthetic limb

70
Q

ramp training

what is part of the strategy with leading with the prosthetic limb on the descent

A

taking advantage of hammy strength in socket

71
Q

what is the goal of advanced balance activities

A

get them stronger and more stable in the socket

72
Q

what are examples of advanced balance activities

(8)

A
  • balance on foam/balance board
  • SLS
  • multi-task/distraction/ EC
  • tandem walking
  • side stepping
  • crossover stepping
  • braiding/ grapevine / karaoke
  • close-quarter turning
73
Q

what does an advanced balance activity like tandem walking facilitate

A

narrow BOS

74
Q

what does an advanced balance activity like side stepping facilitate

A

hip ABD and ADD

75
Q

what does an advanced balance activity like braiding or karaoke/grapevine facilitate

A

inc pelvic and trunk rotation
trunk dissociation

76
Q

what does an advanced balance activity like close-quarter turning facilitate

A

simulates grocery store, functional environment
- amps tend to make wide turns, we are fine tuning

77
Q

what are 5 self-report outcome measures

A
  • SF-36
  • sickness impact profile
  • amputee activity survey (AAS)
  • locomotor capabilities index (LCI)
  • prosthesis eval Q (PEQ-17)
78
Q

what are 5 performance based outcome measures

A
  • 6MWT
  • 2MWT
  • TUG
  • L-test
  • AMP
79
Q

what is the significance of the AMP as a performance based outcome measure

A

predicts k-level
* justify to insurance what they will get for prosthesis

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