Prosthesis and Gait Flashcards
A horizontal amputation through the calcaneus is better known by which of the following names?
A Chopart
B Syme
C Boyd
D Pirogoff
Answer: C
Explanation:
• A Boyd amputation is is a horizontal amputation through the calcaneus.
• A Pirogoff amputation is a vertical amputation through the calcaneus.
• A Syme amputation spares the tibia, fibula, and calcaneal fat pad (all other bones are removed).
• A Chopart amputation is an amputation that removes all foot bones except tibia, fibula, and talus.
• A Lisfranc amputation is a pre-metatarsal foot amputation (sparing all bones proximal to the foot metatarsals).
The hyperlordosis observed in a myopathic gait pattern is due to which of the following? A. Tight quadriceps B. Weak quadriceps C. Weak hip extensors D. Tight plantarflexors
Answer: C
• Hyperlordosis occurs due to hip extensor weakness (e.g. gluteus maximus). The patient “throws” their body posteriorly over the weak muscles (just as they throw their body laterally over the weak hip abductors in a compensated trendelenburg gait), resulting in the hyperlordosis posture.
A patient’s center of gravity is located at which of the following locations? A. 5 inches anterior to the S2 vertebra B. 2 inches anterior to the S1 vertebra C. 5cm anterior to the S2 vertebra D. 2cm anterior to the S1 vertebra
Answer: 5cm anterior to the S2 vertebra
• The center of gravity is located 5cm anterior to the S2 vertebra.
Which of the following is the most common type of amputation? ATransfemoral BTranstibial CTransradial DTransmetatarsal
Answer: D
• Of those listed, transmetatarsal amputations are the most common. Consider that in lower limb amputations, dysvascular disease (the most common cause of lower limb amputations) tends to affect the limb distally > proximally.
- Which of the following may result in a prosthetic limb exhibiting excessive knee extension during ambulation?
A. Too little friction in the prosthetic knee
B. Excessive prosthetic foot dorsiflexion
C. Foot placed too far anteriorly
D. Socket placed too far anteriorly
Answer: C
• Of the answer choices, only a too-anterior foot would cause excessive knee extension, by forcing the line of gravity to tend to extend the knee.
• An anterior socket, excessive dorsiflexion, and too little knee friction would all cause knee flexion moments.
You are considering how to treat your patient’s knee pain. During their gait you notice that their knee hyperextends during stance phase, and this causes pain to the patient. Which of the following do you recommend as the most reasonable next step to improve your patient’s pain?
AIbuprofen
BTENS unit
CSwedish knee cage
DKnee immobilizer
Answer: C
• This gait describes genu recurvatum (the knee bending backwards); the cause of this is weak or excessively tight quadriceps. It can lead to increased knee pain and instability. Treatment involves physical therapy for quadriceps and knee/hip girdle strengthening, as well as the use of a Swedish knee cage or similar type of brace that prevents knee hyperextension during gait
Which of the following is not a determinant of gait? A. Hip mechanisms B. Foot mechanisms C. Pelvic rotation D. Pelvic lateral excursion
Answer: Hip mechanisms
• The 6 determinants of gait are as follows: pelvic tilt, pelvic rotation, pelvic lateral excursion, foot mechanisms, knee mechanisms, knee flexion.
Gait that exhibits the foot slapping on the ground at the start of each stance phase?
• Steppage gait: This is a foot drop. It is due to ankle dorsiflexion weakness.
Time spent in stance vs swing phase?
60:40
Time spent in single vs double-limb support during gait?
80:20
A 6 month-old female is found to have myelomeningocele at the S1 level. Which of the following is most likely to be true?
A Knee-ankle-foot orthosis (KAFO) will most likely be required for ambulation
B There will be little impact, if any, on function
C Ankle-foot orthosis (AFO) will most likely be required for ambulation
D Bowel/bladder function will be spared
Answer: C
Explanation:
• This patient will theoretically have normal myotomal function through L5, but disrupted function at the S1-S5 levels.
• The S1-S2 myotomes control plantarflexion and intrinsic foot muscle function, but spares the quadriceps, hamstrings, and other L2-L5 muscles.
• Thus, KAFO is NOT needed, but AFO would be useful to stabilize the ankle and allow for modified independent ambulation.
• Bowel/bladder dysfunction is expected to occur; for example, the parasympathetic and somatic control of the bladder arises from the sacral nerve roots.
Which of the following amputee K levels describes a patient who is capable of unlimited household ambulation and limited community ambulation at a fixed cadence?
A K4
B K3
C K2
D K1
Answer: C
Explanation:
• Medicare’s K levels are defined as follows.
• K0: nonambulatory - “K0 = zero prosthesis”.
• K1: limited household ambulator at a fixed cadence.
• K2: unlimited household ambulator and limited community ambulator at a fixed cadence.
• K3: unlimited community ambulator with a variable cadence.
• K4: high impact sports activities, unlimited community ambulation, variable cadence.
The optimal wheelchair cushion utilized for maximal pressure relief is which of the following? A. Visco-elastic B. Air-villous C. Fluid-filled D. Foam
Answer: Air-villous
• Air-villous cushions are the most popular wheelchair cushion for their excellent pressure relief, light weight, and reduced risk of pressure ulcers/injuries. They require more maintenance than other types of cushions.
• Foam cushions are good for softening impacts, but are poor at heat transfer.
• Fluid cushions are heavier, but conform nicely to a patient’s shape.
• Visco-elastic cushions are good for heat transfers, but do not soften impacts well.
The optimal wheelchair backrest height in a manual wheelchair is at which location?
A At the level of the neck
B At the thoracolumbar junction
C Just above the spine of the scapula
D Just below the inferior angle of the scapula
Answer: D
Explanation:
• The optimal position for a MWC backrest height is just below the inferior angle of the scapula; this corresponds to the T8 vertebra. In a power wheelchair, the optimal backrest height is to the top/spine of the scapula.
Which of the following is NOT a characteristic of pneumatic wheelchair tires?
A. They perform better on carpeted surfaces than solid rubber tires
B. They require less maintenance than solid rubber tires
C. They have increased risk of a flat tire
D. They provide a generally smoother ride
Answer: B
• Pneumatic tires are rubber tires with an inner air-filled tube. They provide a smooth, cushioned ride, and are better on carpets than solid rubber tires, but require more maintenance and have greater risk of popping and “going flat”.
• Solid rubber tires produce a less smooth ride, but require less maintenance, and have virtually no risk of “going flat”.
You are prescribing a cane for an 84 year-old male with left groin pain due to hip osteoarthritis. On which side of the body should the cane be used, and which leg should advance along with the cane? A. Right side; right leg advances B. Left side; right leg advances C. Right side; left leg advances D. Left side; left leg advances
Answer: C
• When using canes for hip osteoarthritis, the purpose is to offload the painful hip so that it no longer hurts as much during weight-bearing. This is accomplished by using the cane in the opposite hand of the painful hip.
• In other words, left hip pain requires a right hand cane, and right hip pain requires a left hand cane. When advancing the cane, the opposite leg advances.
• In summary, the painful leg needs an opposite-handed cane, and the two advance together during gait. This achieves a wider base of support for stability, and helps to offload the painful hip joint.
Which of the following is the most common activation method for an upper limb body-powered terminal device of a prosthesis?
A Voluntary closing
B Voluntary opening
C Proximity closing
D Proximity opening
Answer: B
Explanation:
• The most common activation method for an upper limb body-powered terminal device is voluntary opening.
• The terminal device remains closed at rest (safer than open at rest), and only by force from the patient does the terminal device open and allow the patient to grasp something.
• Voluntary closing is the opposite, and is less common.
• Proximity opening/closing is not a method.
Regarding limb amputation, in general, which of the following applies?
A The longer the residual limb, the better the patient’s function
B The longer the residual limb, the more likely cancer was the reason for amputation
C The longer the residual limb, the higher the cost of ambulation
D The longer the residual limb, the healthier the skin
Answer: A
Explanation:
• The longer the residual limb, the more functional a patient can be with that limb (for example, comparing a shoulder disarticulation with a transmetacarpal amputation).
• The shorter the limb, the higher the cost of ambulation, and the more likely cancer was involved as the reason for amputation.
You are prescribing a cane for an 84 year-old male with left groin pain due to hip osteoarthritis. On which side of the body should the cane be used, and which leg should advance along with the cane?
A Right side; right leg advances
B Left side; right leg advances
C Right side; left leg advances
D Left side; left leg advances
Answer: C
Explanation:
• When using canes for hip osteoarthritis, the purpose is to offload the painful hip so that it no longer hurts as much during weight-bearing. This is accomplished by using the cane in the opposite hand of the painful hip.
• In other words, left hip pain requires a right hand cane, and right hip pain requires a left hand cane.
• When advancing the cane, the opposite leg advances.
• In summary, the painful leg needs an opposite-handed cane, and the two advance together during gait. This achieves a wider base of support for stability, and helps to offload the painful hip joint.
Which of the following may result in a prosthetic limb exhibiting excessive knee extension during ambulation?
A Too little friction in the prosthetic knee
B Excessive prosthetic foot dorsiflexion
C Foot placed too far anteriorly
D Socket placed too far anteriorly
Answer: C
Explanation:
• Of the answer choices, only a too-anterior foot would cause excessive knee extension, by forcing the line of gravity to tend to extend the knee.
• An anterior socket, excessive dorsiflexion, and too little knee friction would all cause knee flexion moments.
Which of the following is the most common cause of upper extremity amputation?
A Hypercoagulable state
B Trauma
C Diabetes
D Cancer
Answer: B
Explanation:
• Trauma is the most common cause of upper limb amputation.
• Dysvascular disease due to hypertension, diabetes, factor 5 leiden mutation, etc.) is the most common cause of lower limb amputation.
Regarding socket dimensions, which of the following socket designs is generally preferred for transfemoral amputation patients receiving a prosthesis?
A Wide superoinferior
B Wide mediolateral
C Narrow superoinferior
D Narrow mediolateral
Answer: D
Explanation:
• Ischial containment socket is preferred for transfemoral amputees. This involves a socket that is narrow in the mediolateral plane and wider in the anteroposterior plane; weight is borne by the ischia.
• Quadrilateral socket has wide mediolateral dimensions and narrow anteroposterior dimensions.
Which of the following will assist dorsiflexion of an ankle-foot orthosis (AFO)?
A Spring placed in the posterior channel
B Pin placed in the posterior channel
C Spring placed in the anterior channel
D Pin placed in the anterior channel
Answer: A
Explanation:
• In an Ankle-Foot-Orthosis (AFO):
• A pin placed in the anterior channel will prevent dorsiflexion.
• A spring in the anterior channel will assist plantarflexion (will not prevent dorsiflexion, but will assist the opposite movement - plantarflexion).
• A pin in the posterior channel will prevent plantarflexion.
• A spring in the posterior channel will assist dorsiflexion.
A vertical amputation through the calcaneus is better known by which of the following names?
A Chopart
B Syme
C Boyd
D Pirogoff
Answer: D
Explanation:
• Pirogoff amputation is a vertical amputation through the calcaneus.
• Boyd amputation is is a horizontal amputation through the calcaneus.
• Syme amputation spares the tibia, fibula, and calcaneal fat pad (all other bones are removed).
• Chopart amputation is an amputation that removes all foot bones except tibia, fibula, and talus.
• Lisfranc amputation is a pre-metatarsal foot amputation (sparing all bones proximal to the foot metatarsals).
In preparation for the residual limb to accept a prosthesis, which of the following is the ideal shape of the residual limb following a transtibial amputation?
A Cylindrical
B Ovoid
C Conical
D Rhomboid
Answer: A
Explanation:
• Cylindrical is the ideal shape for a transtibial residual limb.
• Conical is the ideal shape of a transfemoral residual limb.
In a patient with terminal transradial deficiency, surgically separating the radius and ulna to allow the patient to use them like a pincer to grasp objects is sometimes performed. This surgery is known by which of the following names?
A Krukenberg procedure
B Still’s surgery
C Schismatic osteotomy
D Van Ness surgery
Answer: A
Explanation:
• Krukenberg procedure: separating the radius and ulna to allow their use like a pincer to grasp objects in terminal transradial deficiency
• Van Ness Rotation is sometimes performed for patients with partial proximal femoral focal deficiency (PFFD), which involves rotating the foot around so that the ankle is effectively the new “knee”, and the patient can be fitted for a lower limb prosthesis for ambulation.
• “Shismatic osteotomy” and “Still’s surgery” are fictional.
Which of the following will prevent plantarflexion of an ankle-foot orthosis (AFO)?
A Spring placed in the posterior channel
B Pin placed in the posterior channel
C Spring placed in the anterior channel
D Pin placed in the anterior channel
Answer: B
Explanation:
• In an AFO:
• A pin placed in the anterior channel will prevent dorsiflexion.
• A spring in the anterior channel will assist plantarflexion (will not prevent dorsiflexion, but will assist the opposite movement - plantarflexion).
• A pin in the posterior channel will prevent plantarflexion.
• A spring in the posterior channel will assist dorsiflexion.
Which of the following is the most common type of wheelchair hand brake?
A Lock-and-key
B Twist-to-lock
C Push-to-lock
D Pull-to-lock
Answer: D
Explanation:
• Pull-to-lock is the most common method for locking a wheelchair’s wheels in place to prevent inadvertent wheelchair movement.
• Push-to-lock is risky when the patient is rising to attempt a transfer, as they may inadvertently bump against the lock while rising, accidentally unlocking the wheelchair in the process.
• Twist-to-lock and lock-and-key mechanisms do not exist.
Which of the following is not characteristic of a myopathic gait?
A Knee flexion
B Plantarflexion
C Trendelenburg gait abnormality
D Hyperlordosis
Answer: A
Explanation:
• A myopathic gait involves hyperlordosis, trendelenburg abnormality, and plantarflexed ankles.
Which of the following is the primary advantage of prescribing a prosthetic socket with a total contact fit?
A It pairs better with existing suspension systems than a partial contact fit
B It is more comfortable
C It is cheaper
D Reduced risk of venous choking
Answer: D
Explanation:
• The primary reason for prescribing a total contact socket is so that the residual limb remains healthy.
• If the distal part of the residual limb is NOT in contact with the socket wall, then the distal limb venous return is at risk for being choked off, leading to pain, skin breakdown, and other abnormal skin changes.
In preparation for the residual limb to accept a prosthesis, which of the following is the ideal shape of the residual limb following a transfemoral amputation?
A Cylindrical
B Ovoid
C Conical
D Rhomboid
Answer: C
Explanation:
• Cylindrical is the ideal shape for a transtibial residual limb.
• Conical is the ideal shape of a transfemoral residual limb.
Which of the following statements could be used to describe a power wheelchair’s tilt-in-space mechanism?
AAll of these statements could describe the tilt-in-space mechanism
BIs more expensive
CDoes not increase shear forces
DEnables independent pressure relief
Answer: A
Explanation:
• Tilt-in-space wheelchairs have all of the mentioned features.
• Recline is a different feature, essentially in which the chair does not totally tilt, but the backrest itself tilts backwards, enabling the patient to create a larger angle between their torso and their legs.
• Recline alone increases shear forces, but provides improved access for clean intermittent catheterization.
For a patient in a power wheelchair, the optimal seat width should be:
A The distance between the greater trochanters +2 inches
B The distance between the greater trochanters +1 inch
C The distance between the greater trochanters +0.5 inches
D The distance between the greater trochanters
Answer: B
Explanation:
• Proper seat width measurements can be vital to ensuring stability of the patient within the chair without risking skin breakdown at the greater trochanters.
• This optimal width for power wheelchairs is the intertrochanteric distance + 1 inch (this would be adding 0.5 inches on either side of the body for a total increased width of 1 inch).
You are discussing your patient’s new knee-ankle-foot orthosis (KAFO) with the patient’s orthotist. She mentions that she intentionally offset the KAFO’s hinge joint to sit posterior to the patient’s knee. Which of the following is the most likely purpose of offsetting the hinge posterior to the patient’s knee?
A To promote knee flexion
B To cause the line of gravity to fall anterior to the knee
C To counteract spastic quadriceps
D To offset the anteriorly placed AFO components
Answer: B
Explanation:
• Offsetting the hinge joint of a KAFO serves the purpose of moving the line of gravity anterior to the patient’s knee, which then tends to lock the knee in extension, producing a stable knee during ambulation that locks appropriately and will not buckle.
• This is useful in patients with weak quadriceps (not spastic quadriceps) who need extra assistance in extending/locking the knee during ambulation.
• Promoting knee flexion would occur if the hinge were fixed anteriorly to the patient’s knee.
Which of the following is not a determinant of gait?
A Hip mechanisms
B Foot mechanisms
C Pelvic rotation
D Pelvic lateral excursion
Answer: A
Explanation:
• The 6 determinants of gait are as follows: pelvic tilt, pelvic rotation, pelvic lateral excursion, foot mechanisms, knee mechanisms, knee flexion.