Prosthetic Gait Flashcards
K-levels are used to classify the patient’s ______ function
POTENTIAL
T or F: shoes matter with prosthetics
T
what 3 things does prothetic alignment aim to do
1 - increase residual limb WB capacity
2 - maintain ML stability in midstance
3 - encourage knee flexion in stance
too high of a heel leads to knee ______ and too low of a heel leads to knee ______-
flexion
extension
3 goals for socket shape
1 - distribute load over large area
2 - load pressure tolerant areas
3 - maintain ideal alignment for gait stability
pin and shuttle locks are for _____ while lanyard straps are for ________
TTA
TFA
4 critical parts of prosthetic alignment
1 - symmetrical leg length
2 - foot slightly inset
3 - flexed socked
4 - TKA line
knee stability is maintained by what 2 things
1 - voluntary muscle control
2 - TKA line
what is one thing not related to the amputation itself that you have to think about when deciding what suspension system is best for the patient
can they cognitively and physically put on and adjust the suspension system
when a pt sits, what should you look for in both TTA and TFA
can they sit comfortable with hips and knees at 90 and feet flat on the floor
With TTA, what 2 things should you check for while pt is sitting
1 - hamstring relief
2 - residual limb should not pull out of socket
what TFA, what are 3 things you should check for while pt is sitting
1 - can they sit forward
2 - are the knees level
3 - does knee flex
if the residual limb is short, they will need ______ trim lines
higher (allows for less range of motion)
what 4 things should you look for in static frontal plane analysis? (iliac crests, foot, socket, pylon)
1 - iliac crests are level - no trunk lean
2 - foot is inset
3 - socket adduction/abduction matches the sound limb
4 - pylon is vertical or foot is flat on the floor at midstance
what does an inset foot do?
loads the prox-medial and distal-lat aspects of the residual limb and encourages an energy efficient, narrow-based gait
are sockets usually adducted or abducted
adducted 2-5 degrees
what 3 things should you look for in static sagittal plane analysis
1 - no forced knee flex/ext when standing
2 - shoe has even contact with floor and is bearing weight evenly
3 - socket is in initial flexion
what does the initial flexion of the socket do (3)
1 - increases weight bearing capacity of load tolerant areas
2 - allows for smooth gait pattern by placing hamstrings on stretch
3 - lessens possibility of hyperextension of the knee
what 2 things should you look for in static transverse plane analysis
1 - degree of toe-out should be about equal to the sound limb
2 - degree of toe-out should not decrease stance phase stability
what part of the prosthetic prevents foot slap during gait
PF bumper
what should you look for in the trunk during gait (2)
lumbar lordosis
lateral trunk lean
what is a deviation you may see in the transverse plane at terminal stance
medial or lateral whip
T or F: both the sound lib and prosthetic can push off with the same level of force at pre-swing
F: the prosthetic will have less force during toe off
what are a few things that may cause atypical gait during prosthetic ambulation
- loss of active torque generation
- loss of somatosensory feedback and proprioception
- additional degrees of freedom
- decreased strength/ROM
- pain
- prosthetic fit
- limitations of the device
- functional impairments in contralateral limb
T or F: amputees have a higher energy expenditure
T
what are 3 intrinsic factors that can impact energy expenditure
1 - age
2- disease
3 - gait deviations
what are 4 extrinsic factors that can impact energy expenditure
1 - prosthetic mal-alignment
2 - leg length discrepancies
3 - limb socket interfaces
4 - knee type
does a pt with bilateral TTA or unilateral TFA expend more energy
unilateral TFA
*the higher the amputation, the more energy you expend
does foot type have a major effect on mechanics
no
T or F: energy storing feet provide for a higher self-selected velocity
T
do hydraulic/microprocessor knees or constant friction knees provide more symmetry and gait velocity
hydraulic/microprocessor
for the geriatric and more sedentary amputee, a _____ knee may be more stable and efficient
locked
metabolic costs are _______ with microprocessor knees
less
T or F: in TTA gait, the stance limb is positioned in a manner nearly identical to that of uninjured led during initial contact
T
TTA gait: what is happening at hip, knee and ankle during initial contact
1 - ankle is neutral
2 - knee extended
3 - hip flexed 25-35 degrees
at IC, shock absorption and ankle motion is achieved by…
compression of the heel component
during loading response at the ankle, there is an external ____ moment and internal ______ moment
PF
DF
TTA spend more time on the ______ during loading response
heel
T or F: in amputees the external PF/internal DF moment is increased in duration and magnitude during loading response
T
during pre-swing, peak DF of the ankle is determined by… (3)
foot stiffness
alignment
ankle joint moment from loading the trailing limb
patients can attain normal internal ______ torque during pre-swing with proper prosthetic management and use
plantar flexor
T or F: mid-stance to pre-swing kinetics are generally similar to controls
T
TTA amputees have _______ knee flexion from loading response to pre-swing compared to normal gait
decreased
*this may be an effective compensatory strategy
TTA have ____ external knee flexion/internal knee extension moment during stance phase
reduced
TTA may have _____ hip flexion at IC and toe off
increased
what muscle often has increased activation during stance phase in TTA
hamstrings
*doesnt seem to effect the inematics/kinetics though
you often see ______ frontal plane motion at the trunk and pelvis during gait in TTA
increased
T or F: increased frontal plane motion at trunk and pelvis can be reduced with training and proper prosthetic management
T
What is the most important part of swing phase
toe clearance
what could cause decreased toe clearance in a TTA
- loss of active control of ankle
- distal migration of socket
*may compensate proximally
T or F: you see more gait deviations later in TTA
F:early
gait deviations in TTA are influenced by what 2 things related to the prosthetic foot
1 - stiffness of the foot
2 - training to control loading of the foot
T or F: TFA have near normal sagittal plane kinematics during stance at the ankle
T
*just like TTA
in TFA, the external PF/internal DF moment is _______ during loading response
increased
*just like TTA
T or F: TFA have more joint power compared to TTA
F: TTA has more
TFA have _______ knee flexion throughout stance
reduced
TFA have _______ external knee flexion/internal knee extension moment across stance
reduced
in TFA: what happens at terminal stance at the knee
it moves from an extended position in mid-stance rapidly into knee flexion
*this could be a compensatory strategy
In TFA, the hip is more _____ early in stance. this may increase demand on hip _______
flexed
extensors
in TFA, there is ______ hip flexor torque
greater
T or F: posterior pelvic tilt is common in terminal stance in TFA
F: anterior
