prosthetic gait assessment Flashcards
impairment level fits under patient or prosthetic cause of TF gait deviations?
patient
Name the 4 most common TFA deviations
1) short step length on intact limb
2) short stance time on prosthetic side
3) limited WB
4) increased UE WB on device
What muscles in TFA are rotating the pelvis?
Pelvis and core! NOT quads and hamstrings
Name the 6 gait deviations you need to know
1) step width
2) step length
3) toe load
4) knee flexion
5) pelvic rotation
6) trunk rotation
which of the 6 gait deviations can increase shear force on the intact limb?
step length, they try to quickly get off prosthetic side and back onto intact limb.
maintenance of what stability is important for step length impairments?
balance training in these individuals
lateral hip stability
higher level balancing strategies have to be trained (hip and stepping not ankle strategies)
with TFA what do you have loss of muscle wise? what %?
30% loss of isometric ABD strength
- IT band lost
- glute med and min produce 70% in a normal person so we have to make this perform even more in this population
the shorter the residual limb what does this do to bone lever in terms of torque? (talking about step length)
Torque = force over a distance
with a shorter limb the less distance the muscles have to work with and therefore the harder they have to work
Loss of what causes you to have to train higher level balance strategies?
contraction speed
what is the optimal length tension relationship for the hip?
3-7 degrees of ABD (remember we’re not talking about the position of the socket itself)
Toe load what is expected
forefoot rocker extension in 20-50% of gait cycle
what is the observed deviation in toe load?
absence of toe break: not taking a long step on intact side and not loading the prosthesis
may lift the foot off the ground prematurely
what are the three possible causes of toe load deviation
1) unable to balance over prosthetic foot
2) decrease in transverse pelvic plane rotation
3) foot is too stiff
best energy return: SACH, flex foot, seattle dynamic?
flex foot 89%
human foot 246%
why is toe load so important?
no anatomical push off, the prosthetic feet are passive so they only give out what gets put in
What two things have to work overdrive for someone to get toe load?
hip extensor activity: normally present from IC to midstance but person with amputation has to increase this activity
core stability
what two core muscles are super important for achieving toe load
TA
multifidus
tight quads or overstretched hamstrings (depending on attachments) lead to what?
Anterior pelvic tilt –> bad posture for core contraction and hip extension
what are the 5 possible causes of decreased knee flexion
1) decreased pelvic rotation
2) inability to roll over toe
3) short prosthesis
4) too much resistance
5) knee axis way too posterior to weight line
What is often the primary cause of limited knee flexion
decreased pelvic rotation
facilitating anterior pelvic rotation to get knee flexion works in what 2 kinds of knees?
microprocessor and polycentric
what is the observed deviationfor a lack of pelvis rotation
prosthetic side of the pelvis rotated posteriorly
what are the two possible causes of lack of pelvic rotation
lack of pelvic transverse rotation
prosthesis too short
what do you expect to see for trunk rotation
5 degrees opposite pelvic rotation
what are the two observed deviations of trunk rotation
1) decreased trunk rotation
2) asymmetrical arm swing
What are the three possible causes of trunk rotation deviations
1) poor balance
2) habit
3) use of AD
what cannot occur until you develop trunk rotation?
arm swing
What are the two most important factors for prosthetic fit?
socket design
alignment
what can most prosthetic fit problems be solved with?
proper sock management
Explain the sock mark test
what is it for?
how do you do the test?
Assess where pressure is located on the residual limb
What does the lipstick test test for?
specific pressure points
Do you ever put padding over a boney area if pt is complaining of pain?
no! this just increases peak pressure in this area!
built up the PRESSURE TOLERANT areas
Clay ball test looks at the thickness of the clayball to assess what?
distal weight bearing/too much pressure
what are the two kinds of amputations that distal wt. bearing is okay?
bone bridge, or jt articulations
What is botox good for and how long does it last?
stopping perspiration
6 months
