prosthetic gait assessment

Question 1

impairment level fits under patient or prosthetic cause of TF gait deviations?

Answer 1

patient

Question 2

Name the 4 most common TFA deviations

Answer 2

1) short step length on intact limb
2) short stance time on prosthetic side
3) limited WB
4) increased UE WB on device

Question 3

What muscles in TFA are rotating the pelvis?

Answer 3

Pelvis and core! NOT quads and hamstrings

Question 4

Name the 6 gait deviations you need to know

Answer 4

1) step width
2) step length
3) toe load
4) knee flexion
5) pelvic rotation
6) trunk rotation

Question 5

which of the 6 gait deviations can increase shear force on the intact limb?

Answer 5

step length, they try to quickly get off prosthetic side and back onto intact limb.

Question 6

maintenance of what stability is important for step length impairments?

balance training in these individuals

Answer 6

lateral hip stability

higher level balancing strategies have to be trained (hip and stepping not ankle strategies)

Question 7

with TFA what do you have loss of muscle wise? what %?

Answer 7

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

Question 8

the shorter the residual limb what does this do to bone lever in terms of torque? (talking about step length)

Answer 8

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

Question 9

Loss of what causes you to have to train higher level balance strategies?

Answer 9

contraction speed

Question 10

what is the optimal length tension relationship for the hip?

Answer 10

3-7 degrees of ABD (remember we’re not talking about the position of the socket itself)

Question 11

Toe load what is expected

Answer 11

forefoot rocker extension in 20-50% of gait cycle

Question 12

what is the observed deviation in toe load?

Answer 12

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

Question 13

what are the three possible causes of toe load deviation

Answer 13

1) unable to balance over prosthetic foot
2) decrease in transverse pelvic plane rotation
3) foot is too stiff

Question 14

best energy return: SACH, flex foot, seattle dynamic?

Answer 14

flex foot 89%

human foot 246%

Question 15

why is toe load so important?

Answer 15

no anatomical push off, the prosthetic feet are passive so they only give out what gets put in

Question 16

What two things have to work overdrive for someone to get toe load?

Answer 16

hip extensor activity: normally present from IC to midstance but person with amputation has to increase this activity

core stability

Question 17

what two core muscles are super important for achieving toe load

Answer 17

TA

multifidus

Question 18

tight quads or overstretched hamstrings (depending on attachments) lead to what?

Answer 18

Anterior pelvic tilt –> bad posture for core contraction and hip extension

Question 19

what are the 5 possible causes of decreased knee flexion

Answer 19

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

Question 20

What is often the primary cause of limited knee flexion

Answer 20

decreased pelvic rotation

Question 21

facilitating anterior pelvic rotation to get knee flexion works in what 2 kinds of knees?

Answer 21

microprocessor and polycentric

Question 22

what is the observed deviationfor a lack of pelvis rotation

Answer 22

prosthetic side of the pelvis rotated posteriorly

Question 23

what are the two possible causes of lack of pelvic rotation

Answer 23

lack of pelvic transverse rotation

prosthesis too short

Question 24

what do you expect to see for trunk rotation

Answer 24

5 degrees opposite pelvic rotation

Question 25

what are the two observed deviations of trunk rotation

Answer 25

1) decreased trunk rotation

2) asymmetrical arm swing

Question 26

What are the three possible causes of trunk rotation deviations

Answer 26

1) poor balance
2) habit
3) use of AD

Question 27

what cannot occur until you develop trunk rotation?

Answer 27

arm swing

Question 28

What are the two most important factors for prosthetic fit?

Answer 28

socket design

alignment

Question 29

what can most prosthetic fit problems be solved with?

Answer 29

proper sock management

Question 30

Explain the sock mark test

what is it for?
how do you do the test?

Answer 30

Assess where pressure is located on the residual limb

Question 31

What does the lipstick test test for?

Answer 31

specific pressure points

Question 32

Do you ever put padding over a boney area if pt is complaining of pain?

Answer 32

no! this just increases peak pressure in this area!

built up the PRESSURE TOLERANT areas

Question 33

Clay ball test looks at the thickness of the clayball to assess what?

Answer 33

distal weight bearing/too much pressure

Question 34

what are the two kinds of amputations that distal wt. bearing is okay?

Answer 34

bone bridge, or jt articulations

Question 35

What is botox good for and how long does it last?

Answer 35

stopping perspiration

6 months