Prosthetics, orthotics, and Gait

Question 1

Describe a SACH

Answer 1

Solid Ankle Cushion Heel
Simple lower level for ADLS, even terrain, K1, K2 more than higher levels

Question 2

What are two prosthetic causes for excessive early stance knee flexion (too much bend) in transtibial amputee

Answer 2

Firm/hard heel cushion, anterior socket placement (increases flexion moment)

Question 3

What are two anatomical causes for excessive knee extension (too straight) in early stance (initial contact) of BK Amputee

Answer 3

Weak quadriceps, spasticity of quadriceps

Question 4

Name two prosthetic causes for early knee flexion (too much knee flexion) in the late stance phase of transitbial amputee

Answer 4

High heel (drives tibia forward because if heel is raised, DF must occur “to bring foot to ground”), insufficient DF stop, Anterior socket placement, Insufficient PF (too much DF)

Overall think what causes DF + still ant socket consideration

Question 5

What is an anatomical cause for early stance excessive knee flexion (too much) in transtibial case

Answer 5

Flexion contracture, quad weakness

Question 6

Name an anatomical cause for early knee flexion (excessive knee flexion) in the late stance phase of a BK amputation

Answer 6

Flexion Contracture

Question 7

What are two prosthetic causes for too little knee flexion in early stance aka excessive knee extension in a BK patient

Answer 7

Posterior socket, soft heel cushion

Because post socket pushed GRF mote ant increasing ext moment

and soft heel cusion absorbs load, slowding down tibal progession (knee bend)

Question 8

Name an anatomical cause for delayed knee flexion (insufficient knee flexion) in the late stance phase for transtibial amputation

Answer 8

Extensor spasticity

Question 9

Name two prosthetic causes for delayed knee flexion (not enough knee flexion) in the late stance phase for BK amputee

Answer 9

Low heel, excessive PF, socket placed too far posteriorly (no flexor momenta)

Question 10

Name Prostehtic causes for circumduction during swing phase for a transfemoral amputee

Answer 10

Long prosthesis, Locked knee, Lose or tight socket (causes longer limb), suspension issues, PF foot = All cause longer functional limb

Question 11

Name an anatomical cause for circumduction in transfemoreal amputee

Answer 11

Hip abd contracture.

Question 12

Name Prostehtic causes for hip hiking/vaulting during swing phase for a transfemoral amputee

Answer 12

Vaulting is plantarflexing to lift a side.. Hip hiking and vaulting also due to functionally longer limb, so same as for circumduction.

Question 13

Name Prostehtic and anatomical causes for heel whips (medial or lateral) during swing phase for a transfemoral amputee.

Answer 13

Think the same as regular hip rotation. Medial heel whip due to external rotation and lateral heel whip due to internal rotation (of socket). Also could be misaligned distally

The anatomical cause is fast pace

Question 14

What is and what are compensations for inadequate knee unit friction?

Answer 14

Knee unit friction refers to a lack of friction or resistance in the knee joint, which leads to uncontrolled and loser movement. Compensations would be high heel rise (too much) and terminal impact (hard clunk at end)

Question 15

What are the prosthetic and anatomical causes for uneven step length

Answer 15

Pain/discomfort due to prosthesis, and hip flexion contracture or instability for anatomical

Question 16

Describe K-level 0

Answer 16

Not eligible for any prosthesis due to low level of ability

Question 17

Describe K-level 1

Answer 17

Able to complete transfers, walk on even surfaces, household ambulatory to some degree (full or partial). Not community

Uses SACH or Single axis (simple)

Question 18

Describe K-level 2

Answer 18

Full household ambulator. Limited community ambulator, can navigate curbs, uneven surfaces, etc.

Multi, poly, more flexible orthoses

Question 19

Describe K-level 3

Answer 19

Full community ambulator, various cadences, more than simple level ambulation

Can use multiple/high tech prosthesis

Question 20

Describe K-level 4

Answer 20

Full community ambulator and high level (sports, running, etc.), high impact. Can use any prostehsis

Question 21

Solid AFO

Question 22

Posterior Leaf Spring

Answer 22

Improves DF and swing phase clearance
Flexible co-polymer polypropylene or carbon fiber that typically allows for stored energy
potential.
Improves walking mechanics

Least stable so requires good ability. (e.g isolated DF issue or mild cases)

Question 23

GRAFO

Answer 23

Indicated if knee buckling occurs. Pt must have at least 3/5 in extensors and hip control. Limits DF to prevent knee flexion

Question 24

Articulating Hinged AFO

Answer 24

Good for if posterior (PF) stop or dorsiflexion (ant) stop is needed. Allows for free sagittal motion but limits med lateral stability

One step up for solid AFO* that is too rigid and does not allow as much freedom and functionality

Question 25

AFO with stirrups

Answer 25

2. Split stirrups are bulky and would not address the pronation malalignment (p. 1292).

THey do add extra support

Question 26

Metal AFO

Answer 26

4. This type of ankle-foot orthosis is not the best choice for this patient because it is heavy, and a metal ankle-foot orthosis would not address the pronation malalignment (p. 1296).

Good for spasticity