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LL Ox > Q3: Biomechanics & Components Proximal to the Knee > Flashcards

Q3: Biomechanics & Components Proximal to the Knee Flashcards

1
Q

Knee: Type of Joint and Inhibitors

A

Joint:
* Modified Hinge Joint (2-6 DOFs)

Limiters:
* Menisci
* Ligaments/Muscles

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2
Q

Main Knee Motion

A

Sagittal Plane (Flex and Ext)

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3
Q

Initial Contact

Knee Mechanics

A

Approaching neutral; extensors are active

0 degrees

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4
Q

Midstance

Knee Mechanics

A

Slight flexion; extensors are active

0 degrees

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5
Q

Terminal Stance

Knee Mechanics

A

Approaching neutral

0 degrees

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6
Q

Preswing

Knee Mechanics

A

Rapid flexion is initiated

40 degrees flexed

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7
Q

Hip: Type of Joint and Inhibitors

A

Joint:
* Ball & socket

Limiters:
* socket depth
* muscles/ligaments

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8
Q

Acetabulum

Hip Joint

A

Acetabular labrum - fibrocartilaginous rim
Transverse ligament - closes the upside down “U”
Capitis femoris ligament - limits adduction

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9
Q

When standing…

Hip Forces and ligaments

A

0.3x bodyweight

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10
Q

When standing on 1 limb…

Hip Forces and ligaments

A

2.4-2.6x bodyweight

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11
Q

When walking…

Hip Forces and ligaments

A

1.3-5.8x bodyweight

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12
Q

When running…

Hip Forces and ligaments

A

4.5+ times bodyweight

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13
Q

Ligamentous Support

Hip ligaments

A

Iliofemoral (Y-lig)
* strongest in the body
Ishiofemoral
* limits ext. and abduction
Pubofemoral

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14
Q

Parastance

Hip Forces

A

standing using GRF; moves it posteriorly

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15
Q

Inital Contact

Hip Mechanics

A

Flexed 30 degrees; extensors active

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16
Q

Midstance

Hip Mechanics

A

Close to neutral; abductors active for balance

If abductors are weak, Trendelenberg will be (+)

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17
Q

Terminal Stance

Hip Mechanics

A

Extended 10 degrees

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18
Q

Preswing

Hip Mechanics

A

Rapid Flexion Initiated

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19
Q

Early/Mid Swing Phase

Hip Mechanics

A

Flexion continues; Flexors are active

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20
Q

Terminal Swing

Hip Mechanics

A

Hamstrings are active to slow tibia and prevent excessive hip flexion

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21
Q

Antalgic Gait

Hip Joint

A

Painful Hip may cause…
* PF for shock absorption
* Flex., Abduct, external rot. combo - optimize femoral head position
* pivot met. heads to avoid forceful push off in late stance

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22
Q

Initial Contact

GRF

A

Ankle - PF
Knee - Ext.
Hip - Flex

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23
Q

Loading Response

GRF

A

Ankle - PF
Knee - Flex
Hip - Flex

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24
Q

Midstance

GRF

A

Ankle - DF
Knee - Ext.
Hip - Ext.

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25
Q

Terminal Stance

GRF

A

Ankle - DF
Knee - Ext.
Hip - Ext.

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26
Q

Preswing

GRF

A

Ankle - DF
Knee - Flx
Hip - Ext

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27
Q

Goals

KAFO

A
  • Control tibia and femur
  • correction
  • prevention
  • muscle compensation
  • increase stability
  • decrease pain
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28
Q

Sagittal Indications

KAFO

A
  • Quads MMT - 3+ or less
  • Genu Recurvatum - > 30 degrees
  • Knee flexion contractures
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29
Q

Coronal Indications

KAFO

A

Genu varum and valgum

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30
Q

Transverse Indications

KAFO

A

Rotary and/or triplanar instability

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31
Q

Other Indications (not plane of motion related)

KAFO

A

Proprioception or Sensory impairment

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32
Q

Types/Styles

KAFO

A

Conventional, Thermoplastic, Hybrid

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33
Q

Thermoplastic

KAFO

A

Increased contact, cosmesis, control
Decreased weight

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34
Q

Common Components

Conventional KAFO

A
  • Proximal thigh band
  • Distal thigh band
  • Knee joints/Sidebars
  • Calf band
  • Ankle joints
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35
Q

Types of Ankle Joints

KAFO

A
  • Double action
  • Dorsi assist - swing phase help
  • Free motion - coronal control
  • Limited motion - stops PF
36
Q

Solid Stirrups

KAFO

A

Direct attachment to shoe
Strong - continuous piece of metal

Can be hard to align mech. and anatomical joints

37
Q

Split Caliper Stirrup

KAFO

A

Not as strong as solid (3 parts)
Easier to align
Can use multiple shoes

38
Q

Hybrid AFO NYUCBL

A

Increased foot control while avoiding proximal contact

39
Q

T-Strap

KAFO components

A

Address pronation or supination based on orientation
Sup. - attached laterally
Pron. - attached medially

40
Q

Straight Knee Joints

Knee Joints

A

Uses ring/drop locks with a ball retainer; used for patients with UE issues

41
Q

Swiss/Cam/French Lock

Knee Joints

A

Hands free lock; uses a bail release

Can disengage accidentally

42
Q

Posterior Offset Joints

Knee Joints

A

Mech. joint is set posteriorly to provide knee stability
Indicated for hyperextention
Allows for flexion is swing phase

43
Q

Dial Lock

Knee Joints

A

adjustable for knee deformities/contractures

44
Q

Step (Ratchet) Lock

Knee Joints

A

hands free with incremental locking; self adjusts to available knee ROM

45
Q

Key Lock

Knee Joints

A

Like a step lock but only locks in full extension

46
Q

Stance Control KAFOs

A
  • Free flexion in swing phase
  • Locked knee in stance phase

Weight line shifts anterior to the knee after temporal midstance

Usually locked from IC to Midstance

47
Q

Ankle Driven

Stance Control KAFO

A

Requires DF at Mid to Terminal stance to unlock

Cannot be used with solid ankle

48
Q

Positional

Stance Control KAFO

A

Locks/Unlocks based on tibial inclination and hip positon

can be overly safe; knee can unlock early going downhill

49
Q

Microprocessor

Stance Control KAFO

A

based on MP prosthetic knee technology; expensive

50
Q

Spreader Bars

KAFO components

A

Controls hip motion when using B/L KAFOs

51
Q

Axial Resist KAFO

A

Uses prosthetic principles to load limb proximally
Weight through:
* Ischial Tuberosity
* Scarpa’s triangle

Locked knee

52
Q

Indications

Axial Resist KAFO

A
  • Malunion
  • Fx distal to midshaft of femur
  • post-op
  • arthritic conditions
53
Q

Indications

Hip Orthoses

A
  • Dysplastic disorders
  • Trauma
  • Post-Op
54
Q

Unilateral or Bilateral Pelvic Bands

Hip Ox Components

A
  • Midpoint from Iliac Crest to Greater Troch
  • Rigid portion is 33% of circumference
  • Anterior trimline - 30mm medial ASIS
  • Posterior trimline - posterior midline
55
Q

Free Motion

Hip Joints

A

Free sagittal motion;
controls coronal and transverse motion

56
Q

Ring (Drop) Locks

Hip Joints

A

Hold in all planes

57
Q

Trigger Lock

Hip Joints

A

Automatic locking

58
Q

Adjustable (Dial) Lock

Hip Joints

A

Used when variable sagittal ROM is needed; 6 degree increments

59
Q

Abduction-Flexion Joint

Hip Joints

A

used when variable sagittal/coronal ROM is needed
Indications:
* S/P hip replacement
* Hip dislocation
* lumbar fusion

60
Q

Twister Cables

Transverse Hip Motion

A

Controls hip rotation; attaches to a pelvic band and shoe
Usually in small children

Contraversial

61
Q

Walk About/Up & About Systems

A

Articulation proximal and medial to anatomical hip joint
* facilitate reciprocating gait but not forward progression

62
Q

Landmarks

HKAFO

A
  • Iliac Crest
  • ASIS
  • Greater Trochanter
  • Anatomical Hip Joint
63
Q

Anatomical Hip Joint

A

12 mm anterior & 25 mm proximal to the greater trochanter

64
Q

Advantages of Crossing the Hip

A
  • Increase coronal control
    1. adductor issues
  • Increase transverse control
    1. int./ext. rotation issues
65
Q

Rationale

HKAFO

A
  • Allow weight bearing (contracture prevention)
  • Seat femur in acetabulum
  • delay deformites (pediatrics)
  • Post-Op
  • stability
  • transverse control

Usually short term and unilateral

66
Q

Paraplegic Patient Goals

HKAFOs

A
  • Therapeutic
  • Improve Independence
  • Hold alignment
  • achieve external stability
67
Q

Swing to/through

HKAFOs Gait Possibilities

A

Most efficient pattern

68
Q

Swivel Walking

HKAFOs Gait Possibilities

A

Very slow but easy; may not require aids

69
Q

Reciprocal Walking

HKAFOs Gait Possibilities

A
  • Appears more normal
  • Increased stability
  • Less energy consumption, but more training
70
Q

Standing Frames

Static HKAFOs

A
  • SCI L3 or higher
  • Need to have head control and seated balance
  • Independent standing (FREE HANDS)
  • Gravity affects bone density/GI tract
  • reduces contractures
71
Q

Parapodium

Static HKAFOs

A

Mech. Hip & Knee joints for sit to stand
* independent mobility
* swivel walker adaptation can be used

72
Q

ORLAU Swivel Walker

Static HKAFOs

A

No joints; Swivels by laterally shifting weight
* allows for forward progression
* adjustable growth
* used only on flat ground

73
Q

Connection methods

RGO

A

Reciprocating Gait Ox
1. Isocentric Bar
2. Double Cable
3. Single Push-Pull System

74
Q

Ambulatory Progression

RGO

A
  • Lateral shift
  • Trunk extension
  • Contralateral leg advancement
  • Lateral shift
  • repeat
    gait training is important
75
Q

Common Assistive Devices

RGO

A

Lofstrand Crutches

76
Q

Indications

RGO

A
  • Spina Bifida
  • Paraplegia
  • Atrophy
  • MS
  • CP
  • Polio (not common anymore)
77
Q

Contraindications

RGO

A
  • contractures
  • spasticity
  • poor UE strength
  • obesity
  • ulcers
  • poor bone density
  • poor conditioning (cardio)
  • lack of motivation/support/compliance
  • hemiplegia
78
Q

Advantages

RGO

A

Independent Locomotion;
Gravitational Benefits

79
Q

Disadvantages

RGO

A

Expense,
issues with clothing,
and difficulty don/doffing

80
Q

Gait Training Ox

GTO

A

Provides pelvic and trunk support; pt. can move hips and legs to facilitate progression

81
Q

Indications

GTO

A
  • CP
  • Developmental Delay
  • Step ability when unweighted
  • Low weight (<74 lbs)
  • plantigrade feet
  • knee contractures up to 20 degrees
  • stable hips
82
Q

Contraindications

GTO

A
  • Contractures
  • Spasticity
  • Lack of motivation, support
  • Poor cognitive skills
83
Q

Benefits

GTO

A
  • Hands-free mobility
  • guidance and control
  • independence increases
  • improves bowel/bladder function
  • improves bone density
  • self esteem and social interaction
84
Q

Alignment and Fit

GTO

A
  • Flat heel and sole with ground
  • joint congruency (mech. and anat.)
  • horizontal joint axis
  • adequate confromity to pt. anatomy
85
Q

Trimline Criteria

KAFO

A
  • 35mm distal to perineum
  • 10mm distal to troch.
    Knee clearance:
  • medial - 6mm
  • lateral - 3mm
86
Q

Fitting Criteria

KAFO

A
  • Distal thigh & calf strap = equal distance from knee center
  • min. 105 degrees knee flexion
  • If thermoplastic, then Total Contact fit
  • If conventional, then 3-6mm clearance
  • If conventional ankle, then 5-6mm clearance

Use appropriate foot plate length

LL Ox (24 decks)

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