quiz 2 (6- Flashcards
an asymmetric step length gait pattern may be caused by
-potentially spending less time in stance phase on amputated side
-shortening swing time and step length on intact side
knee flexion in amputees is produced by
hip flexion and momentum
prosthetic gait has a decreased…
walking speed
stride length
cadence
energy efficiency
biomechanical efficiency
transtibial energy expenditure
16-28% above normal
transfemoral energy expenditure
60-110% above normal
gait goals in initial contact/ loading response
-stride length
-controlled knee flexion
gait goals in midstance phase
-pylon position
-step width
gait goals in terminal stance phase
-smooth progression over forefoot
-smooth flexion of the limb
gait goals in pre-swing phase
pelvic, trunk, and head position
gait goals in swing phase
prosthetic path
TT: keeping the knee extended as much as possible in both swing and stance phase may lead to what deviations?
excess knee extension, vaulting, and circumduction
TT: spending as little time on the prosthesis as possible may lead to what deviation
uneven step length
TT: increasing their BOS may lead to what deviation
wide base of support
excess knee extension
phase: IC, LR, Mst
plane: Sagittal
prosthetic causes:
socket aligned too posterior, foot too anterior, heel too soft, insufficient socket flexion
user causes:
locking knee, weak muscles around knee
bench alignment
static alignment. 1/2 inch medial to center, posterior to center, heel height 5* of flexion
checkout
process of dynamic adjustments to make sure the patient is safe and capable of utilizing the prosthesis. aka dynamic alignment
what are the 4 alignment goals
- facilitate heel strike at IC
- provide adequate single limb stability during stance phase
- create smooth forward progression in late stance
- ensure toe clearance during swing
transtibial pressure tolerant areas
supracondular ares
suprapatellar areas
patella tendon
tibia flares
lateral flare of fibula
posterior area of stump
popliteal area (gently)
distal end of stump for total contact socket
TT: inset foot problems
-excess pressure at medial proximal and lateral distal areas
-gap at lateral proximal area
-lateral instability
TT: outset foot problems
-excess pressure at lateral proximal and medial distal areas
-gap at medial proximal area
-medial instability
TT: foot too anterior problems
-excess pressure at patellar tendon and posterior distal areas
-posterior instability
-difficulty flexing the knee in stance
TT: foot too posterior problems
-excess pressure posterior proximal and anterior distal areas
-anterior instability
-excess flexing the knee during stance
TT: heel too high problems
increased flexion moment
transfemoral goals
minimize rotation of prosthesis and provide frontal and sagittal plane stability
transfemoral pressure tolerant areas
ischial tuberosity
medial & lateral flares of stump
anterior & posterior flares of stump
distal end of the stump for total contact socket (no pressure contact only)
transfemoral pressure sensitive areas
greater trochanter
ramus
ASIS
adductor tendon
distal end of femur
inguinal fossa
pubic tubercle
surgical suture
TF: inset foot problems
-excess pressure at medial proximal and lateral distal areas
-gap at the lateral proximal area
-lateral instability
TF: outset foot problems
-excess pressure lateral proximal and medial distal
if the socket is too far anterior it will…
move the line too far in front of the knee axis making it hard to extend/flex the knee
if the socket is too far posterior it will….
move the line too far behind the knee axis making the knee prone to buckling
excess knee extension causes
-socket aligned too posterior/ foot too anterior
-locking knee to prevent fall
-seen in IC, LR, MSt
vaulting causes
-prosthesis too long
-long toe lever arm
-socket too posterior
-holding knee in extension too long
-seen in swing phase
in prosthetic uneven step length, the short stride length is the ___ side
sound limb. decreased confidence on the prosthetic will shorten stance phase on prosthetic and swing on sound limb
wide BOS causes
-outset foot
-medial leaning pylon
-insufficient weight shift
-pt fear
-hip abduction tightness
TT weak quads can lead to which deviations
-increased pressure on distal residual limb
-shortened stance on prosthetic limb
-knee instability
-drop off
knee instability causes
socket too far anterior/ foot too posterior
-heel firm
-excessive foot DF
-weak quads
-knee flexion contracture
IC, LR
Knee drop off causes
socket too anterior/ foot too posterior
-inappropriate foot choice
-knee flexion contracture
-TSt
TT fit issues deviations
-pistoning
-hip drop (too short)
-circumduction (too long)
-vaulting (too long)
pistoning causes
socket too large
not enough socks
volume changes
IC, LR, MST, SW
hip drop causes
pelvic drop towards prosthetic side. prosthesis too short, residual limb pain
MST
Terminal impact causes
-inadequate knee friction
-fear of knee giving away
-forceful hip flexion
SW - IC
foot slap causes
-PF bumper too soft
-increased hip ext force at IC
circumduction causes
-prosthesis too long
-inadequate suspension
-excess knee friction
-medial wall high
-fear
-hip flexor weak
-hip abduction contracture
abducted gait causes
-prosthesis too long
-medial wall too high
-lateral wall not adducted
-foot too far outset
-decreased balance
-abduction contracture
-lateral/distal RL pain
-adductor roll
TF glute max weakness can result in
knee instability and excess trunk extension
TF glute med weakness can result in
lateral trunk bend, trendelenburg gait pattern
excess trunk extenison causes
increased socket extension
not enough flexion built in to socket
weak hip extensors
weak abs
hip flexion contracture
very short RL
MST
lateral trunk bend causes
prostheis short
socket too abducted
medial wall too high
glute med weak
pain
decreased balance
adductor roll
MST
TF fit issues can cause
drop off, medial whip, lateral whip
drop off causes
short toe lever, socket too posterior to knee
TST
medial whip causes
external rotation of knee component, improper alignment of knee, improper donning
lateral whip causes
internal rotation of knee component, improper alignment of knee, improper donning
