Rehab

Question 1

How much of the gait cycle is spent in stance phase vs swing phase?
How much of stance phase is spent in double-limb support?

Answer 1

Stance = 60%
Swing = 40%

12% of stance phase is spent in double limb support

Question 2

How much does the normal NWB contralateral pelvis drop during single leg stance?

Answer 2

5 degrees

Question 3

What type of isotonic contraction is mostly seen in the gait cycle?

Answer 3

Eccentric!

TA does BOTH eccentric (heel strike) and concentric (swing)

Question 4

What type of altered gait does an ACL deficient knee have?

Answer 4

Quadriceps-avoidance gait -> decreased quad moment during midstance

Question 5

Which hand do you hold the cane in?

Answer 5

Contralateral -> will help shift body center of gravity over the affected side to decrease the joint reactive forces

Question 6

Which needs more energy expenditure to walk:

Bilateral transtibial or Unilateral transfemoral

Answer 6

Unilateral transfemoral (65% more energy above baseline vs 41%)

Question 7

What factor is MOST predictive of successful wound healing?

Answer 7

Transcutaneous partial pressure of oxygen (> 30-40 mmHg)

Question 8

What are the following values a/w wound healing?

1. ) Serum albumin
2. ) Absolute Lymphocyte count
3. ) Hb concentration
4. ) Doppler pressure
5. ) Ischemic index
6. ) Transcutaneous partial pressure of oxygen

Answer 8

1. ) Serum albumin > 3.5 g/dL
2. ) Absolute Lymphocyte count > 1,500/mm3
3. ) Hb concentration > 10 g/dL
4. ) Doppler pressure > 70 mmHg
5. ) Ischemic index > 0.5
6. ) Transcutaneous partial pressure of oxygen > 30-40 mmHg (GOLD STANDARD, MOST PREDICTIVE!)

Question 9

When performing transmet or Lisfranc amputations - what other procedure should you think about performing with this?

Answer 9

Percutaneous Achilles tendon lengthening

Question 10

In order to perform a Syme amputation - what do you need to make sure that you have?

Answer 10

Patent posterior tibial artery in order to ensure healing (also important to have a good, secured heel pad)
*Even though more proximal, it is more energy efficient than a midfoot amputation!

Question 11

What did LEAP study show in regards to knee disarticulations?

Answer 11

Knee disarticulations result in the slowest walking speed and lest self-reported satisfaction
(They are okay for nonambulatory pts b/c provide a good WB surface for sitting and transfers)

Question 12

In a transfemoral amputation - what procedure do you need to make sure you include?

Answer 12

Adductor myodesis

Question 13

What change to the gait cycle does antalgic gait cause?

Answer 13

Decreased time in stance phase to lessen the time the painful limb is loaded

Question 14

When performing a Lisfranc amputation - what must be preserved and if its not, what happens?

Answer 14

Soft tissue at base of 5th MT b/c is insertion site of peroneus brevis and tertius - needed antagonists to the PT. If you don’t preserve is there will be inversion during gait!

Question 15

What is the optimal bone length to leave a transtibial amputation? Transfemoral?

Answer 15

12 cm below knee joint

12 above knee joint!