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Management of Special Populations > Return to Running & Sports Following Limb Loss > Flashcards

Return to Running & Sports Following Limb Loss Flashcards

1
Q

Pre-requisites to high level mobility

A
  • Strength
  • Balance
  • Postural Stability
  • Prosthetic Control
  • Endurance
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2
Q

Components of high-level mobility

A
  • Dynamic Balance
  • Power
  • Agility
  • Ability to move in multiple planes of motion
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3
Q

Type of ambulator based on K level

A

K1 = limited ambulator
k2 = limited community ambulator
K3 = community ambulator
K4 = high level community ambulator

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4
Q

Describe the CHAMP (comprehensive high-level activity mobility predictor)

A
  • Assess coordination, power, speed, & agility in multiple planes, composed of: single limb stance, Edgren side step test, T-Test, & Illinois agility test (ability to accelerate/decelerate when performing a variety of maneuvers)
  • High-impact activities (jumping, hopping, & long distance running) are not included due to possible harmful friction/shear forces at the stump/socket
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5
Q

Verbal instructions for single limb stance

A
  • On the command “Ready”, fold arms across your chest
  • When you are ready, lift your foot above the 15 cm cone or box
  • If your foot falls below the 15 cm cone or box, you will be asked to raise it
    You will take a 30 second rest period after each trial
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6
Q

Stop the time for a single limb stance test if

A
  • Your foot touches the floor
  • You do not maintain your foot above the 15 cm cone or box
  • Arms come un-crossed
  • The stationary foot loses contact with the floor (i.e., hopping)
  • You achieve 30 seconds
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7
Q

Verbal directions for the Edgren side step test

A
  • The diagram illustrates the path you will complete for this test
  • On the command “Ready” you will assume a standing position outside the far left cone
  • On the command “Set”, prepare to sidestep
  • On the command “Go”, you will sidestep to the right
  • Sidestep to the right until your right foot has touched or crossed the right outside tape mark
  • Then sidestep to the left until your left foot has touched or crossed the left outside tape mark
  • Repeat this procedure as fast as possible in 10 seconds
  • Points are awarded based on the number of cones you cross in 10 seconds
  • If you fail to reach the outside cones, 1 point will not be awarded
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8
Q

You will score a 0 & be asked to repeat the Edgren side step test if

A
  • You fail to keep your trunk and feet pointing forward at all times
  • You cross your legs
  • You will take a 60 second rest period after each trial
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9
Q

Verbal instruction for the T-Test

A
  • The diagram illustrates the path you will complete for this test
  • On the command “Ready” you will assume a standing position behind the starting line
  • On the command “Set”, prepare to start
  • On the command “Go”, you will run or move as quickly as possible forward to the center cone (cone #1)
  • Facing forward sidestep right to the right cone without crossing your feet (cone #2)
  • One foot must touch or cross the tape mark
  • Facing forward sidestep left to the left cone without crossing your feet (cone#3)
  • One foot must touch or cross the tape mark
  • Facing forward sidestep right back to the center cone without crossing your feet (cone
    #1)
  • One foot must touch or cross the tape mark
  • Facing forward run or move as quickly as possible backwards to the finish line
  • Your total time of completion of the T-Test will be recorded
  • You will take a 60 second rest period after each trial
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10
Q

You will score a 0 & be asked to repeat the T-Test if

A
  • You fail to run the course as instructed
  • You fail to reach the end lines
  • You fail to complete the course
  • You move any cones
  • You fail to keep your trunk and feet pointing forward at all times or you cross your legs more than once
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11
Q

Verbal instructions for the Illinois Agility Test

A
  • The diagram illustrates the path you will complete for this test
  • On the command “Ready” lie on your stomach behind the starting line with your arms at your side and your head turned to the side or facing forward.
  • On the command “Set”, prepare to start, but you may NOT move your hands from your side
  • On the command “Go”, get up and run or move as quickly as possible to the first tape mark
  • One foot must touch or cross the tape mark
  • Turn around and run or move as quickly as possible back to the first center cone
  • Weave up and back through the 4 center cones
  • Run or move as quickly as possible to the second tape mark on the far line
  • One foot must touch or cross the tape mark
  • Turn around and run or move as quickly as possible across the finish cone
  • Your total time for completion will be recorded
  • You will take a 60 second rest period after each trial
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12
Q

You will score a 0 & be asked to repeat the Illinois Agility Test if

A
  • You fail to run the course as instructed
  • You fail to reach the end lines
  • You fail to complete the course
  • You move any cone
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13
Q

What score on the CHAMP is equivalent to active duty service members without lower limb loss

A
  • Score ≥33 points
  • MDIC: CHAMP = 3.74; Single limb stance = 1.09; Edgren side step test = 1.53; T-Test = 0.91; Illinois agility test = 1.10
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14
Q

Describe the relationship of a prosthetic foot and the CHAMP s/p TTA

A
  • Service members who used a J-shaped Energy Storing and Releasing (ESAR) foot performed better on the CHAMP than those using other prosthetic feet
  • ESAR design allows for a combination of increased dynamic DF and active hip/knee flexion leading to greater lower limb power production
  • Also allows for max toe load & energy return from the foot which improves single limb stance time
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15
Q

Considerations with Transfemoral amputees

A
  • Those s/p are more susceptible to postural asymmetries at the pelvis & hip
  • More susceptible to degenerative changes to the intact hip, knee, & ankle joints that may impair function & restrict activity over the long term
  • Type of prosthetic knee & ankle/foot assembly did NOT explain differences in performance on CHAMP
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16
Q

Progression to higher level mobility skills is dependent on

A
  • Symmetrical weight distribution b/w both limbs
  • Utilizing remaining musculature of the residual limb
  • This allows the individual to take advantage of the potential contribution of the prosthetic knee unit & ankle/foot assembly
17
Q

Considerations for Return to Run and High Impact Activities

A
  • Skin integrity
  • Socket fit/tolerance
  • Cardiovascular health/endurance
  • Cause of amputation
  • Patient goals
  • Bone Density: FAILED DEXA SCAN IS THE BIGGEST DEAL BREAKER WITH REGARD TO RETURN TO RUNNING PROGRAM
18
Q

Minimum Criteria for Consideration to Advance to a Return to Running Program Must be independent with the following

A
  • Prosthetic Management: Don/doff prosthesis and liner; Skin inspection, hygiene; Regulation of stump socks for appropriate socket fit
  • Rolling, Supine<>sit
  • Sit<>Stand
  • Step-Ups
  • Floor recovery to standing
  • 30 minutes continuous walking without skin breakdown
19
Q

Transtibial pre-running requirements

A
  • Single leg wall squat, 10 reps w/neutral hip/knee position
  • Single leg hop & regain control, 10 reps
  • SLS on prosthetic side X 15 sec (1 min on sound side)
  • Ambulate w/o limp or assistive device on level & uneven surfaces
20
Q

Transfemoral pre-running requirements

A
  • Single leg machine squat X 10 reps with neutral hip/knee position
  • SLS on prosthetic side X 10 sec (1 min on sound side)
  • Ambulate w/o limp or assistive device on level & uneven surfaces
21
Q

Shorty Progression for Bilateral Transfemoral Amputees

A
  • Shorties -> increase pylon length
  • Locking Knees
  • Knees
  • Activity/Sport specific prosthesis
22
Q

Points of emphasis in return to run program

A
  • Strength: establish hip musculature string enough for quick control & stabilization
  • Dynamic balance/agility
  • Pre-run specific activities
  • Cardio preparation
23
Q

5 Steps for Introducing Running to Lower-Limb Amputees

A
  • Prosthetic trust: reaching out with the prosthetic limb & knowing it will be there
  • Backward extension: pushing back against the socket wall exerting a forward force
  • Sound limb stride: reaching out with sound limb for an equal stride length
  • Stride symmetry: relax, comfortable jogging pace, equal & relaxed strides
  • Arm carriage: moving the arms in opposition to the movement of the legs
24
Q

Slide 39 running gait analysis

25
Q

Patient related problems for running gait

A
  • Hip Weakness
  • Bad Habits
  • Socks (too many vs too few)
  • Sweat
  • Fatigue
26
Q

Prosthetic related problems for running gait

A
  • Too Short vs Too Tall
  • Stiffness/Category of Prosthetic Foot
  • Alignment
  • Loose Components
  • Socket Fit
27
Q

Most people with amputations should not experience pain that interferes with their QOL or requires regular medication more than _____ months following the amputation surgery

28
Q

Progression of Training in Return to Run Program

A
  • Constant monitoring of skin integrity & socket fit is essential
  • Training parameters
  • Cross training
  • Can increase running mileage at 10% oof distance per week
  • Begin with walk/run interval training to increase running time/mileage
29
Q

Interval training progression

A
  • Six 5 minute intervals
  • 4 min. walk & 1 min. run
  • 3 min. walk & 2 min. run
  • 2 min. walk & 3 min. run
  • 1 min. walk & 4 min. run
  • 30 min run
  • Training 3-4x/wk

Management of Special Populations (13 decks)

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