week 4

Question 1

Ligament Injuries garde 1

Answer 1

stretched fibres but normal ROM on
stressing ligament

Question 2

Ligament Injuries grade 2

Answer 2

considerable proportion of fibres torn, stressing of ligament reveals increased laxity, but definite end point

Question 3

Ligament Injuries grade 3

Answer 3

complete tear of ligament with excessive
joint laxity and no end point (be wary using pain as
guide)

Question 4

Tendon injuries categories

Answer 4

• Partial failure(a) = some strength
• Complete failure (b) = no strength
  eg can cor can’t do a calf raise for an achilles tear

Question 5

Hysteresis

Answer 5

energy loss

Question 6

creep

Answer 6

As stress/load is kept constant the strain increases relatively
quickly at first, then more and more slowly

Question 7

Stress relaxation

Answer 7

Strain/deformation kept constant, the stress decreases
rapidly at first, then more and more slowly
results are invisible

Question 8

Factors influencing behaviour of tendons and ligaments

Answer 8

Maturation & Ageing
Pregnancy
Mobilisation/Immobilisation
Grafts
Diabetes Mellitus
Haemodialysis
Steroids
NSAIDs

Question 9

Maturation & Ageing

Answer 9

During maturation number & quality of cross-
links increase
* Also increase in collagen fibril diameter
* After maturation as ageing progresses,
collagen properties plateau, tensile strength
& stiffness begins to decrease

Question 10

Pregnancy

Answer 10

Increased laxity of tendons & ligaments of pelvic region

Question 11

Mobilisation & Immobilisation

Answer 11

Ligaments & tendons remodel in response to mechanical demands placed on them

Question 12

Grafts

Answer 12

Reconstruction of torn ligaments common

Question 13

Diabetes Mellitus

Answer 13

Diabetics show higher rates of musculoskeletal disorder:
* Tendon contracture (29% vs 9%)
* Tenosynovitis (59% vs 7%)
* Joint stiffness (40% vs 9%)
* Capsulitis (16% vs 1%)

Question 14

Haemodialysis (condition)

Answer 14

• Tendon rupture ~36%

fyi * Dialysis related amyloidosis may cause deposition of amyloid
in synovium of tendon

Question 15

Steroids

Answer 15

• Corticosteroids known to inhibit
  collagen synthesis
• Decreased stiffness, failure
  load, energy absorption

Question 16

NSAIDs

Answer 16

some say but not certain
* Impairs bone-tendon healing
* Decreases tenocyte proliferation and collagen formation

Question 17

What is the purpose of walking aids?

Answer 17

A walking (or gait) aid enhances the individual’s participation by allowing them to move about their homes, participate in ADLs
Reducing the effort of walking
Providing a sense of security and confidence
Reducing the physical strain and fatigue associated with walking.

Question 18

indications for walking aid use:

Answer 18

A weight-bearing restriction (to enable the healing process of a fracture, for example)
A person has reduced balance
A person has reduced lower limb strength or endurance
Pain with weight bearing
Absence of a limb

Question 19

Baseline function

Answer 19

• Previous level of mobility (Pre-morbid function)
  eg how far do you generally walk/ did u use a gait aid before

Question 20

weight bearing status

Answer 20

• Non weight bearing
• Touch weight bearing
• Partial weight bearing
• Full weight bearing

Question 21

Cognitive Function questions

Answer 21

Can the patient understand the procedure?
* Can the patient follow the instructions?

Question 22

Vision

Answer 22

Flooring
* Lighting
* Looking at feet
* Scanning the environment for
obstacles

Question 23

Vestibular Function

Answer 23

balance in inner ear

Question 24

Upper Body Strength

Answer 24

• Upper limbs equal strength?
• Hand grip
• Push through the walking aid handles

Question 25

Physical Endurance

Answer 25

Walking with an aid requires increased energy expenditure
and therefore individuals fatigue very quickly
Co existing medical conditions

Question 26

Weight

Answer 26

All walking aids have a weight limit
* The manufacturer will specify the maximum weight for which the aid
has been tested.

Question 27

Home Environment

Answer 27

• Floor surfaces
• Loose mats
• Doorway width
• Bathroom
• Stairs

Question 28

Walkers/frames positives and negatives

Answer 28

+ =
Improve balance and stability
Allow some weight bearing
Allow greater endurance
- =
Can be cumbersome
Difficult to manoeuvre through doorways and in small rooms like bathrooms
Encourage a “flexed posture”, especially if not adjusted correctly
Can encourage an abnormal gait pattern
Cannot be used on stairs

Question 29

Crutches

Answer 29

Crutches increase the base of support (BOS) and therefore increase stability when there is pain, reduced strength or restricted weightbearing.

Question 30

Axillary crutches

Answer 30

Can be used for low or non-weight bearing clients.
They are inexpensive but require high energy expenditure and difficult to use.
They are therefore generally used for periods of temporarily limited mobility.

Question 31

Forearm/Canadian crutches

Answer 31

These are less cumbersome than axillary crutches and allow some freedom for the use of the hands.
They can be useful for very active patients with weightbearing restrictions or with pain or reduced body strength.
However, they should not be used for NWB clients as they are unstable to take a person’s whole-body weight

Question 32

Sticks

Answer 32

Walking sticks widen an individual’s base of support thereby making them more stable and improving balance

Question 33

Ensure safety

Answer 33

• Check
• Brakes
• Stoppers
• Weight bearing
• Environment
• before you give it to the patient!

Question 34

Measuring for walking aids

Answer 34

greater trochanter/ wrist crease
2 fingers from axillary
approx 30 degree elbow flexion
forearm crutches= 2-3 fingers below olecranon

Question 35

Normal Gait

Answer 35

Heel strike * Mid stance * Heel off * Toe off * Step length * Step through * Arm swing

Question 36

step to gait

Answer 36

limb is advanced, and then the intact limb brought to the same position.