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Advanced movement analysis > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What are the principles to being fitting a person for a prosthetic?

A
  • Wound closure
  • Tolerant to force couple pressures
  • Circumference reduction
  • Sound side weight bearing ability
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2
Q

What are the components of preparing a person for their first prosthesis?

A 
• Don’t deny based on
current presentation
• Set goals of independence
without a prosthesis
• Primary factors that can
be overcome with PT
• Contracture reduction (esp with a transfemoral)
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3
Q

What are the primary factors that can be overcome with PT when preparing a person for their first prosthesis?

A
  • Contractures
  • Sound side weakness
  • UE weakness
  • Excess weight
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4
Q

What are the components of contracture reduction when preparing a person for their first prosthesis?

A 
• Progresses slowly
• Measure and give pt a goal
• Passive stretching
• Active stretching when
ambulating with a prosthesis
• >25 degrees not advised
to fit
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5
Q

When you have a patient whose current presentation is not ideal for a prosthetic, what do you do?

A

Set measureable performance goals. Ex:
• Independent use of walker for a stated distance (100’)
• Must incorporate good
mechanics in preparation for the prosthesis

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6
Q

What is the progression for assisted prosthesis use?

A
  • Contact guard/min assist
  • SBA , stand by assist
  • Supervision
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7
Q

What are the characteristics of modified independent prosthesis use?

A
  • Takes longer

- Use of ass. device

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8
Q

What kind of prosthesis can be helpful for transfers in a patient that has being decided to be a non candidate for a prosthesis?

A

Trans-tibial limbs

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9
Q

What kind of prosthesis can be helpful for household ambulation in a patient that has being decided to be a non candidate for a prosthesis?

A

Trans-femoral.
• Use a locking knee
• May free up their hands for certain activities

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10
Q

What are the goals for the 1st PT session of a person with a prosthetic?

A 
Goal 1
  - Don’t compromise your PT session with poor fitting limbs that cause you more problems
Goal 2
  - Solve issues within your
scope without the prosthetist
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11
Q

What are the parts of a trans-tibial limb and what is their function?

A 
• Socket
  - Weight support
• Inner Liner
  - Protect skin, absorb shock
• Suspension
  - Secures prosthesis to limb
• Foot/ankle
  - Transfers weight to the
ground
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12
Q

What are the weight bearing regions that needs to be evaluated in a trans-tibial limb, before putting the prosthesis on a patient?

A
  • Patella tendon
  • Medial tibial flare
  • Pre-Tibial musculature
  • Gastroc muscle belly
  • Fibular shaft
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13
Q

How is the trans-tibial/femoral limb inner liner worn?

A
  • Invert inside out and roll onto limb
  • Adheres to the skin
  • Protection against shear
  • Shock absorbing
  • Conforming
  • Airtight
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14
Q

What are the characteristics of the suction suspension

sleeve, used in a trans-tibial limb?

A

Attached to the prosthetic socket, and is rolled on to the thigh. It makes an airtight seal on the skin, that does a great job of reducing movement between the residual limb and the prosthesis

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15
Q

What are the characteristics of the pin lock suspension, used in a trans-tibial limb?

A

Popular for ease of use and having less surface coverage of the skin. The liner is rolled on to the skin, with a pin attached at the end of the liner. When the patient dons the prosthesis, the pin will lock at the distal end of the segment, keeping the prosthesis stable on the limb, as long as the liner adheres properly to the skin. A release button is pushed to disengage the pin and allow the prosthesis to be removed.

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16
Q

What are the characteristics of the elevated vacuum suspension, used in a trans-tibial limb?

A

Requires sleeve and electric or mechanical pump. Used to provide maximum suspension capabilities. A suspension sleeve is used to provide an airtight environment, and a pump is integrated into the prosthesis to keep a constant draw on the limb

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17
Q

Why are socks worn over the liner, before putting the prosthesis on?

A

To adjust the tightness and support of the residual limb within the socket

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18
Q

What will a patient report when too few socks are used in a prosthesis?

A

Pt reports distal patella and end pressure. And will carry excess weight at the distal end of the limb

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19
Q

What will a patient report when excess socks are used in a prosthesis?

A

Pt reports pressure at tibial tubercle. And won’t get fully into the socket

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20
Q

What are the possible causes for a patient to feel distal end pressure?

A

• Excess contact
• Distal gapping and lack of
contact
• Do a distal contact test

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21
Q

What are the type of movements a prothetic foot/ankle can have?

A
  • Torque absorbing
  • Shock absorbing
  • Plantar/dorsiflexion
  • Inversion/eversion
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22
Q

If a patient complains of pain when you first help then don the prosthesis, what are the things to do before calling the prosthetist?

A 
• Take leg off and put on again
• When in gait does it hurt?
  - On heel, midfoot, or toe?
• Can you duplicate the
pain with the leg off?
• Are there pressure areas on the limb you can relate to gait?
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23
Q

What are the components of a trans-femoral limb?

A
  • Socket
  • Interface
  • Knee
  • Suspension
  • Foot/ankle
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24
Q

For a trans-femoral limb, how much flexion of prosthetic socket is needed?

A

Match the pt flexion +5

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25
Q

What are the weight bearing regions that needs to be evaluated in a trans-femoral limb, before putting the prosthesis on a patient?

A 
• Ischial tuberosity
  - Healthy skin coverage
• Quadriceps and hamstrings
• Lateral shaft of femur
• Tolerance to Circumferential
tightness
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26
Q

What are the characteristics of the lanyard suspension, used in a trans-femoral limb?

A

• Roll on the liner
• Feed the string or Velcro
through the hole in the end of socket
• May be used in temporary limbs

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27
Q

What are the characteristics of the sealing liner suspension, used in a trans-femoral limb?

A
  • Invert and roll on the limb
  • Alcohol lubricate the ring and socket
  • Works on a suction principle
  • For higher activity
28
Q

What are the characteristics of the skin suction suspension, used in a trans-femoral limb?

A 
• Socket is made a % smaller
that the limb
• Airtight seal holds the leg on
• Pull the limb into the socket
and screw in the valve
• Ensure there is full contact
• Tolerant skin (no adherances, invaginated scar,
inelastic tissue)
29
Q

How do we establish full distal contact in a trans-femoral prosthesis?

A 
• View and palpate distal
limb through the valve hole
• Note the lanyard length
that exits the socket (if it applies)
• Check Pelvis for length
equality. Leg will appear
high if not fully donned
30
Q

How do we establish correct rotational position of socket in a trans-femoral prosthesis?

A 
• Adductor longus should
be in anterior medial corner
• Ischial tuberosity
  - Have pt flex forward at the
hip
  - Palpate IT and have the pt
extend back into the socket
  - IT matches the seat on the
socket
31
Q

How do we establish a comfortable medial brim in a trans-femoral prosthesis?

A

• Pubic ramus free of pressure
• Adductor tissue contained
with no tissue roll present

32
Q

How do we check the anterior brim in a trans-femoral prosthesis?

A 
• No tissue rolls outside of
socket
• No anterior adductor
longus impingement
• Ample ASIS clearance
when sitting and bending
forward
33
Q

How do we check the lateral brim in a trans-femoral prosthesis?

A

• No gapping, especially
when shifting weight laterally
• Trochanter is free of pressure

34
Q

How do we check the posterior-medial brim in a trans-femoral prosthesis?

A
  • Ischial tuberosity containment/support

* Gluteal musculature support and loading

35
Q

What are the things to observe in a patient with a prosthesis in the sagittal plane?

A
  • Tibial progression

* Knee stability

36
Q

What are the things to observe in a patient with a prosthesis in the frontal (coronal) plane?

A
  • Varus/valgus knee
  • Pelvic shift
  • Trunk lean
37
Q

What are the gait deviations causes that are correctable by the PT?

A

Heel height, sock ply, donning technique, limb edema

38
Q

What are the gait deviations causes that are correctable only by the prosthetist?

A

Alignment, socket pain, knee adjustments and software programming

39
Q

What are some non-prosthetic causes of gait deviations?

A 
• Limits in ROM and
strength
• Muscular asymmetries
  - Common in transfemoral
• Co-morbidities
• Fear of falling
• Previously developed gait habits
40
Q

What are the prosthetic causes of rapid knee flexion in loading response?

A
  • Prosthetic heel too firm
  • Socket set too far anterior over the foot
  • Socket is excessively flexed (>7 degrees)
41
Q

What are the patient causes of rapid knee flexion in loading response?

A 
• Quadriceps weakness
• Heel of shoe too high
(patient has changed shoes)
• Patient has changed to a
higher heel
42
Q

What are the prosthetic causes of rapid knee extension in loading response?

A
  • Heel is too soft
  • Socket set too far posterior over the foot
  • Foot is excessively plantarflexed
43
Q

What are the patient causes of rapid knee extension in loading response?

A
  • Weak quadriceps
  • Habit
  • Patient changed to lower heel
44
Q

What are the prosthetic causes of rapid excessive toe out in loading response?

A

Prosthetic foot was aligned in excessive external rotation

45
Q

What are the patient causes of rapid excessive toe out in loading response?

A

External hip rotation (from weak internal rotators)

46
Q

What are the prosthetic causes of valgus moment at the knee out in midstance?

A 
• Foot excessively outset
• Excess valgus angulation in
alignment
• Fibular head pain
• Looseness in socket fitting
47
Q

What are the patient causes of valgus moment at the knee out in midstance?

A

• Short residual limb
• Ligament laxity with coronal
instability
• Wide base of support

48
Q

What are the prosthetic causes of varus moment at the knee out in midstance?

A
  • Foot excessively inset
  • Excessive varus angulation in alignment
  • Looseness in socket fitting
49
Q

What are the patient causes of varus moment at the knee out in midstance?

A
  • Short residual limb

* Ligament laxity with coronal instability

50
Q

What are the prosthetic causes of lateral bending of trunk in midstance?

A 
• Foot excessively outset
leading to a wide base of
support
• Prosthesis too short
• Socket aligned in hip
abduction
• Distal lateral femur pain
51
Q

What are the patient causes of lateral bending of trunk in midstance?

A 
• Weak hip abductors or
abductor contracture
• Very short residual limb
• Inability to weight-bear
• Fear or habit
52
Q

What are the prosthetic causes of an abducted gait in midstance?

A 
• Pubic ramus pressure
  - Medial brim too high
• Prosthesis too long
• Improper relief for distal
femur on lateral wall
• Foot excessively outset
53
Q

What are the patient causes of an abducted gait in midstance?

A
  • Hip joint abduction contracture
  • Weak gluteus medius
  • Fear or habit
54
Q

What are the prosthetic causes of an exaggerated lordosis in terminal stance?

A

Insufficient socket flexion built into limb

55
Q

What are the patient causes of an exaggerated lordosis in terminal stance?

A
  • Hip flexion contracture
  • Weak hip extensors
  • Weak abdominal muscles
56
Q

What are the prosthetic causes of a rapid knee flexion (Pelvic Drop Off ) in terminal stance?

A 
• Socket is too far anterior
over the foot
• Excessive knee flexion in
socket
• Foot too dorsiflexed
• Foot is too soft
57
Q

What are the patient causes of a rapid knee flexion (Pelvic Drop Off ) in terminal stance?

A

• Patient has changed to a

higher heel

58
Q

What are the prosthetic causes of a circumduction in swing phase?

A

• Prosthesis too long
- More likely to cause abducted gait
• Knee is too stable and difficult to flex (alignment or friction)

59
Q

What are the patient causes of a circumduction in swing phase?

A
  • Abductor tightness

* Knee control insecurity

60
Q

What are the prosthetic causes of a vaulting in swing phase?

A

• Prosthesis too long
- Verify in static evaluation, dual limb support
• Too much knee stability and won’t swing freely
• Plantarflexed foot
• Inadequate suspension
- Prosthesis “lengthens” in swing

61
Q

What are the patient causes of a vaulting in swing phase?

A
  • Fear of dragging the toe and falling

* Very Common HABIT!

62
Q

What are the prosthetic causes of excessive heel rise in swing phase?

A

Insufficient resistance to knee flexion

63
Q

What are the patient causes of excessive heel rise in swing phase?

A

Flexing hip too aggressively

64
Q

What are the causes of knee/foot whip in swing in swing phase?

A
  • Prosthesis was donned in rotation

* Knee is incorrectly rotated

65
Q

What is the remedy of knee/foot whip in swing in swing phase?

A 
• Re-donn limb in correct
rotation
• Check landmarks
• Have prosthetist adjust knee
rotation
66
Q

What are the prosthetic causes of terminal impact in swing phase?

A
  • Insufficient extension resistance

* Mechanical extension assist too strong

67
Q

What are the patient causes of terminal impact in swing phase?

A
  • Too strong hip flexion

* Patient may practice hip extension to speed knee extension

Advanced movement analysis (6 decks)

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