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Prosthetics/Orthotics > Gait & Gait Deviation for Prosthetics > Flashcards

Gait & Gait Deviation for Prosthetics Flashcards

1
Q

What is each part of the stance phase and the definition for each part?

A
  • Initial Contact: instant heel contacts the ground
  • Loading Response: Heel contact to foot flat
  • Midstance: Foot flat until contralateral extremity lifts off the grounds
  • Terminal Stance: From midstance through heel off of the WB extremity
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2
Q

What is each part of the swing phase and the definition for each part?

A
  • Preswing: Heel off until toe off of the WB extremity
  • Initial Swing: From toe off until max knee flexion
  • Midswing: From max knee flexion until tibia is in vertical position
  • Terminal Swing: From vertical tibia until just before initial contact
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3
Q

Where are the ground reaction forces during initial contact?

A
  • Posterior to ankle
  • Anterior to knee
  • Anterior to the hip
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4
Q

What is velocity?

A

Rate of linear forward motion of the body (m/sec)

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5
Q

What is cadence?

A

Number of steps taken per unit of time (steps/min)

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6
Q

What is stride length?

A

Heel strike to ipsilateral heel strike

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7
Q

What is step length?

A

Heel strike to contralateral heel strikeWha

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8
Q

What is step width?

A

Width of base of support

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9
Q

What is stance?

A
  • Weight acceptance
  • Single limb support
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10
Q

What is swing?

A
  • Foot clearance
  • Swing limb advancement
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11
Q

What items should be considered in TT static standing alignment eval?

A
  • Equal weight distribution
  • Level pelvis
  • ASIS, PSIS, IT
  • Foot position
  • Knee position
  • Hip position
  • Position of pylon
  • Pain
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12
Q

What can occur when setting the knee socket in slight flexion?

A
  • Accommodate knee flexor contracture
  • Increase exposure to patellar tendon for WB
  • Prevent genu recurvatum
  • Help resist tendency of residual limb to piston
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13
Q

What occurs with TT medial displacement of foot?

A
  • Maintain fairly normal BOS
  • Loads more pressure on medial aspect
  • Decreased pressure on fibular head
  • Slight varus force created at knee
  • Medial displacement of GRF
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14
Q

What does foot insert refer to?

A

Displacement of prosthetic foot toward the midline of the body

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15
Q

What does foot outset refer to?

A

Displacement away from the midline

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16
Q

What are some common gait deviation for patients with transtibial amputation?

A
  • Excessive knee flexion in loading response
  • Insufficient knee flexion in loading response
  • Lateral/ varus thrust at midstance
  • Medial/valgus thrust at midstance
  • Ipsilateral lateral trunk bending during prosthetic limb stance
  • Sound side vaulting
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17
Q

What are some prosthetic causes of excessive knee flexion in loading response after TTA?

A
  • Heel height to high
  • Stiff heel cushion
  • Excessive ankle DF
  • Socket too far anterior or tilted forward
  • Foot too posterior
  • Socket excessively flexed
  • Prosthesis too long
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18
Q

What are some anatomical causes of excessive knee flexion in loading after TTA?

A
  • Knee and/or hip flexion contracture
  • Weakness of quads
  • Pain in residual limbs
  • Poor balance
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19
Q

What is the functional significance of excessive knee flexion in loading after TTA?

A
  • Impaired shock absorption
  • Increased demand on quadriceps to prevent further knee flexion
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20
Q

What are the prosthetic causes of insufficient knee flexion in loading response after TTA?

A
  • Low shoe heel
  • Soft heel cushion
  • Excessive ankle PF
  • Socket too far posterior or tilted posterior
  • Foot too far anterior
  • Socket insufficiently flexed
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21
Q

What are some possible anatomical causes of insufficient knee flexion in loading response after TTA?

A
  • Extensor spasticity
  • Weakness of quads
  • Anterior-distal pain
  • Arthritis
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22
Q

What is the functional significance of insufficient knee flexion in loading response after TTA?

A
  • Reliance on bony structures stance stability
  • Insufficient shock absorption
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23
Q

What are the prosthetic causes of lateral/varus thrust at midstance after TTA?

A
  • Excessive foot inset
  • Poor M-L stability
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24
Q

What is the anatomical cause of lateral/varus thrust at midstance after TTA?

A

Proximal weakness

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25
Q

What is the functional significance of lateral/varus thrust at midstance after TTA?

A

Increased stress on medial knee joint, which could lead to early degenerative changes

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26
Q

What are the prosthetic causes of medial/valgus thrust at midstance after TTA?

A
  • Excessive foot outset
  • Poor M-L stability
27
Q

What is the anatomical cause of medial/valgus thrust at midstance after TTA?

A

Proximal weakness

28
Q

What is the functional significance of medial/valgus thrust at midstance after TTA?

A

Increased stress on lateral knee joint- could lead to early degenerative changes

29
Q

What is the prosthetic cause of ipsilateral trunk bending during prosthetic limb stance after TTA?

A

Prosthetic length too short

30
Q

What are the anatomical causes of ipsilateral trunk bending during prosthetic limb stance after TTA?

A
  • Poor gait training
  • Poor proprioception
  • Weak ipsilateral hip abductors
31
Q

What are the prosthetic causes of sound side vaulting after TTA?

A
  • Prosthesis too long
  • Inadequate prosthetic suspension
  • Prosthetic positioned in too much PF
32
Q

What are the anatomical causes of sound side vaulting after TTA?

A
  • Poor proprioception
  • Poor gait training
  • Lack of confidence
33
Q

What is the functional significance of sound side vaulting after TTA?

A
  • Deviation to assist w/ foot clearance
  • Increased energy expenditure
34
Q

Is more stance time observed on prosthetic or intact limb after TTA?

A

Stance time on prosthetic < intact

35
Q

Is longer step length observed on prosthetic or intact limb after TTA?

A

Step length prosthetic > intact

36
Q

What are contributing factors to step length/single stance time asymmetries?

A
  • Patient confidence
  • Pain
  • Improper weight shifting
37
Q

If short step length is observed on prosthetic side what is the possible cause?

A

Knee flexion contracture

38
Q

What occurs if the TFA prosthetic socket is set in flexion?

A
  • Accommodates hip flexion contracture
  • Weight line shifts posterior to knee joint center
39
Q

What are some control mechanisms for knee stability for patients with TFA?

A
  • Alignment of knee joint axis in sagittal plane
  • Inherent mechanical stability of the knee
  • Voluntary control swing muscular power
  • Microprocessor controlled
40
Q

What are common gait deviations for patients with transfemoral amputation?

A
  • Excessive abduction in stance
  • Excessive ipsilateral trunk bend in stance
  • Excessive forward trunk flexion in stance
  • Contralateral vaulting, hip hike, circumduction
  • Medial whip in swing
  • Lateral whip in swing
  • Foot rotation at loading response
41
Q

What are some prosthetic causes of excessive abduction in stance in patients after TFA?

A
  • Long prosthesis
  • Abducted socket
  • Sharp or high medial wall
  • Inadequate suspension
42
Q

What are some anatomical causes of excessive abduction in stance in patients after TFA?

A
  • Abduction contracure
  • Lateral/ distal pain
  • Weakness of hip flexors or hip adductors ipsilaterally
  • Adductor roll
43
Q

What is the functional significance of excessive abduction in stance after TFA?

A

Widens BOS for stability

44
Q

What is the prosthetic causes of excessive ipsilateral trunk bend in stance after TFA?

A
  • Short prosthesis
  • Sharp or high medial wall
  • Prosthesis aligned in abduction
45
Q

What is the anatomical causes of excessive ipsilateral trunk bend in stance after TFA?

A
  • Abduction contracture
  • weak abductors
  • hip pain
  • instability
  • Short residual limb
  • Lack of proprioception
  • Poor balance
  • Hypersensitive or painful residual limb
46
Q

What is the functional significance of excessive ipsilateral trunk bend in stance after TFA?

A

Increased energy expenditure

47
Q

What are the prosthetic causes of excessive forward trunk flexion in stance after TFA?

A
  • Socket too big
  • Poor suspension
  • unstable knee unit
48
Q

What are the anatomical causes of excessive forward trunk flexion in stance after TFA?

A
  • Instability
  • Hip flexion contracture
  • Pain w/ ischial WB
49
Q

What is the functional significance of excessive forward trunk flexion in stance after TFA?

A
  • Forward displacement of COM
  • Increased energy expenditure
50
Q

What are some other causes of excessive forward trunk flexion in stance after TFA?

A

Short walker or crutches

51
Q

What are the prosthetic causes of contralateral vaulting, hip hiking, & circumduction after TFA?

A
  • Long prosthesis
  • Locked knee
  • Inadequate suspension
  • Loose socket
  • Foot PF
52
Q

What is the functional significance of contralateral vaulting, hip hiking, & circumduction after TFA?

A
  • Assists with foot clearance
  • Increased energy expenditure due to displacement of COM
53
Q

What are the anatomical causes of contralateral vaulting after TFA?

A
  • Residual limb discomfort
  • Fear of stubbing toe
  • Short residual limb
  • Painful hip/residual limb
54
Q

What are the anatomical causes of hip hike after TFA?

A
  • Weakness of hip flexors
  • Difficult initiating knee flexion
55
Q

What are the anatomical causes of circumduction after TFA?

A
  • Abduction contracture
  • Poor knee control - inability to initiate knee flexion
  • Weakness of hip flexors
  • Painful anterior distal residual limb
56
Q

What are the prosthetic causes of medial whip in swing after TFA?

A
  • Faulty socket contour
  • Prosthesis donned in malrotation (ER)
  • Poor socket fit
  • Knee axis in excessive ER
57
Q

What is the anatomical cause of medial whip in swing after TFA?

A

Weakness of hip rotators

58
Q

What is the functional significance of medial whip in swing after TFA?

A

Assists with foot clearance

59
Q

What are the prosthetic causes of lateral whip in swing after TFA?

A
  • Faulty socket contour
  • Foot malrotated
  • Prosthesis donned in malrotation (IR)
  • Knee in IR
60
Q

What is the anatomical cause of lateral whip in swing after TFA?

A

Weakness of hip rotators

61
Q

What is the functional significance of lateral whip in swing after TFA?

A

Assists with foot clearance

62
Q

What are the prosthetic causes of foot rotation at loading response after TFA?

A
  • Stiff heel cushion (rigid SACH foot)
  • Malrotated foot
  • Loose fitting socket
63
Q

What are the anatomical causes of foot rotation at loading response after TFA?

A
  • Poor muscle control
  • Improper training
  • Weak hip medial rotators
64
Q

What is the functional significance of foot rotation at loading response after TFA?

A
  • Poor stance stability
  • Alters forward progression

Prosthetics/Orthotics (12 decks)

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