Exam 5: Transfemoral Gait Deviations

Question 1

Gait deviations you are likely to see intial contact to loading response

Answer 1

1. Rotation of prosthetic foot at initial contact
2. instability of prosthetic knee
3. Foot slap

Question 2

Problem with amputee that may lead to rotation of prosthetic foot at initial contact

Answer 2

too vigorous extension of knee by amputee

Question 3

Problems with prosthesis that may lead to rotation of prosthetic foot at IC (2)

Answer 3

• heel cushion too firm/ too hard PF bumper
• loose socket

Question 4

Problems with amputee that may result in instability of P.knee during IC and LR

Answer 4

• weak hip extensors
• significant flexion contracture- the more severe the contracture, the earlier in stance it cause instability; therefore most contractures cause problems in or near mid-stance

Question 5

Problems with prosthetic that may result in instability of P.knee during IC and LR (4)

Answer 5

• unstable knee (too far anterior to Tr-Kn-An line)
• too firm heel cushion or PF bumper
• insufficient flexion in socket
• heel too high or excessive dorsiflexion

Question 6

Reasons foot slap may occur (2)

Answer 6

Prosthetic: Posterior bumper too soft

Amputee: forceful driving of prosthesis into ground to ensure knee stability

Question 7

Gait Deviations you are likely to observe in Mid-stance

Answer 7

1. Ipsilateral bending of trunk
2. Contralateral bending of trunk

Question 8

Problems with the amputee that may cause I-lat trunk leaning during mid-stance

Answer 8

• very short RL
• habit/fear/poor balance
• weak abductors
• abduction contracture
• habit or poor gait training (inadequate weight shifting)

Question 9

Problems with the prosthesis that may cause I-lat trunk leaning during mid-stance (4)

Answer 9

• too short
• lateral wall allows too much abduction of femur
• foot outset
• distal lateral RL pain

Question 10

Problem causing contralateral trunk lean during

mid-stance

Answer 10

cotch pressure

Question 11

Gait Deviation likely to be observed terminal stance to pre-swing

Answer 11

Drop-off at end of stance

Question 12

Problems that may cause drop-off at end of stance

Answer 12

Amputee: nothing

Prosthesis:

• inadequate limitation of DF
• too soft DF bumper
• toe break too far posterior
• socket too anterior on pilon
• foot too posterior

Question 13

Gait deviations you are likely to see dring intial swing (4)

Answer 13

1. excessive heel rise
2. excessive pistoning
3. lateral whip
4. medial whip

Question 14

Problems with amputee that may cause excessive heel rise during initial swing

Answer 14

forcible hip flexion

Question 15

Problems with prosthesis that may cause excessive heel rise during initial swing (3)

Answer 15

• insufficient friction at knee
• inadequate extension aid
• improper knee selection

Question 16

Problems that may cause excessive pistoning during intial swing

Answer 16

Amputee: may occur w/ lg. flabby RL w/ poor muscle control

Prosthesis: pt. not seated in socket (socket too big or improperly donned)

Question 17

Problem with amputee that may cause lateral whip during initial swing

Answer 17

improper donning

Question 18

Problem with prothesis that may cause lateral whip during initial swing

Answer 18

too much IR at knee

Question 19

Problem with amputee that may cause medial whip during initial swing

Answer 19

improper donning

Question 20

Problems with prothesis that may cause medial whip during initial swing (2)

Answer 20

• too much ER at knee
• socket too loose

Question 21

Gait deviations that may be observed during mid-swing (3)

Answer 21

1. vaulting
2. circumduction
3. abducted gait

Question 22

Where is the pressure focused during an abducted gait deviation?

Answer 22

abducted gait causes excessive distal. lateral pressure

Question 23

Problems with the amputee that may cause vaulting during mid-swing (4)

Answer 23

• habit
• poor balance/ poor knee control, ex: weak hip extensors
• fear of stubbing prosthetic toe
• weak hip flexors or improper gait training for intiation of flexion

Question 24

Problems with prothesis that may cause vaulting during mid-swing (4)

Answer 24

• too long
• inadequate suspension
• too much knee friction leading to insufficient knee flexion
• excessive built-in knee stability (such as knee joint too far posterior to TKA line)

Question 25

Problems with amputee that may cause circumduction during mid-swing (3)

Answer 25

* habit * weak hip extensors * insecurity regarding knee control

Question 26

Problem with prosthesis that may cause circumduction during mid-swing

Answer 26

too much stability at knee joint (too much friction or knee posterior to TKA line)

Question 27

Problems with amputee that may cause an abducted gait during mid-swing (4)

Answer 27

* abduction contracture * habit * fear (such as results from weak hip extensors) * RL pain (crotch pressure)

Question 28

Problems with prosthesis that may cause an abducted gait during mid-swing (3)

Answer 28

* too long * too high medial wall * too much foot outset or valgus alignment between shank and socket may mimic this

Question 29

Gait deviations that may be observed during terminal swing and in general (3)

Answer 29

_Terminal Swing_ * terminal impact _General_ * uneven timing (short prosthetic stance) * uneven arm swing

Question 30

What is terminal impact?

Answer 30

The prosthetic shank comes to a sudden stop with a visible and possibly audible impact as the knee reaches full extension

Question 31

Problems with amputee that may cause terminal impact during terminal swing (2)

Answer 31

* intentional- to get audible cue * too vigorous hip flexion followed by strong hip extension

Question 32

Problems with prosthesis that may cause terminal imact at terminal swing (2)

Answer 32

* insufficient friction at knee * too strong extension aid

Question 33

Problems with amputee that may cause uneven timing (3)

Answer 33

* weakness/unstable knee * poor balance/insecurity * pain

Question 34

Problems with prosthesis that may cause uneven timing (5)

Answer 34

* socket fits poorly causing pain * alignment instability * excessive DF * poor suspension * unaccommodated hip flexion contracture

Question 35

Problems with amputee that may cause uneven arm swing (3)

Answer 35

* habit * poor balance * insecurity

Question 36

Problems with prosthesis that may cause uneven arm swing (2)

Answer 36

* occassional due to stump pain (that's what Mincer has on the sheet- seems weird) * inadequate suspension

Question 37

Some sage advice

Answer 37

Question 38

What gait deviations might you observe in a transfem amputee with weak hip extensors? (3)

Answer 38

1. instability of prosthetic knee during IC to LR phase 2. circumduction during mid-swing 3. abducted gait during mid-swing (fear component with this)

Question 39

What gait deviations might you see in a transfem amptee with an abduction contracture? (2)

Answer 39

1. ipsilateral bening of trunk during mid-stance 2. abducted gait during mid-swing

Question 40

What gait deviations might you see in a transfem amputee with poor balance and/or fear? (5)

Answer 40

1. ipsilateral trunk bending during mid-stance 2. vaulting during mid-swing 3. abducted gait during mid-swing 4. uneven timing (short prosthetic stance) 5. uneven arm swing

Question 41

What gait deviations might you see if the transfem prosthesis has too much DF? (3)

Answer 41

1. instability of prosthetic knee during IC to LR 2. drop-off at end of stance during terminal swing to mid-stance 3. uneven timing (short prosthetic stance)

Question 42

What gait deviation might you see in a transfem amputee with a significant hip flexion contracture?

Answer 42

instability of the prosthetic knee during IR to LR

Question 43

What gait deviation are you likely to see in a transfem amputee with weak hip flexors?

Answer 43

Vaulting during mid-swing

Question 44

What gait deviations might you see in a transfem prothesis if the socket is too loose? (2)

Answer 44

1. rotation of prosthetic foot at IC 2. medial whip

Question 45

What gait deviations might you see if the transfem prosthesis has a heel cushion that is too firm or PF bumper is too hard? (2)

Answer 45

1. rotation of prosthetic foot at IC 2. instability of prosthetic kneeduring IC to LR

Question 46

What gait deviation might you see in transfem prothesis if the posterior bumper is too soft

Answer 46

foot slap during IC to LR

Question 47

What gait deviation might you see of the transfem prosthesis is too short?

Answer 47

ipsilateral trunk bending during mid-stance

Question 48

Gait deviations you are likely to see due to lack of or poor gait training according to Mincer (3)

Answer 48

* instability of prosthetic knee during IC-LR * I-lat trunk bending during midstance * vaulting during mid-swing

Question 49

Gait deviation that have nothing to do with the amputee and we can only blame the prosthesis (1)

Answer 49

Drop-off