Exam 1 Flashcards
(178 cards)
1
Q
purpose of locomotion
A
mobility and forward progression
2
Q
tasks of gait
A
support body and prevent collapse of weight bearing lower limb
maintain upright posture and balance
control the foot - insure ground clearance during swing / soft initial heel strike
generate mechanical energy to propel the body forward
provide shock absorption and stability to slow forward propulsion of the body
3
Q
% of gait cycle (GC)
- stance
- swing
A
60
40
4
Q
explain double limb support’s role in GC
A
beginning and end of each stance phase
10% each of GC
– 20 total
5
Q
explain double limb stance in running
A
nonexistent
6
Q
kinematics
A
displacement
velocity
acceleration
7
Q
normal swing to stance time ratio
A
0.6
8
Q
timing and degree of maximal hip flexion during gait
A
initial contact / terminal swing
25 degrees
9
Q
timing and degree of maximal hip extension during gait
A
terminal stance
20 degrees
10
Q
timing and degree of max knee flexion
A
heel off / initial swing
60 degrees
11
Q
timing and degree of max knee extension
A
initial contact
0 degrees
12
Q
timing and degree of max dorsiflexion
A
late stance before heel off
10 degrees
13
Q
timing and degree of max plantarflexion
A
toe off
20 degrees
14
Q
timing and degree of max subtalar pronation/supination
A
pro = loading response
sup = heel - toe off
4-6 degrees
15
Q
hip movement in the frontal plane during gait
A
pelvis toward WB LE
– adduction
drop of pelvis on NWB LE
– abduction
16
Q
explain transverse motion at hip during gait
A
IR from weight acceptance to midstance
ER from midstance to midswing
17
Q
ankle @ initial contact
- external moment
- muscle action
A
posterior to knee = plantarflexion
eccentric - dorsiflexors
18
Q
knee @ initial contact
- external moment
- muscle action
A
- posterior to knee = flexion
- eccentric = quads
19
Q
hip @ initial contact
- external moment
- muscle action
A
anterior to hip = flexion
isometric/concentric = extensors
20
Q
ankle @ loading response
- external moment
- muscle action
A
posterior to ankle = plantarflexion
eccentric = dorsiflexors
21
Q
knee @ loading response
- external moment
- muscle action
A
posterior to knee = flexion
eccentric = quads
22
Q
hip@ loading response
- external moment
- muscle action
A
none
concentric = extensors/abductors
23
Q
role of hip mm during loading response
A
stabilize and generate power
24
Q
ankle @ midstance
- external moment
- muscle action
A
at midfoot = transitioning PF –> DF
eccentric = PFs
25
knee @ midstance
- external moment
- muscle action
anterior to knee = extension
PF-knee extensors coupling concentrically
26
hip @ midstance
- external moment
- muscle action
changing from anterior to posterior = flexion --> extension
concentric --> almost none
27
ankle @ terminal stance
- external moment
- muscle action
anterior to ankle = dorsiflexion
concentric = PF
28
knee @ terminal stance
- external moment
- muscle action
anterior to knee = extension
none
29
hip @ terminal stance
- external moment
- muscle action
posterior to hip = extension
none
-- passive stretch of flexors
30
ankle @ toe-off
- external moment
- muscle action
anterior to ankle moving posteriorly = reduced DF
concentric changing to eccentric = PF quickly transitioning to DF
31
knee @ toe-off
- external moment
- muscle action
posterior to knee = flexion
none
32
hip @ toe-off
- external moment
- muscle action
minimal moment
concentric = flexors
33
ankle @ initial swing
- external moment
- muscle action
PF
concentric DF
34
knee @ initial swing
- external moment
- muscle action
posterior to knee = flexion moment
quads
35
hip @ initial swing
- external moment
- muscle action
posterior to hip = extension
concentric hip flexors
36
ankle @ midswing
- external moment
- muscle action
moving from midline to posterior = zero moment to a PF moment
concentric DF
37
knee @ midswing
- external moment
- muscle action
posterior to anterior = flexion turning into extension
HS eccentric control
38
hip @ midswing
- external moment
- muscle action
none
glute eccentric
39
ankle @ terminal swing
- external moment
- muscle action
0 --> PF
DF eccentric
40
knee @ terminal swing
- external moment
- muscle action
anterior moving posterior = extension --> flexion
co-contraction of HS / Glutes
41
hip @ terminal swing
- external moment
- muscle action
posterior = extension
hip extensor eccentric
42
what supports the ankle during stance
valgus moment supported by deltoid ligaments
43
what supports the knee during stance
varus moment supported by LCL
44
what supports the hip during stance phase
varus moment supported by ABductors
glute med/min
TFL
45
COM location in adults vs children
anterior to S2
T12
46
correction vs accommodation
if deformity has mobility
fixed deformity
47
explain 3 point pressure system
class 1 lever
2 stabilizing forces
-- one above and one below corrective
1 corrective force
48
moment equation
force x length of lever
-- more lever = less force
49
force equation
pressure x area
-- more area = less pressure
50
elements of preorthotic examination
limb / joint movement
-- either excessive, abnormal or insufficient
fixed/flexible deformity
51
orthotic goal of "assist"
when joint movement is insufficient
52
orthotic goal of "stabilize"
stopping or limiting motion
- excessive, abnormal, or unwanted
53
orthotic goal of "protect"
reduce excessive, unwanted, or damaging forces
54
orthotic definition of "free"
no control is exerted -- free to move
55
orthotic definition of "resist"
resisting unwanted motion
application of force to decrease velo/force
56
orthotic definition of "stop"
stop/limit motion
-- which specific motion and when in gait
57
orthotic definition of "hold"
control/eliminate all motion at a joint in all planes
58
conventional orthoses are made of
metal / leather
59
molded orthotics are made of
thermosetting plastics
thermoplastics
composite materials
60
hybrid orthoses are made of
combo of conventional and molded
-- will be hinged/articulated
61
what is a positive cast
3D replica / model of the patient's body part that is to be braced
62
what is a negative cast
mold or impression of the part of the client's body
-- empty due to "negative" space
63
features of therapeutic footwear
enhance shock absorption
reduce shear stresses
accommodate/support foot deformities
accommodate/relieve pressure-sensitive areas
accommodate shoe inserts/other orthotic devices
64
general parts of the shoe
upper (over dorsum)
sole
reinforcements
65
what is a "last"
real/virtual model of a foot that the shoe is constructed over
66
pedorthotist
professional who fits foot orthoses, shoes and shoe modifications
67
important things to consider from a shoe's "upper"
shoe depth
toe box height/width
height of quarters
throat style
type of closure
material
stabilizers for hindfoot/rearfoot
68
explain extra-depth shoes
when more inserts are needed, the shoe depth is increased
- additional 1/4 inch of depth in the shoe
- two 1/4 inch inserts
69
how to fit length/width of toe box
length = should have 1/2 inch to the end of the shoe from the longest toe
width = width of foot at metatarsal head
70
define quarters
sides and back of shoe upper
-- will either be above or below malleoli
71
explain the blucher throat style
preferred for most orthosis
-- greater adjustability for changes in foot volume due to larger opening
72
define a "counter"
reinforcement of the posterior aspect of the quarters at the heel
73
portions of the sole of a shoe
outsole
welt
midsole
insole
heel
shank
74
what must a sole be able to do to facilitate gait? what specific part of gait?
flexible enough to facilitate "toe-break"
terminal stance
75
what is a "shank"
longitudinal reinforcement of midportion of non-athletic shoe
76
what / where does a shank work on
determines where the sole flexes during terminal stance
can go from heel to
- met head
- crease of toes (sulcus)
- tip of big toe
77
what can a stiff heel cause if worn with rigid orthoses? implication?
early stance phase knee instability
-- need to have a compressive heel if wearing a rigid ortho to balance forces
78
explain lower vs higher ______
idk what im getting at here.. lmk if you know
low = knee hyperextension or gait deviations
high = excessive stance phase knee flexion
79
main methods of shoe construction (aka lasting)
slip
board
combination
-- lasting
80
compare slip vs board lasted shoe
slip = lightweight and flexible
board = less flexible / more stable
81
explain internal inserts
adding materials directly to insole/inserts
82
goal of internal modifications
cushioning/shock absorption
relieve pressure sensitive areas
balance leg length discrepancies
83
pros of internal modificaitons
do not permanently alter shoe
relatively inexpensive
can be used as trial devices for more longer-lasting devices
84
explain external modifications
added to outsole
-- permanent and cannot be moved
-- will experience wear and tear
85
what are external modifications used for
balance leg length discrepancies
relieve pressure sensitive areas on plantar aspect
shift center of pressure on weight-bearing foot
86
indication of internal vs external leg length discrepancy lift? how to do so?
LL discrepancies up to 3/8in
internal = heel wedges or 3/4 length inserts to met head
external = larger lift to outsole
87
what are heel wedges used for?
address rearfoot problems
-- fixed or functional valgus, varus, or equinus
88
explain thomas vs reverse thomas heel
T = extends further anterior on medial side
RT = extends further anterior on lateral side
89
what is a SACH and what is it for
solid ankle cushion heel
cushion limb during loading of heel strike
90
explain heel flares
increase size of foot base of support
inflare = reduce calcaneal eversion
outflare = reduce calcaneal inversion
91
rocker sole
curved external modification that allows foot to roll from heel strike to toe-off without bending the foot
92
what is the point of rocker soles
reduce pressure on met heads
stimulate/substitute ankle PF/DF or toe extension in stance
93
role of forefoot rocker
stimulate toe extension during late stance phase
94
role of heel/posterior rocker
substitutes for PF during loading response
95
explain accommodative foot orthoses
provide protection/relief to areas of the foot
reduction of plantar pressure/shock absorption
96
explain functional orthoses
control and support subtalar joint, rearfoot, and forefoot
97
what is a "post"
wedges of material added to orthotic base to balance or support a fixed or correct a flexed deformity
98
explain an extrinsic post
wedges of material added to orthotic base, typically the inferior (floor) surface
99
explain UCBL orthoses
rigid foot orthosis
- corrects hindfoot valgus
- limits subtalar joint motion
-
100
what is a SMO
supramalleolar foot orthosis
corrects rearfoot valgus
101
foot orthoses for non-ambulatory children
Denis Browne abduction bar
dynamic foot abduction orthosis
hinged shoe or bebax bootie
102
what is used to treat CTEV and what is it?
denis browne abduction bar
dynamic foot abduction orthosis
club foot
103
what does the hinged shoe correct
congenital metatarsal adductus (varus)
104
what is a total contact cast used for? what does it do?
used to protect pressure ulcerations in an insensitive foot
- immobilizing
- preventing edema
- reducing pressure
- reducing shear force
105
what is a "CROW" boot
charcot restraint orthotic walker
- for diabetic patients with charcot neuropathy
106
what are stirrup AO composed of
rigid plastic struts that cover the malleoli and lower one-third of the leg
107
what is a lace up AO?
basically an ASO ankle brace
108
what is an AFO-PLS
posterior leaf spring
assists dorsiflexion during swing
109
what is an AFO-SA
solid ankle AFO
-- does not permit any movement
will prevent knee hyperextension
110
what is and why are GR-AFOs used
ground reaction AFO
those who need orthotic control at both ankle and knee
in order to keep knee from buckling
111
explain the purpose of a spiral AFO
uncoils during weight acceptance to allow PF
and
will return coiled during swing to avoid foot drop/drag
112
explain the design of spiral vs hemispiral AFO
spiral = starts medial ends medial
hemi = starts lateral and ends medial
-- from the foot plate up
113
indication of spiral AFO
does not interfere with normal DF/PF action
114
toe-off AFO are considered dynamic because
the composite material can deform and has elastic properties
-- not like made of elastic things, more so can return to OG shape
115
cons of a rigid full-length foot plate? why does this matter?
interference of toe extension
delayed knee flexion during terminal stance
--> indicates anterior floor reaction orthosis
116
explain TRAFOs
tone reducing AFO
-- indicated for neurological patients with hypertonicity
--> molded to reduce spasticity
117
how does a TRAFO work
providing a prolonged stretch to PFs and long toe flexors
constant pressure to tendons
inhibit tactile reflexes
improve muscle recruitment sequencing
118
indication of hinged AFO
free sagittal movement
119
what is a PTB-AFO
patellar tendon bearing AFO
120
purpose of polycentric orthotic knee joints
have an instantaneous center of rotation of anatomical joint
121
explain the posterior offset knee joint and its purpose
single axis mechanical joint that is displaced posteriorly
enhances knee extension during stance by keeping GRF anterior
122
types of knee locks and stops in KAFOs
drop-ring
Cam lock with bail release
adjustable knee lock
123
explain what a SC-KAFO is and how they help
stance control KAFO
engages knee control during stance and disengages for swing phase
124
supracondylar GR-AFO purpose
for larger individuals that need greater forces
- increases lever arm and surface area of force distribution
125
goal of rehabilitative KOs
ortho post-op to protect surgically repaired tissues
126
explain varus knee deformity related to OA
medial compartment OA
127
goal of unloading brace for medial knee OA
application of abduction moment
-- move joint forces more laterally
128
if you notice knee buckling during stance, what orthoses are indicated
KAFO
- posterior offset knee
- knee lock
- stance control
Floor Reaction AFO
---> DF Stop
129
if you notice hyperextension during stance, what orthoses are indicated
KAFO w extension stop
Floor reaction AFO
--> PF stop
swedish knee cage
small heel lift
130
if you notice flexible excessive valgus/varus during stance, what orthoses are indicated
KAFO free knee
Functional KO w/free knee
131
if your patient has knee pain during stance, what orthoses are indicated
unloading (med/lat OA)
patellofemoral KO
132
explain wearing schedule education for new orthotics
30 min, 3x daily
-- if no issues, double wear time
133
explain the steps of the orthotic checkout
examination of orthosis
reexamination of client's physical status
static and dynamic examination of orthosis on client
examination of skin during sustained orthotic wear
134
explain relationship between full and 3/4 length (on the foot) orthotics
full = more control, difficult to fit in every shoe
3/4 = less control, more able to fit in every shoe
135
explain rigid firmness FO
greatest amount of control
-- generally for pronation
136
explain soft firmness FOs
those with accommodative problems
-- increased SA to decrease pressures
137
explain intrinsic vs extrinsic posting
intrinsic = modification made to shape of positive impression
extrinsic = external addition to build up the orthotic
138
role of rearfoot posting
abnormal hindfoot pronation
139
role of forefoot posting
correct varus or valgus deformity
- either medial or lateral wedge
140
gold standard for casting
plaster casting
- functional orthotics
141
explain plaster casting
NWB - subtalar neutral
142
for someone who is full/semi vs NWB, how do we cast?
full/semi = impression foam or molding pillow
NWB = plaster cast
143
heel/shoe lifts are typically used to treat
achilles tendinopathy
ankle equinus
LL inequalities
if contralateral CAM boot is worn
144
functional determinants of gait
stance stability
clearance in swing
swing pre-positioning
adequate step length
energy conservation
145
explain the heel rocker
initial contact --> foot flat
loading response
-- > DF and knee extensors are eccentrically working
146
explain the ankle rocker
as tibial advancement occurs in mid-stance
ankle PF eccentrically working
147
explain forefoot rocker
heel rise to toe off
ankle PF working concentrically
148
if one's SVA is in a position of DF, what does this mean
external knee flexor moment
-- GRF posterior to knee
decrease hyperextension during stance
149
if one's SVA is in a position of PF, what does this mean
external knee extensor moment
during loading response
-- GRF anterior to knee
150
patient indications for conventional AFOs
fluctuating edema
insensitivity
wounds/scars
151
explain pros of AFO with posterior chamber springs
controlled PF during loading response
assisted DF during initial swing
152
explain pros of AFO with posterior chamber pins
limits PF ROM
- PF Stop
153
explain pros of AFO with anterior chamber springs
control of DF in midstance
assists PF during toe-off
154
explain pros of AFO with anterior chamber pins
DF stop during midstance
155
explain location and purpose of varus strap
lateral shoe
-- control inversion
156
explain location and purpose of valgus strap
medial shoe
- control eversion
157
explain knee joint axis
not a static joint
158
purpose of polycentric knee joint
match changing knee axis during flexion
159
explain orthosis specifics that minimize posterior hip dislocations
restriction of adduction, hip flexion and IR
160
indication of hip abduction orthosis
history of previous hip dislocation
neuromuscular disorders
soft tissue laxity
THA revision patients
161
what is a SWASH orthosis
"standing walking and sitting hip"
-- holds hip in abduction to reduce scissoring gait
-- encourages trunk extension
162
location of pelvic bands
between greater troch and iliac crest
163
explain counterforce systems for HKAFO/HOs
via 3 or 4 pt counterforces
force couples in sagittal or frontal planes
164
most common hip lock joint
drop-ring lock
165
what are reciprocal orthotic hip joints used on
bilateral (H)KAFOs
166
what do reciprocal orthotic hip joints do
limit step length
- one side facilitates hip flexion and the other facilitates extension
167
explain cons of reciprocal gait orthotics
short step length
excessive horizontal hip rotation
-- slow energy expensive gait
168
what is an adjustable positioning orthotic joint
moveable single-axis hip joint that allows for positioning in the frontal and transverse plane
169
explain Scott-Craig KAFOs
provide sagittal plane stability for those with extensor weakness / paraplegia
170
how do scott-craig AFOs work
move GRF posterior to hip and anterior to knee
171
explain AD and gait pattern for those who use scott-craig AFOs
bilateral crutches
swing-to/through tripod gait pattern
172
explain the main difference in the rochester parapodium than regular standing frames
roch = articulations at the hip and knee that allow pt to sit and stand
173
major types of reciprocal gait orthotics
LSU-RGO
ARGO
IRGO
174
what HO is used for developmental hip dysplasia
pavlik harness
holds hip in flexion and abduction
175
what orthoses are used for legg-calve-perthes
atlanta abduction orthosis (scottish rite)
petrie cast/brace
176
explain relationship between sagittal and frontal plane motion in a SWASH orthosis
> abduction in flexion (seated)
< abduction when in extension (standing)
177
what does a hip-spica cast do
completely immobilizes hips
178
what orthotic is indicated for patients with excessive hip flexion in stance
drop ring lock - HKAFO
GRF KAFO
- ankle PF/DF stop
