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1
Q

What are some biomechanics deficiencies in gait for a partial foot amputation

A
  • reduce plantar weight bearing surface
  • impaired pronation/supination
  • loss of active push off
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2
Q

Tibial Tubercle Height (AFO TYPE) increases what and spread forces where

A

Increased toe lever arm

Spread forces over larger area

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3
Q

Where is most of the weight bearing in a socket for a BKA

A

50% patella tendon

20% tibial flare
30% tissue

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4
Q

Where is most of the weigh bearing for a trans femoral socket

A

50% on the ischial tuberosity

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5
Q

What are pressure sensitive areas from transfemoral socks

A

• Pubic Ramus
• Symphasis Pubis
• Adductor Tendon
• Lateral Distal Femur

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6
Q

What are the 4 suspension types of transtibila or trans femoral

A

Suspension sleeve: extra support
Pin Lock: pin that looks into leg
Harmony/V ASS: vacuumed assited suction socket
Suction/ Seal In

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7
Q

What suspention is used as a vacuum assisted suction socket

A

VASS

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8
Q

What are the K levels for these feet
SACH- solid ankle cushion heel
Single Axis (
Flexible Keel
Multi-axis
Dynamic response
MPK Feet

A
  • SACH- solid ankle cushion heel (K1 or Cost Effective)
  • Single Axis (K2,K3)
  • Flexible Keel (K2)
  • Multi-axis (K2, K3, K4)
  • Dynamic response (K3, K4)
  • MPK Feet (K3,K4)
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9
Q

What K levels are these knees for an AKA

Weight Activated “Safety”
4 bar knee- polycentric
Hydraulic knee
Microprocessor knee – C-leg, Rheo, Etc…

A
  • K2
  • K2
  • K3, K4’
  • K3, K4
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10
Q

When should dynamic alignment be studies

A

In midstance

Foot flat on the floor

Knee slightly flexed

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11
Q

What is the energy expenditure for these

  • trans tibial
  • trans fem
  • bilateral trans TiB
  • bilateral trans fem
A
  • 15-30%
  • 40-65%
  • 125%
  • 240% & up
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12
Q

Who is more likely to be a functional prosthetic user… a bilateral trans TiB or a unilateral trans fem

A

Bilateral

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13
Q

What percent are trans tib

A

65%

Most common

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14
Q

What is the preferred length of tibia for a BKA and femur for AKA

A

50% (8cm below knee)
75% (10cm above distal femur)

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15
Q

What is the main casue of amputation

A

Disease

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16
Q

What kind of knee should BKA have

A

Soft knee bc weight bearing thru patella

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17
Q

What is a common complaint for a BKA pateint

A

Front leg (distal tibia) hurts

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18
Q

What could a patient wiht BKA be dong if they dont have a soft knee

A

Over extending and pushing into the socket

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19
Q

What is important to maintain to stabilize stance control for a AKA

A

Hip extenion

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20
Q

Why is it important to maintain hip extension for a AKA

A

Stabilize stance control

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21
Q

How do u cue a AKA to maintain hip extension

A

Tell them to push back into socket

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22
Q

What does a pt need to do to break/flex their knee for a AKA

A

Transverse pelvic rotation

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23
Q

What does doing a transverse pelvic rotation do for a AKA

A

Break/flexes the knee

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24
Q

If the hip is not forward for a AKA then what cant they do

A

Break/flex the knee with trasnverse pelvic rotation

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25
How can u cue the pt to help with trans pelvic rotation
Push the hip forward
26
What does **prosthetic limb stepping partial weight bearing** help facilitate
Forward pelvic rotation
27
When doing stairs what is the different between BKA and AKA
BKA: should be able to do a normal step thru pattern AKA: step to for ascending and step thru for descending
28
How do u go up and down the stairs for AKA
Going up: up with the sound leg then then AKA Going down : doesn’t matter but step thru
29
How does a AKA do ramps
Side stepping down with prosthetic leg leading Lean forward and take small steps , push back
30
What prosthetic Has a “**braking**” mechanism that controls knee if initial contact is made when knee isn’t completely extended to prevent knee flexion (or buckling) during stance.
Safety knee (weight activated)
31
How does **swing phase** occur for a **safety knee** (weight activated)
Occurs at the same rate regardless of the persons change in gait speed
32
What does a **4 bar knee/polycentric knee** help enhance ## Footnote K2
Stance phase stability due to the mechanical characteristics
33
What prosthetics **provides stance control** and **variable cadence** in **swing** phase
Hydraulic knee
34
How does **gait speed** change w the **hydraulic knee**
As it changes , the rate of the prosthesis changes
35
What prosthetic is an **computer controlled, battery operated**
Microprocessor knee (C leg)
36
What is the **microproccess** knee best for
Control from stance and swing phase Use for athletes
37
What prosthetic **swings freely** in flexion/extension, **no mechanical stability**, must **rely** on use of **GRF/weigh**t line for knee to be **stable** during **stance**
Single axis knee ## Footnote K1
38
What kind of stability does a **single axis knee** provide
Stability in stance
39
What prosthetic foot absorbs **impact of IC** (stable foot)
SACH ## Footnote K1
40
What does a **single axis foot** ensure
Rapid foot flat to promote knee extension and asssit in knee stability at loading
41
What kind of motin is the **multi axial prosthetic** foot ## Footnote K2
Triplanar motion , ensures rapid foot dilate during loading Good for uneven terrain
42
What foot prosthetic is an **energy storing foot** and is good for **highly active people**
Dynamic response foot
43
What kind of heel cushion would u want for a transtibal patient vs a transfemoral pt
Harder heel cushion for a trans tibial to promote knee flexion Softer heel cushion for a transfem bc it delays forward progression of the pylon —> promoting knee extension
44
How does a harness system operate
By certain body movements
45
What are the 2 types of **harness** for a **trasnhumero** prostheses
**Single** control —> controls the terminal device **Double** control —> controls both the terminal device and elbow flexion
46
What kind of harness system does a transradial prosthese use
Single
47
T/F: terminal devices can have options for voluntary opening or closing
T
48
How can u cue a TT pt if they have pain on the anterior distal tibial
Cue them into a soft knee —> 5-10° of knee flexion to WB on patellar tendon
49
What do u need to maintain for a TF pt for stance control
Hip extension
50
How much weight do u need on the prosthetic foot to unlock their knee
70%
51
What % should u train for HRmax
70-85%
52
What can u get out of doing the **AMPRO**
K levels
53
What does the amputee mobility predictor assess
Mobility of people wiht LE amputation prior to prosthetic fitting and prediction function
54
The patient does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility What K level
0
55
The patient has the ability or potential to use a prosthesis for transfer or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator. What. Level
1
56
The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as **curbs, stairs or uneven surfaces**. Typical of the limited community ambulator. What K level
2
57
The patient has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic utilisation beyond simple locomotion. What K level
3
58
The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete What K level
4
59
When would u use a solid ankle AFO
DF weakness and PF weakness
60
If a patient has a PF stop but is still buckling and hyper extending what else can u add
DF restraint
61
What is the difference between floor and ceiling affect
Floor is to hard for the pateint Ceiling is to easy for the pateint
62
What is the most critical angle to consider when aligning the orthoses
The floor to shank angle (normla is 10-12)
63
What would be the most common cause of curcumduction in gait
Weak DF and HF
64
When are teh hamstrings usually on during gait
Terminal stance
65
What mm contrl DF
Gastroc and soleus
66
When would u usually use a posterior leaf spring
During swing phase
67
What is the percent of stance and swing phase for walking
60% stance 40% swing
68
What is the % for stance and swing phase for gait
60% 40%
69
What is the % for single limb support and double limb for gait
Single: 80* Double: 20°
70
What is the critical event in IC
Heel contact first
71
What phase is the heel rocker
Loading response
72
When is the ankle rocker
midstance
73
What ist eh critical event for midstance
Controlled tibial advancement
74
Whar rocker is in terminal stance
Forefoot
75
When is there the most DF in gait
Terminal stance
76
What is the critical even for terminal stance
Calf mm control ankle DF always heel rise
77
What rocker is in the pre swing
Toe rocker
78
What could be weak if a patient has excessive knee extenion
Weak PF or quads
79
What is the critical event in terminal swing
Knee extension
80
What is weak if a patient has foot slap
Weak pre tibialis (anterior)
81
What orthotic would. Use for a flexible pes planus , valgus foot , heel pain or plantar fasciitis
UCBL
82
What orthotics would u use for a severe pes Plano valgus foot , intermittent toe walking and low tone … and u want to facilitate foot clearing in swing
SMO
83
When would u use a ground reaction AFO
When u want an extension moment at the knee —> assist w weak quad and PF
84
When would u not use a ground reaction
If the person has hyperextension during stance

A; POG (12 decks)

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