Final Exam - Gait Deviations, Aquatic, Vestibular

Question 1

Characteristic of circumducted gait

Answer 1

Prosthesis swings laterally in a wide area during swing phase

Question 2

Potential prosthetic cause of circumducted gait

Answer 2

Prosthesis is too long

Prosthesis has too much alignment stability or friction in the knee, making it difficult to bend the knee

Question 3

Potential patient causes of circumducted gait

Answer 3

Abduction contracture of the residual limb
Lack of confidence for flexing the prosthetic knee because of muscle weakness or fear of stubbing toe
Habit

Question 4

Characteristic of vaulting gait

Answer 4

Rising on toe of the sound foot permits the individual to swing the prosthesis through with little knee flexion

Question 5

Potential prosthetic causes of vaulting

Answer 5

Prosthesis is too long
Inadequate socket suspension
Excessive stability in the alignment or some limitation of knee flexion such as a knee lock or a strong extension aid

Question 6

Potential patient causes of vaulting

Answer 6

Fear of stubbing toe
Habit
Discomfort in residual limb

Question 7

Potential prosthetic causes for rotation of prosthesis upon heel strike

Answer 7

Too much resistance to plantarflexion by plantarflexion bumper or heel wedge
Too much toe out build into prosthesis
Socket too loose

Question 8

Potential patient causes for rotation of prosthesis upon heel strike

Answer 8

Extend residual limb too vigorously at heel strike

Poor muscle control of residual limb

Question 9

Characteristic of uneven arm swing

Answer 9

Arm on prosthetic side is held close to body during locomotion

Question 10

Potential patient causes of uneven arm swing

Answer 10

Poor balance
Fear and insecurity
Habit

Question 11

Characteristics of uneven timing

Answer 11

Unequal duration steps with usually a very short stance phase on the prosthetic side

Question 12

Potential prosthetic causes for uneven timing

Answer 12

Improperly fitting socket may cause pain
Weak extension aid or insufficient friction in prosthetic knee can cause excessive heel rise with prolonged swing through

Question 13

Potential patient causes for uneven timing

Answer 13

Weak residual limb
Poor balance
Fear and insecurity

Question 14

Characteristics of long prosthetic step

Answer 14

Individual takes longer step with the prosthesis than with the uninvolved LE

Question 15

Potential prosthetic causes of long prosthetic step

Answer 15

Initial flexion in socket is insufficient when an irreducible flexion contracture is present

Question 16

Potential patient causes of long prosthetic step

Answer 16

Flexion contracture that cannot be accommodated prosthetically

Question 17

Characteristics of excessive trunk extension

Answer 17

Individual creates an active lumbar lordosis during stance phase

Question 18

Potential prosthetic cause of excessive trunk extension

Answer 18

Improperly shaped posterior wall causing forward rotation of pelvis to avoid full weight bearing on ischium
Insufficient initial flexion built into socket

Question 19

Potential patient causes of excessive trunk extension

Answer 19

Hip flexor tightness 
Hip extensor weakness 
Weak abdominals
Habit 
Move shoulders back to gain balance

Question 20

Characteristics of uneven heel rise

Answer 20

Prosthetic heel rises quite markedly and rapidly when the knee is flexed at beginning of swing phase

Question 21

Potential prosthetic cause of uneven heel rise

Answer 21

Insufficient knee joint friction

Inadequate extension aid

Question 22

Potential patient cause of uneven heel rise

Answer 22

Use more power than necessary to force knee into flexion

Question 23

Characteristics of terminal swing impact

Answer 23

Rapid forward movement of the shin piece allows the knee to reach maximum extension with too much force before heel strike

Question 24

Potential prosthetic cause of terminal swing impact

Answer 24

Insufficient knee friction

Too strong knee extension aid

Question 25

Potential patient cause of terminal swing impact

Answer 25

Deliberate, forceful extension of residual limb to ensure knee in full extension

Question 26

Characteristics of instability of prosthetic knee

Answer 26

Unstable knee creates danger of falling when knee flexes

Question 27

Potential prosthetic cause of instability of prosthetic knee

Answer 27

Knee joint too far anterior of TKA line Insufficient initial flexion built into socket PF resistance too great, causing knee to buckle at heel strike Failure to limit DF can lead to incomplete knee control

Question 28

Potential patient cause of instability of prosthetic knee

Answer 28

Hip extensor weakness | Severe hip flexion contracture

Question 29

Characteristics of medial or lateral whips

Answer 29

Medial whip is present when the heel travels medially on initial flexion and the beginning of swing phase; a lateral whip exists when the heel moves laterally

Question 30

Potential prosthetic causes of medial/lateral whips

Answer 30

``` Lateral: excessive IR of prosthetic knee Medial: excessive ER of prosthetic knee Overly tight socket Excessive valgus of prosthetic knee toe break in conventional foot malaligned ```

Question 31

Characteristics of foot slap

Answer 31

Too rapid descent of the anterior portion of the prosthetic foot

Question 32

Potential prosthetic causes of foot slap

Answer 32

PF resistance too sfot

Question 33

Potential patient causes of foot slap

Answer 33

Drive prosthesis into walking surface too forcibly to assure extension of knee

Question 34

Characteristics of dropoff at the end of stance phase

Answer 34

Downward movement of trunk as the body moves over prosthesis

Question 35

Potential prosthetic causes of dropoff at the end of stance phase

Answer 35

Inadequate limitation of DF in prosthetic foot | Too short heel in SACH

Question 36

Characteristics of lateral bending of trunk

Answer 36

Excessive bending occurs laterally from midline, generally to prosthetic side

Question 37

Potential prosthetic cause of lateral bending of trunk

Answer 37

Prosthesis too short Improperly shaped lateral wall failing to provide adequate support for femur Prosthetic aligned in abduction, causing wide-based gait

Question 38

Potential patient cause of lateral bending of trunk

Answer 38

Inadequate balance Abduction contracture Oversensitive, painful residual limb Habit

Question 39

Characteristics of abducted gait

Answer 39

Very wide based gait with prosthesis held away from the midline at all times

Question 40

Potential prosthetic causes of abducted gait

Answer 40

Prosthesis too long Too much adduction built into prosthesis High medial wall, causing ramus pressure Improperly shaped lateral wall failing to provide support for femur

Question 41

Potential patient causes of abducted gait

Answer 41

Abduction contracture | Habit

Question 42

Thermoneutral

Answer 42

93-95

Question 43

Convection

Answer 43

Movement of water across the skin or movement of body through water

Question 44

Conduction

Answer 44

Physical contact between water and body

Question 45

Radiation

Answer 45

Exchange of thermal energy between body and air

Question 46

Four phases of Halliwick

Answer 46

Mental adaptation to being in the water Restore balance from all positions in the water Inhibit unwanted movement and remain stable in water Swim from stabilized position

Question 47

Shaw swimming

Answer 47

Combines swimming technique with Alexander technique

Question 48

Feldenkrais pool conditions

Answer 48

86-94 degrees in chest deep water

Question 49

Bad ragaz pool conditions

Answer 49

92-98 and in three to four feet in depth

Question 50

Watsu pool conditions

Answer 50

92-96

Question 51

What does Jahara mean

Answer 51

Third arm

Question 52

What are the purposes of vestibular rehab

Answer 52

Stabilize visual images on fovea of retina during head movements Postural stability Spatial orientation

Question 53

What are the otolith organs

Answer 53

Saccule | Utricle

Question 54

What is the tonic firing rate

Answer 54

80 pulses per second Rotation of head to the side depolarizes the hair cells and causes increased firing rate. Hyperpolarization occurs on the opposite labyrinth

Question 55

Vestibulo-ocular reflex

Answer 55

Maintains gaze stability during rapid head movements | Operates from 60-400 degrees/second

Question 56

What maintains gaze stability when the head is moving at less than 60 degrees per second?

Answer 56

Smooth pursuit

Question 57

Meniere's disease

Answer 57

Low frequency hearing loss and episodic vertigo, may have tinnitus Related to endolymph fluid build-up

Question 58

Perilymphatic fistula

Answer 58

Rupture of the oval or round windows causing fluid to leak into the middle ear