gait deviations

Question 1

BK

Prosthesis

Vaulting, Pelvic Hike, Circumduction (3)

Answer 1

1. prosthesis is too long
2. insufficient suspension: pistoning and dropping down lengthens it
3. foot set in too much PF: lengthen it

Question 2

BK

Patient

Vaulting, Pelvic Hike, Circumduction (3)

Answer 2

1. knee extension contracture: cannot shorten
2. weak hip and knee flexors: need to compensate with trunk or pelvis
3. Lack pre-ambulation training

Question 3

BK

Rapid and Excessive Knee Flexion in Early Stance (6)

Answer 3

1. BK socket tilted too far anteriorly
2. foot set too far posteriorly
3. hard cushion heel: if cannot compress for FF need to bring forward tib and fib –knee flexion
4. knee flexion contracture
5. pain in residual limb –protective knee flexion
6. inability to compress heel

Question 4

BK

prosthesis

Rapid and Excessive Knee Flexion in Early Stance (3)

Answer 4

1. BK socket tilted too far anteriorly
2. foot set too far posteriorly
3. hard cushion heel: if cannot compress for FF need to bring forward tib and fib –knee flexion

Question 5

BK

patient

Rapid and Excessive Knee Flexion in Early Stance (3)

Answer 5

1. knee flexion contracture
2. pain in residual limb –protective knee flexion
3. inability to compress heel: if cannot compress for FF need to bring forward tib and fib –knee flexion

Question 6

BK

Insufficient Knee Flexion In Early Stance (6)

Answer 6

1. insufficient anterior tilt of socket
2. foot set too far anteriorly = not far enough posteriorly
3. Heel is too soft
4. knee extension contracture
5. Quadriceps weakness–lock knee in extension and lean forward with trunk to create biomechanical extension moment at knee–dont want a flexion moment because of weak quads so lack flexion
6. Residual Limb Pain

Question 7

BK

Prosthesis

Insufficient Knee Flexion In Early Stance (3)

Answer 7

1. insufficient anterior tilt of socket
2. foot set too far anteriorly = not far enough posteriorly
3. Heel is too soft

Question 8

BK

Patient

Insufficient Knee Flexion In Early Stance (3)

Answer 8

1. knee extension contracture
2. Quadriceps weakness–lock knee in extension and lean forward with trunk to create biomechanical extension moment at knee–dont want a flexion moment because of weak quads so lack flexion
3. Residual Limb Pain

Question 9

BK

Excess Valgus at Midstance (4)

Answer 9

1. foot set too far laterally
2. poorly fitting socket
3. Genu Valgum
4. MCL Laxity

Question 10

BK

Prosthesis

Excess Valgus at Midstance (2)

Answer 10

1. foot set too far laterally

2. poorly fitting socket–prosthesis is thrusting in medially as a result crating a valgus moment

Question 11

BK

Patient

Excess Valgus at Midstance (2)

Answer 11

1. Genu Valgum

2. MCL Laxity

Question 12

BK

Excess Varus at Midstance (4)

Answer 12

1. foot set too far medially
2. poorly fitting socket
3. genu varum
4. LCL laxity

Question 13

BK

Prosthesis

Excess Varus at Midstance (2)

Answer 13

1. foot set too far medially

2. poorly fitting socket

Question 14

BK

Patient

Excess Varus at Midstance (2)

Answer 14

3. genu varum

4. LCL laxity

Question 15

BK

Medial and Lateral Whips (2)

Answer 15

medial whip: heel turns in medially
lateral whip: heel turns out laterally

1. poorly fitting socket
2. insufficient accommodation of hamstring tendon
   - —(hamstring tendon pushes into the posterior wall and creates the rotation)

Question 16

BK

Asymmetrical Step Lengths and Times (7)

Answer 16

1. decreased prosthetic stance time: decreased SLS on the prosthetic leg- quicker shorter steps with contralateral leg
2. quick and short step with intact LE
3. Residual limb pain: WB less on painful side
4. poor prosthetic fit/alignment
5. lack preambulation training
6. weakness
7. fear

Question 17

How much does AK need to allow in knee flexion to sit?

Answer 17

115 degrees

Question 18

if limb is neutral but prosthesis is IR

Answer 18

adductor tendon may be on anterior wall

Question 19

if limb is neutral but prosthesis is ER

Answer 19

adductor tendon may be on medial wall

Question 20

Allow LLD

Answer 20

no more than 1/2 inch

Question 21

AK

Lateral Trunk Bend During Prosthetic Stance (5)

Answer 21

1. prosthesis is too short
2. medial wall is too high–pubic area
3. lateral wall is not adducted–not efficient glut medius
4. weak gluteus medius
5. hip pain-bring weight to prosthetic side to decrease compressive force in SLS on that side

Question 22

AK: why lateral wall is not adducted of AK cause lateral trunk bend during prosthetic stance

Answer 22

lateral wall is supposed to be 10 degrees angle relative to the vertical, trandelenburg–if it is adducted it locks the femur in so it doesnt abduct when go into stance

if not adducted and femur abducts in stance it shortens gluteus medius which cannot generate as much tension causing the opposite side of the pelvis to drop and then the person uses lateral trunk flexion to bring COG over the weak gluteus medius

Question 23

AK: why would hip pain cause lateral trunk bend to prosthetic side in SLS on that side?

Answer 23

hip pain-bring weight to prosthetic side to decrease compressive force in SLS on that side

Question 24

AK

Prosthesis Abducted (5)

Answer 24

1. prosthesis is too long
2. medial wall is too high : pubic area
3. abduction contracture
4. patient fear
5. lack preambulation training

Question 25

AK vaulting, pelvic hiking, circumduction (5)

Answer 25

1. prosthesis is too long 2. insufficient suspension--causes pistoning 3. too much knee friction (or locked knee unit) 4. insufficient hip flexion 5. lack pre-ambulation training

Question 26

AK Terminal Impact (3)

Answer 26

---at the end of swing when getting ready to HS: there is an abrupt and quick uncontrolled knee extension where the knee extends out faster than it should, snaps out in extension 1. insufficient knee friction: - -need it to act like eccentric hamstrings 2. too string extension aide - -external: elastic band in front stretches and then snaps back too much into extension because too tight or too strong - -internal: too much of a spring effect in the spring 3. too forceful hip flexion followed by extension - -strong quick hip flexion followed by abrupt hip extension, ie in a hurry - -cases a whiplash effect

Question 27

Terminal Impact what is it?

Answer 27

---at the end of swing when getting ready to HS: there is an abrupt and quick uncontrolled knee extension where the knee extends out faster than it should, snaps out in extension

Question 28

AK | how does too strong an extension aide cause terminal impact?

Answer 28

--external: elastic band in front stretches and then snaps back too much into extension because too tight or too strong --internal: too much of a spring effect in the spring

Question 29

AK Excess Heel Rise (3)

Answer 29

1. insufficient knee friction - -not enough friction at knee to control movement of lower part of prosthesis back 2. insufficient knee extension aide - -doesnt resist knee flexion/heel rise (supposed to resist flexion and help extension) 3. too forceful hip flexion - -gets too much knee flexion

Question 30

Why does insufficient knee friction cause excess heel rise in AK?

Answer 30

not enough friction at knee to control movement of lower part of prosthesis back

Question 31

Why does insufficient knee extension aide cause excess heel rise in AK?

Answer 31

doesnt resist knee flexion/heel rise (supposed to resist flexion and help extension)

Question 32

AK Rotation of Prosthetic Foot at Heel Strike (2) person brings foot down into HS and the prosthesis either rotates out or rotates in

Answer 32

heel is supposed to allow for a nice foot flat without the prosthesis rotating 1. heel cushion too firm --cushion should be compressed and allow a nice FF witout the prosthesis rotating, cannot get the WB down through the hind foot--they go into FF with rotation more likely to rotate outward than inward 2. inability to compress cushioned heel - -this is part of training, AK has less ability to press down and need to work harder because less residual limb connected to the prosthetic foot

Question 33

AK: why heel cushion too firm cause rotation of prosthetic foot at HS?

Answer 33

cushion should be compressed and allow a nice FF witout the prosthesis rotating, cannot get the WB down through the hind foot--they go into FF with rotation more likely to rotate outward than inward

Question 34

AK Foot slap at HS (2)

Answer 34

1. cushion is too soft | 2. pushing down too hard

Question 35

AK Anterior Pelvic Tilt in Terminal Stance (3)

Answer 35

when getting to heelrise and toe off get an increased lumbar lordosis and anterior pelvic tilt 1. insufficient posterior tilt of socket 2. tight hip flexors 3. discomfort around the ischial tuberosity: they anterior pelvic tilt to take pressure off the IT on the shelf

Question 36

AK: why insufficient posterior tilt of socket causes Anterior Pelvic Tilt in Terminal Stance??

Answer 36

posterior socket tilt allows flexors to be more short and allows shank/foot to get back in terminal stance =do not need to elongate hip flexors as much to get flexed attitude prosthesis if not enough posterior tilt socket and tight hip flexors: hip flexors pull on the pelvis into an anterior pelvic tilt psoas on spine into lordosis (L1-L5 VB) increase anterior convexity

Question 37

AK Asymmetrical Step Length and Stance Time (7)

Answer 37

1. decreased prosthetic stance time 2. quick and short steps with intact LE 3. residual limb pain 4. poor prosthetic fit or alignment 5. lack of pre-ambulation training 6. weakness 7. fear