Gait, prosthetics/orthotics, AD Rx Flashcards
(169 cards)
1
Q
What is the first period of the gait cycle with double limb support?
A
Heel strike/initial contact
Lasts until end of heel off/terminal stance phase
2
Q
What is the first period of single limb support during the gait cycle?
A
Midstance
3
Q
What muscles are activated during Heel strike?
A
Quadriceps (Knee extension) - shock absorption
Ankle DF - control lowering of the foot from heel strike to foot flat
4
Q
What muscles are activated during foot flat phase?
A
Triceps surae - eccentrically control tibial advancement
5
Q
What muscles are activated during midstance?
A
Hip extensors - control FWD motion of the trunk
Hip Abductors - stabilize pelvis suring single limb support
Knee Extensors (quads)
Triceps Surae - control FWD tibial advancement
Ankle DF
Achilles tendon elongates and stores energy
6
Q
What muscles are activated during heel off?
A
Ankle PF - Generates propulsion of the body and swing limb
The energy stored in the Achilles tendon releases
7
Q
In what phase is the peak activity of the ankle PF mm?
A
heel off
8
Q
What muscles are activated during the toe-off phase?
A
Hip extensors (Hamstrings)
Knee Extensors (Quads)
FWD propulsion
9
Q
What muscles are activated during acceleration gait phase?
swing phase
A
Hip Flexors
Knee extensors (Quads)
10
Q
The quadriceps become silent during what phase of the swing phase? Why?
A
a. Midswing
b. Pendular motion is in effect
11
Q
What phase of the gait cycle has the most knee flexion?
A
Midswing
12
Q
What muscles are activated during midswing?
A
Hip and knee flexors
Ankle DF (elevate the toe for clearance)
13
Q
What muscles are active during terminal swing/Deceleration?
A
Early phase - Hip extensors (Hamstrings)
Late swing phase - Quads and ankle DF for preparation of heel strike
14
Q
How much does the pelvis rotate during the gait cycle?
A
8 degrees in total
4 degrees for each limb
15
Q
How much lateral pelvic tilt is there during gait cycle?
A
5 degrees
Controlled by hip ABD - swinging limb drops during loading response
16
Q
To what degree is the pelvis naturally anteriorly tilted?
A
10-15 degrees
hip Flexors pull FWD until end of terminal stance
17
Q
The pelvis moves side-side by ___ cm, towards the stance limb, in loading response.
A
4 cm
18
Q
What is the avg cadence?
A
110 steps/min
19
Q
What is the avg step width range?
A
1-5 inches
Steps width increases as a person grows
20
Q
What is the avg. walking speed?
A
1.3 m/s
3 mi/hr
21
Q
What is the avg metabolic cost of walking while on a even surface?
A
5.5 kcal/min
22
Q
What is/are the possible cause(s) of the following Gait deviation?
Lateral Trunk bending during stance phase
A
- Weak gluteus medius
- Hip pain
23
Q
What is/are the possible cause(s) of the following Gait deviation?
Backward trunk lean during stance phase
A
Weak gluteus maximus
Will also see difficulty with stairs and/or ramps
24
Q
What is/are the possible cause(s) of the following Gait deviation?
FWD trunk lean during stance phase
A
- Weak quads
- hip/knee contractures
25
What is/are the possible cause(s) of the following Gait deviation?
Excessive hip FLX during stance phase
1. weak hip EXT
2. tight knee FLX
26
What is/are the possible cause(s) of the following Gait deviation?
Limited hip EXT during stance phase
Tight hip flexors
27
What is/are the possible cause(s) of the following Gait deviation?
Limited hip FLX during stance phase
1. Weak hip flexors
2. tight extensors
28
What is/are the possible cause(s) of the following Gait deviation?
Antalgic gait (painful gait)
UNINVOLVED limb as a shorter step length as WB occurs sooner than normal
| asymmetrical gait pattern
29
30
What is/are the possible cause(s) of the following Gait deviation?
Excessive knee FLX during stance phase
1. weaks quadriceps
2. knee FLX contracture
| Can observe difficulty going down ramps and/or steps
31
What can be a compensation for weak quads?
FWD trunk bending
32
What is/are the possible cause(s) of the following Gait deviation?
Knee hyperextension during stance phase
1. weak quads
2. PF contracture
3. extensor spasticity
33
What is/are the possible cause(s) of the following Gait deviation?
Forefoot initial contact
1. weak DF
2. tight/spastic PF
3. LLD- shortened limb
34
What is/are the possible cause(s) of the following Gait deviation?
Foot slap
1. weak DF
2. hypotonia
35
What is/are the possible cause(s) of the following Gait deviation?
Foot flat
1. weak DF
2. decreased ROM
3. neonatal/immature gait pattern
36
What is/are the possible cause(s) of the following Gait deviation?
calcaneal gait
## Footnote
Loading predominately on heel with excessive DF and uncontrolled FWD motion of the tibia
Weak PF
37
What is/are the possible cause(s) of the following Gait deviation?
Equinus gait
## Footnote
Heel does not touch the ground
spasticity/contracture of PF mm
38
What is/are the possible cause(s) of the following Gait deviation?
Supination
| Varus calcaneus with excessive loading on lateral foot
1. spastic inverters
2. weak everters
3. pes varus
4. genu varum
39
What is/are the possible cause(s) of the following Gait deviation?
Hyperpronation
| Valgus calcaneus and excessive medial contact of foot during stance
1. weak invertors
2. spasticity
3. pes valgus
40
What is/are the possible cause(s) of the following Gait deviation?
Clawed toes
1. spastic toe flexors
2. hyperactive plantar grasp reflex
41
What is/are the possible cause(s) of the following Gait deviation?
Inadequate push-off
1. weak PF
2. decreased ROM into PF
3. forefoot pain
42
What is/are the possible cause(s) of the following Gait deviation?
insufficient FWD pelvic motion during swing phase
1. weak abdominal muscles
2. weak flexor muscles
43
What is/are the possible cause(s) of the following Gait deviation?
Insufficient hip and knee FLX during swing phase
1. weak hip and knee flexors
2. inability to lift the leg and move it FWD
44
What is/are the possible cause(s) of the following Gait deviation?
Circumduction
weak hip and knee flexors
45
What is/are the possible cause(s) of the following Gait deviation?
hip hiking
| QL action
1. Weak hip and knee flexors
2. extensor spasticity
46
What is/are the possible cause(s) of the following Gait deviation?
Excessive hip and knee FLX during swing phase (Steppage gait)
| compensation for shortening the leg
weak DF
47
What is/are the possible cause(s) of the following Gait deviation?
insufficient knee FLX during swing phase
1. extensor tightness
2. pain
3. decreased ROM
4. weak hamstrings
48
What is/are the possible cause(s) of the following Gait deviation?
Excessive knee FLX during swing phase
1. flexor spasticity
2. flexor withdrawal reflex
49
What is/are the possible cause(s) of the following Gait deviation?
Foot drop
1. weak or delayed DF
2. spastic PF
50
What is/are the possible cause(s) of the following Gait deviation?
Varus or inverted foot during swing phase
1. spastic inverters
2. weak evertors
51
What is/are the possible cause(s) of the following Gait deviation?
equinovarus during swing phase
1. spastic posterior tibialis and/or triceps surae
2. developmental abnormality
52
Describe two point gait pattern
| Cane or crutches
AD and opposite LE are moved together
53
Describe delayed two-point gait pattern with a cane
1. cane advancement
2. involved LE advanced
3. uninvolved LE advanced
54
Describe three-point gait pattern
| Crutches
1. Both crutches and involved LE are advanced together
2. uninvolved limb advancement
55
When is a delayed three-point gait pattern indicated?
When the patient requires increased stability and slower movements
56
Describe a delayed three-point gait pattern
1. both crutches are advanced
2. involved LE advancement
3. uninvolved LE advancement
57
Describe the Three Point Pressure Principle use for orthotics
Single force is placed at the deformity/angulation; two additional counterforces are applied in opposing direction
58
What are metatarsal pads used for?
Moves pressure from the metatarsal heads to the shafts --> allows for more push-off in weak or inflexible feet
| Located posterior to metatarsal heads
59
What is a cushion heel used for?
Used of relieve strain on plantar fascia --> Absorbs forces at heel contact
60
What is a longitudinal arch support used for?
Decompression of the subtalar joint and corrects pes planus/flat foot
61
What is a UBCL (university of California Biomechanics Lab) Insert used for?
Plastic molded insert to correct flexible pes planus
62
What is a scaphoid pad used for?
supports longitudinal arch
63
What is rearfoot posting used for?
Alters position of subtalar joint/rearfoot from heel strike to foot flat
64
What is a varus post/medial wedge used for?
Limits/controls eversion of the calcaneus and internal rotation of the tibial after heelstrike
65
What is a valgus post/lateral wedge used for?
Controls calcaneus and subtalar joints that are excessively inverted and supinated at heel strike
66
What orthotic modifications should you avoid when a patient has insensitive feet?
1. heel lifts
2. rocker bars
| can inrcease localized forefoot pressure
67
What are heel lifts used for?
Correction of LLD and accommodates for ankle DF limitation
68
What heel wedge size can be inserted into the shoe?
Up to 3/8 of an inch -- If a thicker wedge is warranted, it will be applied to the outer sole of the shoe
69
What is a rocker bar used for?
Improves weight shifting onto the metatarsals
| Proximal to metatarsal heads
70
What is a rocker bottom used for?
Builds up the sole of a shoe over the metatarsal heads to improve push-off
71
What does a hinged/articulating AFO do?
Allows motion in the sagittal plane while controlling motion in other planes
72
What does a free motion AFO do?
Helps maintain alignment and medial/lateral stability
| Little to no DF/PF resistance
73
When does a PF-stop AFO block further PF?
at 90 degrees of PF
74
What is a static/solid AFO used for?
- provides maximal ankle stability and ankle control
- assists in swing clearance and prepositioning
75
What does a Ground reaction AFO do?
Controls FWD progression of the tibia
- primarily for weak PF
- resists ankle DF
- can control knee extension during stance
76
What does a patellar tendon bearing AFO do?
- unloads the distal limb
- primarily for PF weakness
- anterior shell transfers force to the medial tibial flare
77
What does a hinge joint knee provide?
Mediolateral and hyperextension control of the knee
| Allows FLX and EXT
78
What does a Oregon Othotic system provide?
| Specialized KAFO
Triplanar control in all planes of motion
| combination of plastic and metal components
79
What does a postsurgery Knee orthosis provide?
Protects repaired ligaments from overloading
80
When is a functional knee orthosis used?
Long term use - sports, activity, etc.
81
What does a swedish knee cage provide?
Mild control for excessive hyperextension of the knee
82
What does a neoprene sleeve provide?
- Compression, protection, and proprioceptive feedack
- retains body heat promoting local circulation
## Footnote
Provides little stabilization unless it has hinges
83
What motions does a HKAFO control at the hip?
ABD/ADD and ROT
84
What motions does a HKAFO control at the hip when locked?
FLX
85
What is a flexible LSO (corset) used for?
- increases intrathoracic pressure
- provides tactile cues for posture
## Footnote
Uses: Pregnancy, posture control, respiratory assistance, compression of abdominal incisions, low back pain, postoperative protection
86
What is a Denis-Browne Splint used for?
Connecting two shoes on a swivel to correction of pes equinovarus or developmental hip dysplasia
87
What is a Frejka pillow used for?
Preventing hip ADD -- Used for conditions with tight ADD and/or hip dysplasia
88
What is a Toronto Hip ABD orthosis used for?
ABD the hip
| used for Legg-calve perthes disease
89
What is a rigid LSO (shell) used for?
- tactile posture reminder
- controls FLX/EXT, and SB of sacral and lumbar regions
| Three-point pressure system
90
What is the correct trimline/fitting of a rigid LSO (shell)?
Anterior portion: Below the xiphoid process to the pubic symphysis
Posterior portion: Below inferior angle of scapula to the sacrococcygeal junction
91
What is a TLSO Shell used to control?
FLX/EXT, SB, ROT of thoracic, lumbar, and sacral regions
92
What is the correct trimline/fitting of a TLSO?
Anterior portion: distal to sternal notch to pubic symphysis
Posterior portion: distal to scapular spine down to the sacrococcygeal junction
## Footnote
Uses: postoperative protection, stable vertebral Fx, scoliosis, SCI
93
What does an Anterior control TLSO Jewett Orthosis used for?
| Also called Cruciform Anterior Spinal Hyperextension orthosis (CASH)
controls FLX of thoracic and lumbar segments
## Footnote
Use: Thoracolumbar anterior vertebral compression Fx
94
What is a Cx soft collar used for?
- Controls cervical motion and provides cues for posture
| Minimal control
## Footnote
Uses: Whiplash injury, cervical pain, weakness
95
What is a Cx semirigid collar used for?
| Miami J Collar / Philadelphia collar
- controls FLX/EXT, SB, and ROT of Cx spine
-
## Footnote
Uses: Postoperative protection, stable cx injury, whiplash
96
What is the correct trimline/fitting of a Semirigid Cx collar?
Anterior portion: Mandible to sternal notch
Posterior portion: Occiput to T1
97
What is a Rigid-halo collar/orthosis used for?
maximal control of all Cx motion with a halo attachment to the skull and a thoracic jacket
| "Regina George Halo"
## Footnote
Uses: Unstable Cx Fx, SCI
98
What is a minerva orthosis / Cervical thoracic orthosis (CTO) used for?
Control of all Cx motions via cervical collar attached to a thoracic jacket
## Footnote
uses: stable cervical and upper thoracic Fx and fushions
99
What is a wrist cock-up splint used for?
1. weak/absent hand strength
2. wrist pathologies
| Palmar splint that contains forearm, metacarpals and/or phalanges
## Footnote
Ex: RA, carpal Fx, Colles' Fx, Carpal tunnel, stroke paralysis
100
What is a thumb spica splint used for?
Immobilize the first CMC joint
## Footnote
Ex: CMC arthritis, scaphoid Fx, scaphoid-lunate instability, De Quervain's
101
What is the correct fitting for a wrist cock-up splint when used for weak/absent hand strength?
- Support full hand with phalanges slightly flexed
- Slight thumb ABD and OPP
102
What is the correct fitting for a wrist cock-up splint when used for wrist pathologies?
distal palmar crease to thenar crease
103
What is a dorsal wrist splint used for?
Flexor tendon repairs
104
What is an airplane splint used for?
To immoilize the shoulder following Fx or burn injury to prevent axillary region contracture(s)
105
What is the correct fitting for an airplane splint?
90 degreees ABD
90 degrees elbow FLX
- connected to a padded lateral trunk bar and iliac crest band
106
What does a tendonesis splint do?
- Assists with wrist extension to approximate grip in the absence of active finger flexion
- Facilitates tendonesis grasp in those with quadriplegia
107
Definition: Amputation through ankle joint; preserves the heel pad and is then connected to distal tibia for WB
Symes amputation/Ankle disarticulation
108
definition: Amputation of entire LE along with the pelvis below L4/L5
hemicorporectomy
109
definition: Amputation of entire LE and lower 1/2 of pelvis
hemipelvectomy
110
definition: below elbow amputation
transradial amputation
111
definition: above elbow amputation
transhumeral amputation
112
definition: amputation through elbow joint
elbow disarticulation
113
What two components are included in all prosthetics?
1. socket
2. terminal device
114
Describe selective loading sockets
Sockets that allow increased loading at pressure-tolerant areas
| Decreases load on pressure-sensitive areas
115
What is the most commonly prescribed foot for a BKA prosthesis?
Solid ankle cushion heel (SACH) foot
116
What does a SACH heel do?
1. Limits DF/PF motion
2. assists in hyperEXT of the knee during stance phase
117
What population commonly uses a SACH foot?
1. youth
2. sedentary individuals
118
What plane of motion does a single axis foot only allow movement in?
sagittal (PF/DF)
119
What foot prosthetic is commonly used for medium-highly active individuals?
Multi-axis foot
| BUT not used often due to weight of device
120
What foot prosthetic is commonly used for active community ambulators?
Energy storing foot
| leaf spring shank used with endoskeletal prosthesis- lightweight
## Footnote
Decreased energy consumption due to smoother gait pattern and energy return in terminal stance and preswing
121
What does a prosthetic shank do?
1. provide leg length and shape
2. connect and transmit WB from socket to foot
| endoskeletal vs. exoskeletal
122
What are pressure sensitive areas of a typical BKA limb?
1. anterior tibial condyle
2. anterior tibial crest
3. fibular head and neck
4. distal cut end of tibia and fibula
123
What are the pressure tolerant areas of a typical BKA residual limb?
1. tibial plateau
2. shafts of tibia and fibula
3. gastrocnemius
124
What type of BKA socket allows for a more natural fit?
Total surface bearing socket
| weight is equal throughout soft tissue and bones - must use gel liner
125
If a Total Elastic suspension for an AKA prosthesis is used, what can occur in the gait cycle if it is the only form of suspension within the prosthesis?
Pistoning
126
Definition: Strap that wraps around the pelvis (below iliac crest) to anchor an AKA prosthesis
Silescian Belt
127
A lower shank for a knee disarticulation prosthesis is (shortened/lengthened) to balance leg length while standing
shortened
128
What movements of a body-powered above/below elbow prosthesis are used to put tension on the cable and open the hand?
1. Bilateral scapular ABD
2. Bilateral scapular depression
3. ipsilateral FLX
129
How does a myoelectric system work for UE prostheses?
1. utilizes surface electrical activity of various muscles
2. small electric motors operate the terminal device via signal intensity from the muscles - allowing graded power output from the terminal device
130
When using KT tape, injured ligaments should be held in a (shortened/neutral, lengthened) position
shortened
| Ex: lateral ankle injury should be taped into Eversion
131
KT tape must be applied with even pressure and overlap the previous strip of tape by ___ inch(es)
1/2 inch
132
What positions should a patient with a BKA avoid to prevent contracture?
- prolonged Hip FLX and ER
- prolonged Knee FLX
133
What positions should a patient with an AKA avoid to prevent contracture?
Hip FLX, ABD, and ER
| FABER- counteract with regularly scheduled prone time
134
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
Circumduction
| Arc swinging
1. long prosthesis
2. locked knee
3. small or loose socket
4. inadequate suspension
5. PF
6. Hip ABD contracture
7. poor knee control
135
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
ABD gait
| Lateral displacement of prosthesis
1. medial wall discomfort
2. long prosthesis
3. low lateral wall
4. tight hip ABD
136
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
Vaulting
| rising up on sound limb to advance prosthesis
1. prosthesis too long
2. inadequate suspension
3. small socket
4. increased PF
5. decreased knee FLX
137
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
Lateral trunk bending during stance phase
| Towards prosthetic side
1. low lateral wall
2. short prosthesis
3. high medial wall
4. weak ABD
5. ABD contracture
6. hip pain
7. short limb
138
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
FWD FLX during stance phase
1. unstable knee
2. short AD
3. hip FLX contracture
139
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
High heel rise during early swing phase
1. inadequate knee friction
2. decreased tension in the extension aid
140
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
Terminal swing impact
| peosthesis comes to sudden stop as the knee extends during late swing
1. insufficient knee friction
2. too much tension in the extension aid
3. pt fear for knee buckling
4. forceful hip FLX
141
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
Swing phase whips
| heel moving medially or laterally during toe-off
1. rotated socket
2. rotated knee bolt
3. malaligned foot
142
What is/are the possible cause(s) of the following Gait deviation with an AKA prosthesis?
Foot rotation at heel strike
1. malaligned foot
2. stiff heel cushion
3. PF bumper
143
What is/are the possible cause(s) of the following Gait deviation with a BKA prosthesis?
excessive knee FLX during stance
1. socket too far FWD or tilted anteriorly
2. PF bumper is too stiff
3. high heels
4. knee FLX contracture
5. weak quadriceps
144
What is/are the possible cause(s) of the following Gait deviation with a BKA prosthesis?
Inadequate knee FLX during stance
1. socket is aligned too far back or posteriorly tilted
2. PF bumper or heel cushion is too soft
3. low heel shoes
4. anterodistal discomfort
5. weak quadriceps
145
What is/are the possible cause(s) of the following Gait deviation with a BKA prosthesis?
Drop off or premature knee FLX in late stance
1. socket too far FWD
2. DF bumper is soft resulting in excessive DF
3. knee FLX contracture
4. prosthetic keel to short
146
What is/are the possible cause(s) of the following Gait deviation with a BKA prosthesis?
Delayed knee FLX during late stance phase
1. socket set too far back
2. DF bumper is too stiff causing excessive PF
3. prosthetic keel too long
147
Pressure relief activities are typically encouraged every ---- minutes when using a WC
15-20 minutes
148
Add __ inches to a patient's hip width to prescribe correct WC seat width
2 inches
149
WC footplates should be at least ___ inches from the floor
2 inches
150
Add __ inches to a patient's hanging elbow measurement to prescribe correct WC armrests
1 inch
151
(true/false) patient's with C6 injuries can be independent with transfer boards
true
152
What is a standard door width for ADA when using a WC?
32 inches
| ouside swing doors: 26 inches
153
What is the optimal toilet seat height according to ADA?
17-19 inches
154
What is the optimal height of horizontal grab bars from the floor?
33-36 inches
155
What is the recommended ramp ratio?
1:12 -- for every inch of vertical rise, 12 inches of ramp is required
156
Handicapped parking spots require a ___ foot aisle for WC maneuverability
4 feet
157
What is the rancho los amigos term for heel off?
terminal stance
158
What is the ranchos los amigos term for toe off?
preswing
159
What is the rancho los amigos term for acceleration?
initial swing
160
What is the rancho los amigos term for deceleration?
terminal swing
161
What is the rancho los amigos term for foot flat?
loading response
162
What is the rancho los amigos term for heel strike?
initial contact
163
(true/false) The abdominal muscles are active throughout the whole gait cycle
true
164
The (ipsilateral/contralateral) erector spinae muscles are active during the toe off phase as the contralateral limb is being loaded
ipsilateral
165
During terminal stance, which muscles are active at the knee?
none
166
When are all hip extensors active during the gait cycle?
initial contact (heel strike) to prepare for loading response
167
When are hip Flexors only activated during the gait cycle?
only activated during toe-off and part of midswing
168
When are the knee flexors only active during the gait cycle?
Only activated for last 30 degrees of midswing and all of heel strike
169
When are the hip ADD muscles active during the gait cycle?
heel off and toe off
