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P - Prosthetic Gait Training Flashcards

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1
Q

what is the name of the typical guideline for amputee strengthening

A

“rule of ten”

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2
Q

what is the Rule of Ten

A

10 second exercise
- 2sec upward
- 6sec hold
- 2sec downward

10 second rest
10 reps

should still be individualized, modify prn to individualize to pt

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3
Q

hip extension strengthening

ms activated
exercise set up
phases of gait

A

gluts, HS

bridge (pressing into residual limb)
- glut sets, trying to get hips up
- BL bridge, towel under residual limb
- progress to single limb bridge on residual

phases of gait:
- terminal swing
- initial contact
- loading response

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4
Q

hip ABD strengthening

ms activated
exercise set up
phases of gait

A

glut med, glut min

side plank (on amp side)
- start isometric
- BL, push down w both limbs and hips go up
- progress to single limb on residual, keeping sound limb elevated, pressin hips up

phases of gait: SL support (for balance and stability)
- mid stance
- terminal stance

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5
Q

hip flexor strengthening

ms activated
exercise set up
phases of gait

A

iliopsoas, rectus fem

prone, reverse bridge
- pressing limbs down to lift hips up

phases of gait:
- mid stance
- entire swing phase
- loading response

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6
Q

what is a consideration of hip flexion strengthening in amputees

A

iliopsoas tightness is common in almost amps, spend more time stretching and not strengthening bc pts will need hip ext for gait

prone is a good place to start for stretching

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7
Q

back extension strengthening

ms activated
exercise set up
phases of gait

A

back ext, glut max, hip ADDs

prone, towel roll b/w legs
- lifting chest/head/legs up like a superman

phases of gait:
- initial contact
- loading response
- mid swing
- terminal swing

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8
Q

who should you take caution with for a back extension strengthening exercise? how can you modify for that pt pop?

A

LBP

avoid end range, use ab pillow, glut sets

he doesn’t do a lot of this, focuses more on bridges

common to have LBP in amps bc using different ms for stability

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9
Q

hip ADD strengthening

ms activated
exercise set up
phases of gait

A

hip ADD

side lying on sound side
- have residual limb propped on a step, they push down into it and lift hips up

phases of gait:
- mid swing
- terminal swing
- initial contact

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10
Q

bridging for sound limb strengthening

ms activated
exercise set up
phases of gait

A

glut max, back ext, sound side IRs

bridging (typical setup)

phases of gait:
- loading response
- mid stance
- terminal stance

will help dec LBP bc dec stress in bridging vs the prone back ext

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11
Q

sit-ups

ms activated
exercise set up
phases of gait (& why?)

A

abdominals

typical sit up
- can progress to lift legs at same time when you crunch up

phases of gait: mid stance
- for lumbo pelvic stabilization

he doesn’t do sit ups a lot
- he thinks you can get more stabilization from leg lowering
- more appropriate for advanced pts

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12
Q

what pt pop should you be cautious of doing sit ups with

A

LBP

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13
Q

knee extension strengthening

ms activated
exercise set up
phases of gait

A

quads

in prone, towel roll under tibial tub - leg presses down into it to straighten knee
- can incorporate different positions

phases of gait:
- initial contact
- loading response
- mid stance

in prone will work on iliopsoas flexibility

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14
Q

what is the significance of knee extension strengthening

A

need TKE for ambulation

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15
Q

knee flexion strengthening

ms activated
exercise set up
phases of gait

A

HS

supine, towel roll inferior to popliteal fossa & leg presses down to bend knee
- can progress to have leg off table and bending knee there

phases of gait:
- initial swing
- mid swing

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16
Q

what is a consideration of knee flexion strengthening

A

important to have full HS ms length
- will likely spend more time working on HS flexibility rather than strength

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17
Q

how can having the prosthesis on for exercises alter the activity

A

can inc activation and control of residual limb musculature

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18
Q

how can exercises be performed to inc activation and control of residual limb ms

A

pt places pressure on each part of socket to engage ms for stability
- pt needs to feel engaged ms bc affects pressure against various parts of socket –> engages different ms
- want to engage entire socket

start in sitting or standing pending fatigue and standing abilities

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19
Q

what are examples of general stabilization exercises

A

abdominal stabilization:
- supine: TrA, UE/LE mvmt
- seated: mat, ball, UE/LE mvmt

hip stabilization:
- half kneeling (w pro)
- tall kneeling (w pro)
- Q-ped (w pro)
- planks

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20
Q

what was the key to functional activities and their progression with amputee strengthening

A

hip flexor and extensor/glut strength

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21
Q

what were differing characteristics in TTA fallers and non-fallers

A

fallers = walk faster

non-fallers = ext support, hip ABD and knee ext eccentric training, proper socket fit

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22
Q

how often should the amputee perform a skin inspection

A

every time doff prosthesis

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23
Q

managing a prosthesis: how do you work on increasing wearing tolerance

A

gradual inc thru duration and activities the prosthesis is worn

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24
Q

when and why do you need to adjust sock ply

A

as volume of residual limb will change throughout the day

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25
at what point w the # of sock ply is a new socket indicated
if >10-15 sock ply, talk to prosthetist about a new socket bc this is a lot of sock
26
what is a concern with sweating in the residual limb w a prosthesis
sweating can lead to skin maceration --> once you get skin breakdown, it all slows down and you have to change gait training
27
how do you monitor the fit of the prosthesis
in sitting standing - look at pelvic landmarks to check alignment
28
when you do skin checks what do you look for
ID areas of skin concerns: redness, abrasions - short term redness is fine bc there is a certain amt of compression w a prosthesis - if longer than short term - there is too much compression or force on the residual limb
29
what environment do you often start gait training w a prosthesis
in parallel bars
30
what is the purpose of establishing a wearing schedule and how do you create one
gradually inc wearing time and wt bearing 30min 3x/day to start inc by 30min each day if no issue - concerned if redness lasts >15-20min
31
tolerant vs intolerant pressure areas
**tolerant**: load bearing areas - designed for WBing and can accept weight from prosthesis **intolerant:** not meant to bear weight - these are the areas to assess
32
what are tolerant vs intolerant areas in a TTA
tolerant: * patellar tendon * medial tibia * lateral fibula * gastrocs intolerant: * tibial crest * fibular head * distal ends * HS tendons
33
what are tolerant vs intolerant areas in the TFA
tolerant: - ischial tub - soft tissues (protective) intolerant: - distal femur - pubic ramus (superior medial portion of socket)
34
what is a common complaint of pts w a TFA prosthesis
pain by pubic ramus if too high up in the groin
35
what are pre-gait activities to promote ambulation
* stretching - hip flexors, HS * strengthening - sound, residual, lumbopelvic region * WBing * trunk rotation - dissociate trunk from pelvis * balance activities - challenge systems and improve confidence
36
what is there a loss of in TFA which impacts ambulation
lose distal HS attachment & ability for post pelvic tilt
37
what is there a loss of in TTA which impacts ambulation
dec HS length d/t 5-10deg knee flexion w gait
38
what are benefits to pre-gait weight bearing | (5)
1. dec phantom pain 2. inc strength/stability 3. dec edema 4. inc joint compression 5. dec forces on sound limb - more WBing in prosthesis promotes symmetrical WBing
39
how does BOS and COG change after an amputation
BOS is much smaller - COG moves laterally and slightly superiorly - have to work on balance w new BOS and moved COG
40
how big should their standing BOS be roughly after an amputation
2-4''
41
what are strategies to improve proprioception pre-gait | (4)
* tapping & vibration * reflex hammer vs prosthetic foot - (A/P) vibratory sensation and feedback * sensation in socket - (A/P) feel limb in socket for more awareness and control * EO -> EC
42
what is the goal of sit to stand transfers
equal body weight on both limbs - pts have a tendency to shift wt to should side
43
how can a PT facilitate equal WBing during a STS transfer
apply lateral and anterior force on same side as amputation during the STS - facilitates WBing on prosthetic limb
44
what is the goal of weight-shifting
equal body weight on both limbs
45
how do you facilitate a weight shift and what cues do you give
cue hip and shoulders to go together - find balance point (marble) and feel for change in ms activation
46
what is the progression of weight shifting in pre-gait training
1. lateral 2. A/P 3. diagonal 4. no UE support on sound side 5. no UE support at all 6. stool stepping with sound limb
47
what is the importance of diagonal weight shifting practice
more functional for amb - mimics gait and swing phase
48
how is diagonal weight shifting introduced and how do you progress it
shift from prosthetic side to sound side - heel to toe shift from sound side to prosthetic side - toe load unlocks knee
49
how do you remove UE support progressively with weight shifting
remove UE support on sound side first - inc WBing on prosthesis progress to remove UE support on prosthetic side when stable
50
what is the rational for tool taps w the sound limb | (3)
1. promotes single leg balance on prosthetic side 2. facilitates ms within socket 3. assists w kinesthetic awareness of prosthetic foot in space
51
what are the pre-gait requirements to "graduate" to a gait training program
good ROM/ms length strength balance lumbopelvic stabilization
52
what is the progression of gait training activities
1. sound limb stepping 2. prosthetic limb stepping 3. sidestepping 4. resisted gait training 5. amb outside parallel bars
53
what is the pre-gait counterpart to sound limb stepping
diagonal weight shift
54
what are critical components to look for with sound limb stepping
normal 2-4'' BOS no crossover
55
where do you facilitate for both sound and prosthetic limb stepping
tactile cues at anterior pelvis
56
what is crossover or "scissoring" gait pattern often a compensatory habit from
following amb w crutches
57
what do you look for in prosthetic limb stepping
can they advance leg from pelvis forward and back w/ good anterior pelvic rotation in transverse plane
58
what compensations do you watch for to avoid with prosthetic limb stepping
* kicking leg forward * posterior pelvic rotation * leaning trunk back
59
how do you progress prosthetic limb stepping
start w rhythmic initiation at ant pelvis - progress from PWB to FWB
60
# sidestepping: set up facilitation
to sound side first resistance at swing limb - facilitates glut med - activating ms inside the socket
61
how is resisted gait training facilitated and what is the rationale for this intervention
resist at ASIS encourages anterior pelvic rotation in transverse plane - help w pelvic dissociation from trunk
62
how is ambulation outside parallel bars introduced and progressed
1. pt puts UE on PT's shoulders, PT provides resistance at ASIS to facilitate transverse plane motion 2. progress to facilitate trunk rotation & arm swing 3. rhythmic initiation w PT behind pt and tactile cues at shoulders for facilitating trunk rotation
63
do we use an AD w the pt when they first start outside the parallel bars and why?
goal: no AD - depends on pt and safe functional mobility - if cane start w it on sound side (normal) - discourage ASAP
64
why do we care about fine tuning ambulation outside of parallel bars w trunk rotation and arm swing
key for energy expenditure as ambulate - normal arm swing helps w balance and ability to amb
65
# stair training ascent and descent pattern in TTA
**ascent** - step over step **descent** - step over step
66
# stair training ascent and descent pattern in TFA and why
**ascent** - step to * knee "locked" by pushing back into the socket **descent** - step over step - take advantage of resistance in knee to lower the body weight down
67
# stair training why is the prosthetic foot placement important in the descent for both TTA and TFA
foot forward on step d/t loss of DF/PF - allows knee flex and PF
68
what is the "safe" technique to teach amps first when starting to use ramps
side step technique
69
# ramp training ascent and descent body mechanics
**ascent** * lean forward * lead with sound limb **descent** * lean backward * lead with prosthetic limb
70
# ramp training what is part of the strategy with leading with the prosthetic limb on the descent
taking advantage of hammy strength in socket
71
what is the goal of advanced balance activities
get them stronger and more stable in the socket
72
what are examples of advanced balance activities | (8)
* balance on foam/balance board * SLS * multi-task/distraction/ EC * tandem walking * side stepping * crossover stepping * braiding/ grapevine / karaoke * close-quarter turning
73
what does an advanced balance activity like tandem walking facilitate
narrow BOS
74
what does an advanced balance activity like side stepping facilitate
hip ABD and ADD
75
what does an advanced balance activity like braiding or karaoke/grapevine facilitate
inc pelvic and trunk rotation trunk dissociation
76
what does an advanced balance activity like close-quarter turning facilitate
simulates grocery store, functional environment - amps tend to make wide turns, we are fine tuning
77
what are 5 self-report outcome measures
* SF-36 * sickness impact profile * amputee activity survey (AAS) * locomotor capabilities index (LCI) * prosthesis eval Q (PEQ-17)
78
what are 5 performance based outcome measures
* 6MWT * 2MWT * TUG * L-test * AMP
79
what is the significance of the AMP as a performance based outcome measure
predicts k-level * justify to insurance what they will get for prosthesis

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