POAT Unit 2: Principles of Footwear and Orthotic Interventions for the Neurologically impaired Individual

Question 1

Why might a neuro patient need orthotic intervention involvement?

Answer 1

• Lacking appropriate movement or range
• Impacted by unwanted movement
• Multi-system involvment and impairments

Question 2

With is the goal for orthotic intervention for adults with neurological involvement?

Answer 2

Improve biomechanical dysfunction

Question 3

What are the Prerequisites for EFFECTIVE upright standing (starting from the bottom)?

Answer 3

• A plantigrade feet
• An extended knee (or slightly hyperextended)
• “Extended” hips
• COM balance over the BOS

Question 4

What are the Prerequisites for safe and energy efficient walking?

Answer 4

Adequate:

• Lower limb stability to accept and support body weight
• Foot position at IC and LR
• Foot clearance in swing phase of gait
• Motor control and motion at the foot, ankle, knee, hip and pelvis
• Balance of limb segment kinetics

Question 5

What is the basic framework when prescribing LE orthotic devices?

Answer 5

1. Identify where in the gait cycle (GC) abnormal tone or muscle performance is impaired
2. Determine what factors could be compomising the particular abnormal phase(s) of the GC
3. Identify what specific orthotic interventions would benefit the particular abnormal phase(s) of the GC

Question 6

Within the Gait Cycle, what are some potential etiologies with Forefoot First Initial Contract?

Answer 6

• Inadequate dynamic knee extension control
• Inadequate pre-tibial muscle eccentric capacity/control
• Premature calf muscle activation (Soleus muscle)
• PF contracture
• Inadequate proprioceptive feedback at the ankle/knee

Question 7

Within the Gait Cycle, what are some potential etiologies with Common Alterations in Weight Acceptance {excessive knee and hip flexion}?

Answer 7

• Inadequate eccentric knee extension capacity/control
• Inadequate hip extensor eccentric capacity/control
• Loss of adequate hip extension ROM - Hip Flexion contracture
• Hamstring contracture

Question 8

Within the Gait Cycle, what are some potential etiologies with Common Alterations in Single Limb Support {Limited body COM progression}?

Answer 8

• Compensations for inadequate knee and hip extensor capacity/control
• Compensation for inadequate PF capacity/control
• Loss of adequate ankle and forefoot rocker functions
  —ROM Impairments
  —PF spasticity

Question 9

Within the Gait Cycle, what are some potential etiologies with Common Alterations in Single Limb Support {Excessive Knee and Hip Flexion with Excessive Ankle DF}?

Answer 9

• Distal and/or proximal neuromuscular control inadequacies
  a) weak ankle PFs
  b) weak hip or trunk extensor
  c) weak knee extensor
• Compensation for inadequate hip extension ROM capacity
  a) hip flexor contracture
  b) hip flexor spasticity
• Compensation for inadequate knee extension ROM capacity
  a) contracture
  b) hamstring hypertonicity

Question 10

Which is a factor facilitating excessive knee flexion in midstance?

A) Soleus muscle weakness
B) Popliteus muscle weakness
C) Hypertonicity of PF
D) Hip flexor weakness

Answer 10

A) Soleus (PF) muscle weakness

• This would result in knee buckling