POG Final Exam Flashcards
(113 cards)
1
Q
Stance vs. Swing Phase of Running
A
Stance: IC –> MSt –> Toe Off + Float Phase 1 (40%, most muscle activity)
Swing: ISw –> MSw –> TSw + Float Phase 2 (60%, mostly passive)
2
Q
Initial Contact Muscle Activity (Running)
A
Glutes isometrically support hip / knee
Quads eccentrically control knee flexion
HS reduce anterior tibial translation
Anterior Tib eccentrically controls foot drop
Posterior Tib eccentrically controls pronation
3
Q
Mid Stance Muscle Activity (Running)
A
Glute Max concentrically contracts for hip extension
Glute Med / Min supports hip and knee
HS concentrically control tibia as knee extends
Posterior Tib eccentrically controls pronation and readies to complete rocker motion
4
Q
Toe-Off Muscle Activity (Running)
A
Iliopsoas eccentrically contracts as it gathers potential energy for Initial Swing
Gastroc / Soleus generate nearly all support (concentrically contract for propulsion)
5
Q
Initial Swing Muscle Activity (Running)
A
Iliopsoas potential energy now released as leg “slingshots” forward
6
Q
Mid Swing Muscle Activity (Running)
A
Anterior Tib concentrically contracts for DF
7
Q
Terminal Swing Muscle Activity (Running)
A
HS eccentrically control knee extension
8
Q
What part of the body is most common site of injury during Running?
A
Knee
9
Q
What age range within adolescence has the highest injury rate during Running? Why is this?
A
12-14 y/o
Peak height velocity (growing at fastest rate)
Bone Mineral Content
10
Q
There is a ___ risk of OA in ___ runners compared to ___ and ___.
A
decreased
recreational (2-3 times/week, 10-40 miles/week)
sedentary
competitive
11
Q
Explain the Overload Principle (Running)
A
Not allowing enough recovery after fatigue (workout) to return to baseline before exercising once again
12
Q
Bone Stress Injury Continuum
A
Stress Reaction
-
Stress Fracture
13
Q
T or F: Imaging is NOT very helpful in acute shin pain.
A
T
14
Q
Bone Stress Injury (Cause / Presentation)
A
Cause: Insufficient recovery - leads to osteoclast resorption exceeding osteoblast formation
Presentation: Focal tenderness along medial border of Tibia (commonly presents in the following order: after run - during run - ADLs) / soft-tissue swilling and redness
15
Q
Bone Stress Injury (Special Tests)
A
Fulcrum Test
Tuning Fork Sign
Bump Test
16
Q
What is the MOST common running-related MSK injury in the knee?
A
PFPS
17
Q
PFPS Presentation
A
TTP medial and lateral patellar facets
Retropatellar crepitus
Pain with prolonged sitting
18
Q
PFPS Cluster
A
Pain with resisted knee extension
Pain with squatting
Pain with kneeling
3/3 = 89% Sp
19
Q
How are Stride Length and Cadence impacted in the case of PFPS? What are the implications of this?
A
Decreased Stride Length / Increased Cadence
Impacts shock and attenuation
Energy absorption at hip / knee / ankle
20
Q
How is hip stability affected during gait in a patient with PFPS?
A
Greater hip IR
Contralateral pelvic drop
21
Q
IT Band Proximal and Distal Attachments
A
Proximal: Superficial and deep layers attach to TFL and Glute Max - anchoring to Iliac Crest
Distal: Over Lateral Femoral Epicondyle and attaches at Gerdy’s Tubercle
22
Q
Stretches targeting the IT Band actually result in ___ elongation in the ITB itself.
A
minimal
23
Q
How does Foam Rolling impact pain suspected to be caused by ITB irritation?
A
Temporary pain relief
Does NOT address the cause
24
Q
Subjective Qs (Related to Running - Training)
A
Double Runs
Time of Day
Upcoming Races
Age of Shoe (Miles vs. Time)
25
Subjective Qs (Related to Running - Outside of Training)
Time between meals (build increased calorie intake to coincide with energy expenditure)
Time from meals to runs / workouts
26
Overstrider Gait Deviation (Running)
What is it?
What do we address?
Strike from COM / ankle DF and knee flexion at IC / increased tibial inclination
Address Cadence (metronome / verbal cueing) and Ther-Ex (Running Wall Drill - high knees to a beat with hands on wall to practice Cadence / Dynamic Drills)
27
Collapser Gait Deviation (Running)
What is it?
What do we address?
Hip ADD / knee flexion at mid-stance / contralateral hip drop
Strengthening (hip / pelvis / core stability) - SL bridge with rotation / SL RDL / lateral step down / crossover step up / Runner's Pose (SLS with 1 knee up)
28
Weaver Gait Deviation (Running)
What is it?
What do we address?
Crossover at IC / shoe more worn at lateral side / decreased knee gap
Address Cadence (increasing gives decreased time to cross foot over - Visual Cue w/ white tape)
29
Bouncer Gait Deviation (Running)
What is it?
What do we address?
Vertical oscillation / "pony tail" sign (moving up and down) / noise (louder upon contact)
Address Cadence (to limit amount of time available to stay in the air) / Running Wall Drill and Dynamic Drills
30
Glute Amnesiac Gait Deviation (Running)
What is it?
What do we address?
Trunk Lean / decreased hip extension in Terminal Stance
Glute Max activation / hip and core stability / MT (hip ROM / mobility)
31
Abductory Twist
*Incidence*
AKA "Heel Whip"
More than half of recreational runners have more than a 5 degree whip
32
What is the goal in providing a patient with a metronome to train Cadence?
Goal is to wean patient off metronome feedback
33
What characterizes "Normal Gait" observed in a patient with a Transtibial Amputation?
Flexion moment throughout stance
Slight varus moment (about 1/2 inch)
Slight toe-out
34
In a patient with a Transtibial Amputation, what should characterize the position of their knee? What does this promote?
5-10 degrees of knee flexion ("soft" knee)
Promotes WB through the Patella
35
What factors can contribute to variations in residual limb *volume?*
Changes in diet
Meds
Shrinker wear
Activity level
36
How long should a patient wear a "Shrinker" after they undergo an amputation? What is this for?
6 months - 1 year after amputation anytime the prosthesis is not donned
Edema management
37
Transtibial Amputation
Excessive Knee Extension
*Prosthetic Causes*
Foot too anterior to socket (toe lever too long)
Heel cushion too soft (may delay pilon (what would be tibial) translation)
Excessive PF of the foot
38
Transtibial Amputation
Excessive Knee Extension
*Amputee Causes*
Shoe heel height too low (can tip pylon too far back)
Excessive use of knee extensors (poor gait pattern)
39
Excessive knee extension in a patient with a Transtibial Amputation can lead to what? How do we treat this?
Anterior distal pain on residual limb + skin abrasions
Encourage pt to bend knee slightly to promote WB through patellar tendon
40
Transtibial Amputation
Excessive Knee Flexion (Knee Instability)
*Prosthetic Causes*
Heel too firm (throws pylon forward too fast)
Foot too far posterior
Foot too DF
41
Transtibial Amputation
Excessive Knee Flexion (Knee Instability)
*Amputee Causes*
Knee Flexion contracture (puts high demand on quads)
Shoe height too high
Weak quads
42
Transtibial Amputation
Narrow Based Gait and Excessive Varus Thrust
*Prosthetic Causes*
Pylon leans laterally
Foot too inset (closer to midline than Pylon)
Socket too wide
43
Transtibial Amputation
Wide Based Gait and Excessive Valgus Thrust
*Prosthetic Causes*
Pylon leans medially
Foot too outset
Socket too wide
44
Transtibial Amputation
Lateral Trunk Bending to Prosthetic Side
*Prosthetic Causes*
Prosthesis too short
Abducted socket
45
Transtibial Amputation
Lateral Trunk Bending to Prosthetic Side
*Amputee Causes*
Pain on lateral distal aspect of residual limb
Weak hip abductors
46
Transtibial Amputation
Early, Abrupt Heel Off (Drop-Off)
*Prosthetic Causes*
Toe lever arm too short or too soft (due to excessive posterior position of the foot)
Foot excessively DF (socket in too much flexion)
Both contribute to too much (sudden) flexion at the knee
47
Transtibial Amputation
Early, Abrupt Heel Off (Drop-Off)
*Amputee Causes*
Heel height too high
48
Define *Pistoning.*
Gait deviation in patients with Transtibial Amputation
Vertical displacement of residual limb in socket
49
Transtibial Amputation
Pistoning
*Prosthetic Causes*
Socket too large
Suspension (ability to keep socket on) inadequate
50
Transtibial Amputation
Pistoning
*Amputee Causes*
Limb shrinkage
51
A "whip" at the foot is named after which direction? What knee positions correspond with each subtype?
The direction the heel is pointing in
Knee IR - Lateral Whip / Knee ER - Medial Whip
52
Transtibial Amputation
Foot Whips Medially or Laterally
*Prosthetic Causes*
Inadequate suspension - misaligned
53
Transtibial Amputation
Foot Whips Medially or Laterally
*Amputee Causes*
Irregular loading at Terminal Stance
Improperly donned prosthesis
54
General Causes of Gait Deviations in pts w/ Transfemoral Amputation
Limb volume changes
Inappropriate number of socks
Changing footwear
Improper donning
Inadequate suspension
55
What is more common to recommend for a patient with a Transfemoral Amputation, a softer or firmer heel?
Softer to promote stability
Firmer heel promotes Pylon translation, softer delays it
56
Transfemoral Amputation
Knee Instability
*Prosthetic Causes*
Knee axis set too far anterior (creating a flexion moment)
Heel cushion is too hard - creates a flexion moment at heel strike
57
Transfemoral Amputation
Knee Instability
*Amputee Causes*
Hip Flexion contracture
Hip extensor weakness (active hip extension in prosthesis assists in stabilizing knee)
Change in heel height
58
Transfemoral Amputation
Foot Slap
*Prosthetic Causes*
Insufficient PF resistance in prosthetic foot
Heel cushion too soft for users weight and activity level
59
Transfemoral Amputation
Foot Slap
*Amputee Cause*
Forces heel into ground to ensure complete knee extension / stability
60
Transfemoral Amputation
ER of the Prosthetic Foot
*Prosthetic Causes*
Excessively firm heel cushion
Inappropriate toe-out alignment
61
Transfemoral Amputation
ER of the Prosthetic Foot
*Amputee Causes*
Poor muscle control (maintains hip in ER)
Limb shrinkage - may need to add socks
62
What is the primary WB surface for a patient with a Transfemoral Amputation?
Ischial Tuberosity
63
Transfemoral Amputation
Abducted Gait
*Prosthetic Causes*
Medial brim of socket too high
Prosthesis too long
Insufficient femur support by lateral wall
Socket too abducted
64
Transfemoral Amputation
Abducted Gait
*Amputee Causes*
Increased limb volume
Excess pressure on Pubic Ramus
Pain at distal lateral femur
Contracted hip abductors
Patient insecurity, habit
65
Transfemoral Amputation
Excessive Lateral Trunk Bending
*Prosthetic Causes*
Prosthesis is too short
Excessively outset foot
Medial wall of the socket too high
Adduction of socket inadequate (too much abduction)
66
Transfemoral Amputation
Excessive Lateral Trunk Bending
*Amputee Causes*
Weak abductors
Pain
Limb shrinkage - positioned too deeply in socket
67
Transfemoral Amputation
Pelvic Rise ("Uphill Walking")
*Prosthetic Causes*
Toe lever too long (harder to roll over toe in sufficient amount of time)
Foot placed too anteriorly with respect to knee / socket
Excessively PF foot
68
Transfemoral Amputation
*Drop-Off
*Prosthetic Causes*
Drop-Off: Excessive pelvic drop with forward progression ("stepping into a hole")
Toe lever too short / foot too DF
69
Transfemoral Amputation
Excessive Lumbar Lordosis
*Prosthetic Causes*
Insufficient initial socket flexion leads to extension of lumbar spine in an effort to obtain hip extension necessary for knee control
Improperly shaped posterior wall - causing painful ischial WB
70
Transfemoral Amputation
Excessive Lumbar Lordosis
*Amputee Causes*
Weak hip extensors or abs
Hip Flexion contracture that cannot be accommodated prosthetically
Pain from ischial WB
71
Transfemoral Amputation
Medial or Lateral Whip
*Prosthetic Causes*
Medial - prosthetic knee aligned in excessive ER
Lateral - prosthetic knee aligned in excessive IR
72
Transfemoral Amputation
Medial or Lateral Whip
*Amputee Causes*
Medial - socket donned with too much ER
Lateral - socket donned with too much IR
73
Transfemoral Amputation
Inadequate or Delayed Knee Flexion
*Prosthetic Causes*
Excessive mechanical resistance to knee flexion
Prosthesis aligned with too much stability
74
Transfemoral Amputation
Inadequate or Delayed Knee Flexion
*Amputee Causes*
Poor gait mechanics (patient not trusting knee and walking on it locked)
75
Inadequate or delayed knee flexion in a patient with a Transfemoral Amputation could cause what gait deviation?
Circumduction
OR
Vaulting
76
Transfemoral Amputation
Circumducted Gait
*Prosthetic Causes*
Prosthetic knee with excessive mechanical resistance to knee flexion
Prosthetic knee locked in extension (extension bias too strong)
Prosthesis too long
77
Transfemoral Amputation
Circumducted Gait
*Amputee Causes*
Fear of knee flexion or catching toe
Inadequate hip flexion
Pain due to high medial brim
78
Transfemoral Amputation
*Vaulting
*Prosthetic Causes*
Vaulting: Client rises on toe of the sound limb to swing prosthesis through with little knee flexion
Inadequate socket suspension / prosthesis too long / too much resistance to knee flexion / prosthetic knee locked in extension (extension bias too strong)
79
Transfemoral Amputation
Vaulting
*Amputee Causes*
Fear of knee flexion or dragging toe
Patient habit
80
Transfemoral Amputation
*Excessive Terminal Impact
*Prosthetic Causes*
Excessive Terminal Impact: Shin of prosthesis moves forward quickly (reaching full extension early) w/ an audible or visible impact against the proximal section of prosthetic knee
Insufficient resistance to extension of knee unit
81
Transfemoral Amputation
*Excessive Terminal Impact
*Amputee Causes*
Forceful hip flexion in initial swing to build momentum for knee extension
Forcefully extends hip in terminal swing to snap knee into full extension (in prep for IC)
82
Transfemoral Amputation
Unequal Step Length (Long Prosthetic Side Step)
*Prosthetic Causes*
Insufficient initial socket flexion to accommodate hip flexion contracture
83
Transfemoral Amputation
Unequal Step Length (Long Prosthetic Side Step)
*Amputee Causes*
Hip flexion contracture
Fear of falling
Pain
84
Can learning be measured directly?
No!
85
Learning produces relatively ___ changes in behavior.
permanent
86
Fitts and Posner Three-Stage Model
Cognitive Stage: Acquisition of knowledge / trial and error stage
Associative Stage: Refining a skill / less variability
Autonomous Stage: Skill is automatic / low degree of attention
87
Systems Three Stage Model
Novice / Advanced / Expert
Controlling degrees of freedom
88
T or F: Neural plasticity is the basis for learning in both the intact brain and the damaged brain.
T
89
Skill Learning vs. Motor Learning (Brain Activity)
Skill: Rewiring of motor cortex
Motor: Increased number of synapses in motor cortex
90
Principles of Neuroplasticity for Walking Retraining (4)
Specificity matters
Repetition matters
Intensity matters
Salience matters
91
Post-Stroke Intensive Gait Training Program
Ideal HR Max / RPE?
80-85% of age predicted max HR
RPE 17
92
Measures of Intensity
HRMax / HRR / RPE
HRMax: 208 - (0.7 * age) OR 220 - age
HRR: Resting HR + ((HRMax - Resting HR) * %Training Intensity)
RPE: Borg (6-20) / Modified Borg (0-10)
93
Recommended Levels of Intensity (General)
70-85% HRMax
60-80% HRR
> or = 14/20 RPE
94
ACSM Contraindications to Initiating High-Intensity Gait Training in CVD
Unstable angina
Uncontrolled HTN (Resting Systolic BP > 200 mmHg / Diastolic BP > 110)
Orthostatic BP drop of >20 mmHg with symptoms
95
Locomotor CPG
Clinicians *SHOULD* use ___ to improve walking function.
Moderate to high intensity walking training interventions (60-80% HRR or 70-85% HRMax)
VR walking training interventions
*In favor of specificity / intensity / repetition*
96
Locomotor CPG
Clinicians *MAY CONSIDER* using ___ to improve walking function.
Strength training (> or = 70% of 1 RM) / circuit training / cycling / recumbent stepping (up to 85% HRMax)
Balance training with VR
*In favor of intensity, NOT in favor of specificity / repetition*
97
Locomotor CPG
Clinicians *SHOULD NOT* use ___ to improve walking function.
Sitting / standing balance training
Body weight supported-treadmill training
Robot-assisted gait training
98
Biomechanical Subcomponents of Gait
*Stance Control:* Absence of vertical limb or trunk collapse during stance
*Limb Advancement:* Adequate foot clearance and a positive step length bilaterally
*Propulsion:* Ability to move COM in a specific direction (forward, backward, etc.) during stance
*Postural Stability:* Maintaining upright in sagittal and frontal planes, keeping COM within BOS
99
T or F: Frequent feedback has a positive effect.
F, it has a *negative* effect
100
After stroke, what may limit improvements in efficiency of gait? What can be done to enhance learning?
eliminating errors
augmenting errors (application of perturbations to do so)
101
Internal vs. External Focus of Attention
Internal - directing patient's attention to self-maintenance
External - directing patient's attention to their control / impact on an external object
102
What *SHOULD* we be using AFOs for during gait training?
Gait speed
Dynamic balance
QOL
Other mobility
Walking endurance (more for chronic stroke pts)
103
What *MIGHT* we use AFOs for during gait training?
Walking endurance
Gait kinematics
Muscle strength / activation
104
What should we *NOT* be using AFOs for during gait training?
Tone
Spasticity
105
Role of FES in Gait Training
Evidence primarily for patients with foot drop
Swing phase device - often used to stimulate Ant Tib (does NOT help with stance control issues)
106
Shrinkers for Residual Limb
Use once suture line is healed
Potential for skin shearing during application
May be difficult for people to apply with decreased hand strength or impaired mobility
Use shrinker whenever not wearing a prosthesis for 6 months - 1 year (edema management)
107
Elastic Compression for Residual Limb
Stockinet and Tubigrip
Double-layered
Advantages: Cheap / good for bulbous residual limbs
Disadvantages: Potential for shearing (not as durable)
108
Ace Wrapping for Residual Limbs
Most frequent immediately post-op (wound drainage may be present)
Apply distal to proximal in a diagonal pattern - avoid circular turns / make sure all areas of limb are covered evenly to promote proper prosthetic fitting
109
Ace Wrapping for Residual Limbs
Advantages and Disadvantages
*Advantages:* Easily applied over dressings / sutures, no potential for shearing
*Disadvantages:* Frequent reapplication (every 4-6 hours) / movement may loosen bandage / difficult to don independently
110
Main Causes of Amputation
Disease (PVD / Diabetes / Cancer) - 74%
Trauma - 23%
Congenital - 3%
30-50% will become bilateral
111
Common Contractures (Transfemoral Amputation)
Hip flexion
Hip ER
Hip abd
112
Common Contractures (Transtibial Amputation)
Hip flexion
Hip ER
Hip Abd
Knee flexion
113
Strength Training
*Transfemoral Amputation*
*Transtibial Amputation*
*Geriatrics*
TFA: Emphasize hip extension
TTA: Emphasize knee flexion
Geriatrics: Emphasize balance
