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COMP EXAM PREP > Prosthetics & Orthotics Gait > Flashcards

Prosthetics & Orthotics Gait Flashcards

(61 cards)

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1
Q

Levels of Amputation:

A

Involving the Foot

Below Knee Amputation (BKA) or
Transtibial

Knee Disarticulation

Above Knee Amputation (AKA) or Transfemoral

Hip Disarticulation

Hemipelvectomy

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2
Q

Transtibial / Below Knee Amputation (BKA)

A

Foot & ankle removed; tibia and fibula remain

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3
Q

Knee Disarticulation

A

Entire leg below femur removed at knee joint; femur intact

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4
Q

Transfemoral / Above Knee Amputation (AKA)

A

Foot, ankle, tibia, fibula, and part of femur removed

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5
Q

Hip Disarticulation

A

Entire leg removed at hip joint; pelvis intact

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6
Q

Hemipelvectomy

A

Leg and part of pelvis removed

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7
Q

A patient comes to a physical therapy clinic following a left below knee amputation. Assuming the black dot in the middle was the patient’s center of mass before amputation,
which of the following location is MOST LIKELY to be the new center of mass after amputation?

A. Moves higher on the right side (Yellow dot)
B. Moves lower on the right side (Red dot)
C. Moves higher on the left side (Blue dot)
D. Moves lower on the left side (Green dot)

A

A. Moves higher on the right side (Yellow dot)

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8
Q

Center of Mass principle:

A

unilateral amputation = COM towards the opposite side

COM moves to side with more mass

UE amputation = COM shifts down

LE amputation = COM shifts up

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9
Q

UE intact and LE cut ->

A

COM moves up = towards heaviest part of body

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10
Q

trunk lean:

A

towards:
> painful
> weak
> amputation

trunk lean towards cut side = compensate to bring trunk neutral

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11
Q

Care after Amputation:

A
  • Wound care
  • Pain control
  • Limb shaping
  • Initial prosthetic fitting
  • Balance
  • Strengthening
  • Gait training
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12
Q

Analyze the Prosthesis:

A

Gait deviation may be prosthetic or anatomical in nature

Some deviations will need adjustment in the prosthetic device

Some will require further PT treatment

Need to know both!

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13
Q

AKA example: R prosthetic

A

R trunk lean

weak R glute med

L side pelvis drop

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14
Q

Prosthetic Walls vs. Muscle Function

A

In a prosthetic limb, the walls of the socket provide external support and control forces — similar to how muscles stabilize and guide joints.

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15
Q

Above Knee Prosthesis

low walls =

A

Similar to weak muscles = lean toward weak m.

  • E.g., Low anterior thigh wall = weak quadriceps (trunk lean forward)
  • Low lateral wall = weak abductors- glute med. (trunk lean lateral)
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16
Q

Above Knee Prosthesis

high walls =

A

Similar to tight muscles

  • E.g., High anterior thigh wall = tight hip flexors which pulls pelvis into anterior pelvic tilt

pull pelvis down = lordosis

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17
Q

medial wall =

A

adductor magnus

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18
Q

posterior wall =

A

main one

glute max

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19
Q

most common wall problems:

A

medial wall too high

lateral wall too low

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20
Q

Gait Deviations – AKA Stance Phase

A

lateral bend
abduction
lordosis
forward flexion

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21
Q

Gait Deviations – AKA Stance Phase - lateral bend

A

Short prosthesis, inadequate lateral wall

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22
Q

Gait Deviations – AKA Stance Phase - abduction

A

Long prosthesis, abducted hip joint

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23
Q

AGait Deviations – KA Stance Phase - lordosis

A

Anterior socket wall discomfort

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24
Q

Gait Deviations – AKA Stance Phase - forward flexion

A

Unstable knee joint, short walker

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25
A patient with a right above knee prosthetic limb is displaying right lateral trunk bending while ambulating. Which of the following would be the MOST LIKELY cause of this gait abnormality? A. Short prosthesis B. Medial wall too low C. Lateral wall too high D. Long prosthesis
A. Short prosthesis weak L glute med - too low lat. wall R LE -> R lat trunk lean
26
Gait Deviations – AKA - early swing
deviation - High heel rise cause - Inadequate friction, slack extension aid (too loose goes into flexion)
27
Gait Deviations – AKA - late swing
deviation - Terminal impact cause - Inadequate friction, taut extension aid (helps with extension)
28
Gait Deviations – AKA - stance heel off
deviation - Heel whip cause - Knee bolt rotated; prosthesis donned in malrotation loose screw
29
Gait Deviations – AKA - heel contact
deviation - Foot rotation cause - Stiff heel cushion, malrotated foot
30
terminal impact:
knee flexed high heel rising walking into extension: lose control NOT enough friction + taut (short) extension aid
31
Taut Extension Aid
tension - Too tight Knee extends too early or too forcefully during swing Jerky, abrupt extension in terminal swing → may cause instability or stumble Feels like the leg “snaps” into place
32
Slack Extension Aid
tension - Too loose Knee may not fully extend before heel strike Insufficient extension → knee may buckle at initial contact Feels like the knee is “wobbly” or collapses
33
Medial Heel Whip
heel of the prosthetic foot swings inward (toward midline) during early swing phase of gait Just after toe-off during swing phase Seen from behind the patient as the heel rotates medially cause: - Socket internally rotated - Knee axis improperly aligned - Excessive socket tightness around thigh
34
Lateral Heel Whip
heel swings outward (laterally) during swing Often due to external rotation of socket
35
During gait analysis of a patient with transfemoral amputation, the clinician observes a medial heel whip during heel off on the left side. Which of the following is the MOST LIKELY cause of this deviation? A. Taut extension aid B. Inadequate medial rotation of the knee joint C. Prosthetic knee bolt is externally rotated D. Short prosthesis
C. Prosthetic knee bolt is externally rotated OR knee axis is in excessive ER -> heel moves closer to midline of body at heel off
36
lateral vs medial heel whip
lateral heel whip -> knee bolt IR medial heel whip -> knee bolt ER
37
If plantarflexion of the foot is restricted by stiff heel cushion or hard plantarflexion bumper:
The amputee’s knee may have to flex through more than the normal range to allow the sole of the foot to reach the floor Bumper will not absorb the impact of the heel striking the floor, thus tending to produce abrupt and excessive knee flexion NO PF -> goes into DF + excessive knee flexion
38
Too soft heel cushion or soft plantarflexion bumper allows excessive compressibility of heel cushion:
The ground reaction force passes anterior to the knee between heel strike and mid stance Causes hyperextension of the knee joint too much PF -> excessive knee extension
39
A clinician is observing the gait of a patient with right transtibial amputation and notices increased plantarflexion at heel strike. What is the MOST LIKELY cause? A. Plantarflexion bumper too rigid B. Plantarflexion bumper too soft C. Heel cushion is too firm D. Excessive inset of the foot
B. Plantarflexion bumper too soft
40
Heel Bumpers - soft vs hard
soft = excessive hard = limited movement
41
Orthotic Gait anatomic causes
Weak dorsiflexors Plantarflexor spasticity
42
Weak dorsiflexors =
Inadequate dorsiflexion assist
43
Plantarflexor spasticity =
Inadequate plantarflexion stop
44
Orthotic Gait =
Inadequate assist is similar to weak muscles Inadequate stop is similar to spastic muscles
45
Orthotic Gait deviations caused:
* Toe drag * Circumduction * Hip hiking * Vaulting
46
A patient demonstrates hip hiking in the swing phase of the gait cycle with their current orthotic. Which of the following orthotic impairment would MOST LIKELY contribute to this gait deviation? A. Excessive dorsiflexion assist B. Inadequate plantarflexion stop C. Inadequate knee lock D. Excessive plantarflexion stop
B. Inadequate plantarflexion stop hip hike -> inadequate - hip flexion - knee flexion - ankle DF
47
During examination, the physical therapist observes the exudate from the wound site. Which of the following findings indicates an infected wound and should be reported to the physician? A. Dark red blood B. Bright red blood C. Viscous yellow exudate D. Serosanguineous exudate
C. Viscous yellow exudate dark red/bright red blood = inflamed wound serosanguineous exudate = typical in small or medium amounts -> wound is beginning to heal
48
L AKA - expected contracture:
flexion and abduction limb loss -> try to come close to the trunk
49
Which position to be avoided for a BKA?
flexion > put them in prone
50
During the follow up visit a month later, the patient reports shooting pain at the end of the residual limb. Examination of the residual limb does not show any erythema. What is the MOST LIKELY cause of this shooting pain? A. Cellulitis B. Dermatitis C. Impetigo D. Neuroma
D. Neuroma
51
Cellulitis
Bacterial infection of the skin and subcutaneous tissues Red, hot, swollen, tender skin May have fever, chills, or malaise Commonly caused by Strep or Staph bacteria Needs immediate medical attention → refer to physician
52
Dermatitis
nflammation of the skin due to irritants, allergens, or autoimmune triggers Itchy, dry, red, flaky patches Can be: Atopic dermatitis (eczema) Contact dermatitis (irritant or allergic) Not contagious
53
Impetigo
Highly contagious superficial skin infection, common in children Honey-colored crusts over red sores, often on face/hands Caused by Staph aureus or Strep pyogenes Spread by skin contact or contaminated surfaces
54
Neuroma
A benign nerve growth or thickening, often painful Common type: Morton’s neuroma (between 3rd and 4th toes) Causes burning, tingling, or numbness Aggravated by pressure or narrow shoes
55
When proper loading of residual limb with the prosthesis is achieved the following can be observed:
Pressure tolerant areas Pressure sensitive areas
56
Pressure tolerant areas:
Transient redness is to be expected after prosthetic use hard surfaces AAF2: Anterior tibia Anterior tibial crest Fibular head and neck Fibular head and neck
57
Pressure sensitive areas:
No redness should be observed in these areas after prosthetic use soft surfaces M-DPT: Medial tibial plateau Distal end (rarely, may be sensitive) Patellar tendon Tibial and fibular shafts
58
After gait training a patient with a new below knee prosthesis, you notice redness along the shafts of the tibia and fibula. What would this indicate? A. The socket is too small, and the residual limb is not seated properly B. The socket is too large and pistoning is occurring C. Improper weight distribution during stance D. Pressure tolerant weight bearing during stance
D. Pressure tolerant weight bearing during stance
59
what happens when the socket is too small, and the residual limb is not seated properly:
he limb doesn’t fully sit inside the socket → “riding high” Causes excessive distal pressure and tightness at the brim May feel like the socket is "too tall" or pinching at the top Pain at distal end of limb Socket brim may feel like it’s cutting into groin or thigh Gait deviations: Vaulting, circumduction, shortened stance time
60
what happens when Socket Too Large:
Residual limb moves up and down inside the socket (pistoning) Poor suspension leads to loss of control Visible movement of prosthesis during swing phase May feel loose or unstable Patient reports “falling into the socket”
61
what happens when mproper Weight Distribution During Stance:
Patient may overload pressure-sensitive areas (e.g., distal tibia, fibular head) Underload pressure-tolerant areas (e.g., patellar tendon, medial tibial flare) Complaints of pain or skin redness over sensitive areas Poor alignment → may cause compensatory gait (e.g., lateral trunk lean) Possible gait asymmetry due to offloading

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