Transtibial and Transfemoral Gait Deviations Flashcards
(110 cards)
1
Q
TRANSTIBIAL GAIT DEVIATIONS
A
TRANSTIBIAL GAIT DEVIATIONS
2
Q
What is the goal with transtibial prosthetic gait?
A
Gait that is as close to normal as possible.
3
Q
Normal gait is a function of what things in TT?
A
- Socket fit
- Prosthetic alignment (between foot and socket in transtibial)
- Components used
- User ability
4
Q
Phases of gait an what we are looking for in each phase.
A
IC/LR
- stride length
- controlled knee flexion
MSt
- pylon position
- step width
TSt
- smooth progression over the foot
- smooth flexion of the limb
PSw
-pelvic, trunk, and head position
Swing Phase
-prosthetic path
5
Q
List the TT Gait Deviations.
A
- Excessive Knee Extension
- Knee Instability
- Hip Drop
- Lateral Thrust
- Wide Based Gait
- Drop-Off
- Vaulting
- Pistoning
- Uneven Step Length
- Circumduction
6
Q
Excessive Knee Extension is seen in what phase(s) of gait?
A
IC → MSt
sagittal
7
Q
What are some prosthetic causes of Excessive Knee Extension?
A
- Socket aligned too far posterior/foot aligned too far anterior.
- Heel too soft.
- Insufficient socket flexion.
8
Q
What are patient causes of Excessive Knee Extension?
A
- Weak musculature around knee.
- Locking knee to prevent fall.
9
Q
Patients with Excessive Knee Extension may develop skin breakdown where?
A
Anterior distal tibia from extending excessively into the socket. (Bell clapping)
10
Q
Knee Instability is seen in what phase(s) of gait?
A
IC → LR
sagittal
11
Q
What are some prosthetic causes of Knee Instability?
A
- Socket aligned too far anterior/foot aligned too far posterior.
- Heel too firm.
- Excessive foot DF.
12
Q
What are some patient causes of Knee Instability?
A
- Weak quads.
- Knee flexion contracture.
13
Q
- Patients with Knee Instability will report feeling unstable and having excessive pressure where?
- These patients may also present with a shortened stance phase on the _________ side.
A
- distal residual limb
- prosthetic
14
Q
Hip Drop is seen in what phase(s) of gait?
A
MSt
frontal
15
Q
With Hip Drop, we see a pelvic drop toward the ________ side during MSt.
A
prosthetic
16
Q
What are some prosthetic causes of Hip Drop?
A
Prosthesis too short.
17
Q
What are some patient causes of Hip Drop?
A
Residual limb pain.
18
Q
Lateral Thrust is seen in what phase(s) of gait?
A
MSt
frontal
19
Q
A narrow BOS with lateral thrust of the socket durinig MSt creates excessive ______ at the knee.
A
Varus
20
Q
What are some prosthetic causes of Lateral Thrust?
A
- Foot too far inset.
- Laterally leaning pylon.
21
Q
What are some patient causes of Lateral Thrust?
A
- Glute med weakness.
- Knee ligament insufficiency.
22
Q
Patients with Lateral Thrust will complain about increased __________ and ____________ residual limb pain and pressure leading to breakdown.
A
- proximal medial
- distal lateral
23
Q
Wide Based Gait is seen in what phase(s) of gait?
A
MSt
frontal
24
Q
With a Wide Based Gait, we see an increase in ______.
A
BOS
25
What are some prosthetic causes of Wide Based Gait?
- Outset foot.
| - Medial leaning pylon.
26
What are some patient causes of Wide Based Gait?
- Insufficient weight shift over prosthesis.
- Hip abduction tightness.
- Patient fear.
27
Drop-Off/Knee Instability is seen in what phase(s) of gait?
TSt
| sagittal
28
Drop-Off involves early and excessive knee ______ durinig TSt.
flexion
29
What are some prosthetic causes of Drop-Off?
- Socket aligned too far anterior/foot too far posterior.
| - Inappropriate foot choice.
30
What are some patient causes of Drop-Off?
Knee flexion contractures (results in early and excessive knee flexion).
31
Vaulting is seen in what phase(s) of gait?
SW
| frontal
32
Vaulting is excessive ___ of sound limb during MSt to clear prosthetic foot.
PF
33
What are some prosthetic causes of Vaulting?
- Prosthesis too long.
- Long toe lever arm.
- Socket too far posterior.
34
What are some patient causes of Vaulting?
Holding knee in extension for too long.
35
Patients with Vaulting will often complain of _______ in the sound limb.
fatigue
36
Pistoning is seen in what phase(s) of gait?
SW, IC → MSt
| sagittal
37
Pistoning involves a loss of __________.
suspension
38
What are some prosthetic causes of Pistoning?
- Sockets too large.
| - Not enough socks.
39
What are some patient causes of Pistoning?
- Volume changes.
| - Not enough socks.
40
Pistoning is a ____ risk and usually results in a _____ step with the prosthesis.
- fall
| - short
41
With Pistoning, where will we have residual limb pain?
-distal residual limb
42
Uneven Step Length is seen in what phase(s) of gait?
SW
| sagittal
43
An Uneven Step Length involves taking a long step with the ________ limb, step-to pattern with the ______ limb.
- prosthetic
| - sound
44
What are some prosthetic causes of Uneven Step Length?
n/a
45
What are some patient causes of Uneven Step Length?
- Insufficient gait training.
| - Decreased patient confidence.
46
Circumduction is seen in what phase(s) of gait?
SW
| frontal
47
With Circumduction the patient swings the leg around in an ________ position to advance it forward.
abducted
48
What are some prosthetic causes of Circumduction?
- Poor suspension.
| - Prosthesis too long.
49
What are some patient causes of Circumduction?
- Feeling of instability.
| - Decreased knee flexion during swing phase.
50
Do TT or TF present with circumduction more?
TF
51
TT Gait Deviations Main Takeaways:
- Any gait deviation is going to have an impact on gait efficiency and work.
- Analyze gait from multiple viewpoints to catch deviations.
- Patients may have a ___________ of deviations.
- Recognize when a deviation is out of your control and _____ appropriately.
- Treat __________ when possible.
- combination
- refer
- impairments
52
TRANSFEMORAL GAIT DEVIATIONS
TRANSFEMORAL GAIT DEVIATIONS
53
In TF amputations we see an overall decrease in gait speed to around __% normal.
40%
54
Normal gait is a function of what things in TF?
- Socket fit
- Prosthetic alignment (between socket, knee, and foot in transfemoral)
- Components used
- User ability
55
Phases of gait an what we are looking for in each phase.
IC/LR
- stride length
- gait cycle
- knee joint stability
MSt
- weight shift over prosthetic
- braking to propulsion
- pylon position
TSt
- SLS time
- progression
PSw
- heel rise
- adequate suspension
Swing Phase
-velocity
56
Terminal Impact is seen in what phase(s) of gait?
SW → IC
| sagittal
57
Terminal Impact involves forceful and excessive knee __________ that is usually _________.
- extension
| - audible
58
What are some prosthetic causes of Terminal Impact?
Inadequate knee friction.
59
What are some patient causes of Terminal Impact?
- Fear of knee giving way.
| - Forceful hip extension.
60
Terminal Impact involves a ________ of the knee into extension. This gait deviation impacts _______ absorption.
- snapping
| - shock
61
Foot Slap is seen in what phase(s) of gait?
IC → LR
| sagittal
62
Foot Slap is accelerated ___ at heel strike resulting in the foot getting flat to the floor too soon.
PF
63
What are some prosthetic causes of Foot Slap?
-PF bumper too soft.
64
What are some patient causes of Foot Slap?
-Increased hip extension force at IC.
65
Knee Instability is seen in what phase(s) of gait?
IC → LR
| sagittal
66
Knee Instability involves giving way in early ________ phase.
stance
67
What are some prosthetic causes of Knee Instability?
- Knee axis too far supereior.
- Socket too far posterior.
- Lack of socket flexion.
68
What are some patient causes of Knee Instability?
- Inadequate hip extension strength/ROM.
| - Hip flexion contracture.
69
Knee Instability is relatively rare in ___________ knees.
microprocessor
70
Lateral Trunk Bend is seen in what phase(s) of gait?
MSt
| frontal
71
Lateral Trunk Bend involves excessive lateral lean over the hip during _____ phase.
stance
72
What are some prosthetic causes of Lateral Trunk Bend?
- Socket too abducted.
- Prosthesis too short.
- Medial socket wall too high.
73
What are some patient causes of Lateral Trunk Bend?
- Pain.
- Glute med weakness.
- Decreased balance.
- Adductor roll.
74
If a patient is ambulating with Lateral Trunk Bend, there is likely a decrease in contact with the _______ wall of the socket which decreases the ability of the glute med to stabilize the pelvis. Patients may complain of _____________ residual limb pain.
- lateral
| - distal lateral
75
Lateral Trunk Bend is essentially a __________ __________ pattern.
Compensated Trendelenburg
76
Abducted Gait is seen in what phase(s) of gait?
MSt
| frontal
77
Abducted Gait involves excessive _____ abduction during stance leading to a wide based gait pattern.
hip
78
What are some prosthetic causes of Abducted Gait?
- Foot/leg too far outset.
- Prosthesis too long.
- Medial socket wall too high.
- Lateral wall not adducted enough.
79
What are some patient causes of Abducted Gait?
- Abduction contracture.
- Lateral-distal RL pain.
- Decreased balance/trying to increase BOS.
- Adductor roll.
80
Excessive Trunk Extension is seen in what phase(s) of gait?
MSt
| sagittal
81
With Excessive Trunk Extension we see excessive lumbar _________ during stance or a posterior trunk lean.
lordosis
82
What are some prosthetic causes of Excessive Trunk Extension?
- Increased socket extension.
| - Not enough flexion built into socket.
83
What are some patient causes of Excessive Trunk Extension?
- Weak hip extensors.
- Weak abdominals.
- Hip flexion contracture.
- Very short RL.
84
Drop-Off is seen in what phase(s) of gait?
TSt
| sagittal
85
Drop-Off involves sudden and excessive knee ________ during late stance phase.
flexion
86
What are some prosthetic causes of Drop-Off?
- Short toe lever.
| - Socket set too posterior to knee axis.
87
What are some patient causes of Drop-Off?
n/a
88
Excessive Heel Raise is seen in what phase(s) of gait?
PSw → SW
| sagittal
89
Excessive Heel Raise involves the prosthetic heel rising excessively (both in _________ and _________).
distance and velocity
90
What are some prosthetic causes of Excessive Heel Raise?
-Insufficient knee friction.
91
What are some patient causes of Excessive Heel Raise?
-Forceful hip flexion.
92
Circumduction is seen in what phase(s) of gait?
SW
| frontal
93
With Circumduction the user swings the leg in a circular motion laterally to advance it during _______ phase.
swing
94
What are some prosthetic causes of Circumduction?
- Prosthesis too long.
- Inadequate suspension.
- Excessive knee friction.
- Medial wall too high.
95
What are some patient causes of Circumduction?
- Hip flexor weakness.
- Hip abduction contracture.
- Fear.
96
Vaulting is seen in what phase(s) of gait?
SW
| frontal
97
Vaulting involves excessive ____ of the sound limb to clear the prosthetic limb.
PF
98
What are some prosthetic causes of Vaulting?
- Prosthesis too long.
- Inadequate suspension.
- Excessive knee friction.
99
What are some patient causes of Vaulting?
- Hip flexor weakness.
| - Fear.
100
Medial Whip is seen in what phase(s) of gait?
SW
| frontal/transverse
101
Medial Whip involves a medially directed whipping motion of the __________.
prosthesis
102
What are some prosthetic causes of Medial Whip?
- External rotation of knee component.
| - Improper alignment of knee bolt.
103
What are some patient causes of Medial Whip?
-Improper donning.
104
Medial Whip is named after the position of the _______ and the ______.
pylon and the foot
105
Lateral Whip is seen in what phase(s) of gait?
SW
106
Lateral Whip involves a laterally directed whipping motion of the __________.
prosthesis
107
What are some prosthetic causes of Lateral Whip?
- Internal rotation of knee component.
| - Improper alignment of knee bolt.
108
What are some patient causes of Lateral Whip?
-Improper donning.
109
Lateral Whip is named after the position of the _______ and the ______.
pylon and foot
110
TF Gait Deviations Main Takeaways:
- Any gait deviation is going to have an impact on gait efficiency and work.
- Increased number of components = increased likelihood of ________.
- Analyze gait from multiple viewpoints to catch deviations.
- Patients may have a ___________ of deviations.
- Recognize when a deviation is out of your control and _______ appropriately.
- Treat __________ when possible.
- deviations
- combination
- refer
- impairments
