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458 Cards in this Set
- Front
- Back
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What are the two phases of the gait cycle?
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stance and swing
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What is stride?
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from heel strike to heel strike of SAME foot
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What is step?
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from heel strike of one foot to heel strike of other foot
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How many steps is a stride?
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2 steps = 1 stride
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What are the 5 subdivisions of stance?
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initial contact
loading response midstance terminal stance preswing |
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What is the mnemonic for the five stance subdivisions?
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I Like My Tea Presweetened
I initial contact L loading response M midstance T terminal stance P preswing |
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During what subdivision does weight shift occur?
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loading response
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During what subdivision is center of gravity the lowest?
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loading response
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During what subdivision is the center of gravity the highest?
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midstance
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What is the mnemonic for the 3 swing phase subdivisions?
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In My Teapot
I - initial swing M - midswing T - terminal swing |
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During walking, what percentage of time is stance and what % for swing?
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stance: 60%
swing: 40% |
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What % is spent in double limb support?
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20%
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What is lack of double limb support called?
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running
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What is cadence?
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number of steps per unit time
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What are two ways to slow walking speed?
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*decrease cadence
*decrease stride or step length |
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Where is the center of gravity in a man located?
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5 cm anterior to S2
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During the adult male step, how much is the center of gravity displaced horizontally and vertically?
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5 cm horizontally
5 cm vertically |
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Falling is avoiding if what is maintained?
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COG is over base of support
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What are the 6 determinants of gait?
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1. pelvic rotation
2. pelvic tilt 3. knee flexion in stance phase 4. foot mechanisms 5. knee mechanisms 6. lateral displacement of the pelvis |
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Trendelenburg gait is caused by a weakness in what muscles?
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gluteus medius
gluteu minimus |
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During what determinant of gait is the COG the lowest?
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pelvic rotation
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What is knee flexion degrees at pelvic tilt?
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15%
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What is the increase in energy expenditure over normal in wheelchair propulsion?
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9% increase
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What requires more energy, walking with crutches or with a prosthesis?
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crutch walking
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What 6 muscles need strengthening in preparation for crutch walking?
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* latissimus dorsi
* triceps * pectoralis major * quads * hip extensors * hip abductors |
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Which one of the 6 determinants of gait reduces displacement on the horizontal plane?
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lateral displacement of the pelvis
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What is the cause of foot slap during initial contact?
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weak dorsiflexors
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What gait abnormality can weak dorsiflexors cause?
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foot slap during initial contact
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What 2 muscular weaknesses cause genu recurvatum during initial contact through midstance?
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quadriceps
hamstring |
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What are three causes of excessive foot supination during initial contact through midstance?
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forefoot valgus deformity
pes cavus short limb |
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What are 4 causes of excessive trunk extension during initial contact through midstance?
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*weak hip extensors
*weak hip flexors *hip pain *decreased knee ROM |
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What are 3 causes of excessive trunk flexion during initial contact through midstance?
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*weak gluteus maximus
*weak quadriceps *hip flexion contracture |
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What are 5 causes of excessive knee flexion during initial contact through preswing?
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*hamstring contracture
*increased ankle dorsiflexion *weak plantar flexor *long limb *hip flexion contracture |
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What are three causes of excessive medial femur rotation during initial contact through preswing?
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*tight medial hamstrings
*anteverted femoral shaft *weakness of opposite muscle group |
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What are three causes of excessive lateral femur rotation during initial contact through preswing?
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*tight lateral hamstrings
*retroverted femoral shaft *weakness of opposite muscle group |
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What are 4 causes of wide base of support during initial contact through preswing?
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*hip abductor muscle contracture
*instability *genu valgum *leg length discrepency |
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What are two cause of narrow base of support during initial contact through preswing?
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*hip adductor muscle contracture
*genu varum |
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What are two causes of excessive trunk lateral flexion (compensated Trendelenberg gait) during loading response through preswing?
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*ipsilateral gluteus medius weakness
*hip pain |
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What is the cause of pelvic drop (uncompensated Trendelenberg gait) during loading response through preswing?
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ipsilateral gluteus medius weakness
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What is the cause of waddling gait?
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bilateral gluteus medius weakness
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What are 6 causes of excessive foot pronation during midstance through preswing?
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*compensated forefoot or rearfoot varus defomity
*uncompensated forefoot valgus deformity *pes planus *decreased ankle dorsiflexion *increased tibial varum *long limb *uncompensated internal rotation of the tibia or femur *weak tibialis posterior |
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What are 2 causes of bouncing during midstance through preswing?
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*achilles tendon contracture
*gastroc spasticity plantar flexion |
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What are four causes of insufficient push-off during midstance through preswing?
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*gastroc weakness
*achilles tendon rupture *metatarsalgia *hallus rigidus |
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What are two causes of inadequate hip extension during midstance through preswing?
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*hip flexor contracture
*weak hip extensor |
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Weak hip extensor or hip flexor contracture cause what gait pathology?
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inadequate hip extension during midstance through preswing
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What are 3 causes of steppage gait/foot drop during swing phase?
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*severely weak dorsiflexors
*equinus deformity *plantarflexor spasticity |
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What are 3 causes of circumduction during swing phase?
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*long limb
*abductor muscle shortening or overuse *stiff knee |
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What are 4 causes of hip hiking during swing phase?
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*long limb
*weak hamstring *quadratus lumborum shortening *stiff knee |
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What is the increased metabolic cost above normal for a Syme's amputation?
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15%
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What is the increased metabolic cost above normal for a traumatic short transtibial bka amputation?
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40%
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What is the increased metabolic cost above normal for a long traumatic transtibial bka amputation?
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10%
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What is the increased metabolic cost above normal for a traumatic transtibial bka amputation?
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25%
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What is the increased metabolic cost above normal for a bilatateral bka amputation?
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41%
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What is the increased metabolic cost above normal for a traumatic transfemur amputation?
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60-70%
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What is the increased metabolic cost above normal for a traumatic bilateral aka amputation?
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>200%
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What is the increased metabolic cost above normal for a traumatic aka and bka amputation?
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118%
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What is the increased metabolic cost above normal for a vascular transtibial amputation?
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40%
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What is the increased metabolic cost above normal for a vascular transfemur amputation?
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100%
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What is the leading cause of acquired amputations in the upper extremity?
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trauma
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How many cm above the elbow is a transhumeral amputation performed?
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6.5cm
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What does a wrist disarticulation spare? Allowing what functionality ROM?
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the radial ulnar articulation, allowing full forearm pronation and supination
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What is the most common level of UE amputation?
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Transradial
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How much (in degrees)supination and pronation does the long below elbow amputation retain?
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60-120 degrees
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How much (in degrees)supination and pronation does the short below elbow amputation retain?
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less than 60 degrees
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What is the optimal (in %) below elbow residual limb length when an externally powered prosthetic is the goal?
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60-70%
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An elbow disarticulation allows more power for what 3 functions than an above elbow amputation?
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greater lifting
pulling pushing |
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An elbow disarticulation allows what 2 improved prosthetic characteristics than an above elbow amputation?
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*improved prosthetic self-suspension
*reduction of rotation of socket on residual limb |
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What is more desirable bilateral tranhumeral or bilateral elbow disarticulation?
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bilateral elbow disarticulation
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What is the ristk of bone spur or heterotopic ossification with an elbow disarticulation?
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none
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What transhumeral amputation length (%) will give best control and function with a prosthesis?
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90% of humeral length
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What are two suspension systems for an above elbow amputation with residual limb >35%?
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*figure 8
*shoulder saddle with chest strap |
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What is the usual cause of a shoulder disarticulation or forequarter amputation?
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cancer
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A 3-jaw chuck terminal device provides grip with which 3 fingers?
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thumb
index finger middle finger |
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What is the most common type of body powered terminal device?
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voluntary opening
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What is the normal postion (open or closed) for a voluntary opening hook?
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closed
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How much force is each rubber band?
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1 lb
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What are the two types of contol of a myoelectric device?
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digital
proportional |
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What 2 ROMs are allowed by a wrist unit?
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pronation
supination |
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What are two types of wrist units?
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friction
locking |
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What type of wrist unit prevents inadvertent rotation of the TD in the writst unit when a heavy object is grasped?
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locking
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What type of wrist is preferable for bilateral upper extremity amputees?
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electric wrist rotator unit
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What two positions does an add-on wrist unit allow?
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straight
flexion |
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To what bony prominence does a transradial amputation socket extend posteriorly?
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olecranon
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What socket design is used in very short residual transradial limbs?
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split socket
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In a split socket, what is the wrist unit attached to, the inner or outer component?
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outer shell component
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What type of suspension is used for a Muenster socket?
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figure 9
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In what position is a Muenster socket preset?
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flexion
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A Muenster device provides less of what ROM than the split socket?
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flexion
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What are 3 types of elbow hinges?
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flexible
rigid locking |
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What elbow hinge permits active pronation and supination of foream?
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flexible
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What two levels of amputations is a flexible elbow hinge preferable?
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wrist disarticulation
long transradial |
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What elbow hinge is used in a short transradial amputation?
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rigid elbow hinge
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Short transradial amputations are suited for what kind of elbow hinge?
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rigid elbow hinge
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What are 3 types of rigid elbow hinges?
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single axis
polycentric step-up |
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The step-up elbow hinge is used with what type of socket design?
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split socket
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A step-up (rigid) elbow hinge is used in what type amputation?
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very short transradial
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What is the energy cost of a step-up elbow hinge compared to a single axis?
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double for a step-up elbow
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What type of elbow unit is used if there is elbow flexor weakness?
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locking
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A locking elbow joint is used in a patient with what condition?
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elbow flexor weakness
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What is the most commonly used transradial harness suspension?
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figure 8 (O-ring)
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What part of the figure 8 suspension transmits force to the terminal device?
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axilla loop on sound side
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For what type of socket is a figure 9 harness used?
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muenster (self-suspended transradial) socket
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What are the two muscle movements used to operate a Bowden Control Cable system?
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forward humeral flexion
biscapular abduction |
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What is the harness most frequently used for transhumeral prostheses?
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figure 8
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What two functions are performed in a dual control cable system in a transhumeral prosthesis?
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elbow flexion
terminal device operation |
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What 3 shoulder motions accomplish terminal device use at the desired level in a dual control system?
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shoulder depression, extension, and abduction (down, back, out)
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What shoulder motions lock and unlock the elbow unit?
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shoulder depression, extension, and abduction
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What 2 movements accomplish elbow flexion in a transhumeral amputee
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humeral flexion
biscapular abduction |
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What movements accomplish TD opening and closing in a transhumeral amputee?
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further humeral flexion and biscapular abduction
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What is the cable mechanism (dual or single) for
1. elbow flexion 2. elbow lock 3. TD operation 4. elbow unlock? |
elbow flexion: dual control cable
elbow lock: single control cable TD operation: dual control cable elbow unlock: single control cable |
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After TD function is performed how is the elbow unlocked?
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gravity
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What motion opens the TD in a transradial?
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forward flexion of the humerus
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Training with dual control/elbow-locking transhumeral prosthesis should not be attempted before what age?
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3
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What is the most common cause of amputation in >50 year olds?
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vascular disease
infection |
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What is the most common cause of amputation in 15-50 year olds?
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trauma
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What is the most common amputation site in lower extremities?
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transtibial
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What is myodesis?
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muscles and fascia are sutured directly to bone through drill holes
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What is a contraindication to myodesis?
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poor circulation
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What is myoplasty?
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opposing muscles are sutured to each other and to the periosteum at the end of the cut bone.
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What is the muscle attachment procedure of choice in patients with dysvascular residual limbs?
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myoplasty
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For how long is a temporary prothesis used?
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3-6 months
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A toe disarticulation is done at what joint?
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MTP
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A partial foot or ray resection is done where?
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portion up to 3 metatarsals
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Where is the Lisfranc amputation done?
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tarso-metatarsal junction
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What 2 bones remain in a Chopart amputation?
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talus and calcaneus
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Where is the Chopart amputation done?
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mid-tarsal
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What is a Syme's amputation? and what body part is transposed?
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ankle disarticulation; heel pad is attached to distal tibia
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What % is a long BKA?
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>50% of tibia preserved
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What is the % range of a standard BKA?
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20-50% of tibia preserved
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What is a short a BKA%
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<20% of tibia preserved
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What is a long AKA %?
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>60% of femur preserved
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What is a standard AKA %?
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35-60% of femur preserved
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What is a short AKA%
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<35% femur preserved
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Below what lumbar level is a hemicorporectomy performed?
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below L4,5 level
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What 3 LE amputation levels are unsatisfactory?
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distal 2/5 of tibia
very short BKA very short AKA |
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In a very short AKA what 2 excessive ROMs develop at the hip?
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excessive flexion and abduction at the hip
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In a very short BKA what contracture occurs?
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knee flexion contracture
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A transmetatarsal amputation preserves what 2 important muscle group attachements/
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dorsiflexors
plantar flexors |
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What deformity develops in both Lisfranc and Chopart amputations?
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equinovarus defomity
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An equinovarus deformity after a Chopart or Lisfranc deformity causes excessive weightbearing in what direction?
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anterior
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When is weightbearing permitted in a Syme's amputation (with a proper rigid cast)?
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immediately
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What % of elderly have worse functionality after BKA?
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50%
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How much shorter should the fibula be cut than the tibia in standard BKA?
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2-3cm shorted
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If there is a >50% knee flexion contracture and the knee is ischemic, what is the procedure of choice, BKA or knee disartic?
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knee disartic
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What % of AKAs are done due to vascular disease?
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85%
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What is the most common contracture in AKA?
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hip flexion contracture
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Up to what percentage of a hip flexion contracture can be accomodated in the socket?
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20%
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What is the ideal shape for a transtibial amputation?
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cylindrical
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What is the ideal shape for a transfemoral amputation?
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conical
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How many hours per day should a shrinkage device be worn after amputation?
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24 hours
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What is the best prosthetic socket option for a hindfoot amputation?
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self-suspending split socket
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What are 3 prosthetic feet options for a Syme's?
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1.solid ankle cushion heel (SACH)
2. stationary ankle flexible endoskeleton (SAFE 3. energy storing carbon fiber |
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What is the standard socket for a BKA?
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patellar tendor bearing (total contact)
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What are the 4 components in a BKA prosthesis?
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socket, shank, suspension, and foot
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In what wall of the PTB is there a bar that contacts the patellar tendon?
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anterior wall
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Name 5 BKA pressure-tolerant areas.
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patellar tendon
pretibial muscles popliteal fossa lateral shaft of the fibular medial tibial flare |
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Name 5 BKA pressure sensitive areas.
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tibial crest, tubercle, and condyles
fibular head distal tibia and fibula hamsting tendons patella |
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What amount (degrees) of knee flexion contracture can be accomodated in a socket?
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25 degrees
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What suspension is used for short stumps or for controlling genu-recurvatum?
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PTB supracondylar suprapatellar
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What suspension is used for a short BKA?
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PTB - supracondylar wedge
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What is a problem with rubber or neoprene sleeves?
|
persipiration
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Rubber or neoprene sleeves should not be used a primary suspension in what three patient conditions?
|
short residual limb
decreased mediolateral knee stability knee hyperextension |
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Silicone suspension is ideal for what two types of patients?
|
athletes
short residural limbs |
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What device is worn when that patient has knee pain, instability, or cannot tolerate patellar weight bearing?
|
thigh corset
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The SACH is suited for what type of surfaces?
|
flat
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What foot is indicated for those needing greater knee stability?
|
single axis
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Single axis is usually used in what type of amputations?
|
AKA
|
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What weighs more SACH or single axis?
|
single axis
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What 2 movements does a single axis allow?
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dorsiflexion
plantar flexion |
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What 4 motions does a multi-axis foot allow?
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DF
PF eversion rotation |
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What foot is appropriate for uneven surfaces?
|
multi-axis
|
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What foot cannot be used in Syme's?
|
stored energy foot
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What stability is provided by SACH and stored energy?
|
mediolateral stability
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What is a SAFE foot?
|
stationary ankle flexible endoskeleton
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What 2 motions does a SAFE foot not offer?
|
inversion
eversion |
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What foot is good for general sports?
|
seattle
|
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What foot is good for vigorous sports?
|
flex foot
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What foot is most energy storing?
|
flex foot
|
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What foot has lowest inertia?
|
flex foot
|
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What foot is most stable mediolaterally?
|
flex foot
|
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What foot is used to relieve pressure on the distal tibia?
|
single axis
|
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What type of knee device solves the problem of center of rotation?
|
4-bar polycentric
|
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What is the location of the center of rotation in a polycentric knee?
|
proximal and posterior to the knee unit
|
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What are 3 advantages of the polycentric knee?
|
more knee stability
more symmetric gait equal knee length when sitting |
|
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In a ischial containment socket what dimension is the narrowest, the mediolateral or the anteroposterior?
|
mediolateral is more narrow
|
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With the CAT-CAM is the ischial tuberosity inside or outside the socket?
|
inside
|
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With the CAT-CAM what two structures provide weight bearing?
|
medial aspect of the ischium
ishcial ramus |
|
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What position does the narrow mediolateral CAT-CAM design put the femur into during stance phase?
|
adduction
|
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In a quadrilateral AKA socket is the ischial tuberosity inside or outside the socket?
|
outside
|
|
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In a quadrilateral socket where are the two areas of skin irritation?
|
ischium and pubis
|
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What socket has more lateral lurch while walking, the CAT-CAM or the quadrilateral?
|
quadrilateral
|
|
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In a quadrilateral socket is the mediolateral dimension narrow or wide?
|
wide
|
|
|
What type of liner reduces shear?
|
silicone gel
|
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|
Is a total suction prosthesis donned while sitting or standing?
|
standing
|
|
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What knee unit has the worst gait and energy efficiency?
|
manual locking knee
|
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In a single axis knee, faster walking speeds results in what during early swing phase?
|
excessive heel rise
|
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Terminal swing impact of the prosthesis with a single axis knee may occur in what gait phase during faster walking?
|
late swing phase
|
|
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What knee unit has the lowest stability in early stance phase?
|
single axis constant friction unit
|
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Is the walking speed adjustable with a single axis knee unit?
|
no
|
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What knee cannot be used in a bilateral AKA? Why?
|
stance control; knees won't bend with loading and an AKA cannot bend both knees at the same time, so the patient cant sit down
|
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What activity precludes use of a stance control knee?
|
knee motion under weight bearing, such as step over step stair descent
|
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What "control" does a polycentric knee lack?
|
stance control
|
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A polycentric knee is most appropriate for what two amputation levels?
|
knee disarticulation
long residual limb |
|
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What is the main feature of a polycentric knee?
|
stability
|
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A blind or CVA patient requires what type of knee?
|
manual locking
|
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In what position is the manual locking knee kept during the gait cycle?
|
extended
|
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Can a manual locking knee be used with a double AKA? Why?
|
No; knees lock on loading so patient cannot bend both knees at the same time to sit.
|
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What knee is indicated for K3 or K4 ambulators?
|
Fluid controlled knees
|
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Fluid controlled knees can be adjusted to control what tow phases of gait?
|
swing and stance
|
|
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What knee provides cadence variability?
|
fluid controlled knees
|
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What fluid control knee can accomodate a heavier patient, pneumatic or hydraulic?
|
hydraulic
|
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In what knee position only will a fluid controlled knee lock?
|
full knee extension
|
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With a conventional single axis knee a short residual limb AKA amputee cannot adequately contract what muscles? And requires a knee that is set anterior or posterior to the trochanter-knee-ankle line?
|
hip extensors
posterior to the trochanter-knee-anke line |
|
|
With what two motions does a patient with a single axis knee prevent knee buckling?
|
activating hip extensors
keeping knee in full extension |
|
|
What knee unit is most appropriate for a patient with weak hip extensors or who is elderly?
|
stance control knee
|
|
|
Stance control knee is designed for what two patients?
|
weak hip extensors
elderly |
|
|
A what degree flexion will a stance control knee buckle?
|
25 degrees
|
|
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A polycentric knee is ideal for what type of amputees?
|
very long residual limb
|
|
|
What knee is appropriate for those with poor balance?
|
polycentric
|
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What knee allows for variable cadence?
|
fluid control
|
|
|
What phase control is allowed in a pneumatic knee?
|
swing phase control only
|
|
|
What two gait phases can be controlled in a hydraulic knee?
|
swing and stance
|
|
|
A residural femur of less than what length is fitted as a hip disarticulation?
|
less then 5cm of femur
|
|
|
What is the standard hip disartic prosthesis called?
|
Canadian
|
|
|
On what structure is weight beared in a Canadian hip disartic prosthesis?
|
ischial tuberosity
|
|
|
In choked stump syndrome, discoloration of the skin is caused by what?
|
hemosiderin
|
|
|
Where is the constriction in choked stump syndrome, proximal or distal?
|
proximal
|
|
|
What dermatological problem can occur in choked stump syndrome?
|
verrucous hyperplasia
|
|
|
The basic inadequacy in choked stump syndrome is what?
|
lack of total contact in socket (usually due to patient weight gain)
|
|
|
Bone pain in a BKA may be due to what condition?
|
hypermobile fibula due to an inadequate myodesis
|
|
|
In what two amputee age groups in heterotopic ossification most common?
|
children with acquired amputation
young adults with traumatic amputation |
|
|
Is phantom sensation universal in amputees?
|
yes
|
|
|
What is the technical category of phantom pain?
|
deafferentation hyperexcitability
|
|
|
What percentage range of patients experience phantom pain?
|
50-85%
|
|
|
What percentage of amputees have chronic phantom pain?
|
<5%
|
|
|
Does phantom pain occur in a congenital limb deficiency?
|
no
|
|
|
In a Syme's amputee by what percent is gait speed reduced?
|
32%
|
|
|
In a vascular Syme's O2 consumption is increased by how much?
|
13%
|
|
|
What are two common gait problems in an BKA?
|
excessive knee flexion
excessive knee extension |
|
|
What is the cause of excessive knee flexion in a BKA?
|
increased ankle dorsiflexion
|
|
|
What are 4 causes of increased ankle dorsiflexion in a BKA?
|
1. excessive anterior displacement of the socket over the foot
2. excessive posterior displacement of the foot in relation to the socket 3. too hard heel cushion 4. knee flexion contracture |
|
|
What is the cause of excessive anterior displacement of the socket over the foot?
|
moving socket anteriorly in relation to foot
|
|
|
What is the cause of excessive posterior displacement of the foot in relation to the socket?
|
moving foot posteriorly in relation to the foot
|
|
|
What is the cause of excessive knee extension in a BKA at moment of initial contact?
|
increased ankle plantar flexion
|
|
|
Moving socket posteriorly in relation to the foot causes what?
|
increased plantar flexion
|
|
|
Moving foot anteriorly in relation to the socket causes what?
|
increased plantar flexion
|
|
|
Too soft heel cushion or plantar-flexion bumper causes what?
|
increased plantar flexion
|
|
|
What weakness can cause increased ankle plantar flexion?
|
quad weakness
|
|
|
What are three causes of excessive varus at knee during stance phase?
|
1.foot too inset (excessive medial placement of foot in relation to socket
2. abducted socket 3. pain |
|
|
What are 2 causes of excessive valgus at the knee during stance phase?
|
foot too outset
adducted socket |
|
|
A heel wedge that is too soft or the foot is too anterior can cause what gait problem in the BKA? and what is the solution?
|
delayed knee flexion after heel strike; stiffen heel or move foot posteriorly
|
|
|
Excessive plantar flexion in a BKA can cause what? What is the solution?
|
extended knee in stance phase; dorsiflex foot
|
|
|
Excessive dorsiflexion or too stiff heel wedge, or foot too anterior can cause what? and what is the solution?
|
toe stays off floor after heel strike; soften heel wedge, move foot posteriorly, or plantar flex the foot
|
|
|
What are 2 causes of delayed or abrupt knee flexion after heel-strike?
|
heel wedge is too soft
foot is too far anterior |
|
|
What percentage of amputees have chronic phantom pain?
|
<5%
|
|
|
Does phantom pain occur in a congenital limb deficiency?
|
no
|
|
|
In a Syme's amputee by what percent is gait speed reduced?
|
32%
|
|
|
In a vascular Syme's O2 consumption is increased by how much?
|
13%
|
|
|
What are two common gait problems in an BKA?
|
excessive knee flexion
excessive knee extension |
|
|
What are two causes of a delayed or abrupt knee flexion after heel-strike?
|
heel wedge is too soft
foot is too far anterior |
|
|
What is the cause of extended knee throughout stance phase?
|
too much plantar flexion
|
|
|
What are 3 causes of toe staying off floor after heel strike?
|
heel wedge too stiff
foot too anterior too much dorsiflexion |
|
|
What are two causes of "hill-climbing" sensation toward end of stance phase? and what are the two solutions?
|
foot too anterior and too much plantar flexion; move foot posterior, dorsiflex foot
|
|
|
What is the cause of high pressure against patella during stance phase or heel is off floor when standing?
|
foot too plantar flexed
|
|
|
What are three causes of too forceful knee flexion during heel strike? and what are the solutions/
|
heel wedge too stiff, foot too far posterior, foot too dorsiflexed; soften heel, move foot anterior, plantar flex foot
|
|
|
What are two causes of hips level but prosthesis is short? and what are the solutions?
|
foot too far posterior, foot too dorsiflexed; move foot anterior, plantar flex foot
|
|
|
What is the cause and solution of toe off floor as patient stands or knee flexed too much?
|
foot too dorsiflexed; plantar flex foot
|
|
|
What is the cause of valgus moment at the knee during stance and what is the solution?
|
foot too outset; inset foot
|
|
|
What are the two causes and solutions of excessive varus at the knee during stance?
|
mediolateral dimension of socket is too large, foot too inset; fit of socket should be checked, outset foot
|
|
|
What are 4 prosthetic causes of lateral bending of trunk in AKA?
|
* prosthetic too short
* poor lateral wall shape * high medial wall * prosthesis aligned in abduction causing wide gait |
|
|
What are 5 amputee causes of lateral bending in AKA?
|
* poor balance
* hip abduction contrature * pain * very short residual limb * habit |
|
|
What are 5 prosthetic causes of AKA abducted gait?
|
*prosthetic too long
*too much abduction built-in *high medial wall *lateral wall poorly shaped *pelvic band too far from body |
|
|
What are 2 amputee causes of abducted gait?
|
*hip abduction contracture
*habit |
|
|
What are 2 prosthetic causes of abducted gait?
|
*prosthesis too long
*too much alignment stability or friction in knee |
|
|
What are 4 amputee causes of circumducted gait?
|
*inadequate suspension
*abduction contracture *muscle weakness *habit |
|
|
What are 3 prosthetic causes of vaulting?
|
*prosthesis too long
*inadequate socket suspension *too much alignment stability or knee flexion limitation such as a knee lock |
|
|
What are 3 patient causes of vaulting in AKA?
|
*common
*fear of stubbing toe *pain |
|
|
How are "whips" best observed in a patient with an AKA, with patient walking towards or away from observer?
|
away from observer
|
|
|
What a 5 prosthetic causes of whips?
|
*lateral whips - too much internal rotation of knee
*medial whips - too much external rotation of knee *socket too tight *excessive prosthetic valgus *badly aligned toe break |
|
|
What is two amputee causes of whips?
|
*improper donning of socket
*socket rotated on knee |
|
|
What are two causes of foot rotation at heel strike in AKA?
|
*too hard heel cushion
*too hard plantar flexion bumper |
|
|
What is a patient cause of foot rotation at heel strike in AKA?
|
weakness of hip muscles
|
|
|
What is a prosthetic cause of foot slap in AKA?
|
plantar flexion bumper is too soft
|
|
|
What are two prosthetic causes of uneven rise in AKA?
|
*knee friction is insufficient
*knee extension aid may be too weak |
|
|
What is an amputee cause of uneven heel rise in AKA?
|
excessive power to force knee flexion
|
|
|
What are two prosthetic causes of terminal swing impact?
|
*knee friction is insufficient
*knee extension aid may be too strong |
|
|
What is an amputee cause of terminal swing impact?
|
forcing knee extension prematurely
|
|
|
What are three causes of uneven step length in AKA?
|
*insufficient socket flexion
*insufficient knee friction *too loose an extension aid |
|
|
What are two patient causes of uneven step length in AKA?
|
*pain causing premature weight transfer to the sound leg
*hip flexion contracture |
|
|
What are two prosthetic causes of exaggerated lordosis in AKA?
|
*insufficient socket flexion
*insufficient anterior socket brim support |
|
|
What are three patient causes of exaggerated lordosis?
|
*hip flexion contracture
*weak hip extensors *weak abdominal muscles |
|
|
What are 4 prosthetic causes of knee instability in AKA?
|
*knee joint is too far anterior to trochanter-knee-ankle line
*socket is mounted with excess flexion *excessive plantar flexion resistance *failure to limit dorsiflexion |
|
|
What are two patient causes of knee instability in AKA?
|
*hip extensor weakness
*hip flexure contracture |
|
|
What are three prosthetic causes of drop off at end of stance phase
|
*inadequate limitation of dorsiflexion
*heel of SACH foot is too short *toe break too posterior *socket too anterior relative to foot |
|
|
What are three prosthetic causes of knee instability in hip disarticulation prosthetics?
|
*weight bearing line posterior to knee axis of motion
*plantar flexion bumper too firm *hip bumper contacting socket too soon |
|
|
What are three prosthetic causes of circumduction or vaulting with a hip disartic prosthetic?
|
*prosthetic too long
*inadequate suspension *excessive knee stability |
|
|
What are the two developmental milestones for the fitting of prosthetic in a pediatric transradial amputation?
|
*child can sit
*reach across midline for bimanual manipulation |
|
|
What are the 4 elements of a prescription for transradial amputation for a 6 month old?
|
*body power
*passive mitt TD *plastic laminate *self-suspending socket |
|
|
What are 3 elements of a prosthetic prescription for a transradial in a 9 month-old?
|
*external power
*cookie crusher single control *1 movement flexor |
|
|
What is added to a prescription for an 18 month old with a transradial amputation?
|
2 site control
|
|
|
At what age range is the elbow activated in a transhumeral amputation?
|
18-36 months
|
|
|
At what age is external power added to a transhumeral prosthetic?
|
24 months
|
|
|
What is the developmental milestone and age range for the fitting of a BKA?
|
pulls to stand
9-12 months |
|
|
What are 5 elements of a BKA scrip for age 9-12 months?
|
*PTB
*plastic laminate *supracondylar strap *SACH foot *dynamic response foot |
|
|
What are the 3 elements of a scrip for a AKA prosthetic in 9-12 month old?
|
*narrow mediolaterally
*ischial containment WITHOUT knee unit *silesian band suspension |
|
|
At what age is a knee unit added to a pediatric AKA?
|
18 months
|
|
|
In what demographic is bony overgrowth more common, children or adults?
|
children
|
|
|
Bony overgrowth in children is most common in what bone?
|
humerus
|
|
|
In a C handle cane, where does the weight bearing line fall, anterior or posterior to the shaft?
|
posterior
|
|
|
Does a wide base quad cane fit on stairs?
|
No
|
|
|
How many point of body contact are there in a cane/crutch?
|
1/2
|
|
|
What bony landmark marks the height of a cane?
|
greater trochanter
|
|
|
What range of degrees of elbow flexion for cane fitting?
|
20-30%
|
|
|
What is the narrowest part of the sole?
|
shank
|
|
|
High heels predisposes the foot and ankle to what? Why?
|
instability; talus is narrower posteriorly
|
|
|
A heel counter stabilizes what foot bone?
|
calcaneus
|
|
|
Medial longitudinal arch support is provided by what shoe modification?
|
scaphoid or navicular pad
|
|
|
An internal heel wedge provides relief to what bone?
|
cuboid
|
|
|
A heel cup prevents what condition?
|
calcaneal valgus (prevents lateral calcaneal shift)
|
|
|
What sole modification relieves metatarsal pain?
|
rocker bar
|
|
|
Where is a rocker bar placed?
|
just posterior to the metatarsal heads
|
|
|
What are 3 functions of a rocker bar?
|
*quicken gait cycle (assisting rollover during stance)
*assist dorsiflexion *decrease push off demand |
|
|
What does a metatarsal bar do?
|
relieves pressure on metatarsal heads by transferring load to metatarsal shafts during stance
|
|
|
What does a sole wedge do?
|
lateral sole wedge: promotes forefoot eversion
medial sole wedge: promotes forefoot inversion |
|
|
What does a steel shank do?
|
reduces stress on the metatarsals and phalanges
|
|
|
What is a Thomas heel?
|
medial heel extension
|
|
|
What is a reverse Thomas heel?
|
lateral heel extension
|
|
|
A Thomas heel supports what structure?
|
medial longitudinal arch
|
|
|
A reverse Thomas heel supports what?
|
lateral longitudinal arch
|
|
|
A cushioned heel will shift weight line (center of gravity) anterior or posterior to the knee joint at initial contact?
|
anterior to the knee, causing an extension moment of the knee and thus stabilizing the knee
|
|
|
A heel lift can be of help in correcting what two conditions?
|
pes equinus
leg length discrepency |
|
|
What is the main function of a plastizote insole?
|
distributes weight over larger area
|
|
|
What is the most common foot joint affected in RA?
|
MTP
|
|
|
What is a common long term complication of foot RA?
|
hallux valgus
|
|
|
What type of box is necessary for hammer toes?
|
high toe box
|
|
|
What type of box is needed for bunions or hallux valgus?
|
wide toe box
|
|
|
What is most common biomechanical problem with runners' feet?
|
pronated foot
|
|
|
What material is most suitable as an insert for heel spurs or plantar faciitis?
|
Plastazote
|
|
|
What are 4 shoe modifications for runners' pronated foot?
|
*motion control heel counter
*medial support *insole medially *wider flared heel |
|
|
Where is the COG while standing?
|
just anterior to the S2 vertabrae
|
|
|
How many points of pressure are needed for proper control of a joint in orthotics?
|
3
|
|
|
COG passes anterior or posterior to:
cervical vertabrae thoracic vertabrae lumbar vertabrae hip knee anke |
cervical vertabrae: posterior
thoracic vertabrae: anterior lumbar vertabrae: posterior hip: posterior knee: anterior anke: anterior |
|
|
COG passively extends or flexes the following joints?
hip knee ankle |
hip: extends
knee: extends ankle: dorsiflexes |
|
|
What two muscles resists the ankle passive COG provoked dorsiflexion?
|
gastroc and soleus
|
|
|
Where are low temp thermoplastics used: upper or lower body orthotics?
|
upper body
|
|
|
What AFO is used for flaccid foot drop?
|
posterior leaf spring
|
|
|
What AFO is used for foot drop with some extensor tone?
|
semi-rigid plastic AFO
|
|
|
What AFO is used for patients with highest level of spasticity/tone?
|
rigid plastic AFO
|
|
|
What AFO is used for early to moderate Charcot joint?
|
rigid plastic AFO
|
|
|
Name two indications for a metal AFO rather than a plastic one?
|
insensate foot due to neuropathy of nerve injury
edema not managed with compression stockings |
|
|
In a single channel AFO a spring in the chaneel for dorsiflexion assist is called what?
|
A Klenzak joint
|
|
|
What are the channels in a dual channel AFO?
|
posterior and anterior
|
|
|
What is the function of the anterior channel in a two channel AFO?
|
adjustable steel pin to block the forward progression of the tibia at midstance (dorsiflexion stop)
|
|
|
What are two conditions in which a dual channel AFO can be helpful?
|
Charcot joint
quad weakness |
|
|
In a single channel AFO, dorsiflexion is provided by a pin or a spring?
|
spring
|
|
|
In a single channel AFO, plantar flexion limitation is provided by a spring or a pin?
|
pin
|
|
|
What is the most common type of KFO?
|
single axis
|
|
|
What type of single axis is used for genu recurvatum?
|
free motion knee joint (with a hyperextension stop)
|
|
|
In an offset knee joint, is the hinge posterior or anterior to the knee? and where is the weight line - anterior or posterior to the knee?
|
posterior
anterior |
|
|
What are two contraindications to use of an offset knee joint?
|
knee or hip contracture
plantar flexion stop at the ankle |
|
|
What may happen to the knee of the patient with an offset knee joint while walking on ramp?
|
the knee may flex inadvertantly
|
|
|
What range of degrees of motion does a trick knee allow while in the locked position?
|
0-25 degrees
|
|
|
What knee is used to stretch out contratures?
|
ratchet knee
|
|
|
What type of patient uses an adjustable knee lock joint?
|
one with a knee flexion contracture that is improving
|
|
|
What type of knee prevents buckling?
|
trigger lock knee joint
|
|
|
What must the patient be able to do to use a trigger lock knee joint?
|
extend knee
|
|
|
What is a contraindication ot a trigger lock knee joint?
|
knee flexion contracture
|
|
|
What are 4 indications for a HKAFO?
|
*hip flexion/extension instability
*hip adduction/abduction weakness *hip rotation instability *paralysis of the leg |
|
|
What is the highest complete neurological level SCI appropriate for a Scott Craig orthosis?
|
L1 or lower
|
|
|
How many degrees of dorsiflexion are built into a Scott Craig?
|
10 degrees of dorsiflexion
|
|
|
What type of knee is used in a Scott Craig?
|
offset knee with bail lock
|
|
|
What type of standing is possible with a Scott Craig? supported or unsupported
|
unsupported
|
|
|
What ligament provides hip stability when using a KAFO without pelvic bands?
|
Y ligament or iliofemoral ligament (ligament of Bigelow)
|
|
|
What motion must the patient perform to shift the COG posterior to the hip joint and thus engage the Y ligament?
|
leaning backwards
|
|
|
Are ambulatory aids required for a Scott Craig to walk?
|
yes - crutches or a walker
|
|
|
What is the gait pattern of a patient walking with a Scott Craig orthosis?
|
swing to or swing through
|
|
|
What ROM must be perserved to use a reciprocal gait orthosis (RGO)?
|
active hip flexion
|
|
|
What knees are used in a RGO?
|
offset
|
|
|
What type of gait is possible with an RGO?
|
4-point gait
|
|
|
What ambulatory aids are required for RGO ambulation?
|
two crutches
|
|
|
A knee orthosis is prescribed usually for what condition?
|
genu recurvatum
|
|
|
What directional stability does a knee orthosis provide?
|
mediolateral
|
|
|
How many points of pressure are there in a Swedish knee cage?
|
3
|
|
|
A Lenox Hill knee orthosis limits what ROM?
|
rotation
|
|
|
A PTB orthosis reduces by what percentage weight transmission though the mid or distal tibia?
|
50%
|
|
|
What motion is severely restricted or eliminated in a PTB orthosis?
|
ankle motion
|
|
|
What orthosis is used to stabilize the first MCP joint?
|
oppenens orthosis
|
|
|
An opponens orthosis stabilizes what MCP joint?
|
first MCP joint
|
|
|
What type of "pinch" is possible in with the oppenens orthosis?
|
3 jaw chuck pinch
|
|
|
What joints does the long opponens orthosis cross?
|
MCP and wrist joints
|
|
|
What is an example of a long oppenens orthosis?
|
thumb spica
|
|
|
What orthosis is prescribed for claw hand deformity?
|
opponens orthosis with lumbrical bar
|
|
|
What motions does an opponens orthosis with lumbrical bar prevent and permit?
|
prevents MCP hyperextension
allows full MCP flexion |
|
|
What orthosis is used for boutonniere or for postsurgical release of Dupuytren's contracture?
|
Opponens orthosis with finger extension assist assembly
|
|
|
What motions are assisted in an oppenens orthosis with finger extension assist assembly?
|
assists PIP and DIP extension
|
|
|
An opponens orthosis with finger extension assist assembly is used for what conditions?
|
boutonniere deformity
postsurgical release of Dupuytrens contracture |
|
|
Finger orthoses restrict movement at what joints? What are they used for?
|
DIP, PIP
To prevent contractures |
|
|
What does a swan neck ring prevent and allow?
|
prevents PIP hyperextension
allows full IP flexion |
|
|
A Boutonniere ring splint does what two things?
|
keeps PIP in extension and prevents flexion
|
|
|
What splint is appropriate for patients with ulnar deviation a the MCPs?
|
MCP ulnar deviation restriction orthosis
|
|
|
What two joints does a thumb orthosis protect? in what positioin?
|
CMC and MCP/ neutral position
|
|
|
On what surface is a static wrist hand finger orthosis usually placed?
|
volar surface
|
|
|
What type of orthosis is used in acute RA, wrist sprain, CTS, etc?
|
volar wrist hand orthosis (cock-up splint)
|
|
|
What orthosis is used in a radial nerve injury or brachial plexus lesion?
|
MCP extension mobilization orthosis
|
|
|
An MCP mobilization orthosis is used for weakness in with what motion?
|
weak finger extension
|
|
|
An MCP flexion mobilization orthosis is used in lesions of what nerves?
|
medial and ulnar
|
|
|
What orthosis is used for claw hand?
|
MCP flexion mobilization orthosis
|
|
|
What orthosis is used at the wrist for radial nerve injuries?
|
volar wrist flexion control orthosis (cock-up splint)
|
|
|
Through what effect does a volar wrist flexion control orthosis tighten finger flexors?
|
tenodesis
|
|
|
What orthosis is used in a C6 complete tetraplegia patient?
|
wrist driven prehension orthosis
|
|
|
A wrist driven prehension orthosis is used in what level complete SCI?
|
C6
|
|
|
In a C6 complete tetraplegic patient, wrist extension occurs through what intact muscle?
|
extensor carpi radialis
|
|
|
What muscle strength is required to use a wrist driven prehension orthosis?
|
3+
|
|
|
What level tetraplegics rarely accept a wrist driven prehension orthosis since they prefer to use their residual motor power?
|
C7 and C8
|
|
|
What are the three pieces of a RIC tenodesis splint?
|
*wristlet
*short opponens *dorsal plate over middle and index finger |
|
|
What does the RIC tenodesis accomplish?
|
3 jaw chuck prehension
|
|
|
What does a balanced forearm orthosis (BFO) permit?
|
to bring hand to mouth
|
|
|
A BFO is useful in patients with what weaknesses?
|
weak shoulder and elbow muscles
|
|
|
In what 4 conditions is a BFO helpful?
|
GB syndrome
polio brachial plexus muscular dystrophy |
|
|
A BFO can be used for what level quadraplegic?
|
C5
|
|
|
Residual strength (grade 2) is necessary in what 2 muscles to use a BFO?
|
biceps
pectoralis |
|
|
What type of positional endurance is required to use a BFO?
|
sitting endurance
|
|
|
What UE orthoses are not used for spasticity?
|
elbow orthoses
|
|
|
What is the Bobath rationale of tone reducing orthoses?
|
reflex inhibition postioning
|
|
|
What is the Rood or sensorimotor rationale of tone reducing orthoses?
|
firm pressure into volar surface
|
|
|
Name a cervical collar appropriate for neck soft tissue injuries
|
Thomas collar
|
|
|
Of what material is philadelphia collar made?
|
plastazote
|
|
|
Can a sterno-occipital mandibular immobilizer (SOMI)be applied while the patient is supine?
|
yes
|
|
|
What are three indications for a SOMI?
|
OA
postsurgical fusion stable cervical fractures |
|
|
What is the limitation of ROM in a poster-type CTO?
|
flexion/extension control
|
|
|
What CTO is indicated for unstable cervical fractures?
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Minerva or Halo
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To what bony landmark does the Minerva vest extend inferiorly?
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inferior costal margin
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What CTO is preferred for preschool children with an unstable cervical spine?
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Minerva
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What CTO provides the most motion control?
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Halo
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How many external fixation pins in a Halo?
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4
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What is a rare lung complication of a Halo vest?
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reduced VC
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What is the upper border of a TLSO?
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inferior angle of scapula
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What CTO has the maximum cervical rotation limitation?
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minerva (0%)
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What pressure can a TLSO increase?
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intra-abdominal
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A flexion/extension control TLSO with 2 posterior paraspinal bars is called what?
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Taylor brace
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What stablizes a Taylor brace?
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interscapular bands
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What is different about a Knight-Taylor brace in comparison with a Taylor brace?
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lateral and thoracic bands to restrict lateral bending
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What brace is used for stable thoracic or lumbar fractures?
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Knight-Taylor brace
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Name a spine-flexion control TLSO.
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Jewett brace
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Where are the 4 pads in a Jewett brace?
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sternal, suprapubic, anterolateral, and dorsolumbar
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Which pad counteracts the other three in a Jewett brace?
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dorsolumbar pad counteracts the sternal, suprapubic, and anterolateral pads
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What are two indications for a Jewett brace?
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compression fracture
Scheurmann's disease |
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A Jewett brace used in the elderly can provoke what complication?
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posterior element fractures
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What motion does the Jewett brace restrict?
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flexion
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Name a CTLO brace?
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Milwaukee brace
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What is the indication for a Milwaukee brace?
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scoliosis
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How many anterior and posterior bars are there in a Milwaukee brace?
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1 anterior
2 posterior |
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For a Milwaukee brace the curve apex must be above what spinal level?
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T8
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In a Milwuakee brace a load is applied to what structures to correct the scoliosis?
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ribs
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What degree range of scoloisos curvature indicates a Milwaukee brace?
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25-40 degrees
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What is the most frequently prescribed orthotic for low back pain?
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corsets
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By what percentage does a lumbar coset reduce lateral bending?
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29%
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What are the upper and lower borders of a lumbar corset?
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upper border - inferior angle of scapula
lower border - pubic symphysis |
