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S3- Amputation And Prosthetics > Transtibial and Transfemoral Gait Deviations > Flashcards

Transtibial and Transfemoral Gait Deviations Flashcards

1
Q

TRANSTIBIAL GAIT DEVIATIONS

A

TRANSTIBIAL GAIT DEVIATIONS

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2
Q

What is the goal with transtibial prosthetic gait?

A

Gait that is as close to normal as possible.

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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
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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

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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
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6
Q

Excessive Knee Extension is seen in what phase(s) of gait?

A

IC → MSt

sagittal

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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.
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8
Q

What are patient causes of Excessive Knee Extension?

A
  • Weak musculature around knee.

- Locking knee to prevent fall.

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9
Q

Patients with Excessive Knee Extension may develop skin breakdown where?

A

Anterior distal tibia from extending excessively into the socket. (Bell clapping)

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10
Q

Knee Instability is seen in what phase(s) of gait?

A

IC → LR

sagittal

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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.
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12
Q

What are some patient causes of Knee Instability?

A
  • Weak quads.

- Knee flexion contracture.

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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

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14
Q

Hip Drop is seen in what phase(s) of gait?

A

MSt

frontal

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15
Q

With Hip Drop, we see a pelvic drop toward the ________ side during MSt.

A

prosthetic

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16
Q

What are some prosthetic causes of Hip Drop?

A

Prosthesis too short.

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17
Q

What are some patient causes of Hip Drop?

A

Residual limb pain.

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18
Q

Lateral Thrust is seen in what phase(s) of gait?

A

MSt

frontal

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19
Q

A narrow BOS with lateral thrust of the socket durinig MSt creates excessive ______ at the knee.

A

Varus

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20
Q

What are some prosthetic causes of Lateral Thrust?

A
  • Foot too far inset.

- Laterally leaning pylon.

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21
Q

What are some patient causes of Lateral Thrust?

A
  • Glute med weakness.

- Knee ligament insufficiency.

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22
Q

Patients with Lateral Thrust will complain about increased __________ and ____________ residual limb pain and pressure leading to breakdown.

A
  • proximal medial

- distal lateral

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23
Q

Wide Based Gait is seen in what phase(s) of gait?

A

MSt

frontal

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24
Q

With a Wide Based Gait, we see an increase in ______.

A

BOS

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25
Q

What are some prosthetic causes of Wide Based Gait?

A
  • Outset foot.

- Medial leaning pylon.

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26
Q

What are some patient causes of Wide Based Gait?

A
  • Insufficient weight shift over prosthesis.
  • Hip abduction tightness.
  • Patient fear.
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27
Q

Drop-Off/Knee Instability is seen in what phase(s) of gait?

A

TSt

sagittal

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28
Q

Drop-Off involves early and excessive knee ______ durinig TSt.

A

flexion

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29
Q

What are some prosthetic causes of Drop-Off?

A
  • Socket aligned too far anterior/foot too far posterior.

- Inappropriate foot choice.

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30
Q

What are some patient causes of Drop-Off?

A

Knee flexion contractures (results in early and excessive knee flexion).

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31
Q

Vaulting is seen in what phase(s) of gait?

A

SW

frontal

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32
Q

Vaulting is excessive ___ of sound limb during MSt to clear prosthetic foot.

A

PF

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33
Q

What are some prosthetic causes of Vaulting?

A
  • Prosthesis too long.
  • Long toe lever arm.
  • Socket too far posterior.
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34
Q

What are some patient causes of Vaulting?

A

Holding knee in extension for too long.

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35
Q

Patients with Vaulting will often complain of _______ in the sound limb.

A

fatigue

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36
Q

Pistoning is seen in what phase(s) of gait?

A

SW, IC → MSt

sagittal

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37
Q

Pistoning involves a loss of __________.

A

suspension

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38
Q

What are some prosthetic causes of Pistoning?

A
  • Sockets too large.

- Not enough socks.

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39
Q

What are some patient causes of Pistoning?

A
  • Volume changes.

- Not enough socks.

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40
Q

Pistoning is a ____ risk and usually results in a _____ step with the prosthesis.

A
  • fall

- short

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41
Q

With Pistoning, where will we have residual limb pain?

A

-distal residual limb

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42
Q

Uneven Step Length is seen in what phase(s) of gait?

A

SW

sagittal

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43
Q

An Uneven Step Length involves taking a long step with the ________ limb, step-to pattern with the ______ limb.

A
  • prosthetic

- sound

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44
Q

What are some prosthetic causes of Uneven Step Length?

A

n/a

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45
Q

What are some patient causes of Uneven Step Length?

A
  • Insufficient gait training.

- Decreased patient confidence.

46
Q

Circumduction is seen in what phase(s) of gait?

A

SW

frontal

47
Q

With Circumduction the patient swings the leg around in an ________ position to advance it forward.

A

abducted

48
Q

What are some prosthetic causes of Circumduction?

A
  • Poor suspension.

- Prosthesis too long.

49
Q

What are some patient causes of Circumduction?

A
  • Feeling of instability.

- Decreased knee flexion during swing phase.

50
Q

Do TT or TF present with circumduction more?

A

TF

51
Q

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.
A
  • combination
  • refer
  • impairments
52
Q

TRANSFEMORAL GAIT DEVIATIONS

A

TRANSFEMORAL GAIT DEVIATIONS

53
Q

In TF amputations we see an overall decrease in gait speed to around __% normal.

A

40%

54
Q

Normal gait is a function of what things in TF?

A
  • Socket fit
  • Prosthetic alignment (between socket, knee, and foot in transfemoral)
  • Components used
  • User ability
55
Q

Phases of gait an what we are looking for in each phase.

A

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
Q

Terminal Impact is seen in what phase(s) of gait?

A

SW → IC

sagittal

57
Q

Terminal Impact involves forceful and excessive knee __________ that is usually _________.

A
  • extension

- audible

58
Q

What are some prosthetic causes of Terminal Impact?

A

Inadequate knee friction.

59
Q

What are some patient causes of Terminal Impact?

A
  • Fear of knee giving way.

- Forceful hip extension.

60
Q

Terminal Impact involves a ________ of the knee into extension. This gait deviation impacts _______ absorption.

A
  • snapping

- shock

61
Q

Foot Slap is seen in what phase(s) of gait?

A

IC → LR

sagittal

62
Q

Foot Slap is accelerated ___ at heel strike resulting in the foot getting flat to the floor too soon.

A

PF

63
Q

What are some prosthetic causes of Foot Slap?

A

-PF bumper too soft.

64
Q

What are some patient causes of Foot Slap?

A

-Increased hip extension force at IC.

65
Q

Knee Instability is seen in what phase(s) of gait?

A

IC → LR

sagittal

66
Q

Knee Instability involves giving way in early ________ phase.

A

stance

67
Q

What are some prosthetic causes of Knee Instability?

A
  • Knee axis too far supereior.
  • Socket too far posterior.
  • Lack of socket flexion.
68
Q

What are some patient causes of Knee Instability?

A
  • Inadequate hip extension strength/ROM.

- Hip flexion contracture.

69
Q

Knee Instability is relatively rare in ___________ knees.

A

microprocessor

70
Q

Lateral Trunk Bend is seen in what phase(s) of gait?

A

MSt

frontal

71
Q

Lateral Trunk Bend involves excessive lateral lean over the hip during _____ phase.

A

stance

72
Q

What are some prosthetic causes of Lateral Trunk Bend?

A
  • Socket too abducted.
  • Prosthesis too short.
  • Medial socket wall too high.
73
Q

What are some patient causes of Lateral Trunk Bend?

A
  • Pain.
  • Glute med weakness.
  • Decreased balance.
  • Adductor roll.
74
Q

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.

A
  • lateral

- distal lateral

75
Q

Lateral Trunk Bend is essentially a __________ __________ pattern.

A

Compensated Trendelenburg

76
Q

Abducted Gait is seen in what phase(s) of gait?

A

MSt

frontal

77
Q

Abducted Gait involves excessive _____ abduction during stance leading to a wide based gait pattern.

A

hip

78
Q

What are some prosthetic causes of Abducted Gait?

A
  • Foot/leg too far outset.
  • Prosthesis too long.
  • Medial socket wall too high.
  • Lateral wall not adducted enough.
79
Q

What are some patient causes of Abducted Gait?

A
  • Abduction contracture.
  • Lateral-distal RL pain.
  • Decreased balance/trying to increase BOS.
  • Adductor roll.
80
Q

Excessive Trunk Extension is seen in what phase(s) of gait?

A

MSt

sagittal

81
Q

With Excessive Trunk Extension we see excessive lumbar _________ during stance or a posterior trunk lean.

A

lordosis

82
Q

What are some prosthetic causes of Excessive Trunk Extension?

A
  • Increased socket extension.

- Not enough flexion built into socket.

83
Q

What are some patient causes of Excessive Trunk Extension?

A
  • Weak hip extensors.
  • Weak abdominals.
  • Hip flexion contracture.
  • Very short RL.
84
Q

Drop-Off is seen in what phase(s) of gait?

A

TSt

sagittal

85
Q

Drop-Off involves sudden and excessive knee ________ during late stance phase.

A

flexion

86
Q

What are some prosthetic causes of Drop-Off?

A
  • Short toe lever.

- Socket set too posterior to knee axis.

87
Q

What are some patient causes of Drop-Off?

A

n/a

88
Q

Excessive Heel Raise is seen in what phase(s) of gait?

A

PSw → SW

sagittal

89
Q

Excessive Heel Raise involves the prosthetic heel rising excessively (both in _________ and _________).

A

distance and velocity

90
Q

What are some prosthetic causes of Excessive Heel Raise?

A

-Insufficient knee friction.

91
Q

What are some patient causes of Excessive Heel Raise?

A

-Forceful hip flexion.

92
Q

Circumduction is seen in what phase(s) of gait?

A

SW

frontal

93
Q

With Circumduction the user swings the leg in a circular motion laterally to advance it during _______ phase.

A

swing

94
Q

What are some prosthetic causes of Circumduction?

A
  • Prosthesis too long.
  • Inadequate suspension.
  • Excessive knee friction.
  • Medial wall too high.
95
Q

What are some patient causes of Circumduction?

A
  • Hip flexor weakness.
  • Hip abduction contracture.
  • Fear.
96
Q

Vaulting is seen in what phase(s) of gait?

A

SW

frontal

97
Q

Vaulting involves excessive ____ of the sound limb to clear the prosthetic limb.

A

PF

98
Q

What are some prosthetic causes of Vaulting?

A
  • Prosthesis too long.
  • Inadequate suspension.
  • Excessive knee friction.
99
Q

What are some patient causes of Vaulting?

A
  • Hip flexor weakness.

- Fear.

100
Q

Medial Whip is seen in what phase(s) of gait?

A

SW

frontal/transverse

101
Q

Medial Whip involves a medially directed whipping motion of the __________.

A

prosthesis

102
Q

What are some prosthetic causes of Medial Whip?

A
  • External rotation of knee component.

- Improper alignment of knee bolt.

103
Q

What are some patient causes of Medial Whip?

A

-Improper donning.

104
Q

Medial Whip is named after the position of the _______ and the ______.

A

pylon and the foot

105
Q

Lateral Whip is seen in what phase(s) of gait?

A

SW

106
Q

Lateral Whip involves a laterally directed whipping motion of the __________.

A

prosthesis

107
Q

What are some prosthetic causes of Lateral Whip?

A
  • Internal rotation of knee component.

- Improper alignment of knee bolt.

108
Q

What are some patient causes of Lateral Whip?

A

-Improper donning.

109
Q

Lateral Whip is named after the position of the _______ and the ______.

A

pylon and foot

110
Q

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.
A
  • deviations
  • combination
  • refer
  • impairments

S3- Amputation And Prosthetics (10 decks)

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