Movement Analysis Test 2

Question 1

Ipsilateral trunk lean most commonly occurs during reference limb ___.

Possible causes?

Answer 1

Stance

Ipsilateral hip ABD weakness, hip joint pain, IT band tightness, or scoliosis

Examine for: Ipsilateral glut med weakness;
trunk ROM

Question 2

6 goals of post surgical management phase? (Amputation)

Answer 2

1. Promote healing residual limb
2. Protect intact limb
3. Maximize functional independence
4. Prevent motion loss
5. Educate in the process of prosthetic rehab
6. Facilitate psychological adjustment

Question 3

ISw- the ___ continues to ___, which in turn ___ of the transfemoral prosthesis.
The femur has migrated to _____.

Answer 3

Hip flexors continue to flex, which in turn forces the knee.

Femur migrated to anterior
distal aspect of socket - this causes high pressure to the area.
Be mindful of this location when observing this phase of gait.

Question 4

MSt- ankle

Answer 4

DF from neutral -> 5*

GRF moves forward through ankle joint to create increasing DF moment

Ankle PF contract eccentrically to provide controlled motion of tibia
“Ankle rocker”

Question 5

TSt- pelvis

Answer 5

Rotates 5* backward as contralateral stance limb extends forward

Question 6

Transfemoral gait deviations -MSt

Abducted gait

Answer 6

Prosthetic causes:

1. Pubic ramus pressure- medial brim too high
2. Prosthesis too long
3. Improper relief for distal femur in lateral wall
4. Foot excessively outset

Patient cause:

1. Hip joint ABD contracture
2. Weak glut med
3. Fear or habit

Question 7

Transfemoral gait deviations in Swing phase - Knee/Foot whip

Answer 7

Cause:
Prosthesis was donned in rotation
Knee is incorrectly rotated

Remedy:
Re-donn limb in correct rotation
Check landmarks
Have prosthesis adjust if not resolved

Question 8

4 essential factors for efficient prosthetic gait

Answer 8

1. Accept the weight of the body on each leg
2. Balance on 1 foot in single-limb support
3. Advance each limb forward and prepare for the next step
4. Adapt to environmental demands

Question 9

What are the primary phases of rehabilitation for LE amputees?

Answer 9

Post-surgical management
Preprosthetic management
Prosthetic management

Question 10

Transtibial gait deviations -LR
Rapid knee flexion
Causes?

Answer 10

Prosthetic causes:

1. Prosthetic heel too firm
2. Socket set too far anterior over foot
3. Socket is excessively flexed (>7*)

Patient cause:

1. Quad weakness
2. Heel of shoe too high (pt changed shoes)

Question 11

Transfemoral
IC
Common gait deviations

Answer 11

Knee not fully extended

Unequal step length

Question 12

MSt- knee

Answer 12

Extends to 5* by end of MSt

GRF passes across knee joint from anterior-> posterior, changing knee flex moment to knee ext moment

Quads remain active while knee flex moment in effect

Knee stabilized by ankle PF and knee ext moment in latter half of MSt

Question 13

LR primary goals….
The knee is positioned ___
The GRF at the knee …
muscles?

Answer 13

Knee remains stable
Foot remains in line of progression

Knee flexed to 15* throughout LR

GRF lies posterior to knee , creating Flex moment

Quads eccentrically contract to provide controlled flex and shock absorption
Hamstrings concentrically contract to extend femur and pull body over stance leg

Question 14

3 critical places when residual limb is stressed (transtibial prosthesis)

Answer 14

LR (distal- anterior / proximal- posterior)

TSt (distal- Posterior/ proximal-anterior)

PSw (distal- anterior / proximal- posterior)

Question 15

Pros and cons of soft dressings during post-surgical management phase? (Amputation)

Answer 15

Pros:
Easy to apply
Inexpensive
Easy access to incision

Cons:
Little edema control
Minimal protection
Requires frequent rewrapping

Question 16

PACT program lessons learned- successful out outcomes from what?

Answer 16

1. Regular clinical follow up
2. Proper professional footwear
3. Patient education
4. Prescription RX
5. Proper prosthetic care and training

Question 17

TSw- continues to use ___ to support weight of transtibial prosthesis.

____ contract to stabilize limb prior to ___.

Tibia at __.

Answer 17

Knee extension

Hamstrings contract to stabilize limb prior to IC

Tibia at anterior distal socket

Question 18

WB regions of the transfemoral limb

Answer 18

Ischial tuberosity 
Femoral triangle 
Circumference 
Lateral shaft of the femur 
Soft tissue circumference

Question 19

CARF

Answer 19

Commission for accreditation of rehabilitation facilities

Offers a Amputation specialty accreditation
42 programs currently accredited
12 VA facilities accredited

Question 20

Ipsilateral pelvic drop
Swing phase
Possible cause

Answer 20

Contralateral hip ABD weakness, hip ADD spasticity, or hip ADD contracture

Question 21

IC- knee
Transtibial Prosthesis 
COP?
GRF?
Muscles?

Answer 21

COP: corner heel of foot

GRF: little consequence

Co-contraction of quads and hamstrings

Question 22

Most common contracture for transfemoral amputee

Post-op recommendations

Answer 22

Hip FLEX, ER, ABD

Can begin to develop as soon as 72 hours after amputation/immobilization

Proper body positioning should begin immediately after surgery.
Encourage to lay prone (preferred) or supine with pelvis level and hips in neutral position for 5-10 min 3x/day

Question 23

Principles to begin fitting prosthetic for amputee

Answer 23

Wound closure
Tolerant to force couple pressures
Circumference reduction
Sound side WB ability

Question 24

LR- knee
Transtibial Prosthesis 
COP?
GRF?
Muscles?

Answer 24

COP: moves slightly anterior as prosthetic heel compresses

GRF: moves posterior to knee, inducing knee flexion moment

Concentric contraction of quads - extends tibia in attempt to slow progression
B/C tibia not completely stabilized w/in socket it will migrate anteriorly

Question 25

TSt- knee

Answer 25

Remains at max ext (5* flex) throughout most of TSt then flexes slightly (15*) prior to PSw GRF remains anterior to knee, moving posterior as knee begins to flex Knee ext peaks mid-TSt before decreasing and changing to flex for PSw Ankle DF concentrically contract to stabilize knee throughout this phase

Question 26

PACT program

Answer 26

Preservation-Amputation Care and Treatment Program EST by VA in 1993 to prevent/delay amputation by identifying those at risk of limb loss Prior to PACT 9k amputations annually, in 2095 5500, 40% decline

Question 27

IC is described as____. | The pelvis is positioned ___

Answer 27

The moment the foot touches the ground 5* forward rotation

Question 28

WB regions of the transtibial limb

Answer 28

``` Patella tendon Medial tibial flare Pre-tibial region Fibular shaft Popliteal fossa Gastroc-Soleus muscle belly ```

Question 29

How is phantom limb pain treated?

Answer 29

Medical: surgical, pharmacological Psychological: counseling, biofeedback Acupuncture TENS

Question 30

Which program elements are key in the continued rehabilitation of the LE amputee? (9)

Answer 30

1. Donning 2. ROM/flexibility training 3. Strength training 4. CV training 5. Balance and coordination training 6. Gait training 7. Functional training 8. Advanced training 9. Activity-specific training

Question 31

IC is described as____. The knee is positioned ___ The GRF at the knee ... muscles?

Answer 31

The moment the foot hits the ground Knee neutral GRF anterior to knee, creating ext moment Quads remain contracted in prep for LR Hamstrings briefly contract to counter knee ext moment and stabilize knee

Question 32

Transfemoral gait deviations -MSt | Lateral bending of trunk

Answer 32

Prosthetic cause: 1. Foot excessively outset leading to wide BOS 2. Prosthesis too short 3. Socket aligned in hip ABD 4. Distal femur pain Patient cause: 1. Weak hip ABD or ABD contracture 2. Very short residual limb 3. Inability to WB 4. Fear or habit

Question 33

TSt - hip

Answer 33

Femur extends to max 20* ext Pelvic rotation back contributes GRF moves posterior, creating small ext moment that peaks and begins to diminish as limb unloaded Weak hamstring action may act to control ext

Question 34

Excess sock | BK prosthesis

Answer 34

Patient reports pressure at tibial tuberosity

Question 35

What are the goals for the prosthetic management phase?

Answer 35

1. Attain smooth, energy efficient gait 2. Allow the individual to perform ADLs 3. Maximize participation in employment activities 4. Facilitate participation in desired recreational activities

Question 36

Positioning | Post-surgical (Amputation)

Answer 36

Avoid extended sitting and supine sitting in bed propped with pillow To prevent hip flexion contracture Good: Prone and Sidelying with pillow between legs Keep hip and knee in extension

Question 37

Transfemoral gait deviations in Swing phase - terminal impact

Answer 37

Prosthetic cause- Insufficient extension resistance Mechanical extension assist too strong Patient cause- Too strong hip flexion Patient may practice hip extension to speed knee extension

Question 38

Pt feels distal end pressure (BK)

Answer 38

Excess contact Distal gapping and lack of contact Do a distal contact test

Question 39

Transfemoral IC- knee not fully extended Causes?

Answer 39

Prosthetic- Excessive knee extension resistance Patient- Weak hip flexion in early swing initiation Weak hip extensors

Question 40

Pros and cons of IPOP during post-surgical management phase? (Amputation)

Answer 40

``` Pros: Excellent edema control Excellent protection Pain control Early WB ``` Cons: No access to incision More expensive than other dressings Requires proper training for use (IPOP- immediate post-op prosthetic)

Question 41

Gait observation in transtibial | Plane and focus

Answer 41

Sagittal plane: Tibia progression Knee stability Frontal/Coronal plane: Varus/Valgus knee Pelvic shift Trunk lean

Question 42

TSt | Muscles used

Answer 42

Calf (peak)

Question 43

LR - pelvis

Answer 43

Remains in forward rotation throughout LR Hamstrings contract to stabilize pelvis

Question 44

DM national stats

Answer 44

>50% increase in most states >100% increase in 18 states (MS highest; MT lowest)

Question 45

Transfemoral socket- correct rotational position

Answer 45

Adductor longus : anterior medial corner (contained w/ no impingement or roll present anterior and medial brim) Ischial tuberosity Have pt flex forward- palpate IT and have pt extend back into socket IT matches the seat on the socket - pubic ramus free of pressure (medial brim) - ample ASIS clearance sitting and bending forward (anterior brim) - trochanter free of pressure and no gapping- esp when weight shift laterally (lateral brim)

Question 46

One of the most common deviations seen in a coronal plane of individuals with transfemoral prosthetics.

Answer 46

Lateral trunk lean toward prosthetic side during MSt. Causes: Hip ABD weakness Short limb length Poorly fitted socket (lack of femoral ADD in socket)

Question 47

Too few socks | BK prosthesis

Answer 47

Pt reports distal patella and end pressure

Question 48

Transfemoral LR- rapid toe descent Causes?

Answer 48

Prosthetic- excessive heel compression Patient- forcing extension to ensure knee stability

Question 49

Psychological factors in phantom limb pain

Answer 49

Not causal May contribute to course and severity Coping strategies related to functional interference Psychological variables and support prior to amputation may influence pain experience

Question 50

LR: the concentric action of the ____ as the knee is ____ controls the progression of the transtibial prosthesis. Eccentrically the ___ are active in this phase of gait

Answer 50

Quads controls as the knee extends to control progression of the prosthesis Hip extensors and hamstrings

Question 51

``` PSw- knee Transtibial Prosthesis COP? GRF? Muscles? ```

Answer 51

BW transferred to sound leg COP: continues to migrate anteriorly to whatever portion of foot still in contact with the ground GRF: moves back, posterior to knee and causes significant knee flexion moment Quads extend limb w/in socket (anterior tibia position) Pelvic rotation and hip flexion assist in moving limb forward

Question 52

Contralateral pelvic drop Stance phase Possible causes

Answer 52

Ipsilateral hip ABD weakness, hip ADD spasticity, or hip ADD contracture

Question 53

Transtibial amputee PSw Muscle to overcome induced knee flexion moment and to prevent dropping off of toe?

Answer 53

Quadriceps

Question 54

To slow down the (LR) flexion moment at the knee, the ___ used to ___ and control progression of the limb. (Amputee biomechanics- transtibial)

Answer 54

Quads to extend tibia

Question 55

LR primary goals.... The ankle is positioned ___ The GRF at the ankle ... muscles?

Answer 55

Knee remains stable Foot remains in line of progression Ankle rapidly PF to 10* before returning to neutral at end of LR GRF lies posterior to ankle, creating PF moment Pretibial eccentrically contract to provide controlled PF and initial tibial progression “Heel rocker”’

Question 56

``` MSt- knee Transtibial Prosthesis COP? GRF? Muscles? ```

Answer 56

S/B most stable position in gait COP: moves anteriorly towards center of foot GRF: should move through or slightly anteriorly to the knee and NOT produce unwanted flex or ext moments Tibia s/b in neutral position

Question 57

LR primary goals.... The hip is positioned ___ The GRF at the hip ... muscles?

Answer 57

Knee remains stable Foot remains in line of progression Femur extends slightly throughout LR to 20* flex GRF remains anterior to hip, hip flex moment maintained through LR Hamstrings concentrically contract to extend femur and pull body over stance leg

Question 58

Transtibial gait deviations -LR Knee extension Causes?

Answer 58

Prosthetic causes: 1. Heel too soft 2. Socket set too posterior over foot 3. Foot excessively PF Patient cause: 1. Weak Quads 2. Habit 3. Pt changes to lower heel (shoes)

Question 59

Transtibial gait deviations -MSt | Varus moment at knee

Answer 59

Prosthetic cause: 1. Foot excessively inset 2. Excess varus angulation alignment 3. Looseness in socket fitting Patient cause: 1. Short residual limb 2. Ligament laxity with coronal instability

Question 60

MSt - hip

Answer 60

Femur extends throughout MSt to 10* ext GRF moves to hip joint throughout MSt By end of MSt the small hip flex moment is eliminated No hip flex/ext muscle activity

Question 61

Rigid dressing and IPOP difference in outcomes over other dressings

Answer 61

Rigid: Accelerated rehab times Reduced edema IPOP: Fewer post-surgical complications Fewer higher-level revisions

Question 62

Transfemoral gait deviations - TSt | Causes?

Answer 62

Exaggerated lordosis Prosthetic causes: insufficient socket flexion build into limb Patient cause: 1. Hip flexion contracture 2. Weak hip extensors 3. Weak abdominal muscles

Question 63

Transtibial deviation in TSt and cause?

Answer 63

Rapid knee flexion (Pelvic drop off) Prosthetic causes: 1. Socket too anterior over foot 2. Excessive knee flexion in socket 3. Foot too DF 4. Foot too soft Patient cause- changes shoes to higher heel (will also be seen in LR)

Question 64

What defines post-surgical management phase? (Amputation)

Answer 64

Surgery to discharge from hospital

Question 65

Transfemoral LR Common gait deviations

Answer 65

Knee instability ER of foot Rapid toe descent

Question 66

Incidence of amputation

Answer 66

1998- 185k annually 2000- 82k due to DM Nearly 2 million live with major limb loss

Question 67

MSw muscles?

Answer 67

Small amount of iliopsoas (decreasing from ISw peak) Hamstrings (midway starts- increases peaking in TSw) Small amount of Tibialis anterior

Question 68

Pelvic hike during swing phase | Possible causes

Answer 68

Quadratus lumborum assists with limb clearance when hip flex, knee flex and/or ankle DF are inadequate

Question 69

Preparing for first prosthesis

Answer 69

Don’t deny based on current presentation Set goals of independence w/o prosthesis ``` Primary factors that can be overcome with PT: Contractures Sound side weakness UE weakness Excess weight ```

Question 70

IC is described as____. The hip is positioned ___ The GRF at the hip ... muscles?

Answer 70

The moment at which the foot hits the ground Femur flexed 25* GRF anterior to hip, creating large flex moment Hip extensors contract to resist the flex moment

Question 71

Transfemoral IC - unequal step length Causes?

Answer 71

Prosthetic- Excessive or insufficient socket flexion Unstable knee Patient- Poor balance Muscle weakness Fear of knee stability

Question 72

The first PT sessions after prosthesis - 2 goals

Answer 72

1. Don’t compromise session with poor fitting limbs that cause you more problems 2. Solve issues within your scope without the prosthetist

Question 73

Graded motor imagery

Answer 73

Left/Right discrimination Explicit motor imagery Mirror therapy

Question 74

ISw- the knee ___ in preparation to clear the floor. | Thus will cause the ___ to lift transtibial prosthesis, and may increase pressure on ___.

Answer 74

Knee flexed in preparation to clear floor Will cause tibia to flex w/in the socket to lift prosthesis off floor and may increase pressure on the posterior distal aspect of residual limb

Question 75

“Other” factors that influence phantom limb pain

Answer 75

Pre- and Post- operative pain may influence occurrence Mow frequent in adolescents and adults (compared to young children) Unclear relationship w/ regard to mechanism of amputation May be provoked or worsened by physical or psychological factors

Question 76

``` TSt- knee Transtibial Prosthesis COP? GRF? Muscles? ```

Answer 76

COP: moves anteriorly toward metatarsal area/toe region GRF: anterior to knee, causing posteriorly directed knee extension moment Hamstrings flex residual limb w/in socket- pulling body forward and overcomes the knee ext moment

Question 77

LR: Transfemoral Prosthesis COP? GRF? Muscles?

Answer 77

COP: moves slightly anterior as prosthetic heel compresses GRF: moves posterior to knee, inducing knee flexion moment on limb Concentric contraction of hip extensors extensors femur to overcome effect of induced knee flexion moment N/c femur not stabilized- pulled toward posterior wall of socket (concentrated pressure)

Question 78

Deviation: backward trunk lean Primary phase? Cause?

Answer 78

Stance or swing Hip extensor weakness - particularly glut max Hip flexor weakness Limited hip flexion

Question 79

Transfemoral gait deviations in Swing phase - Excessive heel rise

Answer 79

Prosthetic cause- insufficient resistance to knee flexion Patient cause- flexing hip too aggressively

Question 80

``` PSw- knee Transtibial Prosthesis COP? GRF? Muscles? ```

Answer 80

BW transferred to sound leg COP: continues to migrate anteriorly to whatever portion of foot still in contact with the ground GRF: moves back, posterior to knee and causes significant knee flexion moment Knee flexion initiated with hip flexion and pelvic rotation

Question 81

``` Average stride (m) Average velocity (m/s) Average cadence (steps/min) ```

Answer 81

1. 41 m 1. 37 m/s 113 steps/min

Question 82

Transfemoral gait deviations -MSt

Answer 82

1. Lateral bending of trunk | 2. Abducted gait

Question 83

Transtibial gait deviations -LR

Answer 83

1. Rapid knee flexion 2. Knee extension 3. Excessive toe out

Question 84

MSt: Transfemoral Prosthesis COP? GRF?

Answer 84

S/B most stable position in gait COP: anteriorly to center of foot GRF: through or slightly anterior to knee Femurs s/b in a neutral position w/in socket Knee unit can be positioned slightly posterior to add more stability during stance

Question 85

Prosthetic related causes of gait | Correctable by PT

Answer 85

``` Prosthetic causes: Heel height Sock ply Donning technique Limb edema ``` ``` Non-prosthetic causes: Limits in ROM and strength Muscular asymmetries (common in transfemoral) Co-morbidities Fear of falling Previously developed habits ```

Question 86

Key elements in post-surgical assessment? (Amputation)

Answer 86

``` General systems review Post surgical status Pain Functional status ROM ``` ROM- emphasis on active ROM only initially Avoid knee flex/ext following transtibial Avoid vigorous hip ABD/ADD following transfemoral

Question 87

Pros and cons of semi-rigid dressings during post-surgical management phase? (Amputation)

Answer 87

Pros: Better edema control than soft dressing Improved protection Cons: Needs frequent changing Cannot be applied directly by patient No access to incision

Question 88

MSw- as the pt stops ____, the transfemoral knee will begin to __. As the foot passes the floor, therapist may need to cue “_____” This requires coordination of the ___ on sound side, and ___ on affected side. If the foot doesn’t clear the floor in MSw, it is usually due to ___.

Answer 88

As stop additional hip flex, the knee will begin to swing into ext. As the foot passes the floor, may need to cue: Stabilization of pelvis, not allow pelvis to tilt in coronal plane This requires coordination: Sound side- hip ABD Affected side- Quadratus lumborum If toe doesn’t clear in MSw- is usually training issue (NOT prosthetic too long)

Question 89

DM and vascular disease amputations | “Good news stats”

Answer 89

65% decline in DM amputations Improvement in blood sugar control, foot care, diabetes management

Question 90

Transfemoral gait deviations in Swing phase - Circumduction

Answer 90

Prosthetic cause: 1. Prosthesis too long (more likely to cause abducted gait) 2. Knee too stable and difficult to flex Patient cause: 1. ABD tightness 2. Knee control insecurity

Question 91

Pros and cons of shrinkers during post-surgical management phase? (Amputation)

Answer 91

Pros: Easy to apply Inexpensive Cons: Not used until sutures removed Requires changing as residual limb shrinks

Question 92

B/c the ground reaction force vector is ____ to the knee in LR, a(n) _____ directed moment will induce knee ____.

Answer 92

GRF Posterior to knee | Anterior directed moment induces knee flexion

Question 93

Transfemoral gait deviations in Swing phase

Answer 93

1. Circumduction 2. Vaulting 3. Excessive heel rise 4. Knee/foot whip 5. Terminal impact

Question 94

Transtibial gait deviations -LR Excessive toe out Causes?

Answer 94

Prosthetic cause: foot aligned in excessive ER Patient cause: External hip rotation (weak internal rotators)

Question 95

IC: Transfemoral Prosthesis COP? GRF? Muscles?

Answer 95

COP: corner of heel GRF: little effect on knee Hip extension used to control the limb progression and placement Femor is still in relatively neutral position w/in socket, until flexion moments begin moving toward LR

Question 96

What spinal mechanisms contribute to phantom limb pain?

Answer 96

``` Hyperexcitability Disinhibition Unmasking Sprouting Neuropeptide expression ``` ^ all these contribute to: Central sensitization

Question 97

IC is described as____. The ankle is positioned ___ The GRF at the ankle ... muscles?

Answer 97

The moment the foot hits the ground Ankle joint neutral GRF Posterior to ankle, creating small PF moment Pretibial muscles contract to support weight of foot and control PF

Question 98

Prosthesis preparation- contracture reduction

Answer 98

Progresses slowly Measure and give pt a goal Passive stretching Active stretching when ambulation gets with a prosthesis > 25* not advised to fit

Question 99

Force couple pressures on residual limb - transfemoral | MSt

Answer 99

Proximal medial | Distal lateral

Question 100

What supraspinal mechanisms contribute to phantom limb pain?

Answer 100

Cortical reorganization: Somatosensory cortex Motor cortex Subcortical reorganization: Brain stem Thalamus

Question 101

``` TSt- knee Transfemoral Prosthesis COP? GRF? Muscles? ```

Answer 101

COP: moves anteriorly toward metatarsal/toe area GRF: anterior to knee, causing posteriorly directed knee ext moment Femur moves anteriorly as hip flexors activates, begins flex at socket and thus the knee Pelvic rotation and hip flexion work together to overcome knee ext moment and begins prosthetic knee flexion

Question 102

DM and vascular disease- amputation- highest risk?

Answer 102

Men > Women (6 per 1000 vs 1.9) Black folks (4.9 per 1000 vs 2.7) 75+ years old (6.2 per 1000)

Question 103

First transfemoral leg

Answer 103

Confirm the flexion of prosthetic socket: Match the patient flexion +5* ``` Eval WB regions: Ischial tuberosity- healthy skin coverage Quads and hamstrings Lateral shaft of femur Tolerance to circumferential tightness ```

Question 104

What peripheral mechanisms contribute to phantom limb pain?

Answer 104

1. Ectopic discharges from Neuroma in residual limb 2. Ectopic discharges from Dorsal root ganglion 3. Maintenance by sympathetic nervous system 4. Peripheral influence on central reorganization

Question 105

TSw- stabilizing ____ and may employ some ___. ___ will act to rapidly accelerate ____. For most transfemoral knees, it is important to ____ before of IC.

Answer 105

Stabilize femur and may employ some hip ext Hip ext will act to rapidly accelerate knee into ext For most transfemoral knees, important to fully extend knee prior to placing foot in ground for IC

Question 106

Transtibial gait deviations -MSt | Valgus moment at knee

Answer 106

Prosthetic cause: 1. Foot excessively outset 2. Excess Valgus angulation alignment 3. Fibular head pain 4. Looseness in socket fitting Patient cause: 1. Short residual limb 2. Ligament laxity with coronal instability 3. Wide BOS

Question 107

Transtibial gait deviations - MSt

Answer 107

1. Valgus moment at knee | 2. Varus moment at knee

Question 108

MSw- the limb progresses, accelerated by ____, which will cause the tibia to move ___. Most deviations in this phase are related to: (Transtibial prosthesis)

Answer 108

Accelerated by knee extension, moving tibia anteriorly toward anterior socket wall Most deviations related to the suspension aspect of the prosthesis- the weight of the prosthesis must be suspended to allow for proper toe clearance

Question 109

5 elements of functional training are key in prosthetic management?

Answer 109

1. Transfers 2. Stairs, ramps and curbs 3. Advanced training 4. Activity/Sport specific 5. Fall management

Question 110

Transfemoral amputee | Cue to improve knee stability in LR

Answer 110

Push thigh into back of socket

Question 111

MSt- pelvis

Answer 111

Rotates to neutral by end of MSt Hip ABD contract concentrically to stabilize hip

Question 112

Causes of amputation and %

Answer 112

54% vascular disease 45% trauma >2% cancer related

Question 113

Key elements in preprosthetic and prosthetic management phases assessments (10)

Answer 113

``` History Systems review Skin Residual limb Vascularity ROM Muscle strength Neurological Functional status Emotional status ```

Question 114

Contralateral trunk lean most commonly occurs during reference limb ___. Possible causes?

Answer 114

Swing Contralateral hip ABD weakness, Hip joint pain, IT band tightness, or scoliosis Contralateral glut med strength Limited knee flex or excess PF during ISw Leg length discrepancy

Question 115

DM and vascular disease amputation 2nd amputation and mortality “Bad news stats”

Answer 115

55% require a 2nd amputation within 3-5 years 5 year mortality rate for 50% of those with vascular disease related amputation 2010- est 50% of DM amputations were preventable

Question 116

Deviation: forward trunk lean Primary phase? Cause?

Answer 116

Primarily stance phase Quad weakness Hip or knee flexion contractures

Question 117

On transfemoral amputation, which muscles are most affected

Answer 117

ADD and extensor muscles Weakness and limited ability to extend hip

Question 118

TSt - ankle

Answer 118

Continues to DF to 10* GRF moves to toes, MTP joints extend to 30* DF moment reaches max by end of TSt Ankle DF concentrically contract to lift heel off ground “Forefoot rocker”

Question 119

Prosthesis preparation- | Performance goal

Answer 119

Measurable performance goals Independent use of walker for stated distance (100’) Must incorporate good mechanics in preparation for the prosthesis Assisted (contact guard -> stand by -> supervision) -> Modified independent

Question 120

4 goals of preprosthetic management phase? (Amputation)

Answer 120

1. Independent in residual limb care 2. Independent in mobility, transfers and functional activities 3. Demonstrate HEP accurately 4. Care of remaining LE if amputated for vascular reasons

Question 121

Criteria used in selecting dressings during post-op (amputation)

Answer 121

``` Level of amputation Surgical technique Healing requirements Patient compliance Surgeon preference ```