1
Q
What is observational gait analysis?
A
A process by which clinicians gather data regarding a patient’s functional abilities and limitations with gait by watching them walk
2
Q
What is the point of Observational Gait Analysis?
A
- Understand abilities and impairments - Assist diagnosis - Evaluate effectiveness of treatment - Inform intervention
3
Q
How does the Ranchos Los
Amigos (RLA) form work?
A
- Identify a reference limb
- Shade each deviation in the body region in which they are present
4
Q
What is recommended for data
acquisition in the RLA system?
A
- Gross Review to sense the flow of action
- Specific Analysis: should follow an anatomic sequence in order to sort the multiple events happening at the joints
5
Q
What is the sequence of specific analysis?
A
- Floor contact
- Ankle/foot
- Knee
- Hip
- Pelvis
- Trunk
6
Q
How is data interpretation
handled in the RLA system?
A
- Total limb function is identified by summing the gait deviations that occur at each phase of gait
- The findings per phase are then related to the basic cause of the functional deterrence as deduced from the physical exam findings of weakness, contracture, spasticity, sensory loss and pain
7
Q
What are the advantages of the RLA system?
A
• Little to no instrumentation
• Inexpensive
• General description of gait
variables
8
Q
What are the disadvantages of the RLA system?
A
- Unknown reliability
* Unknown validity
9
Q
ow reliable are we with
Observational Gait Analysis?
A
- Inter- rater reliability range from slight to high
- Intra- rater reliability range from moderate to high
10
Q
What are the things thought to contribute to the reliability of observational gait analysis?
A
- Difficulties involved in observing and making accurate judgements about motions occurring simultaneously at numerous body segments
- Inadequate training and observational gait analysis methods
11
Q
What is the effect of the use of video software to
improve reliability?
A
- Inc inter-rater reliability
* Dec efficiency
12
Q
What are the top 10 ways to improve observational gait analysis?
A
- Learn normal gait
- Communicate expectations
- Unobstructed view
- Select plane of observation
- Select joint of focus
- Follow joint through gait cycle
- Systematically repeat at all joints
- Compare right and left
- Use binary scoring
- Corroborate with physical exam
13
Q
What are the issues of Injury/disease and Loss of
Function?
A
• Grief reaction - Why me? • Identity loss - Am I defined by my abilities? • Fear and anxiety - Can I still work? • Loss of confidence - Can I still do that?
14
Q
Why the need for foot/ankle
intervention?
A
• Compressive forces of the ankle - 1/2 body weight during standing - 5 times body weight during walking - 13 times body weight during running
15
Q
What can the therapist influence/role in a patient that needs an orthotic?
A
- Joint mal-alignment
- Limb-length discrepancy
- Decreased flexibility
- Muscle imbalance
- Muscle weakness
- Poor neuromuscular skills
- Kinetic chain dysfunction
16
Q
What are the Indications for an Orthosis Rx?
A
Demonstrated need for: • Support and alignment • Prevention or correction of deformity • Substitution or enhancement of function • Decrease pain
17
Q
What are the goals for an Orthotic Treatment Program?
A
• Restore function • Prevent further injury and progression • Protection of involved joints • Kinesthetic reminder of previous injury • Return to prior activity levels; work, exercise, leisure
18
Q
What are the characteristics of Orthotic Treatment Programs: Prefabricated Devices?
A
- Short term need
- Temporary use
- Simple function
- Diagnostic
19
Q
What are the characteristics of Orthotic Treatment Programs: Custom Molded Devices?
A
- Chronic and progressive prognosis
- Long-term use
- Maximal control
- Control needed at multiple joints
20
Q
What are the Nomenclatures of LE Orthoses?
A
• FO - Foot Orthosis • AFO – Ankle Foot Orthosis • KAFO – Knee Ankle Foot Orthosis • KO – Knee Orthosis • HKAFO – Hip Knee Ankle Foot Orthosis
21
Q
What are the characteristics of Foot Orthoses (FO)?
A
- Can have effect below talo-crural joint
- Hindfoot/subtalar and midfoot anomalies
- Accommodative or Corrective
- Prefabricated or Custom
22
Q
What are the common foot injuries that a foot orthoses may help?
A
• Plantarfaciitis • Ankle sprain • Stress fracture • Metatarsalgia • Tendonitis • 1st MP joint sprain • Pes planus/cavus • Hallux Valgus • Morton’s neuroma • Tarsal tunnel • Rearfoot valgus/varus • Forefoot adduction/abduction
23
Q
What are the effects of a prefabricated FO?
A
- Usually accommodative
- Provide cushion
- Shock absorption
- Arch support
- Negligible adjustments possible
24
Q
What are the indications for custom FO intervention?
A
Foot/ankle alignment • moderate supination • moderate pronation • sub-talar deviations • forefoot abduction/ adduction
25
What are the effects of a custom molded FO?
```
• Corrective or
accommodative
• Joint realignment
• Provide corrective
support
- Longitudinal arch
- Transverse arch
- Metatarsal relief
• May be more adjustable
```
26
What are the common pathologies where and Ankle-Foot Orthoses may be indicated?
```
Muscular imbalances
- acquired deformity
- altered gait
• CVA
• Cerebral Palsy
• Brain Injury
• Guillain-barre
Syndrome
• Ataxia
• Parkinson’s Disease
• Multiple Sclerosis
• Muscular Dystrophy
```
27
Ankle/foot orthosis (AFO) crosses the talo-crural joint and can affect ____
```
• PF/DF
• Coronal stability of the subtalarjoint
• Midfoot positioning
- Transverse arch
- Longitudinal arch
- Forefoot abduction/adduction
```
28
What are the secondary benefits of AFO use?
Mild Knee alignment and function
• Most successful with sagittal plane involvement
• Mild genu recurvatum
• Weaknesses in knee control
29
What are the characteristics of the early designs of an Ankle Foot Orthoses (AFO)?
```
• Metal structure
• Attached to shoes
• Adjustable joints
• Sagittal and some coronal
control
```
30
What are the characteristics of the current designs of an Ankle Foot Orthoses (AFO)?
* Thermoplastic construction
* Can be triplanar control
* Carbon fiber use
31
What are the things to look for in a patient evaluation?
```
• Functional manual
muscle test
- Functional strength
- Muscle group imbalances
- Tone triggers
• Functional range of
motion
- Midtarsal, subtalar,
talocrural, knee and hip
joints
```
32
How are prefabricated orthoses used?
• Stocked in L/R and multiple sizes
- Mild involvements of instability and strength deficits
- Temporary use in an acute situation
- Diagnostic procedures in PT
- Very limited scope of use
33
When is a Custom Orthosis needed?
* Chronic conditions
* Progressive deficits
* Moderate weakness and instability
* Maximal control of the joint is needed
34
What are the multiple stages for custom orthotics?
* Casting and measurement
* Modification of the plaster mold
* Fabrication processes
* Fitting and adjustments
* Follow up
* This all occurs under delivery billing codes
35
What are Solid Ankle AFO used for?
```
Dorsiflexion and Plantarflexion deficits
• Coronal instability of the
ankle
• Places moments on the knee
that require fair-good quad
strength for control
```
36
What are the characteristics of free motion ankle joints?
• CORONAL control only
- ligamentous instability
- Strength deficits
• Requires normal PF/DF strength
37
What are the characteristics of an articulated AFO with ankle stops: Dorsiflexion Weakness?
* Plantarflexion stop
* Induces immediate knee flexion moment
* Eliminates “foot slap” from weak dorsiflexors
* Prevents “drop foot” and steppage gait (equinus) in swing phase
38
What are the characteristics of an articulated AFO with ankle stops: Plantarflexion Weakness?
• Dorsiflexion stop
• Allow controlled tibial
progression
• Prevents “drop off” in terminal stance from lack of PF strength
39
What are the characteristics of Ground Reaction AFO?
Mild/moderate Quad Weakness
• Provides knee extension
moment against the tibial cuff during midstance
• Must have dorsiflexion stop to prevent tibial progression
40
What are the characteristics of an articulated AFO with adjustable joints?
Variable range of motion
• Can be adjusted as patient progresses in strength and/or
range
• Request this design if you anticipate your patient having significant return
41
What are the characteristics of Patella Tendon Bearing Orthosis (PTB)?
```
Axial Load Bearing Pain
• Calcaneal fx
• Talocrual degeneration
• Arthritis
• Intermediate use to allow ambulation
```
42
What are the characteristics of Orthotic Fitting and Follow-Up?
```
• Days 1-2
- 15-30 min NWB if necessary
• Days 3-7
- Weight-bearing 15-30
intervals
• Days 8+
- Extend weight bearing as
tolerated
```
43
What are the characteristics of the accommodation period of Orthotic Fitting and Follow-Up?
* Particularly important when maximal control is attained
* Gradual increase in wear time and activity
* Determine skin tolerance
44
What are the characteristics of the accommodation period of Patient acclimation process in PT of Orthotic Fitting and Follow-Up?
```
• Enhanced with gait
training
• Practice independent
donning and doffing
• Move out of the gym!
• Continue stretching and
strengthening
```
45
What are the characteristics of anticipate the need for
| adjustments of Orthotic Fitting and Follow-Up?
• No device is permanent
• ROM and strength changes
will need accommodation
• Atrophy may occur
46
What are the generalized therapy training for the use of an orthotic?
```
Gait training
• Move toward symmetry and
metabolic efficiency
• Gait phase
- Loading response knee moments
- Midstance stability
- Terminal stance knee moments
- Overall trunk and limb
alignments
• Step length
- Shorten if having difficulty
controlling knee
• Base of Support
- Widen initially for stability if
necessary and decrease width with training
```
47
What are the long-term goals
| and outcomes of an orthotic?
```
• Military High Activity
- PT test
- Return to duty
• Civilian Activity
- Environmental barriers
- Evaluation for long-term
appropriateness of walking aids
- Return to vocation and
avocational activity
```
48
What are the components of identifying the control given by an orthotic?
```
Hold (stop)
• Maximal control against a
motion
Resist
• Allows a range of motion but
slows it down
Assist
• Spring assistance to move a
joint through a range
```
49
Which intervention is most likely to benefit a patient exhibiting hyperextension of the knee in
Loading Response?
Quadriceps muscle strengthening
50
Which of the following is most likely to contribute to a patient exhibiting backward lean of the trunk in Loading Response?
Gluteus maximus weakness
51
During which phase of gait is weakness of the calf most likely to affect function?
Initial Swing
Advanced movement analysis
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