Limb loss prosthesis and gait training

prosthesis

an artificial substitute for a missing part including limbs for functional or cosmetic region or both

total surface bearing socket

a type of socket which uses the entire residual limb to evenly distribute the weight bearing focus leading to no high pressure areas

quadrilateral socket

a type of socket which was popular in the 60s-90s with a transverse plane with a narrow A-P and wide M-L dimensions

true

in a quadrilateral socket weight bearing areas include the ischial tuberosity and the gluteal tissues

t or f

false

in a quadrilateral socket weight bearing areas include the adductor longus tendon and the distal lateral femur

t or f

true

in a quadrilateral socket relief areas include the adductor longus tendon and the distal lateral femur

t or f

false

in a quadrilateral socket weight bearing areas include the ischial tuberosity and the gluteal tissues

t or f

bone lock

the shape of the prosthesis prevents ___ from occurring due to the use of weight bearing onto the glutes and ending below the ischial tuberosity

reduces

when the residual limb ____ in volume the socket can become too loose causing distal migration of the limb, skin irritation, excessive pistoning, gait instability, risk of falls/injury

increases

when the residual limb ___ in volume the socket may become too tight and uncomfortable and may restrict vascular flow dec ability to deal injuries

pistoning

occurs in a prosthesis when the socket is too loose causing unwanted up-and-down movement of a residual limb inside its socket during walking

true

loose sockets leads to pistoning, socket rotn on the limb, distal tibial pressure, excessive patellar pressure, unstable gait and skin friction

t or f

false

loose sockets leads to pistoning, socket rotn on the limb, hammocking , excessive patellar pressure, unstable gait and skin friction

t or f

hammocking

occurs when the socket is too tight leading to tissue being pushed proximally causing tissue tension and distal pain and edema

adductor roll

occurs when soft tissue hangs over the socket of the prosthesis on the medial thigh which can lead to skin breakdown w walking

feet

component used to help absorb shock for WB stresses, acts as a rigid lever for fwd propulsion, loos adapter for uneven terrain, torque absorber for limb rotn, BOS for balance

knee

component used to support BW, shock absorption, allow fwd progression of the body and inc ambulation efficiency

voluntary

knee control which is activated by the pt via active hip extension from initial contact to midstance

involuntary

knee control which is activated via alignment of the prosthesis with the pt weight line ahead of the knee axis to help w braking knee, locking the knee and polycentric knee

least stable

when the BW line is behind the knee axis of the prosthesis then the prosthesis is the ____

most stable

when the NW line is in front of the knee axis of the prosthesis then the prosthesis is the ___

bench alignment

the alignment of the knee which is used to start right after a pt is measured/fitted for one as a safe/standard placement

alignment

the position of the socket over the foot and knee in all three planes

static alignment

prothesis ____ occurs with the patient in standing

dynamic alignment

prothesis ____ occurs with the pt starts to walk to align during movement

axis loading

the vertical force transmission along the long axis of the body to help hold up the body weight in standing

true

when the prosthesis is more lateral compared to the shoe, this can lead to inc pressures on the distal lateral side, medial proximal side and gapping on the lateral aspect

t or f

false

when the prosthesis is more lateral compared to the shoe, this can lead to inc pressures on the distal lateral side, medial proximal side and gapping on the medial aspect

t or f

true

walking is determined by the mech properties of the prosthesis and the physiological quality of the residual limb

t or f

false

walking is determined by the mech properties of the prosthesis and the physiological quality of the remaining limb

t or f

true

if knee flexion has a contracture more than 10 degrees, it is recommended to work on the contracture prior to walking with a prosthesis

t or f

false

if knee flexion has a contracture more than 20 degrees, it is recommended to work on the contracture prior to walking with a prosthesis

t or f

gross gait

observing large, obvious deviations that cause other problems in gait

inital contact

part of gait which involves knees flexion 5-10 deg and an equal stride length

loading response

part of gait which involves 1 cm heel compression, smooth knee flexion to 20 deg and no pistoning

terminal stance

part of gait which involves smooth heel off prior to inital contact on opp side, and knee flexion immediately after heel off

pre swing

part of gait which involves smooth transfer of BW to sound side, no pistoning and smooth knee and hip flexion

swing

part of gait which involves foot clearance, not vaulting on stance leg, knee ready for initial contact and nor medial/lateral whipping

midstance

part of gait which involves foot flat on floor, 5-10cm bw feet as swing limb passes, toe out to contralat side, no excessive trunk lean and min varus moment

true

knee stability is the most important goal of loading response in gait

t or f

false

knee stability is the most important goal of midstance in gait

t or f