Limb Loss Gait

1.46 m/s

normal gait speed = _____

AD, intensity, dosage, comorbidities, monitoring, gait pattern, error, uninvolved limb, overuse, knee pain, LBP

individual considerations for gait include _____ use, _____ and _____ of interventions (_____ present, vital sign _____), consider previous _____ attractor state (changing = increased _____), protection of _____ (high risk for _____, common increased contralateral _____ and _____)

components, demands, technique, alignment, shoe

prosthesis considerations for gait include specific _____ that change _____ or _____ required (microprocessor vs convention, energy storing vs axial), _____ of components (static and dynamic), _____ wear

foot center, anterior ankle, 1 cm lateral, heel center, ER, flexed, quadriceps strength, flat, contact

transtibial alignment: sagittal = proximal socket center vertical line between _____ and _____, frontal = _____ of _____, transverse = foot _____ 5 degrees and socket _____ 5 degrees in sagittal plane (must be matched by _____ to maintain stability), foot _____ with maximal _____

anterior, ankle, knee, extension, 1 cm lateral, heel center, horizontal, lateral tilt, adduction, pelvis, pressure tolerant

transfemoral alignment: sagittal = proximal socket center vertical line just _____ to _____/_____ (produces _____ moment for WB stability), frontal = _____ of _____ to minimize _____ motion during gait, frontal = 7 degrees of _____ or socket _____ so anatomical hip maintains normal relationship with _____, shifts weight from distal femur to _____ lateral limb

adjusted, ideal alignment, contractures

prosthesis can be _____ to achieve more _____ or biased to accommodate _____

body weight, initial contact, balance, SLS, sway, symmetrical, symmetrical, length, erect trunk, pelvic tilt, frontal, pelvic rotation, pressure, toe, environmental

efficient prosthetic gait must be able to accept and support _____ at instant of _____, _____ in _____ without excessive _____, _____ stance time on both limbs, advance each limb with _____ step _____, maintain _____ in stance and swing, minimize _____ and excessive _____ plane compensatory movements, execute anterior transverse _____ during stance to advance _____ on prosthetic foot to _____, adaptation to _____ demands

weight acceptance, reweighting, BOS, limited, perturbations, SLS, contact, extension, COM, knee flexion, kinesthetic

early interventions include _____ (sensory _____ = reaching outside _____, progression of stances can be _____ by socket, ability to react/resist _____), _____ control (static to dynamic, maintaining surface _____, _____ stability, and adjusting _____), and _____ control (developing _____ awareness of knee position through socket pressure

knee control, weight shifting, step ups, forward stepping, task, adapt, external

transfemoral pre gait training goal is _____, _____ in variable stances, _____ with uninvolved limb, _____ (considering pelvic rotation, knee flexion, ankle movement, foot placement, stride length), use _____ specific, ability to _____, _____ focus

weight acceptance, balance, forward propulsion

transtibial pregait training includes _____ at initial contact, _____ adaptation during loading response and midstance (static and dynamic), and _____ = power

steady state, endurance, arm swing, trunk rotation, side, turns, start, stops, proactive, obstacle, turns

gait training includes _____ for _____, facilitating _____ and _____, functional gait should include _____ stepping (watch pelvic height, trunk lean), _____ (to both sides), frequent _____/_____, _____ strategies for _____ management, and head _____

backward, obstacle, incline, decline, stair

advancing mobility skills include _____ ambulation, _____ negotiation, _____/_____, and _____ negotiation

forward, DF, pelvis, stance time, posterior, stance control, side stepping

inclines keep body weight _____, accommodate for _____ ROM, may need to compensate with _____ for increased knee flexion

declines have decreased _____, increase force through _____ wall of socket for knee _____, _____ may be more efficient

joint, level, uninvolved, ankle ROM, heel

step two vs reciprocal pattern depends on _____ type and amputation _____, ascending leads with _____ UNLESS microprocessor knee or transtibial level, descending has altered mechanics due to _____, _____ down first

floor, loaded, imagery, VR, BWS, confidence, split belt

advanced interventions include _____ recovery, progressive _____ tasks, motor _____, augmented _____/game based, _____ for safety and to augment _____, _____ treadmill training

prosthetic, patient

gait deviations may be due to _____ vs _____ centered cause

strength, contracture

patient centered causes are often decreased _____ or _____

circumduction

shank too long, excessive knee joint friction, socket too small, excessive PF can cause _____

vaulting

shank too long, inadequate suspension, excessive PF can cause _____

lateral trunk bend

shank too short, improperly shaped lateral wall, high medial wall, abduction alignment can cause _____

abducted gait

prosthesis too long, high medial wall, improperly shaped lateral wall, abduction alignment, inadequate suspension, excess knee friction can cause _____

excessive knee flexion in stance, buckling

socket set forward in relation to foot, excessive DF, still heel, prosthesis too long can cause _____ = _____

heel whip, toe off

socket fit too tight, loose components, prosthetic knee valgus, toe break not at correct angle can cause _____, seen at or just after _____

medial, ER, lateral, IR

_____ heel whip = too much _____ at knee axis vs _____ heel whip = too much _____

drop off, terminal stance, early, knee flexion

_____ = downward movement of body at _____ as body moves over prosthesis, heel off occurs too _____ causing early _____, caused by DF bumper too soft, foot too small, socket too forward or foot too backward, heel height too high

pistoning

socket or suspension too loose can cause _____

lateral bend, abduction, lordosis, forward flexion, high heel rise, terminal impact, heel whip, foot rotation, heel contact, energy expenditure

transfemoral stance deviations _____ (short prosthesis, inadequate lateral wall), _____ (long prosthesis), ______ (anterior socket discomfort), and _____ (unstable knee joint), swing deviations _____ (inadequate friction, slack extension aid), _____ (inadequate friction, taut extension aid), _____ (knee bolt rotated, donned in malrotation), and _____ at _____ (stiff heel cushion, malrotated foot), increased _____

weak, ipsilateral trunk lean, contralateral, tight, contralateral, ipsilateral, forward, backward, forward

transfemoral low wall presents like _____ muscle, lateral wall = _____ and medial wall = _____ vs high wall presents like _____ muscle, lateral wall = ____ and medial wall = _____, low anterior = _____, low posterior = _____, high posterior = _____

normal, step length, stance duration, knee flexion, heel position, great toe extension, shorter, toe clearance, split toe

transtibial gait pattern should look relatively _____, focus on _____ and _____ (timing of _____), changing shoes can alter _____, no _____ in prosthetic foot options (length often _____ to assist with _____, may see _____ foot)

thrust, stance, inset, ER, outset, energy expenditure

transtibial gait may have _____ = medial/lateral movement of socket during _____, lateral = foot too far _____ or too much foot _____ vs medial = foot too far _____, increased _____ present

absorbed, knee flexion, floor, knee hyperextension, anterior

heel bumper too stiff = forces NOT _____, leads to abrupt/excessive _____ to allow sole to reach _____ vs heel bumper too soft = _____, ground reaction force passes _____ to knee

WB, arch, delay, flexion, early

keel issues (central _____ core of prosthetic foot that mimics function of human _____) too long = _____ knee _____ vs too short = _____

AMPPRO, AMPnoPRO, speed, power, agility, TUG, 2MWT, 6MWT, ABC

outcome measures include _____/_____, comprehensive high activity mobility predictor for _____/_____/_____, and L test, also validated for amputation are _____ (can have ceiling), _____/_____, and _____ scale

elements, temperature, moisture, without shoe, wear and tear, replace, daily

maintenance and protection of prosthesis include exposure to _____ (_____ extremes, _____, dust/sand), not intended to be walked on _____, normal _____ (should not see metallic dust near mechanical parts = _____), wash _____ with mild soap including socket and liner

3-5 years, material, safety, fit, function, 60%

Medicare language is every _____, based on _____ life expectancy, analysis based on _____, _____, and _____, repairs that exceed _____ will be replaced, 20% copay under part B