Deviations- transtibial
What are some patient and prosthetic causes that lead to a lateral or medial thrust in midstance?
Lateral: medial placed foot, laterally leaning pylon
Medical: laterally placed foot, medially leaning pylon
What are some deviations during initial contact? What would be the patient causes of each?
Knee instability: quad weakness, hip flexion contracture, shoe heel height
Foot slap: driving the prosthetic forward forcibly
What would be prosthetic causes of knee instability with a transfemoral prosthetic?
Socket flexion, heel cushion (too stiff)
What would be prosthetic causes of drop off with a transfemoral prosthetic?
socket flexion
What is included in step 1: accepting weight of body on bilateral LE's?
Learning to find center
Weight Shift control
What can cause excessive rising or dropping on the prosthetic side in midstance?
Length of the prosthesis: shoe, socks, length of pylon
What are some deviations during Midstance? What would be the patient causes of each?
Lateral trunk bending: difficulty with balance, weakness of hip abductors, pain
Abducted gait: abduction contracture, inadequate training/poor habit
What would be prosthetic causes of foot slap with a transfemoral prosthetic?
too soft og heel support, short toe lever arm
What would be prosthetic causes of circumduction gait and vaulting with a transfemoral prosthetic?
too stiff mechanical knee or difficult to bend, length of prosthetic
What is included in step 2: balance on one foot?
Stance control: could be step ups, kicking a ball, clock activity
What is it called when there is loss of suspension of the prosthetic in swing phase? Why is this an issue?
Pistoning: friction can cause abrasions
What is a deviation we might see during terminal stance? What would the patient cause be?
Drop off: weakness
What would be prosthetic causes of lateral trunk bending with a transfemoral prosthetic?
socket wall not adducted, too short of prosthesis, too high of socket wall
What would be prosthetic causes of a lateral or medial whip with a transfemoral prosthetic?
Too tight socket, externally or internally rotated knee
What is NOT encouraged for gait training with a prosthetic?
external support
What is the first thing you do when you are observing a prosthetic to find out a cause of a deviation you are seeing?
Reset the prosthetic- take it off and put it back on
What are some deviations during swing phase? What would be the patient causes of each?
Length issues, circumduction gait, vaulting: lack of confidence and training using the knee
Lateral or Medial whip: Donned prosthetic in external or internal rotation
What would be prosthetic causes of abducted gait with a transfemoral prosthetic?
prosthetic is too long, high medial wall
What is the major goal in prosthetic training?
Attain a smooth, energy efficient gait in order to return to ADLs, work and recreational activities
What is a common deviation to see throughout the gait cycle?
Uneven arm swing or uneven steps: mostly caused by inadequate training or fear
What is a deviation we may see during midstance to toe off? What would be the patient cause of this?
Excessive trunk extension: flexion contracture, weakness of hip extensors or abdominals
What would be prosthetic causes of excessive trunk extension with a transfemoral prosthetic?
insufficient socket flexion
What are the steps included in prosthetic training?
1. accepting the weight of the body on bilateral LE's
2. balance on one foot
3. advance each limb forward and prepare for next step
4. adapt to environmental demands