Professional Documents
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Gait/ Walking
base greater than the Normal Range of 5-
Causes:
10cm / 2-4 inches
Excessive knee flexion or abrupt/early knee
flexion 1. Hip Abductors: Socket
2. Abd: Socket
All are excessive: 3. Lat. Wall : Low
1. Foot DF 4. Med. Wall: High
2. Posterior displacement of foot in rel. to 5. Prosthesis: Long
med. Socket 6. Leg: Long
3. Stiff/Hard : Heel, wedge, PF bumper 7. Shank: Invalgus
4. Soft: DF bumper
5. Anterior displacement of heel Circumduction Gait- anything that would
6. Knee Flexion Contracture produce longer leg
Rule: 1. Excessive PF
Foot: I/L 2. Abd Contructure
3. Socket: too small
Socket and Heel: C/L 4. Insufficient: Knee extension
5. Manual: Knee lock
Excessive knee extension / Genu
6. Excessive Knee Friction
recurvatum/ Deleyed, limited, absent knee
7. Tight: Tight Extension Aid
flexion/ “Heel Climbing” Sensation
Jogger’s Foot
- Local entrapment of med. plantar nn at
abd. hallucis
Heel Pain
Plantar Fascitis – over pronation
Calcaneal apophysitis/ Sever’s Dse –
Mortons Neuroma inflammation of growth plate of heel
- Impingement of interdigital nn
Haglund’s Deformity/ “pump bump” –
- m/c webspace: 3-4 webspace
enlargement at the back of the hip
- morton’s test :
Retrocalcaneal Burstis – bet. Calcaneus
S: squeeze metatarsal heas
and triceps surae
R: (+) pain
Metatarsalgia
-
- Pain o metatarsal head d/t abN
MORTONS/ 2>1>3>4>5
distribution of wt.
GREEK’s
- M/c cause: high heeled shoes
toe/ foot
*leg length discrepancy
Common MT conditions:
2nd MT Head : Freiberg’s Common Spinal Problem
2nd MT shaft : March Fx 1. Lordosis : Ant convex Post Concave
5th MT Base: Jones Fx - Exaggeration of the N curves of cervical
5th MT Base apophysitis: Iselin Dse and lumbar
- Ant. curvature of spine
POSTURE - Causes: Lower Crossed Syndrome
Correct Posture: min. stress on body
Faulty Posture: max. stress
m/c cause: mm imbal
2 curves:
Primary Secondary
Present @ birth Develop as the baby
learn to lift head, sit,
stand and walk
Thoracis, Sacral Cervical , Lumbar
COG
Adult: slightly ant to S2
Child: T12 - Postural and functional deformity
Genu varum: 18 mons. - Lax mm
Genu valgum: 3 y/o - Heavy Abdominal
Straight: 6 y/o - Congenital Problems (B/L disloc of hip)
- Fashion ( High Heels)
Foot Flat / Pes Planus - Pathologic Changes assoc with Lordosis
- (+) med. fat pad covers MLA Body Segment Alignment
Ant Pelvic Tilt
Hormonal influences Knees are Hyperextended
Puberty: Female : 8-14 /o last 3 yrs Ankle PF
Male: 9 ½ - 16 y/o last for 5 yrs Mm that are
Elongated and weak
PLUMBLINE TEST Ant abdominal
- To assess posture Multifidus and rotatores
1. Ant. to ext. auditory meatud Lower and Mid Traps
2. Through the cervical vertebra Upper Erector Spinae
3. Ant to thoracic Vertebra (Cevical and Thoracis)
4. Through the Lumbar vertebra Shortened and tight
5. Post to Hip Lumbar ES
6. Ant to Knee (Post to Patella) Hip Flexors
7. Ant to Ankle Hams are weak but become
tight
Causes of Postural Deviations - Pelvic Angles: * N= 30 ˚
1. Postural/ Positional * Lordosis: 40 ˚
2. Structural- Ex: Sway Back/ relaxed Pattern
* scheuman’s dse (m/c T10-T12) Ant Shifting of pelvis
*thin vent end plate Post shifting of thoracic
Inc in pelvic angle of 40 ˚ HO Terminal Stance
Kyphotic posture on TO Pre-Swing
thoracolumbar spine Swing Phase
2. Kyphosis Acc Initial Swing
- Exaggeration of thoracic spinal curve Midswing Midswing
- Roundback Decce Terminal Swing
- Flat Back
- Hump back/ Gibbus Double Support
- Dowager’s hump - There are two periods of double
3. Scoliosis support and one period of single leg
- Lateral curvature of the spine stance during gait
- Mm most commonly weak and - B leg on the ground
elongated mm on convexity - 25% of gait (22%)
- Tight and shortened mm on concavity - No double support in running
- Hip abd on concavity ¦ HS to TO HS to TO & TO to HS
- Hip add on convexity ¦ FF to Acc constitute the double
¦ MS to MS Support
BODY TYPES: ¦ HO to Decce
ECTOMORPH – thin, arthenic (no Force) ¦ TO to HS
MESOMORPH– muscular and sturdy, ¦ Ace to FF
athletic ¦ MS to MS
ENDOMORPH–fat body, pyknic ¦ Dec to HO
GAIT
- Human Locomotion Clinical Significance:
- Translatory progression of a body as a COG - lowest on double support
whole, produced by rotatory movement - Highest in Mid Swing
of the body segments -lower COG greater STABILITY
STANCE: WB, close kinematic chain, 60 % Walking - 25%(20-22%)Double Support
SWING: NWB, OKC, 40 % Running -(+) Floating Phase /
Gait Cycle Double Unsupported Phase
- Time interval or sequence of motions
occurring bet 2 consecutive initial PARAMETERS OF GAIT
contact of the same foot Step Width
3 main tasks: Step Length
Wt acceptance HS / FF Stride Length
Single limb support MS/HO Lat Pelvic Shift
Swing limb advancement Vertical Pelvic Shift
Acc/ Midswing/ Decce Pelvic Rot
Walking Speed = COG
o Gait Speed = 3.0 mpH / 1.4 mpS Cadence
Degree of Toe out
Traditional Term Ranchos Los Amigos
Stance Phase STEP WIDTH/ BASE WIDTH
HS Intial contact - 2-4”
FF Loading Response - BOS
MS Midstance - Small on CP due to Add Spacticity
o CLINICAL SIGNIFICANCE - 90-120 steps/min
1. Poor Balance – Wide BOS - Fast gait = > 120
2. Loss of Sensation – Tabes Dorsalis - Slow agit = <90
3. Musculoskeletal Problem – ex: CP - Average: 113 steps/ min
scissoring gait - Dec. with age
STEP LENGTH - Shorter step length will result to dec. in
- Gait Length cadence at any given velocity
- 15” N Leg - Women has more cadence than men
- Affected by : Degree of toe out
Leg Length and Height = Tall - 7˚
Age = Old - Dec when Inc speed in walking
Gender = Male - And and 2nd toe
o CLINICAL SIGNIFICANCE Standing Walking Running
1. R hip Flexion Contracture 15 ˚ 7˚ Dec or Absent
= Dec L step length Energy cost of walking
2. R Iliopsoas Weakness - Ave. O2 for comfortable walking
=Dec R Step Length = 12 mL/ kg x min
3. R quads weakness - Metabolic cost of walking averages
=Dec R Step Length =5.5 Kcal/min on level surface
4. R knee flexion contracture Gait Parameters are Sig. Dec in women are
=Dec R Step Length compared to men
5. R Calf Weakness Velocity
=Dec L Step Length Stride and Step Length
Stance Time Sagittal hip motion
- Ex. Injured L foot Knee flexion in initial swing
- Dec. stance time on Left and Inc stance BOS
time on Right Vertical Head Excussion
Stride Length Lat Head Excursion
- Distance between two consecutive Sh Sagittal Motion
same foot Elbow motion
- Normal : 30” Gait Variations in Elderly
- Equal to 1 gait cycle Slower speed
Lat. Pelvic Shift Shorter but wider steps
- Side to side movement of pelvis during Dec arm swing
walking Dec LE excursion during swing
- N : 1-2” Less pelvic rot
Vertical Pelvic Shift Inc toe out
- Keeps COG from moving up and down Inc time in stance
- 2” Stance Phase
Pelvic Rotation Jt HS FF Mst HO TO
- Necessary to lessen the angle of the HIP Flex Ext Ext Ext Ext
femur on the floor 20-40 Slight 0˚ 10-20 0˚
- It lengthens the femur Gmax Gmax Gmax Iliopsoas Iliopsoas
- 8 ˚ = 4 ˚ ant / 4 ˚post. Ecc Con Noact Ecc Con
- To maintain balalance, the thorax KNEE Ext Flex Flex Flex Flex
rotates on opp direction Full 20 5-15 4 30
Cadence
Quads Quads Quads Quads Quads
- No. of steps / min
Con Ecc To no To no Ecc flexion heel rise on affected legs occur
act act earlier
ANKLE DF PF PF PF PF 4. Equinus Gait (PLANTAR)
0-neutral 15 5-10 0 20 - Toe walking
Pretibials Pretibials Calf Calf Calf - Seen in clubfoot pt. (talipes
Isometric Ecc Con Con equinovarus)
HO and TO calf = Push off/ Roll over 5. Plantar Flexion Gait
- Loss of PF
Important notes: - Dec or absent Push off
1. Max Hip Flexion = 30 ˚ - Dec stance phase
- Seen in HS and entire swing phase - Shorter step length on unaffected side
- Steppage: excessive hip and knee 6. Psoatic Limp
flexion - Seen in LCPD
- Use to compensate for toe drag - Difficulty in swing through
2. Knee is fully extended only in HS and - Accompanied by exaggerated trunk and
flexed during the remaining stance and pelvic movement
entire swing
3. GMax (Inf Gluteal nn – S1) PARALYTIC GAIT PATTERN
- Max act -HS- eccentric 1. Gmax Lurch
- If weak- backward lurching in STANCE = - Extensor lurch
HONEYMOON’S GAIT - Honeymoon gait
4. Quads- max act – HS - Backward trunk lurch in early stance
- Early stance to FF 2. Iliopsoas Weakness
- Paralysis = forward lurching on STANCE - Backward trunk lurch in early swing
3. Quads
PATHOLOGIC GAITS - Back Knee Gait
1. ANTALGIC GAIT (painful gait) - “Pushing the thigh backward” =
- Stance phase of the affected leg is Buckling
shorter than the non-affected leg. - Forward trunk lurch in early stance
- Dec swing phase of uninvolved leg 4. Gastrocsoleus Weakness
- Dec step length of uninvolved leg - NO rollover/ Push off
- Dec walking velocity - Lack of push off in late stance
- Dec Cadence 5. DF
2. ANTROGENIC GAIT - STANCE: Foot Slap,
- Stiff hip or knee gait Toe Drag (late stance)
- PF on unaffected side to circumduct - SWING: Foot Drop,
affected leg Toe Drag(early swing)
3. CONTRACTURED GAIT 6. G. Med
- Hip flexion contracture result in lumbar - U/L = Trendelenburg
lordosis and ext. trunk - B/L = Waddling, Wobbling, Ghorus G.
- Knee flexion contracture result in GAIT DEVIATIONS AT HIP
excessive DF from late swing to early 1. Weak hip extensors
stance on uninvolved leg/ early heel rise - backward trunk lean in stance
on involved leg on terminal stance. 2. Weak Hip Abd
- PF contracture: knee hyperextension - Lat trunk lean on stance side
forward bending of trunk with hip - Pelvic drop on opp side
3. Hip flexion Contracture
- Excessive lumbar lordosis
- Forward bending during mid and GROUP D/O
terminal stance Seronegative Ankylosing spondylitis
4. Hip Flexion Weakness (Spondyloarthro- Psoriatic Arthritis
- Trunk lurch backward during HO to paties) Inflam. Bowel dse
midswing Reactive Arthritis
- PPT Inflam. Crystal- Gout Metabolic Arthritis
- Hip Circumduction induced dse. (MSUC)
GAIT DEVIATIONS AT KNEE Pseudo Gout = CPPD
1. Rapid ext of knee during IC Calcium Pyrophosphate
- Spastic Quads Deposition Dse
2. Knee remains extended during LR Inflam. Induced by Syphilitic A. ,Bacterial A,
- Weak Quads infectious agents Fungi A. , Tuberculosis
3. Genu Recurvatum Inflam Connective jt RA, JRA, Polymyalgia,
- Weak Quads dse Rheumatica, SLE,
4. Reduced or Absent knee flexion Sjogrens, PM-DM,
- Spastic knee extensor Fibromyalgia, PAN
5. Flexed position of knee during stance
and lack of knee ext in Terminal Swing
- Knee Flexion COntructure PHARMACOLOGY
- Hams Overactivity - Study of drugs and the harmful effects
GAIT DEVIATIONS AT ANKLE of drugs
1. Foot Slap – “FOOT FLAT” DRUGS- any chemical agents that
2. IC w/ ground made by the forefoot FF affects the process of living
by heel region = WEAK DF Pharmacodynamics- effects of drugs in
3. IC w. the ground made by the forefoot the body
but the heel region never makes Pharmacokinetics- body on the drugs
contact with the ground during stance= Pharmacy- process of dispensing drugs
HEEL PAIN/PF CONTRACTURE Toxicology- study of toxins and harmful
ARTHRITIS effects
- Inflammation of jt DRUG NAMING
- Affects the jt and other connective o Chemical Name – specific
tissue compound drugs
- Affecting synovial jt o Generic name – non- proprietary
INFLAM = m/c RA name
NON-INFLAM=m/c OA o Brand name – trade name
m/c arthritis= OA –proprietary name
ARTHROSIS Rout
- Limitation of jts w/o inflammation Drug Administration
1. Enteral – GIT/ Alimentary Canal
a. Oral – m/c form, easiest from,
SIGNS AND SYMPTOMS: first pass effects = LIVER
Impaired mobility b. Sublingual- fastest enteral
Impaired mm performance c. Rectal – via anal canal
Impaired bal - for unconscious, vomiting,
Activity Limitation and participation hemorrhoids, suppositories
restriction (fever,constipated)
2. Parenteral – non- alimentary
INFLAMMATORY ARTHRITIS a. Inhalation – ex. Nebulizer
b. Injection
Types of injection
i. IM = m/c gmax and deltoid
ii. IA=
iii. IU=
iv. Subcutaneous= insulin (under the skin)
v. Intrathecal = sheath of SC
3. Topical
4. Transdermal
– Iontophoresis
– phonophoresis
Bioavailability - % of drugs that us present
and active in the bloodstream
Drug Storage Skeletal mm relaxant / Antispacticity drugs
1. Adipose Tissue – 1st storage 1. Centrally acting
2. Bone ¦ CP- Benzidiazepine (D & V)
3. MM SE: mm weakness
4. Organs (Liver and Kidney) ¦ MS & SCI- baclofen has no mm
Drug Excretion weaknesss SE: SEDATION
KIDNEY - 1 ˚ site of drug secretion 2. Peripherally / Direct-acting
¦ BOTOX – for spasmodic torticollis,
Sedative Hypnotic drug dystonia, blepharospasm
- Use to calm and pacify pt. ¦ DANTROLENE- Sodium (DANTRIUM)
- Promote sleeping and relaxation SE: Gen mm weakness
- SE: Sedation and GI distress NSAIDS aka: COX (cyclooxygenase)
1. Barbiturates ( Phenobarbital) inhibitory
- Tranquilizer SE: Gastric irritation/ upset, bleeding
2. Benzodiazepine 1. Anti-Inflam
- Diazepam / vallium 2. Anti-coagulant
Anti-Depressant drugs 3. Anti-Pyretic
- TCA: tricyclic acid 4. Analgesia – M/c : ASPIRIN
- SE: sedation SE in child: REYE SYNDROME
Anti- Psychotic Drugs/ Neuroleptic Drugs = GI Bleeding, high fever, vomiting
- For psychotic pt. Acetaminophen
- Most feared SE: - Not considered as NSAIDs
Jardive Dyskinesia= invol. Fragmented - For antipyretics and analgesia only
movement of the face , mouth and jaw - Not assoc with GI bleeding and reye
producing lip smocking sound syndrome
Anti-Epileptic Drugs/ Anti-Seizure/ Anti-
Convulsant
1. Barbiturates – SE: Sedation
2. Benzodiazepne – SE: Sedation
3. Carboxylix Acid (Valproic Acid)
4. Hydantoins (Dilantin)
PD
OSTEOPOROSIS:
- Significant dec. in bone density
- Bone Density: (t-score)
N = -1.0 or higher
Osteopenia= -1.0 to -2.5
Osteoporosis= <2.5
RA - Clinical Union: formation of callus from
Goals of drugs: fx site
1. Dec inflammation - Bone Remodeling
NSAIDs and Corticosteroids 1. Activation
2. To halt progression of dse 2. Resorption
DMARDs 3. Reversal
a. Anti-malarial drugs : 4. Formation
SE: retinal damage 5. Quiescence
b. Azathioprine: - Pathogenesis:
SE; Renal Damage Dysequilibrium bet resorption
c. Gold Compounds and formation favoring
OA resorption w/c result to bone
Best tx: wt loss loss
MEDS: NSAIDs – pain management Inc osteoclast
Heart Dec Osteobalct
- Anti-Htn drugs Peak of one mass – 20-30
1. Diuretics – m/c anti-Htn - Classification (CAUSES)
-cheapest Hereditary:
-1st line in tx o Congenital-
-SE: Fluid and electrolyte depletion and ¦ Osteogenesis Imperfecta/
imbal ; Hyponatremia; Hypokalemia Brittle bone
2. Beta Blockers/ Beta Adrenergic Agonist ¦ Neurologic Disturbance
- Dec HR and BP ¦ Growth of litthe known dse
-inhibit adrenergic (epi and Nore) *Osteopetrosis (MARBLE BONE)
3. Vasodilators / Albergs – Shoerbergs
4. Ca++ channel blockers – reduce *Osteopoikilosis –Spotted bone
contractility of heart o Acquired
5. ACE inhibitors – “pril” ¦ Primary
SE: dry hacking cough Idiopathic
6. Anti-coagulant Post-menopausal
- Target is building up of clotting factor Age-related
- Affect the synthesis of clotting factor
7. Anti-Thrombotic ¦ Secondary
- Target the platelets Nutrition
- Inhibit production of platelet Sedentary lifestylr
- Aspirin – SE: Reye Syndrome Drug intake -
8. Thrombolytic Drugs biphospahte
- Breakdown of thrombus Malignancy
- Ex. Streptokinase Endocrine d/o
Osteoporosis is typically a “Silent dse” until ¦ Until 5 y/o – every 15-18 mons/
fx occurs annually
CM: ¦ 5-12 y/o – every 18 mons / every 2
- Back pain yrs
- Dowager’s hump ¦ 12y/o to adulthood
- Multiple fx - Every 2 yrs : 12-21 y/o
- Height loss
- Every 3-4 yrs : >21 y/o
Fx Sites:
¦ Lifespan of UE &LE prosthesis = 3yrs
1. Spine
2. Femur TERMINAL DEVICES
3. Mid Thirax
4. Distal forearm – Colles Fx Classifications
5. Upper Lumbar 1. Mitt (Heart )– sports/ energy absorption
Prevention (Primary) /release
- Adequate Calcium intake 2. Hand – 3 jaw check/ prehensile grasp
¦ Elderly/pregnant – 3. Hook – lat. prehension
1200mg/day Types of Terminal Devices
¦ Young & children – 1. Passive Terminal Devices – no fxnal use,
800mg/day
for cosmesis, lightest
(Secondary)
2. Body Powered Terminal Devices
- Medication - Postural awareness
- Bal exe - Prevention of fall a. Voluntary opening terminal devices
- m/c type; Dorrance
-5-10 lbs
PROSTHESIS -lighter than voluntary closing TD
b. Voluntary Closing T.D
UE Prosthesis
-more physiologic in fxn
- Gen Timing: 3-9 mons -most commonly used and most
- Terminal Device: 1 ½ - 2yrs functional terminal device is :
- Elbow unit: 3-4 yrs VOLUNTARY OPENING HOOK
Best time to fit a child with an initial upper -provide sensory feedback
limb prosthesis = 5 mons -20-25 lb.
When the child can incorporate the 3. Externally Powered T.D.
prosthesis to body image a. Myoelectric – Controlled T.D.
- more motivation needed
LE Prosthesis
-use of AP
- Gen Timing: 3-4 y/o -(+) electron
- Terminal Device: 3<4 y/o b. Microswitch-controlled TD
- Elbow unit: 4.5 y/o Fxn: for easy use
1.Optimal Liner thickens – 3-9 mm UPPER EXTRIMITY
2.Replacement period for body powered Prosthetic wrist unit
prosthesis : 1 ½ - 3 y/o Prosupination
3. Replacement period for myoelectric - Promotes pronation and supination
prosthesis : 2-4 yrs 1. Friction wrist- easily position – not
Prosthetic Replacement Check Up recommended for heavy lifting
2. Quick disconnect/ locking wrist
¦ Best prosthetic unit for blue colar jib Chest- strap with sh straddle saddle harness
¦ For heavy lifting – locking unit - If pt. can’t tolerate axilla loop
¦ Easy usedue ro quick disconnect - 3 notes:
3. Spring- assisted- pronation and sup 1. Very comfortable to girls
for bilat 2. Primary Recommended
- Flexion-wrist flexion = more for b/l = forequarter amputation
amputees to promote midline =(-) harness , some clavicle and scap
consciousness 3. Recommended for heavy lifting
Below-Elbow Prosthesis Socket Above Elbow Prosthesis
- Split Socket – for very short transradial - Tanshumeral/above elbow sockets
amputation = <35% of elbow Lat. socket wall – acromion process
- Merenster Socket/Self Suspended Med socket wall- below axilla
Socket Elbow units
¦ For STA= 35-55% - Internal Elbow jt- 4cm on prox from
¦ 30 degree elbow flexion position epicondyle
¦ (+) figure of 9 harness - Ext. elbow jt ->4cm prox from
¦ Socket encloses the olecranon and epicondyle
epicondyle of harness Control-Cable Sys.
Below-Elbow Prosthesis Elbow Hinges - Single/Bowden Control Cable System
- Flexible ¦ Transradial amputee
Recommended for : ¦ Only operates the terminal device
Wrist disarticulation ¦ Motion: sh abd, scap, protraction and
Long transradial amputee = 55-90% elbow flexion
Note: active pron-sup - Dual Control Cable System
- Rigid ¦ Operates the elbow unit and terminal
For short transradial amp = 35-55% device
Note: (-) active pron and sup ¦ Unlocked elbow unit : Sh Flexion, scap
- Step-up Hinge protraction
For very short transradial ¦ Locked elbow unit: Sh ext, scap
Note: enhances elbow flexion retraction, scap depression
- Prosthetic elbow LOWER EXTRIMITY
a. Flexion – for flexion
Syme’s Amputation/ ankle disartculation
b. Rot. turn table – as compensation
- Socket Design
for sh IR
¦ Posterior Opening
Transradial Harness Suspension
– cut down to level of malleoli
- Figure-8 (O-ring Harness)
¦ Medial Opening
(+) reaction of pt: all force is applied – cut out to allow malleoli to pass
on opp/ unaffected side ¦ Stove pipe Design
m/c use – no flaps/windows are cut
give the widest range of activation – has a cylindrical socket
and least body restriction Foot-ankle asssembly
- Figure 9 - Single Axis Foot
Basically the same but offers ¦ all motion is around one axis (PF&DF)
greater ROM
¦ contains a PF Bumper (15˚) and DF stop Less life-like, more durable
(<5˚) Below Knee Socket
¦ prescribed for: prox amputess - Patellar Tendon Bearing Socket
- Multi-Axis Foot ¦ Trim lines extend ant (midpatellar level)
¦ Controlled mov’t in amp direction and medio-lat post (fem condyle)
¦ For athletic activities/ uneven terrain ¦ Helps prevent edema and recurvation
Rigid Keed - Supracondykar cuff susoension socket
- Solid Ankle Cushion Heel (SACH) ¦ Trim Lines extend medially (sup edge of
¦ m/c used prosthetic foor patella) and laterally
¦ lightest ¦ m/c below knee socket
¦ allow simulation N walking - Rubber/ Neoprene Slum
¦ offers mediolateral stab ¦ Difficult to do
Flexible Keel ¦ Inc Perspiration
- stationary ankle flexible ¦ Provides min to no stability only
endoskeleton(SAFE) foot advantage : retains Heat
¦ Accomodates uneven surfaces but - Hydrostatic Socekt
heavy, costly and not cosmetic ¦ Designed to elongate the tissues
¦ Permits; Both PF and DF - Thigh corset
¦ Doesn’t allow : Ev and Inv ¦ Main advantage: Dec. WB of residual
- Otto back dynamic foot limb– 40-60
¦ Same with SAFE but ¦ Provides mediolateral stability and
¦ Permits: PF only sensory feedback
¦ Doesn’t allow: DF, Inv and Ev ¦ Disadvantages (4)
Energy – Storing / Fynamic Foot - Bulky - atrophy quads
- For jogging and ge. Sports - Pistoning -edema aggravation
1. Stored Energy (STEN) foot – more Borrelia Burgdorferi
exoensive - Lyme’s dse
2. Seattle foot - Knee affectation
3. Carbon Copy II Below knee Scoket
4. Quantum - Pressure tolerant areas (+redness)
5. Flex- Foot 1. Popliteal fossa
6. Flex- Walk- most energy storing , 2. Patellar tendon
lowest inertia 3. Tibial Tuberosity
A type of energy storing with Derlin Kell- 4. Mid Tibial Flare
Seathe 5. Prox medial tibia
Force- Absorbing foot and not an energy 6. Lat Shafts of fibula
storing foot – Safe II 7. Pretibial mm
SHANKS 8. Gastrosoleus mm
- Connects the ankle foot assembly to the 9. Med and Lat residual limb
socket - Pressure sensitive areas
- Types: 1. Fibular head
¦ Exoskeletal/Crustacean 2. Fibular neck
Life-like appearance , lighter 3. Peroneal nn
¦ Endoskeletal/Modular 4. Ant. tibia
5. Tibial crest - Lat sides of residual limbs
6. Ant distal tibia and fibula Pressure sensitive (-) redness
7. Hams tendon - Sacrum -peningeal area
Above Knee Socket - Med. thigh -distal lat femur
- Total Contact Quadrilat. Socket - Patella
¦ Narrow anteroposteriorly and relatively Knee Units
wide mediolaterally - Conventional Single Axis
¦ Provide relief to several mm and bony ¦ Flexion and extension occur around a
landmark single axis
¦ For pt with bulging over scarpa’s ¦ Primary indic. For pediatric pts.
triangle ¦ Disadvantages:
¦ However, it lacks stab; In swing phase/ diff knee flex
¦ (+) tenderness and walking probs early sw/ excessive heel rise
¦ Lurdrines or grad. socket late sw/ terminal sw impact
CHARCOT jts - Manual Locking Knee
Syryngomyelia = SH ¦ Last resort
Tabes Dorsalis= Knee ¦ Offers max stability in stance phase esp.
DM = Ankle ; M/C in elderly and during transfers but stiff
Relief mm of TCQS knee gait
Gmax - Stance control Knee
Hams ¦ For amputees with weak hip extensors
Add Longus and for geriatrics pt.
Rectus Femoris ¦ Disadvantages
Greater Troch 1. Produces a single cadence
- Ischial containment/ Narrow shape N 2. Not recommended for active
alignment (NSWA) walkers
¦ Narrow medio-lat than 3. Not recommended for b/l amp
anteroposteriorly measurement - Fair- bar Polycentric
¦ For younger and more active patients ¦ For pts with very long residual limbs
¦ Wt. bearing – ischium ¦ Dis/A include greater wt , high cost,
- Recommended for : more maintenance, & late stance prob.
1. Mild abductor weakness - Hip Disarticulation / Hemipelvectomy
2. Short above knee amputee ¦ For amputees with <5cm of residual
Sunction Suspension femur
- Most secure suspension method ¦ Canadian hip disarticulation prosthesis
- Advantages: ¦ Standard prosthetic used
1. Provide greatest prosthetic control 1. Ant Prosthetic wall is – Flexible
2. For amputees who have well- 2. What type of shank– endoskeleton
shaped fairly strong residual limbs 3. What type of foot – ankle assembly
3. For young active pts. (AXIS: SINGLE)
- Main disadvantage: 4. What type of foot – ankle assembly
1. Above knee sockets: (KEEL: SACH)
Pressure tolerant areas (+ redness)
- Gluteals, -Ischial Tub
OSTEOARTHRITIS ¦ Tenderness
¦ Palpable osteophyte
- Non inflammation d/o of movable jts
¦ Boggy synovitis
characterized by deterioration of
¦ Crepitation
articular cartilage and formation of new
¦ LOM :
bone at jt surfaces and margins
HIP – Flex, Abd, IR, ER
- Bone eburnation – new bone formation
Knee- Flexion
on articular cartilage
Ankle- loss of df
- Aka. Degenerative jt dse
LAB abN
Patho Findings:
- ESR: N d/t no inflammation
- Early deterioration on disruption of
- CBC : N
articular cartilage
- RF : (-)
- Complete loss of articular cartilage
- Serum Calcium Alkaline (Paget’s, HO) (-)
eburnation of bone
“NO LAB Abnormalities”
- Cyst on subarticular bone
Dse that may lead to OA:
Subchondral cyst- Synovial
- Acute/ Chronic trauma
enters the bone articular
- Alcapturia – urine turn block when
cartilage/eburnation
exposed
- New bone formation found at base of
- Wilson’s Dse – copper deposit
articular cartilage
- Hematochromatosis
Important Etio:
- Acromegaly
- Obesity
- Hyperarathyroidism
- Genetic and heredity forms
- Intra-articular corticosteroid therapy
- Occupation
- DM
- Multiple endocrine dse (ex. Pseudogaut
- Syryngomelia
or gaut)
- Frost Brite
- Multiple Metabolic dse (Acromegaly)
- Hemophilia
Epidemiology:
Primary OA – Iodized or Generalized
- Age: 40 y/o
AKA: Kellgren Syndrome
- M=F
Secondary OA -(+) underlying dse
OSTEOPHYTE – bone “outgrowth”
OA of SH
– main characteristic of OA
¦ AC jt – most limited motion : IR –
AbN in radiograph
*in RA- GH
- Cartilage erosion
Heberden’s Node – bony enlargement
- Bone eburnation
Bouchard’s Node – in PIP
- Subchondral cyst
Mucinous Cyst – PIP, DIP
- Osteophyte
– mucinous fibrous tissue
- Bony Collapse
¦ M/C affected:
- Loose bodies
1st Cervical
- Deformity and malalignment
2nd Lumbar
Symptoms: Cardinal Sx
3rd Knee and Hip
¦ Pain during wt bearing and relieved
4th DIP
with rest or NWB
5th Thumb
¦ Stiffness from awakening in the
OA of the trapeziometacarpal articulation
morning; after periods of inactivity
SLAC – Scapulolunate Advance Collapse
– m/c arthritis of the wrist
STT – Scaphotrapeziotrapeziodal arthosis
– 2nd m/c arthritis of wrist
*HCTT –STT *FTLS –SLAC
BOBATH
- Sensorimotor approach
Bobath concept (1990)
- NDT
- The pt must be active
- Key pts of control and reflex-inhibiting
patterns (RIP)
- m/c use tx approach in neurodev rehab
AbN postural reflex act
- Assoc reaction
- ATNR
- Positive supporting reaction
Key points of control
- Most important are the prox key pts
o Head
o Sh
o Pelvis – most important
Reflex- Inhibiting Pattern (RIP)
- Opp of typical synergy
UE LE
Sh ER Hip ExAbER