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Prosthetic gait deviation
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- 2. INTRODUCTION Amputee gait patternvaries from normal gait pattern. ◦ There is increased energy expenditure. ◦ Transtibial: 25-40% ◦ Transfemoral: 68-100% ◦ Different muscle groups are used to create a smoother gait. ◦ There are compensation for prosthesis, muscle tightness or weakness, lack of balance and fear. ◦ altered gait pattern result in complications, increase energy expenditure , non compliance. ◦ WE NEED GAIT ANALYSIS.
- 3. Gait analysis involves Observation-From front and side and other axes Three dimensional analysis of gait in gait lab. Identification of gait deviations Determination of the causes.
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- 7. FEW DEFINITIONS ◦ GAITCYCLE OR STRIDE : Activity that occurs between the time one foot touches the floor & the time the same foot touches the floor again. ◦ STRIDE LENGTH : Is the distance traveled during gait cycle. ◦ STEP : one half of a stride. It takes two steps ( a rt. one & a lt. one ) to complete a stride or gait cycle. ◦ CADENCE : Is the number of steps taken per minute, & can vary greatly. ◦ STEP LENGTH : Is that distance between heel strike of one foot & heel strike of the other foot. 11 July 2021 7
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- 10. Transtibial gait ◦ Duringinitial contact: Prolong heel strike, weight bearing through heel before flat foot contact, delayed forefoot loading ◦ Knee flexion diminished at initial contact, overall max. flexion achieved is reduced. ◦ During swing of sound limb : Increased heel rise of prosthetic limb to achieve adequate step length of sound limb elevation of COG greater on sound limb(130% vs 111%) greater quads contraction
- 11. ◦ Toe offforce of prosthetic limb diminished ◦ During stance energy generated by prosthetic limb is 50% of normal ◦ Compensation by Increased trunk muscle energy expenditure. ◦ Hip extension ROM 50% to the opposite limb. ◦ Stance time on opposite limb increased than prosthetic limb
- 12. Transfemoral gait ◦ Thegait cycle is affected by the quality of the surgery, the type and alignment of the prosthesis, the condition of the stump and the length of the remaining muscular structure and how well these are reattached. ◦ To prevent knee buckling during stance phase: fixed or free knee. ◦ With fixed knee: Hip hitching or hip hiking is needed to clear the prosthetic limb during swing. ◦ With free knee , need to remain extended longer than stance phase: prolonged heel strike- body move forward over pros limb as an unit – hip extensor as stabiliser ◦ During swing of free knee: hip flexor power similar to opposite side needed – for the speed of hip flexion required, though the weight of prosthesis much less ◦ Stance time of sound side increased. Speed 30% slower
- 13. Scoring system forprosthetic gait: ◦ Gait analysis can be done in 3d gait lab. ◦ Observational gait analysis: POGS scoring system: ◦ New scoring system with 4 subsections for trunk ,hip ,knee and foot- ankle, and total16 different parameters.
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- 15. 1.Patients Factor : Range of motion Muscle strength Limb length Pain Decresed confidence Habitual/learned behaviour 2 .Prosthetic factor: ◦ 1.Socket design ◦ 2.Suspension ◦ 3.Foot and or knee selection THESE ARE TO BE CORRECTED. Causes are following types:
- 16. Basic principles: ◦ Gaitis always different than normal. ◦ Some specific gait patterns in transfemoral and transtibial amputee. ◦ Asymmetry transfemoral > transtibial ◦ Altered trunk motion must be taken into account. ◦ Risk of falling. ◦ Level of amputation, type of prosthesis, knee and ankle jt. allignment to be considered along with hip trunk core muscle strength and stability
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- 20. Excessive knee flexion: TOO FAR TOO HARD TOO HIGH • Socket too far anteriorly displaced • Too hard plantiflexor bar: inhibit plantiflexion • Too high heel of the foot.
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- 22. Insufficient knee flexion: TOOFAR TOO SOFT TOO LOW • Socket is far posteriorly displaced • Too soft plantiflexor bar • Too low heel of foot
- 23. Lateral thrust LIMO • Foottoo much inset leads to lateral Thrust
- 24. Medial thrust: LIMO ◦ Footto much outset leads to medial thrust
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- 28. Abduction at stance NORMALLYLATERAL WALL HIGHER THAN MEDIAL • When medial wall > Lateral, pain in groin region • When hip OA in prosthetic limb. • Weak or contracted abductor • Long prosthesis
- 29. Circumduction at swing 3LONG SIP ◦ Long prosthesis ◦ Lesser knee flexion ◦ Lock knee ◦ Small socket ◦ Inadequate suspension ◦ Plantiflexed foot
- 30. Vaulting: Swing ◦ Itis plantiflexion of normal limb to swing the prosthetic limb. ◦ Cause: similar to circumduction Hip Hiking: swing ◦ Cause: simlar
- 31. Lateral shift towardsprosthetic limb • Short medial high lateral wall • Short prosthesis • Short amputed limb • Weak abductor: Maintain COG • Abd contracture
- 32. Forward flexion Exaggerated lordosis HI,PW • Hip flexion contracture • Insufficient A-P wall support • Painful ischial • Weak hip ext. abd. Or abdominal mscls USHA • Unstable knee • Short ambulation aid • Hip flexion contracture
- 33. Medial/lateral whip atheel off NORMALLY KNEE BOLT KEPT IN SLIGHT EXT. ROTATION ◦ If more external rotated, medial Whip of knee, heel laterally ◦ If not externally rotated, lateral whip at knee, heel medially ◦ Mal-rotated shoe, socket. Other cause(In suction socket) ◦ Flabby muscle causing femoral rotation ◦ Tight socket
- 34. Foot rotation at heelcontact Malrotated shoe Stiff plantiflexion bumper Too hard heel cushion Foot slap: early planter flexion Soft plantiflexion bumper
- 35. High heel riseearly swing Normally heel rise is higher than sound limb ◦ Higher heel rise if there is ◦ inadequate knee friction ◦ Slack knee extension aid ◦ There will be forced hip flexion to keep knee extended at heel strike
- 36. Terminal impact atlate swing ◦ Knee friction: ◦ High at early swing ◦ Low at mid swing ◦ High at late/terminal swing ◦ When less knee friction or taut ext. aid: patient forcefully extend knee ,giving hard impact at terminal swing
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- 38. Unequal step length: prostheticstance lesser than sound limb Causes ◦ Pain or insecurity ◦ Insufficient friction at the prosthetic knee or too loose an extension aid. ◦ Hip flexion contracture ◦ Insufficient socket flexion ◦ If there is pendular socket motion
- 39. Unequal arm swing(2ndary) Thearm on the prosthetic side is held close to the body ◦ Poor prosthetic fit ◦ Poor balance ◦ Fear ◦ Habit Always due to other gait deviations and lack of training
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- 41. ◦ CHECKOUT: Gait trainingmay last from weeks to months. The more proximal levels of amputation require lengthier gait training. STATIC EVALUATION DYNAMIC EVALUATION EVALUATION OFF PROSTHESIS GAIT TRAINING
- 42. Cont.. From even surfaceto unevensurface Specific training of transfer ,knee stability. Independent level of ambulation with or without gait aid Weight shifting and balance activity in parallel bar