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94 Cards in this Set
- Front
- Back
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Two articulations of anatomic knee
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femoral tibial and patello-femoral
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sagital plane ROM of knee
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0-135
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transverse motion of knee?
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5 degree of rotation (screw home mech)
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Knee position at IC to Loading response
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5 flexion to 18 flexion
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three functions of knee during gait
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-weight acceptance
-single limb support -limb advancement |
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amount of flexion needed for toe clearance
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60 degrees of flexion
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3 characteristics of prosthetic knee
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-stance phase stability
-sagittal plane function only -swing phase mobility |
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3 things that functionally shorten the leg
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-hip flexion
-knee flexion -dorsiflexion |
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3 things that make leg function long
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hip extension
knee extension plantar flexion |
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Can extension assist be used for stance stability?
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no...
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What part of gait does knee extension assist help with?
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swing phase
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six types of mechanical knee joints
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-free motion
-polycentric -manually locking -stance control -fluid controlled -microprocessor |
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does single axis knee joint mimic natural joint motion?
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no
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are single axis knee joints stable?
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no.
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How is a minimal amount of stability achieved in a single axis joint?
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friction
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where is the center of rotation of a polycentric knee joint located?
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posterior and proximal to knee
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What moment is present during stance phase within a polycentric joint?
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extension moment
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can you use locked knee joint on bilaterals?
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no
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what type of limb is created with a locked knee joint
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functionally long
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more or less energy expenditure with locked knee
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more
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when is a locked knee joint used
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unstable or weak patients
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Most commonly prescribed knee joint?
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stance control knee
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Is a stance control knee appropriate for bilateral use?
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nah nigga
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how is flexion achieved in a stance control knee
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by unloading the limb thus releasing the brake
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how is stance stability achieved with a stance control knee?
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weight activated brake mechanism
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Is a stance control knee appropriate for high level ambulators?
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no
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what type of patient is the stance control knee used for?
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single and slow cadence patients
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What type of patient is the polycentric stance control knee used for?
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very long residual limbs or knee disarticulation
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2 advantages of fluid controlled knee
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smoother gait and variable cadence
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Pneumatic vs. hydraulic which is better for high impact activities?
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hydraulic
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pneumatic vs. hydraulic which is better for cold climates?
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pneumatic
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3 advantages of micro processor knee
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-reduces impact to skeletal structure at heel strike
-maximizes cadence responsiveness during swing phase -eliminates forced knee hyperextension for stability |
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Three phases of alignment
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-bench
-static\ -dynamic |
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TKA line definition
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stationary alignment line to identify the relative alignment between the center of the socket weight line, the rotation of of the knee and the rotation point of the ankle
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Where is knee axis in sagittal plane bench alignment
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slightly behind TKA
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Flexion angle = ?
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measured flexion angle plus five degrees
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What is the relationship of the heel and the IT in bench alignment for a long socket
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the center of the heel is directly under where the IT contacts the socket
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What is the relationship of the heel to the IT in a medium length residual limb?
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the center of the heel is lateral to the point where the IT contacts the socket
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What is the relationship of the heel to the IT in a short socket?
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center of heel is further lateral to the point where the IT contacts the socket
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4 things to establish in static alignment
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-level pelvis
-knee stability -foot rotation - socket positon |
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burning sensation at IT
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-insufficient radius of ischial seat -thick socket pressing upward when sitting -small medial ap |
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pain in ischial tuberosity |
socket too large wide medial ap posterior brim slopes down from medial lateral overloads ischium |
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pain lateral to ischium |
overloading the gluteus maximus due to poor shape of inner edge posterior wall slants upward from medial to lateral |
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pressure in the socket below the level of the ischium |
socket too small muscle bunching should not undercut |
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pain at medial superior brim (anterior wall) |
poor flare above scarpa's area |
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pinching in lateral 2/3 with sitting (anterior) |
brim too high
belt is too worn pinching may occur |
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numbness of residuum (anterior wall) |
femoral anterior pressure due to too much of scarpa's bulge brim may be too low causing a band of tightness across the anterior section of the brim |
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pain at lateral distal limb |
-poor distal relief -insufficient socket adduction or contouring of the lateral wall for stabilization -socket ML too large the socket may shift at mid stance |
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pain at the proximal brim (lat wall) |
insufficient relief for the GT |
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tight or cutting (medial wall) |
-shallow channel in AM corner of socket narrow medial socket AP |
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crotch pressure or burning sensation (medial wall) |
medial ap too wide painful adductor roll narrow ML crowds the adductors posterior shelf slants down medially |
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pinching in posterior medial corner |
insufficient radius at intersection of posterior and medial walls |
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when would you use a lanyard? |
long transfems, bulbous fleshy limbs |
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Posterior wall of socket shoudl be ________ when the socket has proper _____________ angle |
parallel, adduction |
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Lateral trimline of IC socket |
3 inches higher than the level of the ischium |
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anterior trimline of IC socket |
two inches from ischial level (two inches from scarpa's triangle level)
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medial trimline IC socket |
slopes down between anterior and posterior wall, level where the ischium is |
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Long line deff |
midpoint of the posterior ML of the socket to the middle of the distal end of the residuum |
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three functions of prosthetic feet |
shock absorption at I.C. , smooth transition to stable weight bearing position at foot flat, provide smooth transition from stance to swing |
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landmarks to mark when casting an IC |
IT, adductor longus tendon, GT, Inguinal fold, ASIS |
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what muscle group is responsible for locking of the knee |
hip extensors |
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Hip joint ROM |
20 extension to 120 flexion |
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function of lateral wall of quad socket |
provides medially directed force on the femur, helps resist rotation of the socket |
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relationship of medial wall to line of progression |
should be parallel |
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function of scarpa's mod on quad socket |
posteriorly directed force to keep ischium on the posterior shelf |
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patient to flex her hip against resistance what are you assesing |
rectus femoris strength |
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too high of a trim line above scarpas (2 problems) |
problems with sitting limitations of step length on involved side |
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posterior shelf of the quad socket should be... (2 things) |
parallel to floor flat to provide seat for ischial tuberosity |
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2 major catagories of knees |
single axis and polycentric |
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type of knee joint to give to a bilateral |
polycentric |
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what type of moment is present is stance phase with a polycentric knee |
extension moment |
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4 types of suspension |
straps, elastic belt, silesian belt, suction |
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contraindications of full suction |
fluctuating volume of limb, short limb, not good for recent healing |
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indications of full suction |
whenever clinically feasible, agile and active amputees, residual limb with stable volume and adequate length |
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indications of hypobaric suction |
pt. with donning difficulties, adequate length/stength/muscles |
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contraindication of hypobaric suction |
short limb, fluctuating volume |
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roll on sleeve indications |
patients who prefer "roll on" donning, need for an intimate fit of sleeve |
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contraindication for roll-on sleeve |
short limb, pts with difficulty donning |
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indications of sileasian belt |
auxillary suspension needed with suction, when physical or psychological security is needed, volume fluctuations expected |
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is a sleasian belt used as a primary form of suspension? |
no |
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Indications of TES belt |
auxiary suspension to suction, physical and psychological security needed, volume fluctuations expected |
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contraindications of TES |
not primary suspension |
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what is the suspension of last resort |
suspenders |
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indications of hip joint and pelvic band/waist belt |
weak and elderly pts. , obese patients , non suction candidates, short residual, weak abductors |
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necessary heights needed during alignment |
bottom of socket to floor, KC to floor, height of foot to floor |
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4 considerations of prosthetic locomotion |
stability in stance shock absorption propulsion energy conservation |
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Five principles of Quad and IRC socket design |
proper contours: relief and build-up stabilizing pressure on skeletal structures functional muscles put under stretch no excessive pressure on neuro structures total contact |
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Function of anterior wall of quad socket |
-counter force to prevent pelvis from rotating -bulge provides tissue compression keeps IT on shelf -2 inches higher than posterior shelf - anteriormedial relief for adductor and gracilis tendons -relief for rectus femoris |
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function of posterior wall of quad socket |
-weight bearing area for IT and glutes -provides surface for femur to act against -relief for gluteal musculature - IT sits .5 inch posterior and .5 laterally on shelf |
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functions of lateral wall of quad socket |
-provides a stable surface for femur to maintain M/L pelvic stability - |
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functions of medial wall of quad socket |
-provides even pressure on adductor group -maintains soft tissue to avoid adductor roll -parallel to line of progression -same height as posterior wall |
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at midstance what direction thrust does the femur get |
lateral thrust |
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insufficient flexion angle may result in what |
unstable knee |
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hi |
hi |
