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Biomechanics of Walking for People with Lower Extremity Amputations Dave Thompson PT

Biomechanics of Walking for People with Lower Extremity Amputations Dave Thompson PT http://moon.ouhsc.edu/dthompso/. Objectives. List the gait deviations that are most common in people who wear prostheses, and explain their most frequent causes.

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Biomechanics of Walking for People with Lower Extremity Amputations Dave Thompson PT

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  1. Biomechanics of Walking for People with Lower Extremity Amputations Dave Thompson PT http://moon.ouhsc.edu/dthompso/ Update on Lower Extremity Amputations September 28, 2006

  2. Objectives • List the gait deviations that are most common in people who wear prostheses, and explain their most frequent causes. • Explain how changes in prosthetic alignment alter the position of the ground reaction force and affect prosthetic joint movement during gait. • Explain how prosthetic foot alignment affects the alignment of a person's residual limb inside a prosthetic socket. Update on Lower Extremity Amputations September 28, 2006

  3. When is someone ready for a prosthesis? • when he or she can control the knee joint well enough to walk safely. Update on Lower Extremity Amputations September 28, 2006

  4. Forces that affect joint position and movement during stance: ground reaction muscles joint reaction Controlling the knee joint: Update on Lower Extremity Amputations September 28, 2006

  5. GRF is equal in magnitude and opposite in direction to sum of gravitational and inertial forces Assess GRF’s effect on joint movement in customary way, by evaluating its location with respect to joint axis. Ground reaction force (GRF) Update on Lower Extremity Amputations September 28, 2006

  6. A useful simplification: Moments produced by GRF and muscles are equal and opposite. Mmm = -Mgrf Update on Lower Extremity Amputations September 28, 2006

  7. Moments produced by GRF and muscles are equal and opposite. During loading response, GRF’s sagittal plane location is: • posterior to ankle axis • posterior to knee axis • anterior to hip axis Update on Lower Extremity Amputations September 28, 2006

  8. To preserve stability, people with amputations can compensate for absent or weak muscles by: 1. substituting another muscle in a closed chain 2. moving joint axis to  GRF’s moment about joint. 3. moving GRF to  its moment about joint. Update on Lower Extremity Amputations September 28, 2006

  9. People with amputations can activate muscles to control residual and prosthetic joints: Knee extensors (in TT prosthesis) Hip extensors Hip abductors / rotators Controlling the knee joint during loading response: Update on Lower Extremity Amputations September 28, 2006

  10. reposition knee joint axis posteriorly to  GRF’s moment about joint by posterior rotation of pelvis A less useful way to control the knee joint during loading response: Update on Lower Extremity Amputations September 28, 2006

  11. Position prosthetic foot so origin of GRF is more anterior. Prosthetic alignment can help control knee joint during loading response: Update on Lower Extremity Amputations September 28, 2006

  12. Moments produced by GRF and muscles are equal and opposite. During preswing, GRFV’s sagittal plane location is: • anterior to ankle axis • posterior to knee axis • posterior to hip axis Update on Lower Extremity Amputations September 28, 2006

  13. Initiation of knee flexion during preswing GRF initiates prosthetic knee flexion if it is posterior to knee joint axis. • Heel must rise. • Pelvis must rotate forward, moving the femur. • Body weight must transition smoothly from trailing to forward limb. Update on Lower Extremity Amputations September 28, 2006

  14. Four probable causes  GRF  fwd pelvic rotation  hip flexor action Prosthetic alignment that delays heel rise. Poor preswing initiation of knee flexion Update on Lower Extremity Amputations September 28, 2006

  15. Moments produced by GRF and muscles are equal and opposite. During loading response, GRF’s frontal plane location is: • lateral to subtalar axis • medial to knee • medial to hip axis Update on Lower Extremity Amputations September 28, 2006

  16. Hip abductors counter GRF’s adductor moment Figure from Gottschalk et al. (1989). Does socket configuration influence the position of the femur in above-knee amputation? Journal of Prosthetics and Orthotics, 2, 94-102. http://www.oandp.org/jpo/library/1990_01_094.asp Update on Lower Extremity Amputations September 28, 2006

  17. Lateral trunk lean reduces GRF’s hip adductor moment Update on Lower Extremity Amputations September 28, 2006

  18. Objectives • List the gait deviations that are most common in people who wear prostheses, and explain their most frequent causes. Update on Lower Extremity Amputations September 28, 2006

  19. Objectives • Explain how changes in prosthetic alignment alter the position of the ground reaction force and affect prosthetic joint movement during gait. • Explain how prosthetic foot alignment affects the alignment of a person's residual limb inside a prosthetic socket. • http://moon.ouhsc.edu/dthompso/gait/pobmk/frames.htm Update on Lower Extremity Amputations September 28, 2006

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