ADL

Average Walking Speed: 3 mph

Forward Trunk Lean: weak quads
Antalgic gait: decreased step length on intact limb
Scissor Gait: hip extension/adduction + ankle PF
Insufficient Pelvic rotation: weak abdominals/flexor muscles
Hip Hiking: weak hip/knee flexors, extensor spasticity
Equinovarus: tight tibialis posterior/gastric soleus
Swing to/through gait: bilateral LE involvement, trunk instability.
BWS > 55% contraindicated as it interferes with gait cycle
Pressure Tolerant Areas: patellar tendon, medial tibial plateau, tibial/fibular shafts, distal end
Supinated foot: high arch forefoot lateral wedge
Soft Inserts: reduce areas of high loading, resist forces, protect painful areas
Metatarsal pads: proximal to met-heads to allow efficient push off, moves pressure to
shaft
Cushion Heel: absorbs forces at heel strikes for plantar fasciitis
Longitudinal Arch supports: corrects flexible/rigid flat foot/pes planus/pes valgus
UCBL, Scaphoid pad, Thomas heel
Forefoot corrects, rearfoot accomodates
Rearfoot Posting: alters subtalar joint controls/limits, from heel strike to foot flat
Varus Post: medial wedge, limits/controls eversion of the calcaneus, and internal
rotation of the tibia
Valgus Post: lateral wedge, controls excessive inversion/supination
Forefoot Posting: supports forefoot
Medial wedge: supports forefoot varus
Lateral Wedge: supports forefoot valgus
PTB prosthesis: socket normally aligned slightly posterior/slight flexion to enhance loading,
prevent recurvatum
Buckles: knee set too far anterior
Excessive Knee flexion in early stance: socket too far forward/tilted anteriorly
Lateral Thrust: excessive foot inset
Patellar Brace + Lateral Buttress: for abnormal patellofemoral tracking laterally
Derotation Brace: for rotary instabilities, secondary to cruciate ligament injuries
Heel Lifts: accommodates limitation in ankle DF, LLD
Rocker Bar: improves weight shift onto metatarsals
Rocket Bottom: improves push off
Solid Ankle/AFO: allows no movement
Single Axis Feet/Articulated Feet: rubber bumpers that absorb shock and control plantarflexion
excursion, full sagittal/frontal plane motions NOT allowed
Anterior Stop: resists dorsiflexion Posterior Stop: resists plantarflexion
Dorsiflexion assist: Spring assist, posterior leaf spring
Posterior Leaf Spring: no medial-lateral stability
Contraindications: weak PF or spasticity
Hinged Plastic AFO with PF stop: greatest control for extensor spasticity (PF)
Modified AFO: medial-lateral stability
Spiral AFO: limited control of motion in all planes
Medial Strap Buckles: corrects for valgus
Conventional AFO/calf brand: provides for proximal stability of leg
Lordosis During stance: inadequate socket flexion
Knee:
Hinge Joint Offset: hinge placed posterior, assists extension
Posterior shell: control for genu varum/valgum
Quadrilateral/ischial WB + Toronto hip abduction: legg-calve perthes
Craig-Scott KAFO: paraplegia
FES: must have full PROM
Parapodium: allows for standing, ie. children with myelodysplasia
Swedish Knee Cage: controls knee hyperextension
Neoprene Sleeves: compression, protection, proprioceptive feedback increase local
circulation
RGO: leaning on hip forces hip into extension
Taylor Brace/Jewett TLSO: limits flexion
Boston Orthosis TLSO: used to treat scoliosis + spondylolisthesis + trunk weakness
Resting Splint: places thumb in slight opposition + abduction
Dorsal wrist splint: frees the palm
Assessment:
Midstance: foot should be flat
Orthotic hip joint: 0.8 cm anterior/superior to greater troch
Medial Knee joint: 2 cm above joint space
Ankle Joint: tip of malleolus
Plastic shells: conform to contours of limb
Prosthetic Gait Deviations
Lateral Whip: excessive internal rotation of prosthetic knee
Anterior trunk bending/Knee instability: inadequate knee lock
Posterior trunk bending: inadequate hip lock
Excessive Stance width: knee is locked, sound limb is too short
Taping: injured ligaments should be in shortened position , even pressure, overlap previous
tape strip by

Foot Ankle assembly: absorb shock at heel strikes, plantarflex in early stance, permit MTP
hyperextension
SACH Foot: limits sagittal plane motion, with a small amount of mediolateral motion, energy
absorbing heel, assists hyperextension of knee during stance
SAFE foot: non-articulate like SACH, but more non-sagittal movement, for active individuals
Flex foot: stores energy in early stance for push off, for active individuals
Solid Ankle/AFO: allows no movement
Single Axis Feet/Articulated Feet: more stable, rubber bumpers that absorb shock and control
plantarflexion excursion, full sagittal/frontal plane motions NOT allowed, for bilateral AKA
 Anterior Stop: resists dorsiflexion
Exoskeletal Shank: more durable Endoskeletal Shank: more cosmetic
Supracondylar suspension: medial/lateral stability
Supracondylar/Suprapatellar suspension: for short residual limbs
Knee Unit:
Single axis: permits knee motion
Polycentric: more stable, allows for changing axis of motion for adjustments to the
center of knee rotation
Hydraulic knee: resistance based on walking speed for active individuals
Knee aligned farther posterior very stable
Scarpas bulge: build up to distribute force on femoral triangle
Hinge suspension: control of medial/lateral stability
Hip Disarticulation: stability achieved through extension aid, posterior placement of knee,
anterior placement of hip
Residual Limb: desensitizing with rubbing/stroking, prone time to prevent contractures,
strengthen hip/knee extensor, abductors
Forward Flexion during stance: unstable knee unit
Foot rotation at heel strike: heel cushion/PF bumper too stiff
Foot slap: PF bumper too soft
Excessive knee flexion during stance: PF bumper too hard
PF bumper: in early stance
DF bumper: late stance

Wheelchair:
Average Seat Height: 20 inches
Hemiplegia Seat Height: low to ground, 17.5 inches to allow efficient use of sound side
Obesity: extra wide wheels, displace the rear axle forward for more efficient arm push
SCI: friction rims + antitipping forward
Amputee Chair: drive wheels located 2 inches backward to increase stability/base of
support
Extensor Tone: seat wedge or tilt-in space (may also be used for pressure relief) wheel
chair with pelvic belt NOT reclining back chairs increase tone
Toe Loops: keeps feet on foot pedals
Bariatric chair: rear axle is displaced forward to allow for more efficient arm push
Sports wheel chair: low seat, low back lightweight, small push rims
The lighter the wheelchair greater ease of use
Rigid Frame: stroke efficiency
Leg Rests: contraindicated for knee flexor spasticity/tightness
Lateral Trunk supports: scoliosis
Projections: for quadriplegia
Pneumatic air filled tires provide a smoother ride
Seat belts: 45 degree angle to seat
Hill holder device: brake that allows chair to go forward, but brakes when chair goes backward
Electric reclining back: weight distribution if patient is unable to relieve pressure
Excessive seat width: difficulty propelling chair
Narrow seat width: discomfort/pressure increase
Short seat depth: fails to support thigh
Excessive leg length/seat depth: kyphotic posture, posterior tilting of pelvis, sacral sitting
Sharp turn: pull back on one wheel while pushing other forward
Ascending ramps: short quick strokes
Wheelies: front casters off ground, hands on rims pull forward abruptly and lean forward
after
C5 SCI: assists with sliding board transfer
C6 SCI: independent in sliding board transfer
C7 SCI: independent in transfers without sliding board
Horizontal Grab Bars: 36 inches
Doorway Clearance: 32-36 inches
Total height of chair floor push handles: 36 inches
Bathroom Sink: <40 inches
Grab bars: 1.5 inch in diameter
Ramp slope: 1:12 or <8%
Toilet Seat: 18 inches
Average seat measurements: 18 width, 16 depth, 20 height, back height 16, arm rest 9 inch
above chair seat
Resistance Training: transformation of type 2B2A in early weeks
Muscle Fiber Hyperplasia: response to heavy lifting
Thrust Unloader Brace: for knee OA
Hinged Knee Brace: for MCL/LCL injuries
Infrapatellar Strap: patellar tendonitis
Knee sleeve with lateral buttress: improper tracking of patella
LE spasticity + foot catching: use foot loops for the foot rest