Exam 3 question

[Cathryn Ledwick]

Hi there!

For the exam 3 question about causes of knee hyperextension in mid stance, could you explain how hamstring weakness could contribute to this gait deviation? Thank you!

[Chrissy Durrough Lugge]

Hi Cathryn,

Individuals with profound hamstring weakness may have knee hyperextension in mid-stance due to a lack of eccentric control of knee extension (i.e., normally functioning hamstrings could prevent the knee from snapping into hyperextension).

Chrissy

[Cathryn Ledwick]

Okay that makes sense! Thank you!

[Margaret Frank]

Hi Chrissy

I also have a question regarding exam 3. One question asks what type of AFO would you consider for someone who has the following: decreased foot clearance during swing phase, knee hyperextension during stance phase, 4/5 knee extensor strength, 2/5 ankle DF strength, 3/5 ankle PF strength, ankle DF PROM 0 deg, impaired proprioception and grade 2 ankle PF spasticity.

Due to the spasticity, impaired proprioception and generalized weakness in ankles; I choose rigid AFO.

But the answer is articulating AFO with PF stop

For the criteria to have rigid AFO based on Ranchos ROADMAP – is a rigid only reasonable for this patient if the patient had ABSENT proprioception? and what is the threshold on spasticity that makes you think rigid AFO (i.e. MAS >2) vs artitculated?

Thank you for your help!

[Chrissy Durrough Lugge]

Hi Margaret,
Thanks for this question! Yes, because the patient’s plantarflexor spasticity is graded as 2 on the MAS (“affected part easily moved”) and proprioception is impaired (not absent), he falls into the Group D category (articulating AFO with PF stop) on the ROADMAP. Spasticity grades of 3 or greater tend to fall into the severe category because passive movement becomes difficult at that level.
Hope this helps, and happy New Year!
Chrissy

[Dean Papadopoulos]

Is there a link to the Ranchos ROADMAP?

[Chrissy Durrough Lugge]

Hi Dean! There is a copy of the ROADMAP on the course homepage under Module 12 (Gait and Movement Analysis).

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