Fourth Orthotics Mock Exam Flashcards

1
Q

A patient is seen in clinic for a follow up appointment and is disappointed with the results of his custom solid AFO as he still has a pronounced knee hyperextension moment during stance phase of gait. You noticed this at his last follow up and had your technician add 1/4” heel lift to relatively dorsiflex the AFO to decrease the knee extension moment in stance. What should your first reaction be to this?

A

Check the durometer of the 1/4” heel lift your technician added.
Often times practitioners add a heel wedge to an SAFO to decrease knee hyperextention thrust but, the durometer of the heel wedge is most important as a soft heel wedge will cause ground reaction forces to remain anterior to the knee during loading response whereby increasing knee hyperextention. By utilizing a firm durometer for the heel wedge you can promote knee flexion. Note: check quadriceps strength prior to doing this as they must be able to control the flexion moment.

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2
Q

What all is found in the sartorius (femoral) triangle?

A

Femoral nerve, femoral artery, sartorius muscle and inquinal lymph nodes are all found within the scarpa’s triangle.
Note: Remember SAIL: Sartorius, adductor longus, inquinal ligament

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3
Q

A patient is seen in clinic, you are filling in for a sick practitioner whom delivered a KAFO 1 week earlier. The patient was provided the KAFO as he has 30 degrees genu recurvatum and 15 degrees fixed plantarflexion contracture. The patient states he has a hard time getting over his foot at midstance and that, while his knee extension is decreased, he feels excessive pressure on the posterior aspect of his knee. What adjustments or additions can you make to remedy this problem?

A

Add a 15 degree tapered heel wedge to the foot plate and add a contralateral heel lift.
By adding a 15 degree tapered heel wedge you will neutralize the KAFO in the sagittal plane allowing for a smoother rollover at midstance. It will also be necessary to add a contralateral shoe lift equal to the height of the tapered heel wedge to maintain a level pelvis as well as to assure proper clearance of the KAFO during swing phase of gait.

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4
Q

A patient is seen in clinic. The patient is utilizing foot orthotics with 3/8” heel lifts to decrease inflammation of her “achilles tendonitis”. What lumbar pathologies could this aggravate?

A

L5-S1 spondylolisthesis, DJD of the lumbar facet joints, lumbar spondylolsis.
When recommending heel lifts for achilles tendonitis recognize that it will increase lumbar lordosis. The listed lumbar pathologies are all treated by decreasing lumbar lordosis and can be aggravated by heel lifts on a relative scale.

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5
Q

You are seeing a patient with a diagnosis of peripheral vascular disease. What is the common artery that you can palpate to asses blood flow?

A

Dorsalis pedis.

Palpate the dorsalis pedis pulse along with capillary refill

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6
Q

What would you recommend for an addition to an articulated AFO for drop foot and posterior lateral hyperextension thrust of the knee (mild tone is present)?

A

PF stop will decrease drop foot in swing, 1/4” heel/lateral wedge will negate the posterior lateral knee extension thrust, and the metatarsal pad in combination with elevation of the 2nd-5th MTP’s and digits have been shown to decrease tone on a relative scale.

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7
Q

What additions can you make to an AFO to decrease excessive pronation within the AFO?

A

Extrinsic medial wedge, medial sabolich tab or trim line and/or sustentaculum tali “ST” pad

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8
Q

A patient has failed conservative treatment for plantar fasciitis including foot orthotics, physical therapy, shoe wear modification. What are the surgical interventions?

a. arthrodesis
b. ankle fusion
c. gastroc lengthening
d. plantar fascia release
e. a and b
f. c and d
g. All of the above

A

f. Gastroc lengething and plantar fascia release.
Ankle fusion and triple arthrodesis surgeries are not performed for plantar fasciitis. Usually treated arthritis with fusion of the calcanealcuboid, talonavicular, and talocalcaneal joints of the foot.

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9
Q

A patient is seen in clinic. She presents with severe chronic bilateral posterior tibialis tendon dysfunction “PTTD”. She has worn custom UCBL’s in the past but they were ineffective. What would be the most appropriate recommendation given her presentation and past?

A

An articulated AFO.
Given that UCBL’s were ineffective, articulated AFO’s would be appropriate as they grasp the lower legs and can help to modify internal tibial rotation. By decreasing internal tibial rotation, pronation will decrease whereby decreasing the work load of tibialis posterior muscle

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10
Q

A patient is seen in clinic whom has been diagnosed with guillain-barre syndrome. The patient has weak knee extensors, knee flexors, and ankle plantarflexors, and ankle dorsiflexors. What muscle groups would you expect to regain strength first if the syndrome begins to remit?

A

Knee extensors and flexors proximal to distal.

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11
Q

Having a patient perform a heel raise, screens what myotomal level?

A

S1, having a patient plantarflex is a screening technique for S1 myotome.
Often in the clinic a clinician will have a patient walk on their toes for S1 myotome screen and then walk on their heels for L4-5 screen

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12
Q

You have provided a patient with an articulated AFO and PF stop. When that patient ambulates you notice that they have pronounced knee flexion during loading response. What can cause this?

A

Firm extrinsic heel wedge, PF stop is too dorsiflexed. Both of these can cause ground reaction forces to translate posterior to the knee joint rapidly causing abrupt knee flexion during loading response

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13
Q

True or false, when designing a ground reaction AFO “GRAFO” foot plate, length can be full or sulcus length.

A

False, GRAFO’s tend to be fabricated with full foot plates so as to utilize a longer lever arm to resist knee instabilities throughout stance phase of gait

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14
Q

Damage to the femoral nerve will result in weakness of what main muscle group?

A

Knee extensors
The femoral nerve (L2, L3 and L4) innervates the quadriceps femoris muscle which serves to extend the knee. The hip extensors are innervated by the sciatic nerve. Hip abductors are innervated by the superior gluteal nerve. Ankle dorsiflexors are innervated by the tibial nerve

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15
Q

What describes the design of a GRAFO?

A

Trim lines for a GRAFO include Anterior/distal and posterior/proximal opening as well as posterior/distal and anterior/proximal areas of AFO contact. NOTE: it is important to make sure the patient can fit their foot and lower leg through the opening which tends to be narrow, but it is important to trim carefully so as not to lose the supportive structure of the GRAFO

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16
Q

True or False: a patient utilizing an articulated AFO with a full foot plate complains that it is hard to roll over their foot smoothly throughout stance. Recommending rocker sole shoe and or cutting the foot plate to sulcus length would be appropriate (assuming the have good knee stability in the sagittal plane)

A

True, sulcus length foot plates and rocker shoes can both contribute to a relatively smooth roll over in stance phase

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17
Q

True or false, the duration of double support varies inversely with the speed of walking and, in running, double support is absent.

A

True, in slow walking double support increase compared to the swing phase.

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18
Q

True or false, when fabricating a KAFO the distal/posterior thigh band and the proximal/posterior calf band should be located equidistant from the knee axis.

A

True, When fabricating a KAFO the distal/posterior thigh band and the proximal/posterior calf band should be located equidistant from knee axis so as not to impede knee flexion and soft tissue impingement in the popliteal fossa

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19
Q

A patient is seen in clinic. the patient is utilizing a KAFO for post polio syndrome. The ankle joint height is located correctly but the mechanical ankle joint is in need of replacement for the third time. What could cause this?

A

Tibial torsion was not build into the KAFO. If premature wear is notice in a KAFO ankle joint that is located at the proper height often times tibial torsion was not build into the othosis causing a lick of congruency between the anatomical and mechanical ankle joint

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20
Q

In normal gait, maximum knee flexion reaches approximately What degrees?

A

60 to 65 degrees, knee flexion durning swing phase in normal gait

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21
Q

When taking an impression and delineation for a KAFO what landmark represents knee enter?

A

The midpoint between medial tibial plateau and adductor tubercle. When taking and impression and delineation for a KAFO, knee center is represented by the midpoint between MTP and the adductor tubercle

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22
Q

Patellar tendon bearing AFO is indicated for which pathologies?

A

Charcot joint, avascular necrosis of the talus, osteoarthritis of the ankle joint, and calcaneal fracture are all pathologies potentially utilize a PTB AFO to un-weight the affected area during weight bearing

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23
Q

What is the primary function of brachioradialis?

A

elbow flexion, Brachioradialis muscle serves to flex the elbow

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24
Q

A KAFO patient is seen in clinic for follow up. The patient has utilize a KAFO for three years but has developed avascular necrosis “avn” of the femoral condyles. What change could you make to the current KAFO to allow for minimal ambulation with out slowing the reversal of AVN?

A

Incorporate ischial weight bearing. By fabricating an ischial weight bearing brim you can load proximally while unloading distally at the femoral condyles whereby allowing for minimal ambulation while treating AVN

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25
Q

True or false, an RGO allows forward progression by harnessing energy from one hip extension and translating it into contralateral hip flexion

A

True, by harnessing energy from one hip’s extension and translating it into contralateral hip flexion and RGO can facilitate forward progression

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26
Q

The radial nerve is injured within the radial groove. What muscle would not be paralyzed?

A

Triceps, the triceps muscle is innervated by the radial nerve, but when injury occurs at the radial groove usually it is just weakness not paralyzed. All the muscles in the posterior compartment will be paralyzed leading to wrist drop

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27
Q

When turning a conventional AFO into a dorsiflexion assist AFO, how would you set up double action ankle joint?

A

Springs in the posterior channel will produce dorsiflexion assist in double action ankle joint

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28
Q

A patient is seen in clinic with flaccid ankle plantarflexors and dorsiflexors. Choose appropriate double action joint configurations.

A

Pins in the anterior and posterior channels or springs in the posterior channels and pins in the anterior channels, both these configurations will provide anterior and posterior support for flaccid ankle plantarflexors and dorsiflexors

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29
Q

The claw hand appearance of the hand is due to damage to what nerve?

A

Ulnar nerve, Damage to the ulnar nerve commonly occurs where it passes posterior to the medial epicondyle on the humerus. The patient is likely to have difficulty making a fist due to paralysis of the intrinsic muscles of the hand. Claw hand comes from inability to flex the 4th and 5th MCP joint

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30
Q

The patient is seen in clinic with flaccid ankle plantarflexors and dorsiflexors. The patient also buckles at the knee during loading response/heel strike. You have choosen to recommend a conventional with double action ankle joint. What would be the most appropriate configuration of the ankle joints?

A

Springs in the posterior channels and pins in the anteriors channels. By having springs in the posterior channels and pins in anterior channels you will provide adequate anterior posterior support to the lower leg muscular imbalance but the posterior springs will allow controlled plantarflexsion during loading response whereby keeping the ground reaction forces anterior to the knee joint to decrease knee buckling

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31
Q

A patient with Duchennes muscular dystrophy is seen to ambulate with increased lumbar lordosis secondary to which muscular weakness?

A

Hip extensor. Individuals with duchennes muscular dystrophy often present with weakness of the hip extensors. By increasing lumbar lordosis the position of their center of mass is posterior to the hip joint which locks the hip against the Y-ligament allowing for stability in the sagittal plane.

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32
Q

A patient sustains a hangman fracture. This fracture can cause quadriplegia. What vertebrae and location of the fracture is damaged?

A

Atlas, lamina (pars interarticularis) C2. Hangman’s fracture occurs from fracture through the lamina of the axis. Another injury to the axis is displacement of the dens which may also cause quadriplegia

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33
Q

When designing a thermoplastic KAFO for a patient with severe genu recuravatum, what can you incorporate that will help control the knee hyperextension?

A

Extending the distal/posterior thigh trim lines more distally, decreasing the depth of the thigh section, extending the proximal posterior calf trim line proximally and decreasing the depth of the calf section. All of these design modifications will aid in decreaseing genu recurvatum

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34
Q

A patient wearing a KAFO is seen in clinic. The patient complains of anterior thigh pressure while sitting. What could be the cause?

A

the mechanical knee joint is too distal in relation to the anatomical joint. If the mechanical knee joint of a KAFO is too distal in relation to the anatomical joint the patient will experience pressure on the anterior portion of the thigh while sitting

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35
Q

The erector spine muscles are found in the intermediate layer of the muscle layers of the muscles in the back. When they act bilaterally, they extend the vertebral column. When they act unilaterally what action do they perform?

A

Laterally bend the vertebral column. The erector spine muscles act to extend the vertebral column and unilaterally act to laterally bend the column. Stabilize vertebrae durning local movements of the vertebral column is performed by the deep layer known as transversospinal muscles (multifidi, semispinalis, rotatores).

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36
Q

True or false. A child wearing a pavlic harness in treatment for congenital dislocation of the hips should have their hips oriented in flexion and adduction.

A

False, a child wearing a pavlic harness in treatment for congenital dislocation of the hips should have their hip oriented in flexion and abduction

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37
Q

A 240lb female bears how much weight collectively through her right 2nd-5th MTP joints while standing evenly on both feet.

A

40lbs, A 240lbs patient when standing evenly on both feet will have 120lbs on each foot. 50% goes through the calcaneus and 50% goes through the MTP joints. MTP’s 2-5 receive 66.6% of the total weight on the forefoot. .666X60lbs=40lbs

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38
Q

The axillary nerve innervates teres minor. What other muscles does it innervate?

A

Deltoid, axillary nerve also innervates the deltoid. At times there is injury to this nerve with shoulder dislocation

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39
Q

True or false, guillain-barre syndrome progresses in a ascending order.

A

True, Guillian-barre syndrome progresses in an ascending order “distal to proximal” and recovers in a descending order “proximal to distal”.

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40
Q

A child is seen in clinic. The child is playing on the floor and proceeds to use his hands to stand up by pushing off of his lower extremities until upright. What is the name of this maneuver and what diagnosis does this boy most likely have?

A

Gowers sign and duchennes muscular dystrophy. Duchennes muscular dystrophy is most common in you males and is characterized by the gowers sign “walking of the hands up lower extremities while standing” which is compensating for proximal lower extremity weakness

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41
Q

The lumbricals act to do what?

A

Flex the MP joints and extend the IP joint. Lumbrials act to flex the MP joint and extend IP joints. The interossei muscles act to either adduction or abduct the digits along with pairing with the lumbricals to flex the MC joints and extend the IP joint

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42
Q

When fabricating an AFO, the lateral proximal trim lines is located approximately 1 inch inferior to the fibular neck. What is the anatomical structure you are trying to avoid by doing this?

A

Common fibular nerve. The common fibular nerve “common peroneal nerve” runs just inferior to the fibular head superficially. Trim lines should be design to avoid impingement of this nerve when fabricating a AFO

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43
Q

The nominate bone of the pelvic girdle is known as what?

A

Sacrum. The pelvic girdle is mad up of the innominate bones of the iliums that articulate with the sacrum known as the nominate bone

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44
Q

The claw hand appearance is characterized by an injury to what nerve?

A

Ulnar nerve. Ulnar nerve injury will result in 4th and 5th MCP joints extended and IP joints of the same fingers are flexed

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45
Q

Injury to the medium nerve will result in what characteristic appearance when a patient tries to make a fist?

A

Ape hand and hand of benediction. Injury to the median may result in loss of opposition and flexion of the thumb resulting in the ape hand deformity. Also the of benediction results from injury of the median nerve at the elbow or upper arm.

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46
Q

At heel strike the knee joint is at ____ while the ankle joint is at_____.

A

At neutral/full extension, 90 degrees/neutral.

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47
Q

Trendeleburg gait can be seen in patients after they have total hip arthroplasty, injury to the superior gluteal nerve, and poliomyelitis. This is caused by weakness in what muscle?

A

Gluteus medius. Weakness of the gluteus medius results in trendelenburg gait. durning the stance phase the pelvis on the opposite side drops due to weakness on the stance side

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48
Q

A patient with C6 quadriplegia is able to use a tenodesis grip. What is the action that occurs?

A

Wrist extension which causes MP flexion. C6 quadriplegic patients functionally uses tenodesis grasp. This is caused by wrist extension which allows passive MP flexion

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49
Q

The deltoid muscle acts to abduct the shoulder with what other muscle?

A

Supraspinatus. Supraspinatus part of the rotator cuff assists with a abduction of the glenohumeral joint.

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50
Q

You are seeing a patient in acute rehab with a physical therapist. The patient has had a CVA. Upon examination you see foot drop durning gait, weak dorsiflexors grade 2, weak inversion and eversion grade 2, and increased tone in her plantar flexors. What would be an appropriate orthotic device?

A

A solid ankle AFO. A solid ankle AFO is indicated for a patient with drop who is also has spasticity as a spiral AFO and dorsiflexion assist AFO might increase her tone and are not sufficient to control spasticity.

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51
Q

A 16 year old patient has suffered an L2 complete spinal cord injury. What would be the most likely functional expectation and orthosis for this patient?

A

Ambulation with bilateral AFO’s and canes. A lesion at the level of L2 would be a lower motor neuron lesion as it is a cauda equina injury. You would expect that the patient would have intact hip flexion, hip adduction, and knee extension. This patient would only need AFO’s as bracing for the knee is not needed due to knee extension is still intact

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52
Q

Anterior displacement of the vertebral body on the lower vertebrae is called what?

A

Spondylolisthesis. Spondylolisthesis is described by the percentage of the anterior displacement of the vertebral body described by 4 grades (grade 1 0-25%, grade 2 25-50%, grade 3 50-75%, grade 4 75-100%) Spinal stenosis is the narrowing of the spinal column. Spondylosis is a term for osteoarthritis of the spinal column or neutral foramen. Spondylitis is inflammation of the vertebra

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53
Q

A 54 old female patient recently referred to your office for a KAFO style orthosis after several FTA (fail to appear) missing appointments for final fitting, you should what?

A

Call the prescribing physician and advise him that the device has yet to be fitted. The physician should be notified as they referred the patient to your office so hippa laws apply

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54
Q

When taking an impression for a KAFO, or the best possible impression, it is important to use the segmented impression procedure and what?

A

posterior popliteal rest. The posterior popliteal rest when properly positioned, helps to assure that correct positioning of the impression will help control recurvatum in the impression

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55
Q

Your office receives a telephone call from a lawyer’s office claiming to represent your patient Ms. couchkiller in her lawsuit with the local hospital. They are requesting a copy of her chart and are willing to pay you handsomely to send them overnight. You should reply to this request how?

A

Ask for the request in writing showing the signed release form of the patient for the information requested prior to complying with request. Hippa privacy law apply to all requests of personal information pertaining to the treatment or personal info

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56
Q

A visually impaired 70 year old male patient is referred to your office with a prescription for a HYPEREXTENSION back brace for an anterior thoracic compression fracture as a result of a fall at home. Upon PE, you find a male with marked kyphosis and significant arthritis of both hands. Your choice of orthotic devices should include…

A

Utilization of velcro for the closure to adapt to the patients arthritis. If the patient cannot donn the devise, the weight and ability to make adjustments are of no value to him

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57
Q

When evaluating a 14 year old female patient referred to your office with a prescription for a crouch gait orthosis. Upon observing her gait you are considering several styles of orthoses, they are…

A

custom molded floor reaction AFO with solid ankle and full footplates. The floor reaction design style includes an anterior pre-tibial shell to exert an anterior force keeping the knee in extension and controlling knee flexion. The solid ankle and full footplate help with the needed stability during all phases of gait.

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58
Q

During a follow up appointment with a 71 year old status post CVA patient who lives alone you fitted with a custom fabricated AFO with solid ankle and flexible full footplate PE reveals a reddened area on the tibial crest area. The patient denies any pain or discomfort, prior to scheduling for her 6 month follow up visit, you should what?

A

Add a hypo allergenic pad to the anterior velcro closure. By adding a hypo allergenic pad to the velcro strap you are distributing the pressure exerted on the anterior tibial area and making sure it is hypo allergenic and the patient denies pain or discomfort as well as the fact that she lives alone, you are assuring there will be no further pressure or skin issues with the patient. Additionally, you should schedule her for a follow up appointment sooner than 6 months to make sure that your remedy corrected the redness

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59
Q

True or False: When taking an impression for a dorsiflexion assist AFO, the patient’s optimum ankle foot position is in sub talar pronation forefoot neutral.

A

False, the optimum placement of the foot/ankle complex is sub talar neutral and when the patient is wearing appropriate footwear, the ankle should be 0 to 5 degrees of dorsiflexion to allow the foot to clear the floor

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60
Q

Mrs. Backscratch, a patient of Dr. Heart comes into your office and tells you that her friend was fitted with a lumbosacral support low back pain and that she tried ther corset on and it felt really good. You have and excellent working relationship with Dr. Heart, and you feel it will be ok with him for you to fit her with a corset similar to her friends. Are you correct in fitting he with device even though you do not have a prescription and plan on billing Mrs. Backscratch insurance company?

A

No, in order to submit a claim for third party reimbursement you must have a written, signed prescription from a physician. Also please not that it is good practice management to whenever possible, no matter how minor or simple you feel the device is to have a prescription for the dispensed device.

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61
Q

Mrs. Smith is referred to your office with a prescription for a new replacement KAFO. Upon PE, you find that she had Polio as a child. When treating persons that have had polio, we must be aware that they will have decreased what?

A

Joint stability in all planes, sensation, and muscle function. Polio affects the muscles ligaments and nerves on the affected limbs although, unlike those persons suffering from a stroke, they do not have issues with propriception or speech

62
Q

Oftentimes, we are asked to see a patient with an abdominal hernia. When fitting patients with this disorder, they are best fitted in which position?

A

Lying on their back with knees flexed. By having the patient in the supine position, gravity works with you, keeping both the abdominal muscles at rest and strain of the hernia relaxed

63
Q

The term propriception means…

A

knowing where an extremity is in space. The term propriception means for latin proprius, meaning one’s own and perception is the sense of the relative position of neighboring parts of the body

64
Q

A patient is referred to your facility for a LSO corset with three pull design. When fitting a the patient, the posterior staves should be shaped to the patient while in what position?

A

Standing. When the patient is standing, the spine is in the loading position meaning that the para spinal musculature is tensed. When sitting the spine is flattened and if the staves are shaped to this position they will offer little support

65
Q

True or False: When contouring the posterior bars of a PML, spinal orthosis LSO knight spinal the side bars should be contoured to the patient’s lordosis with no voids

A

False: When contouring the paraspinal bars of any lumbosacral orthotic device. It is preferable to leave a slight void when standing and then have the patient sit ascertain the bars fit the contour of the patients spine while sitting to avoid excess pressure

66
Q

True or False: The tibialis anterior muscle functions in two roles during gait. It is an important dorsiflexor of the foot ankle complex as well as eccentrically contracts to slow plantarflexion of the ankle

A

True.
The eccentric or lengthening contracture of the tibialis anterior muscle decrease foot slap by slowing plantar flexion moment at initial contact or heel strike during gait

67
Q

The primary muscles of the lower extremity that both flex the hip and extend the knee are know as the…

A

Quadriceps.

68
Q

The tricep muscles ____ the lower arm.

A

Extend

69
Q

True or False: When testing the quadricep muscles group, a grade of 3 or good requires the patient to be tested in the horizontal plane and holds test position with no added pressure.

A

A grade 3 would show, in the horizontal plane, the ability to move the femur with assistance through normal flexion.

70
Q

The radial nerve innervates the _____ of the wrist.

A

Extensors

71
Q

Both the dorsal and palmar interossei are innervated by what spinal root levels?

A

C8-T1

72
Q

What muscle weakness results in winging of the scapula?

A

serratus anterior

73
Q

Volar surface of the forearm contains the ____ muscles, which, as a group, originate at the ______ humeral epicondyle.

A

wrist flexor, medial

74
Q

Which of the following nerves innervates the majority of the anterior muscles of the upper arm?

A

musculocutaneus

75
Q

How is the subluxed shoulder typically managed in hemiplegia?

A

sling

76
Q

The 2nd MP joint is abducted by the…

A

1st dorsal interosseus

77
Q

A dynamic IP extension assist with a MP extension stop should be used if a patient has what?

A

has lumbrical weakness and has hyperextended MP’s

78
Q

The most common MP joint deformity in rheumatoid arthritis is…

A

volar subluxation and ulna deviation

79
Q

The mobile segments of the hand’s transverse arch are which metacarpals?

A

1, 4, and 5

80
Q

Swan neck deformity causes the PIP joint to _______ and the DIP joint to _______.

A

PIP joint to hyperextend and the DIP joint to flex

81
Q

Wrist driven orthoses in a C-6 quadriplegic are powered by…

A

extensor carpi radialis longus and brevis

82
Q

In using the wrist driven tenodesis orthosis, what causes what motion?

A

wrist extension causes MP flexion

83
Q

A humeral fracture can be managed orthotically if it is in the ____ of the humerus.

A

distal 2/3s, soft tissue compression

84
Q

Combined MP flexion and IP extension are performed primarily by the…

A

lumbricals, assisted by interossei

85
Q

The most important motor acquisition of the C5 quadriplegic is?

A

shoulder and elbow flexion

86
Q

Which body movement are typically used to power cable driven tenodesis orthosis?

A

glenohumeral flexion and biscapular abduction

87
Q

A boutonniere deformity consists of PIP _______ and DIP ________.

A

PIP flexion with DIP hyperextension

88
Q

A peripheral nerve injury at the wrist of the ulnar nerve could be orthotically managed with what?

A

short opponens HO with a MP extension stop

89
Q

Which nerve rootsform the brachial plexus?

A

C5-T1

90
Q

At the wrist, a WHO wrist driven flexor hinge orthosis functions to _____ motion in the coronal plan.

A

hold

91
Q

The functions of the bicep brachii are…

A

elbow flexion and forearm supination

92
Q

In dupuytren’s contracture, the ______ is most often involved.

A

palmar aponeurosis

93
Q

The desirable length of a thumb post is…

A

mid nail bed

94
Q

The MP extension stop should be fitted where?

A

Just proximal to the PIP joints

95
Q

The claw hand deformity is the result of injury to which nerve?

A

medial and ulnar

96
Q

Abduction and adduction occur within the hand at…

A

metacarpophalangeal joint

97
Q

What is a positive froment’s sign indicator?

A

ulnar nerve loss

98
Q

Two muscles act to abduct the shoulder, one is the deltoid, the other muscle is…

A

supraspinatus

99
Q

A C6 Quadriplegic would have all the following muscles intact except what?

A

extensor carpi ulnaris,

100
Q

You are asked to recommend an orthosis for a 20 year old male how has sustained a L1 burst fracture. What is the best orthotic recommendation?

A

TLSO polymer

101
Q

Which orthosis is best suited to manage a T6, 1 column compression fracture?

A

TLSO sagittal and coronal contral

102
Q

Which orthosis is best suited to manage a compression fracture 20% anterior compression at T11?

A

TLSO anterior control

103
Q

The pectoral membrane fibers combine with which ligament?

A

posterior longitudinal ligament

104
Q

The correct pin placement for a HALO is ______ in the ______

A

10mm superior to the eyebrow, lateral 1/3 of the eyebrow

105
Q

An adolescent female with idiopathic scoliosis presents in your facility with a prescription for orthotic management. Based on the prescription, how is the patient most likely to present?

A

Risser sign of 1+, cobb angle of 35 degrees

106
Q

On which side of the orthosis should the trochanteric extension be placed?

A

the side of decompensation,

107
Q

The orthotic management of a T1 level fracture will have its best 3 point pressure system with which orthosis?

A

cervical thoracic orthosis

108
Q

What is the correct posterior superior trim line for a polymer TLSO not for scoliosis?

A

10mm inferior to the level of the spine of the scapula

109
Q

Upon looking at the surface anatomy of the back, it can be said that the spine of the scapula is at which approximate vertebral level?

A

T3

110
Q

What makes up the erector spinae?

A

Spinalis, longissimus, lliocostalis

111
Q

The end point vertebrae in a scoliosis curve are the…

A

last convergent vertebrae most superior and inferior to the null point

112
Q

Of the three types of odontoid fractures, which is most common and tends to have the least favorable outcome?

A

type 2

113
Q

All of these are characteristics of sheuermann’s Kyphosis…

A

wedged vertebrae, schmoris nodes, osteochondrosis, self limiting disease

114
Q

Which of the following conditions should be positioned in sagittal flexion when managing with a orthosis?

A

spinal stenosis

115
Q

The axillary’s extension of a boston brace style scoliosis for a double curve should extend from the…

A

Window to about T5

116
Q

What does it mean when there is a grade II pedicle rotation?

A

pedicle is rotated 2/3 toward midline

117
Q

Which of the following is a modification that should be made to a scoliosis orthosis for a patient with hypokphosis?

A

extend the posterior superior trim line to T3

118
Q

Spastic paralysis may result from…

A

spinal cord injury and brain injury

119
Q

your patient has suffered a single level burst fracture. The greatest instability, given the nature of the fracture, would be in which plane?

A

transverse

120
Q

For the assembly of the TLSO anterior control what should be done to the overall height measurement?

A

decreased by 72mm

121
Q

Placement of a thoracic band on a conventional orthosis should be where?

A

10mm inferior to the most inferior inferior angle of the scapula

122
Q

In fitting milwaukee CTLSO, the height of the neck ring is located _____ to the mandible

A

36mm inferior

123
Q

What is not considered neuromuscular scoliosis?

A

neurofibromatosis

124
Q

In a scoliotic curve the spinous processes rotate toward the…

A

concavity

125
Q

In an adult the spinal cord terminates at about the level of which spinal segment?

A

L1

126
Q

What is the method used to find the baseline for corset measurement?

A

Inferior costal margin to iliac crest divided by two

127
Q

If you use a TLSO sagittal control and found the patient could not tolerate the strap pressure in the axilla what might be done?

A

Pad the strap, use a harness chest strap with sternal plate

128
Q

The nucleus pulposus of an intervertebral disc do what?

A

absorbs shock and equalizes stress

129
Q

An individual with neuromuscular scoliosis will most likely exhibit cardiopulmonary compromise when the curve reaches what magnitude?

A

70 degrees

130
Q

The lower motor neuron cell body is found in the _____ while the upper motor neuron cell body is found in the ____

A

ventral horn of the spinal cord, motor cortex of the brain

131
Q

For a typical right thoracic, left lumbar adolescent idiopathic scoliosis curve the superior aspect of the window should be ____ while the superior aspect of the axillary extension should be approximately at the level of ________.

A

at least one rib superior to the apical rib, T5

132
Q

Another name for a Knight orthosis is a…

A

LSO sagittal/coronal control

133
Q

In what position should spinal orthoses be tightened on a patient?

A

supine

134
Q

What are the clinical signs of scoliosis?

A

Positive adams test, asymmetrical gapping between arm and waist, shoulder asymmetry.

135
Q

In scoliosis an apical vertebra at T12 would indicate what kind of curve pattern?

A

Thoracolumbar

136
Q

Which stage of menarche would be mast suitable for orthotic management?

A

Greater than six months pre-menarche

137
Q

While under axial loading there is pressure on the nucleus pulposus which in turn causes the annulus fibrosis to stretch. This phenomenon is most consistent which biomechanical mechanism?

A

load sharing

138
Q

Hypokyphosis can be defined as having a sagittal curve magnitude in the range of…

A

0-20 degrees

139
Q

the TLSO anterior control has two anterior pads that provide a posteriorly directed force. The anteriorly directed force by the posterior pad should provide what amount of force?

A

equal to that posteriorly directed force

140
Q

What is the most likely mechanism of injury for a seatbelt fracture (chance fracture)?

A

flexion distraction

141
Q

In the spine, the most rotation occurs at which joint?

A

atlantoaxial joint

142
Q

What characteristic is unique to the cervical spine?

A

transverse foramen

143
Q

Two adjacent vertebrae and their intervening tissue are known as a…

A

motion segment

144
Q

A patient presents in your office with an atypical curve L thoracic R Lumbar this is most likely associated with what disease?

A

syringgomyelia

145
Q

A burst fracture of the vertebral body is most likely associated with which mechanism of injury?

A

axial load

146
Q

What could be considered the fracture site for spondylolysis?

A

isthmus, pars interarticularis, neural arch

147
Q

A Jefferson fracture is a fracture of _____ while a hangman fracture is a fracture of____.

A

C1 and C2

148
Q

Wedge vertebra, bar vertebra, and hemi vertebra are seen most frequently in which type of scoliosis?

A

congenital

149
Q

What measurements are needed to fabricate a milwaukee CTLSO?

A

sagittal diameter of neck, coronal diameter of neck, height to mandible

150
Q

What effect does reducing decompensation have on the critical load of the spine?

A

decreases