Lecutre 8: Pediatric Orthotic Problme Solving

Question 1

What is midfoot break associated with

Answer 1

Ankle DF movement

Question 2

What is the SVA (shank to vertical angle) angle affected by

Answer 2

What type of shoe the pt is wearing

Question 3

What is teh PTG

Answer 3

Patient
Task
Goal

Question 4

What is the difference between R1 vs R2

Answer 4

R1- is the catch during ROM
R2- full ROM

Question 5

Can the ankle AFO angle be set at neutral if the patient does not have the ROM range

Answer 5

No

Question 6

PTG means patient , task and goasl can it can also mean what

Answer 6

Prioritize the goals

Question 7

What are the task for the non ambulatory AFO

Answer 7

1. Contracture Management
2. Wound heeling, protection, or prevention
3. Positioning

Question 8

What are the therapeutic benefit of the force application from a orthosis

Answer 8

▪Resist motion
▪Assist motion
▪Transfer force
▪Protect a body part

Question 9

What is the major element in during comfort for a othrosis

Answer 9

Minimizing pressure by maximizing the area

Question 10

The greater the portion of the body that the orthosis cover then what happens

Answer 10

The lower the unit pressure

Question 11

The amount of ____ and the area of the ___ subjected to the force influences the comfort of the corthosis

Answer 11

Force

Body

Question 12

What is the most common basic pressure system for most orthoses

Answer 12

3 point force system

Question 13

What does the 3 point force system consist of

Answer 13

Principle force acting in one direction and two counterforces acting in the opposite direction

Question 14

What point pressure system is parapodium

Answer 14

4

Question 15

How many groups of classfication is there for the Winters Gait

Answer 15

4 groups

Question 16

What is group 1 characterized by for winters gait classification

Answer 16

• foot drop during swing
• flat foot or forefoot contact during IC
• excessive hip and knee flexion drug in swing
• adequate DF during stance

Question 17

What is group 2 characterized by in the winters gait classification

Answer 17

More constant PF throughout gait

Question 18

What is group 3 characterized by in the winters gait classification

Answer 18

Progressing to knee hyperextension and increased lumbar lordosis

Question 19

What is group 4 characterized by in the winters gait classification

Answer 19

Most severe pattern

Limited hip movement and significantly increased lumbar lordosis

Question 20

What are common compensations in the gait of children with hemiplegia (case 4)

Answer 20

• hemi pelvic retraction
• increased push off on unaffected side
• early firing of fibularis longus

Question 21

What outcome measures are discussed in case 4 (hemiplegic)

Answer 21

• Gait Deviation Index (GDI)
• Salfort Gait Tool (SF-GT)
• Visual Gait Assessment
• GMFM

Question 22

What is a supramallelar orthoses

Answer 22

Type of AFO that crosses the ankle

does not help at the knee

Question 23

Who is the sure step SMO designed for

Answer 23

Children with Down syndrome

Question 24

What is the difference between a typical SMO and a surestep SMO

Answer 24

Shorter toe plate and trim lines for the surestep

Question 25

What is the surestep SMO designed to promote/imporove

Answer 25

High level activities such as jumping and hoping by improving sub talar joint alignment

Question 26

What kind of disorder is Down syndrome and what is the reason

Answer 26

Genetic disorder Trisomy 21 (additional chromosome)

Question 27

What is **Down syndrome** characterized by (5)

Answer 27

▪ Hypotonia ▪ Ligament Laxity ▪ Flatfeet ▪ Cognitive limitations ▪ Delayed Milestones

Question 28

What kind of instability is present in approx 15% of all people with DS

Answer 28

Atlantoaxial instability

Question 29

When shoudl xray be taken for a person with DS

Answer 29

Between ages 3 and 5 years

Question 30

What kind of **hip** issues can a kid with **DS** have

Answer 30

▪ DHD ▪ Acetabular dysplasia

Question 31

who is a **SMO with PLS extension** designed for

Answer 31

Clients that have **sagittal** plane talocrual joint issues in addition to **coronal** subtalar joint issues

Question 32

What are 2 examples of clients that would benefit from a S**MO with PLS extension**

Answer 32

▪ITW ▪Spastic Hemiplegic CP functioning at a GMFCS level II

Question 33

Who are **ground floor reaction AFO** designed for

Answer 33

Pateints with duchenne mm dystrophy

Question 34

What does the **ground floor reaction AFO** provide

Answer 34

Knee extension moment during ambulation

Question 35

What is the most common inherited muscular dystrophy and mm diseae of childhood

Answer 35

Duchenne muscular dystrophy

Question 36

What is a Fatal disease of progressive weakness of skeletal and respiratory muscles

Answer 36

Ducheene

Question 37

What is the typical life expectancy for **Duchenne Muscular Dystrophy**

Answer 37

20 and 30 years

Question 38

For **Duchenne Muscular Dystrophy** there is a **protein** present where

Answer 38

Skeletal mm, smooth mm and in the brain

Question 39

What is **absent** in Duchenne Muscular Dystrophy

Answer 39

Dystorphin ## Footnote whihc is critical for mm fiber stability

Question 40

How does **boys** with **Duchenne Muscular Dystrophy** usually present

Answer 40

* clumsy * may walk up on their toes * show gross motor regression

Question 41

What are the **gait characteristics** for duchenne’s

Answer 41

* wide BODY * lumbar lordosis * knee hyperextension * toe walking

Question 42

there will be ___ of the calf mm and a (+) ___ sign for **duchenne**

Answer 42

▪Pseudohypertrophy ▪Gower

Question 43

When do **cortiosteriods** improve mm mass, strength and function for **duchenne**

Answer 43

First 6 months

Question 44

When is **ambulation** for **duchenne** usually **lost** by

Answer 44

12 y/o

Question 45

What affects about **75-90%** of **non ambulatory** children with **DMD**

Answer 45

Scoliosis

Question 46

When is **sx intervention** for **scoliosis** considered for kids with DMD

Answer 46

When the curve reaches approx 30° .. especially if the child is under 14 years of age

Question 47

What **delays** the **development** of **scoliosis** for kids with DMD

Answer 47

Prolonged walking and standing

Question 48

What is the **primary impairment** causing activity limitation from DMD

Answer 48

Mm weakness

Question 49

What is the **predictable pattern** of invovlment for **DMD**

Answer 49

Proximal to distal Starts early in neck flexors and abdominal mm and then progresses to pelvic girdle and knee extensors and then down to limbs

Question 50

**Spinal muscular atrophy** is a ___ ____ disorder

Answer 50

Autosomal recesssive

Question 51

What is a Gene disruption characterized by degeneration of **anterior horn cells** of the spinal cord, muscle atrophy, wide spread muscle weakness, and **absent deep tendon reflexe**

Answer 51

Spinal muscular atrophy

Question 52

What is the **most severe classification** for SMA

Answer 52

Type 1

Question 53

When is **type 1 SMA** manifested before

Answer 53

6 month

Question 54

When does **type 2** onset occur fro SMA

Answer 54

Between 7 to 18 months

Question 55

When is the onset of **type 3** SMA

Answer 55

Onset after 18 months

Question 56

What is the mildest form of SMA

Answer 56

Type 3

Question 57

All 3 types of SMA are characterized by what 4 things

Answer 57

- limb and trunk weakness - mm atrophy - hypotonia and areflexia - progressive MSK issues

Question 58

If a pateint has a **tight gastroc** will they pronate or supinate

Answer 58

Pronate

Question 59

Resting or non ambulatory AFO is preventing what

Answer 59

Contracture

Question 60

When would u use a **articulating AF0**

Answer 60

whne a joint allows to much motion and we need to control it

Question 61

What are the **most common types of joints** used for a articulating AFO

Answer 61

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