Orthotics & DMD

Question 1

tasks for non-ambulatory AFOs

Answer 1

contracture management
wound healing, protection, prevention
positioning

Question 2

which type of orthotics use a circumferential force system?

Answer 2

sure step
elastic sleeve for burn pt
sensory dynamic pressure garment
theratogs

Question 3

2 main ways to improve comfort with an orthotic

Answer 3

1. minimize pressure by maximizing the area covered
2. provide sufficient leverage through which the longitudinal segments of the orthosis apply force

Question 4

the common basic pressure system for most orthoses is _____

Answer 4

3-point force system

Question 5

a parapodium (THKAFO) uses a _____ pressure system

Answer 5

4-point

Question 6

Winters gait classification group 1

Answer 6

foot drop during swing phase
flat foot or forefoot contact during IC
excessive hip & knee flexion during swing
adequate DF during stance

Question 7

Winters gait classification group 2

Answer 7

more constant PF throughout gait

Question 8

Winters gait classification group 3

Answer 8

increased L lordosis
knee hyperextension

Question 9

Winters gait classification group 4

Answer 9

limited hip movement
significantly increased L lordosis
most severe

Question 10

common gait compensations for children with hemiplegia

Answer 10

hemi-pelvis retraction
increased push-off on unaffected side
early firing of fib longus

Question 11

which orthotic is designed for children with down syndrome?

Answer 11

sure step SMO

Question 12

function of sure step SMO

Answer 12

promote/improve high level activities
correct coronal plane issues at STJ (pronation)

Question 13

how does a sure step differ from a traditional SMO?

Answer 13

sure step has shorter toe-plate and trimlines

Question 14

what is down syndrome characterized by?

Answer 14

hypotonia
ligament laxity
flat feet
cognitive limitations
delayed milestones

Question 15

common comorbidities with down syndrome

Answer 15

AA instability (15%)
cardiac issues
thyroid issues
hip issues (DHD, acetabular dysplasia)

Question 16

when should a child with down syndrome have initial radiographs taken (for AA instability)?

Answer 16

3-5 yo

Question 17

purpose of SMO with PLS extension

Answer 17

sagittal plane TCJ issues + coronal STJ issues

Question 18

what diagnoses would benefit from SMO with PLS extension?

Answer 18

ITW
spastic hemiplegic CP at GMFCS II

Question 19

what can be added to solid AFO to control hindfoot valgus/varus?

Answer 19

lateral or medial flange

Question 20

which orthotic was designed for DMD?

Answer 20

GFR AFO

Question 21

function of GFR AFO

Answer 21

provide extension moment at knee

Question 22

what is the most common inherited muscular dystrophy and muscle disease of childhood?

Answer 22

DMD

Question 23

there is an absence of ___ in DMD

Answer 23

dystrophin

Question 24

gait characteristics of DMD

Answer 24

wide BOS
lumbar lordosis
knee hyperextension
toe walking

Question 25

what is an important sx to check for if suspect DMD?

Answer 25

Gower's sign

Question 26

what can help delay scoliosis in DMD?

Answer 26

prolonged walking and standing

Question 27

what med helps improve muscle mass, strength, and function in DMD?

Answer 27

corticosteroids

Question 28

scoliosis affects ___% of non-ambulatory kids with DMD

Answer 28

75-90%

Question 29

surgery is considered for scoliosis when the curve is _____ degrees, especially if under ___ yo

Answer 29

30 deg 14 yo

Question 30

primary impairment in DMD

Answer 30

weakness

Question 31

pattern of weakness in DMD

Answer 31

proximal to distal (neck flexors and abs 1st)

Question 32

how to differentiate b/w ITW and DMD?

Answer 32

new onset of toe walking at 5-6 yo with no past hx

Question 33

characteristics of spinal muscular atrophy

Answer 33

degeneration of ANTERIOR HORN CELLS muscle atrophy wide spread muscle weakness ABSENT DTRs

Question 34

type 1 spinal muscular atrophy

Answer 34

most severe 50% of cases manifests before 6 mo detah by 2 yo

Question 35

type 2 spinal muscular atrophy

Answer 35

onset 7-18 mo may live into adulthood with respiratory management

Question 36

type 3 spinal muscular atrophy

Answer 36

mildest form onset after 18 mo may walk I or w/ AD into late adolescents or early adulthood

Question 37

all 3 types of spinal muscular atrophy are characterized by...

Answer 37

- significant limb & trunk weakness - more atrophy proximally & in LEs - hypotonia & areflexia - progressive MSK issues

Question 38

a tight gastroc can lead to what deviation?

Answer 38

pronation

Question 39

what is the gold standard of care for children with CP who are being considered for surgery to improve gait?

Answer 39

motional analysis lab d/t ability to view transverse plane

Question 40

kinetic vs kinematic

Answer 40

kinetic - force (GFR) kinematic - ROM

Question 41

most common gait deviation for hemiplegia

Answer 41

hemi-pelvis retraction