Third Orthotics Mock Exam Flashcards
1
Q
On the paraspinal bars of a TLSO: sagittal control should extend superiorly to the…
A
Spine of the scapula
2
Q
On the TLSO: Anterior control should be fitted with the patient in a _____ position.
A
Supine position
3
Q
What orthosis would be used to manage a patient with a T3 compression fracture?
A
TLSO: anterior control with cervical extension
4
Q
In scoliosis management, lateral flexion radiographs are used to…
A
Determine if the curve is structural
5
Q
The axial skeleton is attached to the appendicular skeleton at the…
A
Sternoclavicular and sacroiliac joints
6
Q
The pad most commonly used in conjunction with a CTLSO is a…
A
Thoracic pad
7
Q
Abdominal muscles do what?
A
Help increase intracavitary pressure
Reduce loading on vertebral discs
Decrease excessive lordosis
8
Q
In what order should the halo pins be tightened?
A
Diagonal pins together
9
Q
The goal(s) of treatment for Marie-Strumpell arthritis (ankylosing spondylitis) are…
A
Prevention of further deformity and Relief of pain
10
Q
The most commonly occurring curve pattern in idiopathic adolescent scoliosis is a…
A
Right thoracic, left lumbar curve
11
Q
The method used to find the baseline for corset measurements is…
A
(inferior costal margin to iliac crest) divided by two
12
Q
In a right thoracic curve, the spinous processes rotates…
A
Towards the concavity
13
Q
Carpal Tunnel Syndrome results from compression of which nerve?
A
Median
14
Q
The opponens bar should be located…
A
Proximal to the thumb MP joint
15
Q
A swan neck deformity causes the PIP joint to:
A
Hyperextend and the DIP joint to flex
16
Q
A cable-driven tenodesis orthosis is activated by…
A
Biscapular abduction
17
Q
Extension at the MP joint is produced by…
A
Extensor digitorum communis
18
Q
A muscle grade of “fair” means that the person is able to get through complete range of motion…
A
Against gravity
19
Q
What is a Colle’s fracture?
A
Fracture of distal radius
20
Q
What are the symptoms of erb’s palsy?
A
Adduction and internal rotation of the humerus
21
Q
Mobile arm supports balanced forearm orthosis would be indicated for which patient?
A
Non-ambulatory patient with minimal shoulder power
22
Q
The soft tissue contracture of the hand which is likely to develop following paralysis of the ulnar and median nerves includes…
A
Hyperextension of the MP joints and Flexion of the IP joints of the 2nd, 3rd, 4th and 5th fingers
23
Q
The first dorsal interosseous assist does what?
A
Abducts the second digit to oppose the thumb
24
Q
A median nerve injury at the wrist clinically presents with…
A
Thenar atrophy, loss of thumb opposition, flexion and abduction
25
Which orthosis would be recommended for a radial-ulnar nerve injury at the elbow?
WHO with MP extension stop and 4th and 5th IP extension assist
26
The most effective orthosis to prevent rotation is...
Custom molded TLSO body jacket
27
The _____________ interossei abduct, while the __________________ interossei adduct.
Dorsal/palmar
28
Which of the following nerves innervates all of the anterior muscles of the arm?
Musculocutaneous
29
In general terms, the radial nerve of the brachial plexus innervates...
Supinators and extensors
30
Simultaneous MP flexion and IP extension are performed primarily by the...
Interossei and lumbricals
31
A positive trendelenburg sign is an indication of...
Paralysis of hip abductors
32
During quiet standing, what muscles are acting on the ankle joint in the sagittal plane?
Plantar flexors
33
A cycle of gait consists of _____% Swing phase, ______% stance phase.
40% swing phase, 60% stance phase
34
What is one muscle not posterior to the medial malleolus?
Peroneus brevis
35
Normal cadence is about how many steps a minute?
100-120 steps a minute
36
The range of motion at the ankle is...
20 degrees dorsiflexion, 50 degrees plantarflexion
37
The calf band on a conventional AFO is placed 20 mm distal to the neck of the fibula to...
Provide a long lever arm to counteract forces
38
The lateral side bar on a conventional AFO should deflect posteriorly if the amount of external ankle rotation does what?
Exceeds 28 mm
39
The muscles in the anterior compartment of the leg are innervated by which nerve?
Deep peroneal nerve
40
The relationship of the long axis of the foot to the line of progression as measured from the knee axis is...
Toe out and toe in
41
The placement of the mechanical hip joint is 25 mm proximal and...
And 12 mm anterior to the greater trochanter
42
A heel wedge is placed between what?
Shoe and the stirrup
43
What muscle consists of four parts; only one which acts across the hip joint; Is the chief extensor of the knee; Inserts into the tibial tuberosity?
quadriceps femoris muscle
44
Excessive hip circumduction may result from what?
Dorsiflexor weakness and Hip flexor weakness
45
The femoral or Scarpa's triangle is bordered by which muscles?
Adductor longus, sartorius and inguinal ligament
46
In a fixed equinus deformity, which of the following shoe modifications is most likely to be used?
A heel elevation
47
The cane can substitute for which muscle weaknesses?
hip extensors and hip abductors
48
The distal transverse arch of the foot is where?
Proximal to the metatarsal heads
49
The iliofemoral ligament limits what motion?
Extension of the hip joint
50
In normal ambulation, the quadriceps are the most active at mid stance just after what?
heel strike
51
Maximum dorsiflexion occurs during which phase of gait?
Heel off
52
A single cycle of gait is defined as the time from what?
From heel off of one foot to heel off of the same foot
53
During which phase of gait are the hip extensors most active?
Heel strike to foot flat
54
At what phase of gait is medial lateral stability of the knee most important?
Mid stance
55
What is the best position for managing the chronically dislocating gleno-humeral joint?
Abducted and externally rotated
56
The oblique diameter of a patient's malleoli is 3 5/8" (90mm). What should the inside dimension of the ankle joints be?
4 1/16" (101mm)
57
A hemiplegic patient presents with zero hip extensors, fair quadriceps, zero calf. Which orthosis would you recommend?
HKAFO
58
A 20 year old female patient presents with flaccid anterior compartment and medial lateral instability in her right lower limb. Which orthosis would you recommend?
Polypropylene AFO with trim anterior to the malleoli
59
Which muscle most closely duplicates the function of the anterior tibialis?
Extensor hallucis longus
60
Which of the following is a contra-indication for a spiral AFO?
Edema with frequent volume changes
61
Why is a Milwaukee brace carefully molded superior to the iliac crests?
to Prevent distal migration
62
What level of paraplegia seldom gets braced?
T6 & L5
63
Bunnell (cock-up) splints are frequently used for what?
Trauma
64
What structure assists the deltoid in glenohumeral abductions?
Rotator cuff
65
An orthotic patient's wrist is positioned in ulnar deviation and flexion. You should try to reposition the patient's wrist how?
In 30 degrees of extension
66
Which diagnosis is often the result of an irregular birth?
Erb's palsy
67
What is the primary target organ in rheumatoid arthritis?
Synovium
68
In an LSO what is the superior margin of the paraspinal bars?
10mm inferior angle of the scapula
69
What is the superior margin of the paraspinal bars in a Taylor TLSO?
Spine of the scapula
70
The superior portion of a Milwaukee CTLSO should be carefully fabricated so as to avoid what?
Avoid excessive pressure on the mandibular angle
71
In an attempt to restore upper limb function to a C5 complete quadriplegic, which orthosis should you recommend?
WHO with externally powered wrist and/or prehension
72
In an attempt to restore upper limb function to a C6 complete quadriplegic, which orthosis should you recommend?
WDWHO (flexor hinge)
| WHO with externally powered wrist and/or prehension
73
For a median nerve injury at the wrist which is the most appropriate orthosis?
HO with thumb post
74
What structure is at the distal end of the humerus?
Epicondyle
75
Primary function of the brachioradialis is
Elbow flexion
76
The secondary function of the biceps brachii is...
Supination
77
The primary function of the brachialis is...
Elbow flexion
78
In addition to the deltoid, the axillary nerve innervates the...
Teres minor
79
A patient has sustained a stroke and you note that he has a flexion synergy pattern in this upper extremity and lower extremity, what best describes both synergy patterns?
UE: Shoulder abduction, external rotation, elbow flexion, forearm supination, wrist flexion LE: hip flexion, abduction, external rotation, knee flexion, ankle dorsiflexion, inversion.
80
During normal gait heel strike, the forward hip is how flexed?
25 degrees flexed
81
Gait cycle is described by the activity between what?
Heel strike on one side and the following heel strike on the same side
82
What best describes legg-calve-perthes disease (osteochondrosis)
Male greater then females
Average onset 6 years old,
Psoatic limp due to psoas major weakness
Lower extremity moves into external rotation
Flexion and adduction
MRI will show collapse of subchondral bone at femoral neck
83
A patient is seen in clinic and presents with lumbar DJD. The patient has handed you a script with RX: LSO aligned appropriately. How would you align the patient in the sagittal plane?
Decrease lumbar lordosis
84
A patient is seen in clinic and presents with L5, S1 spondyloisthesis. The patient has handed you a script with RX: aligned appropriately. How would you align the patient in the sagittal plane?
Decrease lumbar lordosis causes lumbar flexion, which is the most appropriate position to prevent progression and allow for healing of the pathology
85
It is early in the recovery phase of patient with a L3 compete spinal cord injury. The expected outcome would most likely be...
The spinal cord ends a level of L1 at the conus medularis From L1 distal (cauda equina lesion) a spinal cord injury would be damage to a peripheral nerve. Some recovery can be expected. A spastic bladder would be associated with the upper motor neuron injury
86
With regards to spondylolisthesis, what are the radiiographic signs that contraindicate orthotic intervention and indicate a surgical candidate?
Anterior translation of the angulations of 50 degrees relative to the inferior vertebrae
87
A patient is seen in the hospital. The patient presents with a L1 burst fracture from a snowmobile accident. Which orthosis would be most appropriate?
A polymer TLSO. When choosing the most appropriate orthosis you must make sure your coverage spans several levels above and below the pathologic site.
Burst fractures are most unstable in the transverse plane. Custom polymer TLSO in the most effective at rotation control and has the proper coverage
88
With a traction injury to the anterior division of the brachial plexus you would expect, weakness of the elbow flexors, wrist flexors and forearm pronators. What other muscles group would you expect to be weak?
Thumb abductors. Anterior nerve root gives rise to C6 nerve root, median nerve which abducts the thumb
89
A patient is seen in the hospital. The patient presents with a T11 anterior compression fracture from a bike accident. The patient is neurologically intact and the fracture is stable. Which orthosis would be most appropriate?
A CASH or Jewett TLSO both are effective for anterior compression fractures near the thoracolumbar junction. By placing the thoracic spine in extension, pressure is removed from the anterior portion of the vertebral body allowing natural bone remodeling to occur
90
When taking an impression for a custom polymer LSO for patient with L5, S1 spondylolisthesis. How would you position the patient if they were allowed to stand through the procedure?
Patient should be asked to flex their hips and knees slightly. by having the patient flex their hips and knees slightly their lumbar lordosis will be reduced giving you optimal alignment for spondylolisthesis management
91
You have a patient that presents for evaluation for an AFO after a stroke. You notice he has a forward flexion posture. What positive muscle length test would you expect to see associated with this posture?
Thomas test. The thomas test tests for iliopsoas (hip flexion) tightness. often with hip flexor contractors the patient will present with a forward flexed posture when standing. Ober test assesses ilio tibial band tightness, hip extensor tightness would have opposite effect on the patient's posture.
92
What are some of the biomechanical principals behind a LSO corset?
An LSO corset provides a kinesthetic reminder to use proper posture and to discourage certain motions. Increased intra-abdominal pressure solidifies soft tissue hydrostatically whereby providing support to the lumbar spine. Three point pressure systems work to hold proper alignment and resist or stop certain motions
93
A patient is seen in clinic. The patient presents with a separated connective tissue in her symphysis pubis. What orthosis is recommended and what hormone can cause the elasticity of the symphysis pubis to increase during pregnancy?
SI belt and relaxin hormone. Relaxin is a hormone that is released in pregnant women in which increases the elasticity of the connective tissue to assist the ease of birth. In some cases the pubic symphysis can become too elastic causing pain instability so a SI belt is utilized to provide increased stability to pubic symphysis joint.
94
You are working with a therapist on gait training for a patient that has a L1 complete spinal cord injury along with another patient that has an L4 spinal cord injury. What bracing would you expect most appropriate for these patients and ambulation tolerance respectively?
L1 spinal cord injury: independent ambulation with knee ankle foot orthosis (KAFO) household distance, L4 spinal cord injury: ankle foot orthosis, community ambulatory independent. With an L1 spinal cord injury the patient would likely need a KAFO due to iliopsoas weakness as inervated by L2 nerve root. Due to high energy cost only household distance would be expected. L4 spinal cord injury is a lower motor neuron lesion resulting in weakness of the ankle dorsiflexors, anterior tibialis, benefiting from use of an AFO due to foot drop
95
The posterior trim lines on a TLSO from the sacrocoygeal joint to just inferior to______. Anterior trim lines extend from symphysis pubis to the ______
Scapular spine, sternal notch. TLSO trim lines are chosen to span a distance above and below the pathological area to maximize control and or guide motion.
96
What pathology would indicate the use of a Williams Flexion LSO?
Sponylolisthesis. The williams flexion LSO allows free lumbar flexion but stops lumbar extension making it a possible orthosis for management of spondylolisthesis
97
The "unhappy triad" includes injury to what structures?
ACL, MCL, Medial meniscus from forces that cause genu valgum, flexion and external rotation applied at the knee when the foot is planted.
98
A patient is seen in clinic. The patient has bilateral pars fractures at L5 and is currently utilizing a custom polymer overlapping style LSO with decreased lumbar lordosis. The physician is not satisfied with the orthosis results and wants to know what you can do to further immobilize the fracture site
Add a hip spica to the LSO. By adding a hip spica to the LSO you adjust how much hip flexion and extension is allowed which can further immobilize the patient and the fracture site.
99
A knight taylor TLSO is classified as _______ where a taylor TLSO is classified as _____
Knight Taylor: AP, ML, control, Taylor: AP control.
100
A patient with an upper motor neuron disorder has a posterior loss of balance with immediate sit to standing due to either tight muscles or weakness. What would be the most likely cause of weakness?
Spasticity of the gastrocnemius-soleus. The muscles around the ankle provide ankle strategies, the gastrocnemius-soleus moves the body posterior while the anterior tibialis helps move the body anterior
101
A scoliosis patient is seen in clinic. Upon radiographic reading you note that the thoracic curve apex is located at T6. Which orthosis is appropriate?
Milwaukee CTLSO. The Milwaukee CTLSO system is utilized for scoliosis curves T7 and higher. In some instances additions can be built into a boston brace system to simulate the effectiveness of a Milwaukee system which can increase patient comfort and compliance
102
Posterior trim lines on an LSO extend from the sacrococcyxgeal joint to just inferior to the _____. Anterior trim lines extend from symphysis pubis to the _______.
Inferior angle of the scapula; xiphoid process.
103
You are seeing a patient with a one year history of amyotrophic lateral sclerosis. She is ambulating with bilateral canes, shows limited endurance and foot drop. Base on the diagnosis what device would you recommend for trial?
Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease where due to the progressive nature you try an AFO, due to her fatigue and foot drop.
104
A patient is seen at the local hospital ortho/neuro floor. The patient presents with an unstable odontoid fracture. Which orthosis would you recommend?
HALO CTLSO is indicated for unstable C1 and C2 fractures.
105
A patient is seen in clinic. The patient presents with DX: lower lumbar stenosis and a RX: LSO align appropriately. Which option would you recommend
An LSO aligned in flexion will allow the spinal canal to relatively decrease occlusion and whereby increase space for the spinal cord
106
When selecting anterior pin placement in a HALO CTLSO application, where is the proper starting position
Lateral 1/3 of eyebrow, slightly superior to eyebrow. This placement gives you a relatively safe starting position to avoid puncturing sinuses, nervous system structures as well as to decrease superior migration of HALO ring.
107
When selecting posterior pin placement in a HALO CTLSO application, where is the proper starting position?
Slightly superior to ear, opposing the anterior pin directly, inferior to equator of the cranium. You will avoid nervous system structures as well as superior migration of the HALO
108
A patient you are working with has a medial nerve lesion, you would expect that they will have loss of all functions except what?
Flexor carpi ulnaris. Flexor carpi ulnaris is one of the few muscles that the median nerve does not innervate on the anterior compartment of the forearm. In general the median nerve serves the flexors of the forearm except for flexor carpi ulnaris which is innervated by the ulnar nerve. Lesion to the median nerve can produce carpal tunnel syndrome, ape hand deformity, denedictine deformity
109
What are all clinically "visible by the eye" signs of scoliosis?
Arm gap, shoulder asymmetry, pelvic obliquity, rib hump, and prominent scapula
110
True or False, when fabricating a williams flexion LSO for spondylolisthesis, the anterior corset panel should be fabricated out of an inelastic material
False, the anterior corset panel should be fabricated out of an elastic material so as not to limit sagittal plan flexion
111
In the hospital you see a 6 year old girl with spina bifida. You are consulted due to the patient's club foot and 30 degree scoliotic thoracic curvature. What is one normal treatment for a child with spina bifida?
Prevent contractors due to neurogenic deformities, with hydrocephalus, decompress and place shunt in place, prevent pressure sores and fit patient with an ankle foot orthosis and a TLSO. Spina bifida is caused by incomplete closure of one or more neural arches that can cause a wide range of impairments. Joint contractures and pressure ulcers are always a risk for a patient with neurological deficits
112
Scoliosis is sometimes sub-divided into different types. What are signs of congenital scoliosis?
Wedge, bar, and hemi-vertebrae are common radiographic findings for congenital scoliosis
113
Scoliosis is sometimes sub-divided into different types. What are signs of neuromuscular scoliosis?
Right lumbar and left thoracic curves are often signs of neuromuscular scoliosis
114
Gower sign is seen when a person gets up from the floor, walking hands up his legs to upright. What is the most common diagnosis where this is seen?
Duschenne muscular dystrophy is characterized by rapid loss of muscle, eventually leading to loss of ability to ambulate and death. By age 10 most are using braces to aide in walking. By 12 patients are usually wheelchair bound. Proximal weakness in the hips leads to the child using their arms to walk up their legs known as gowers sign.
115
When applying a HALO CTLSO for pediatric applications, how may your protocol differ from adult application?
When applying a HALO on a pediatric patient, it is important to use more pins with less torque to distribute the pressure more evenly across the cranium as well as to avoid any potential dural punctures
116
When examining a scoliosis radiograph, the vertebral body is seen rotating towards the ____ in relation to the curve and the spinous process is seen to rotate toward the _____ in relation to the curve.
Convexity, concavity.
117
A Brachial plexus injury occurs resulting in decreased wrist and hand function. Which type of brachial injury would likely be the cause?
a. Klumpke's palsy
b. Trisomy 21
c. Erb's Palsy
d. Ulnar Neuritis
c. Erb's palsy.
Klumpke's palsy results in decrease wrist and hand function due to involvement of C8-C6. Trisomy 21 is another name for Down syndrome and ulnar neuritis may cause wrist and hand dysfunction but is not a brachial plexus injury
118
When evaluating to see if a scoliotic curve is non-structural, what will you notice with forced lateral side bending?
Rotational components of the curve will correct themselves. Forced lateral side bending will show rotational correcting for non-structural curves and no rotational correction for structural curves
119
Which types of scoliotic curves would you expect to progress more, given only the location of the curve?
Single lumbar, thoracolumbar.
120
A scoliosis patient is seen in clinic. Upon radiographic reading, you note that the patient has a risser sign of 5. How would you describe this risser sign?
Osseous cap noted on 100 percent of the iliac crest apophyseal plate. A risser sign of 5 is described as complete osseous capping of the iliac crest apophyseal plate and signals skeletal maturity
121
Parkinson's diseases is a chronic, progressive disease of the CNS with degeneration of dopaminergic neurons. What are the four hallmark symptoms of PD?
a. Rigidity, bradykinesia, tremor, impaired postural reflexes
b. Radiculopathy, tremor, impaired postural reflexes, bradykinesia
c. Lhermitte's sign, impaired posutral reflexes, bradykinesia, tremor
a. Rigidity, bradykinesia, tremor, and impaired postural reflexes.
Radiculopathy is a peripheral nervous system dysfunction. Lhermitte's sign can be seen with upper motor neuron disorders such as MS but not PD
122
A scoliosis patient is seen in clinic for her initial evaluation. After cobbing her x-ray, you and her physician agree that she has a 35 degree left lumbar curve with no sign of progression. What should your treatment consist of at this time?
Scoliotic curves of magnitude 30-45 degrees should be managed with an orthosis immediately, regardless of progress
123
You see a patient who describes pain in her shoulder after chopping wood. You find on physical examination weakness with shoulder flexion and you note scapular winging. The patient's problem could be what?
a. compression of suprascalular nerve
b. Rotator cuff trendonitis
c .compression of axillary nerve.
c. Compression of axillary nerve. Continuos overhead activities can cause inflammation of soft tissue, placing pressure over peripheral nerves such as the long thoracic nerve. With compression this nerve would then cause weakness in the serattus anterior. You would note winging of the scapula especially with arm abduction greater then 90 degrees. Suprascalular nerve innnervates part of the rotator cuff (supraspinatus and infraspinatus) and would not cause winging. Rotator cuff trendonitis also would not cause winging, but could cause flexion weakness
124
A 15 year old patient is seen in clinic for her initial evaluation. After cobbing her x-ray, you and her physician agree that she has a 20 degree left lumbar, 22 degree right thoracic curves with no sign of progression. What should your treatment consist of at this time?
Observation and follow up.
| NOTE: in some cases with very young patient's, earlier management may be indicated due to a lack of skeletal maturity
125
A patient is seen in clinic, DX: Sheurmann's Kyphosis apex=T9 RX: orthosis. What type of orthosis would you recommend?
Custom TLSO. When managing a patient with sheurmann's kyphosis apex location T8 or lower are managed with a custom TLSO and apex location of T7 or higher are managed with a custom CTLSO
126
A patient is diagnosed with a anterior cerebral artery stroke. You may need to assist with bracing. Based on the diagnosis you can expect that the patient to present with what?
a. Hemiplegia, arm more affected than leg
b. locked-in-syndrome
c. contralateral hemiparesis, leg more affected than arm.
d. hemiplegia, leg more affected than arm
e. contralateral hemiparesis, arm more affected than leg.
c. Contralateral hemiparesis, leg more affected than the arm.
Middle cerebral artery stroke results in hemiplegia, arm more affected than the leg. Basilar artery occlusion at the pons produces what is known as locked-in-syndrome causing quadriplegia with no motor function but preserved consciousness
127
Why is sheurmann's kyphosis easier to manage with on orthosis compared to scoliosis?
Sheurmann's kyphosis only has a sagittal plane component of deformity, whereas scoliosis has both sagittal and transverse components of deformity
128
When a HALO application is finished all pins for an adult should be torqued to ______ and between 24-48 hours the pins should be______
All pins should be torqued 6-8 inch pounds, and in 24-48hours should be further torqued to 6-8 inch pounds.
129
Injury to the tibial nerve on the right leg, would cause which gait deviation?
Absent push off during gait cycle, decrease step length on unaffected side.
The tibial nerve innervates muscles on the posterior leg (i.e triceps surae, posterior tibialis etc.) which cause those symptoms.
Foot drop would be seen with injury to common fibular nerve which innervates anterior tibialis
130
What are the characteristics of the congenital abnormality in infants called torticollis?
Contracture of the sternocleidomastoid, ipsilateral head tilt, and contralateral head rotation.
131
The definition of _____, is a cranial asymmetry " nonsynostotic origin" caused by external forces and sometimes attributed to the SIDS
Plagiocephaly is a deformity of the cranium that is usually rhomboid in the shape when viewed in the transverse plane. If caught early it can be managed with a cranial remolding helmet
132
Which nerve innervates the rhomboid muscles and levator scapulae?
a. Dorsal scapular nerve
b. Axillary nerve
c. Suprascapular
d. Long thoracic nerve
a. Dorsal scapular nerve.
The long thoracic nerve innervates serratus anterior. Axillary nerve innervates deltoid and teres minor muscles, suprascapular nerve innervates supraspinatus and infraspinatus muscles on the rotator cuff
133
True or false, To find the anatomical waist you must measure the distance between the inferior costal margin and the posterior superior spine, and divide be two.
False, The anatomical waist is measured by finding the distance between the inferior costal margin and iliac crest, and divide by two
134
A patient is seen in clinic. The patient presents with a midshaft humeral fracture (10 degree of varus is noted at the fracture sight). What orthosis would you recommend?
Sarmiento humeral fracture orthosis.
Long term benefits of the sarmiento: Micro motion at the fracture site promotes bone growth. Movement at elbow throughout the healing process minimizes stiff elbow that requires extensive rehab. Movement of the arm, once comfortable, promotes muscle pump action to aid circulation
135
When you are working with a patient with left hemiplegia you would expect that they would be least likely to respond to you if you were emphasizing what?
Maximum use of demonstration and gesture.
A patient with left hemiplegia has difficulty with sequencing, producing language, difficulty processing in formation and will have visuospatial deficits. Maximum use of demonstration and gesture would not be appropriate
136
You see a patient with wrist drop, paralysis of the triceps, brachioradialis, supinator, and extensor muscles of the wrist and digits. What nerve is responsible for this and where is the injury?
Radial Nerve; superior to the triceps brachii muscle.
The radial nerve innervates the wrist extensors. If the injury causes triceps weakness then the clinician would conclude that the injured nerve occurred proximal to the triceps brachii muscles. If injury occurs within the radial groove, the triceps usually is not completely paralyzed.
137
Sarmiento style fracture orthoses utilize which biomechanical principles for fracture management?
Multiple 3-point pressure systems, total contact, long level arms, and hydrostatic tissue loading.
Because the orthoses are typically bi-valved hydrostatic loading can be maintained as swelling or muscular atrophy occurs by simple modifications.
138
What modification can you make to an ulnar fracture orthosis to increase its effectiveness at immobilizing a distal 2/3 ulnar fracture?
Increase pressure A/P for increased immobilization. Increased pressure creates tension between the radius and ulna. This tension is an effective immobilizer for ulnar fracture
139
A patient with a diagnosis of Brown Sequard Syndrome (SCI) which occurred at C4 affecting his right upper extremity and right lower extremity comes to your clinic for and LE orthosis. He is ambulatory but requires minimal assistance. Initially, what assistive device would be most appropriate and in what extremity?
SPC "cane" on the left side.
Brown sequard syndrome will result in potential lost of motor function on the side of the lesion, with this individual you would have him trial using a SPC "single point cane" on the unaffected side to counterbalance the loss of function on the right. FWW would not be necessarily appropriate as it would require function of both extremities. It is usually recommended that the assistive devices be used on the sound side
140
When fabricating a rancho style HO (hand orthosis), what length would you terminate the thumb post?
1st digit mid finger nail bed.
| This avoids interference with prehensile activities
141
A patient is seen in clinic. The patient presents with her right radial nerve intact and severed median and ulnar nerves. What orthosis would you recommend?
WHFO (wrist driven flexor hinge).
With a radial nerve intact, the patient will still have extensor motion available. A wrist driven flexor hinge will capture the extensor motion and translate it into natural tenodesis to grasp objects with three point palmer prehension
142
The stance phase of gait makes up what percent of the gait cycle?
60%,
| Stance phase makes of 60% of the gait cycle, while swing phase makes up the other 40%
143
A patient is seen in clinic. The patient is utilizing a WHFO (wrist driven flexor hinge). The patient states that she can grasp objects but cannot maintain for long periods of time due to muscle fatigue. What addition can you add to this orthosis to allow for long periods of three point palmer prehension
Add a ratchet lock.
By adding a ratchet lock, the patient can extend the wrist to the desired prehension width and lock it in place over the object while the having the ability to relax their wrist extensor muscles
144
What are some of the pathologies that indicate the need for medial longitudinal arch support in a functional foot orthotic?
Plantar fasciitis, posterior tibialis tendon dysfunction, knee osteoarthritis in the lateral compartment and pes planovalgus.
MLA support decreases pull across the plantar fascia, decreases work load of the patient, unloads lateral knee compartment and provides neutral alignment to decrease likelihood of other pathologies
145
Durning swing phase of the gait cycle, what muscles are active to achieve dorsiflexion?
Anterior tibialis, extensor hallucis longus, and extensor digitorum longus.
These muscle are slightly active during the swing phase to prevent the foot and toes from dragging
146
What are all the pathologies that indicate the need for a first ray relief and lateral wedge in a functional foot orthotic?
Cavo varus foot, peroneal tendon dysfunction, chronic lateral ankle sprains and jones fracture.
All of these pathologies can be treated with a decreased MLA support and increase in 1st MTP relief with a lateral extrinsic wedge.
Decrease work load of peroneal tendons, provides canting to decrease lateral ankle sprains, decreases pressure under the 5th metatarsal. Individuals prone to these pathologies in most instances have a cavo varus foot (rigid foot shape). Softer material used in fabrication will promote a more compliant foot orthotic which is indicated to achieve goals
147
True or False, a patient with pes plano valgus foot and peroneal tendonitis should utilize their functional foot orthotics (MLA support, extrinsic medial wedge, and or carlson modifications) with a pronator motion control type shoe.
True, it is of the utmost importance to use a pronator "motion control" shoe in combination with a functional foot orthotic including a MLA support, extrinsic medial wedge, and or carlson modifications.
Note: as general statement patient's don't necessarily choose appropriate shoe wear to compliment their functional foot orthotics. You should steer them in the right direction.
148
What is the most appropriate foot orthotic for a type two diabetic?
Funtional/accommodative, fabricated out of diabetic multidensity trilaminated foam with a medicare approved foam base layer.
When fabricating diabetic type insert it is still important to consider the individuals foot type so functional modifications may be necessary. I.E. a patient with a cavo varus foot is more likely to receive excess pressure on the lateral border of their foot. So, functional foot orthotic modifications need to be incorporated into the diabetic foot orthotic to decrease the likelihood of ulcer/callus development on the lateral border of their foot.
149
The sciatic nerve innervates what muscles. Which lower limb muscle is not innervated by the sciatic nerve?
The sciatic nerve provides sensation to most of the leg and motor function of most of the posterior leg muscles, there is a tibial division and the common fibular division that innervates the bicpes femoris.
The gluteus medius is innervated by the superior gluteal nerve
150
A patient is seen in clinic for a follow up appointment and is disappointed with the results of his custom orthotics. The patient is being treated by you for a mortons neuroma (between the 3rd and 4th metatarsals). The foot orthotics you provided has utilized "MLA support and carlson modification". What modification would be most effective to increase the effectiveness of the foot orthotics?
Add a metatarsal pad. By adding a metatarsal pad you can relatively increase the distance between each metatarsal and its adjacent metatarsal whereby decrease pressure or shear against the morton's meuroma
