A patient has sustained a stroke and you note that he has a flexion synergy pattern in his
upper extremity and lower extremity. Pick the best answer that 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
During normal heel strike, the forward hip is how flexed:
25 degrees flexed
Gait cycle is described by the activity between
Heel strike on one side and the following heel strike on the same side
Pick the following choice that best describes Legg-Calve-Perthes disease (osteochondrosis):
Males>females, average age 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
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
A patient is seen in clinic and presents with L5,S1 spondylolisthesis. 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
It is early in the recovery phase of a patient with a L3 complete spinal cord injury. The
expected outcome would MOST likely be:
Some recovery of function since damage is to peripheral nerve roots
With regards to spondylolisthesis, what are the radiographic signs that contraindicate
orthotic intervention and indicate a surgical candidate:
Anterior translation of the superior vertebrae over the inferior vertebrae greater
than 50%
Superior vertebrae angulations of 50 deg relative to the inferior vertebrae
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:
Polymer TLSO
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 muscle group
would you expect to be weak:
Thumb abductors
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(s) would be most appropriate:
CASH TLSO or Jewett TLSO
When taking an impression for a custom polymer LSO for a 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
You have a patient that presents for evaluation for an AFO after a stroke. You notice he has
a forward flexed posture. What positive muscle length test would you expect to see associated
with this posture:
Hip extensor tightness
What are some of the biomechanical principals behind a LSO corset? Choose all that
apply:
A) Kinesthetic reminder
B) Increased intra-abdominal pressure
C) Multiple three point pressure systems
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, choose two answers:
B) Relaxin hormone
D) SI belt
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 ambulator
independent
Posterior trim lines on a TLSO extend from the sacrococcygeal joint to just inferior
to_____________ . Anterior trim lines extend from symphysis pubis to
the_____________:
Scapular spine, sternal notch
What pathology would indicate the use of a Williams Flexion LSO:
Sponylolisthesis
The “unhappy triad” includes injury to what structures:
ACL, MCL, medial meniscus
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? Choose the appropriate answer:
Add a hip spica to the LSO
A Knight Taylor TLSO is classified as _______________ where a Taylor TLSO is
classified as ______________:
A/P M/L control, A/P control
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 this:
Spasticity of the gastrocnemius-soleus
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
Posterior Trim lines on an LSO extend from the sacrococcyxgeal joint to just inferior
to_____________ . Anterior trim lines extend from symphysis pubis to
the_____________:
Inferior angle of the scapula, xiphoid process
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. Based on the
diagnosis what device would you recommend for trial:
ALS is a progressive degenerative disease where due to the progressive nature you
feel trial of ankle foot orthosis would be appropriate due to her fatigue and foot drop
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
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:
LSO aligned in flexion
A patient has a fixed forefoot varum. All of the following are considered compensatory
strategies for a fixed forefoot varus malalignment EXCEPT:
Subtalor supination
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
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
A patient you are working with has a medial nerve lesion, you would expect that they will
have loss of all functions EXCEPT one of the following:
Flexor carpi ulnaris (ulnar nerve)
Choose all answers that are clinical “visible by the eye” signs of scoliosis:
A) Arm gap, shoulder asymmetry
B) Pelvic obliquity
C) Rib hump
D) Prominent scapula
T/F - When fabricating a Williams Flexion LSO for spondylolisthesis, the anterior corset
panel should be fabricated out of an inelastic material:
False
In the hospital you see a 6 year old girl with spina bifida. You are consulted due to the
patient’s club foot and a 30 deg scoliotic thoracic curvature. Please circle one choice that
would be part of the normal treatment for a child with spina bifida:
A)Prevent contractures due to neurogenic deformities
B) With hydrocephalus, decompress and place shunt in place
C) Prevent pressure sores
D) Fit patient with an ankle foot orthosis and a TLSO
Scoliosis is sometimes sub-divided into different types. What are signs of congenital
scoliosis:
Wedged, bar, and hemi-vertebrae
Scoliosis is sometimes sub-divided into different types. What are signs of neuromuscular
scoliosis:
Right lumbar curve and left thoracic curve
Gowers sign is seen when a person gets up from the floor, walking hands up his legs to get
upright. Choose the most common diagnosis where this is seen:
Duschenne Muscular Dystrophy
When applying a HALO CTLSO for pediatric applications, how may your protocol differ
from adult applications:
B) Use more HALO pins
D) Use less torque on the pins
When examining a scoliosis radiograph, the vertebral body is seen to rotate toward the
_________ in relation to the curve and the spinous process is seen to rotate toward
the__________ in relation to the curve:
Convexity, Concavity
A brachial plexus injury occurs resulting in decreased wrist and hand function. Choose
which type of brachial injury would likely be the cause:
Erb’s palsy
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
Which types of scoliotic curves would you expect to progress more given only the location
of the curve:
B) Single lumbar
C) Thoracolumbar
Parkinson’s disease is a chronic, progressive disease of the CNS with degeneration of
dopaminergic neurons. What are the four hallmark symptoms of PD:
Rigidity, bradykinesia, tremor, and impaired postural reflexes
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% of the iliac crest apophyseal plate
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 deg left lumbar curve with no signs of progression.
What should your treatment consist of at this time:
Immediate scoliosis orthotic management
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 accounted by what MOST LIKELY:
Compression of the long thoracic nerve
A 15 year old scoliosis patient is seen in clinic for her initial evaluation. After cobbing her
x-ray, you and her physician agree that that she has a 20 deg left lumbar, 22 deg right
thoracic curves with no signs of progression. What should your treatment consist of at this
time:
Observation only at this time and schedule a follow up appointment after her next
radiograph series
A patient is seen in clinic. DX: Sheurmann’s Kyphosis apex= T9, RX: Orthosis. What type
of orthosis would you recommend:
Custom TLSO
A patient is diagnosed with an anterior cerebral artery stroke. You may need to assist with
bracing. Based on the diagnosis you can expect that the patient will present with:
Contralateral hemiparesis, leg more affected than the arm
Why is Sheurmann’s kyphosis typically easier to manage with an orthosis compared to
scoliosis:
Sheurmann’s Kyphosis only has a sagittal plane component of deformity
When a HALO application is finished all pins for an adult should be torqued
to____________ and between 24-48hours the pins should be______________:
A) 6-8 inch pounds
C) Re-torqued
Injury to the tibial nerve on the right leg, would cause which gait deviation:
Absent push off during gait cycle, decreased step length on unaffected side
What are the characteristics of the congenital abnormality in infants called torticollis?
Choose all that apply:
A) Contracture of the sternocleidomastoid
B) Ipsilateral head tilt
C) Contralateral head rotation
The definition of _________, is a cranial asymmetry “nonsynostotic origin” caused by
external forces and sometimes attributed to the SIDS:
Plagiocephaly
Which nerve innervates the rhomboid muscles and levator scapulae:
Dorsal scapular
T/F- To find the anatomical waist you must measure the distance between the inferior
costal margin and the posterior superior iliac spine, and then divide by two:
False
A patient is seen in clinic. The patient presents with a midshaft humeral fracture (10 deg
of varus is noted at the fracture sight). What orthosis would you recommend:
Sarmiento humeral fracture orthosis
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:
Maximum use of demonstration and gesture
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 likely is
the injury:
Radial nerve; superior to the triceps brachii muscle
Sarmiento style fracture orthoses utilize which biomechanical principles for fracture
management? Choose all that apply:
A) Multiple 3-point pressure systems
B) Total contact
C) Long lever arms
D) Hydrostatic tissue loading
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
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 an LE
orthosis. He is ambulatory but requires minimal assistance. Initially, what assistive device
would be most appropriate and in what extremity:
Single Point Cane (SPC) on the left side
When fabricating a rancho style HO (hand orthosis) , what length would you terminate
the thumb post at:
1st digit mid finger nail bed
A patient is seen in clinic. The patient presents with her right radial (forearm extensor) nerve intact and severed median (forearm flexor) and ulnar nerves. What orthosis would you recommend:
WHFO (wrist driven flexor hinge)
The stance phase of gait makes up what percent of the gait cycle during ordinary walking
speeds:
60%
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
muscular fatigue. What addition can you add to this orthosis to allow for long periods of three
point palmer prehension:
Ratchet lock at the wrist
Choose all the pathologies that indicate the need for medial longitudinal arch support in a
functional foot orthotic:
A) Plantar fasciitis
B) Posterior tibialis tendon dysfunction
C) Knee osteoarthritis in the lateral compartment
D) Pes plano valgus
During swing phase of the gait cycle what muscles are active to achieve dorsiflexion:
Anterior tibialis, extensor hallucis longus, extensor digitorum longus
Choose all the pathologies that indicate the need for a first ray relief and lateral wedge in a
functional foot orthotic:
A) Cavo varus foot
B) Peroneal tendon dysfunction
C) Chronic lateral ankle sprains
D) Jones fracture
T/F - A patient with a cavo varus foot and peroneal tendonitis should utilize their
functional foot orthotics (1st ray relief, extrinsic lateral wedge) with a pronator motion control
type shoe:
False
A patient has chief complaint of pain on the medial side of her ankle just below the medial
malleoli. On clinical examination the patient has slight weakness with inversion, pes planus,
pain with heel raises and tenderness and swelling under the medial malleoli. The most likely
cause of the symptoms would be:
Tarsal tunnel syndrome
T/F - A patient with a 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
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
The sciatic nerve innervates all these muscles EXCEPT:
A) Semitendinosis
B) Biceps femoris
C) Semimembranosis
*D) Gluteus medius
A patient is seen in clinic for a follow up appointment and is disappointed with the results
of his custom foot orthotics. The patient is being treated by you for a Mortons Neuroma
(between the 3rd and 4th metatarsals). The foot orthotic you provided has utilized “MLA
support and Carlson modifications”. What modification would be most effective to increase
the effectiveness of the foot orthotics:
Add a metatarsal pad
A patient is seen in clinic for a follow up appointment and is disappointed with the results
of his custom solid ankle foot orthotic 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 a 1/4” heel lift to relatively dorsiflex the SAFO to decrease the knee extension
moment in stance. What should your first reaction be to this:
Check the durometer of the 1/4” heel lift your technician added
Select all that are found in Scarpa’s triangle (femoral triangle):
A) Femoral nerve
B) Femoral artery
C) Sartorius muscle
D) Inguinal lymph nodes
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 deg genu recurvatum and a
15 deg 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:
B) Add a 15 deg tapered heel wedge to the foot plate
D) Add a contralateral heel lift
A patient is seen in clinic. The patient is utilizing foot orthotics with 3/8” heel lifts to
decrease inflammation of her heel chord “achilles tendonitis”. What lumbar pathologies could
this aggravate:
B) L5-S1 spondylolisthesis
C) DJD of the lumbar facet joints
D) Lumbar Spondylolysis
You are seeing a patient with diagnosis of peripheral vascular disease. What is the
common artery that you can palpate to assess blood flow:
Dorsalis pedis
What would you recommend for additions to an articulated AFO for drop foot and
posterior lateral hyperextension thrust of the knee (mild tone is present):
A) Elevation of the 2nd-5th MTP joints and digits.
B) 1/4” heel/lateral wedge.
C) PF stop.
D) Metatarsal pad.
What additions can you make to an AFO to decrease excessive pronation within the AFO:
A) Extrinsic medial wedge
B) Medial Sabolich tab or trimline
C) Sustentaculum tali “ST” pad
A patient has failed conservative treatment for plantar fasciitis including foot orthotics,
physical therapy, shoe wear modifications. Choose all that are common surgical interventions:
A) Gastroc lengthening procedure
B) Plantar fascia release
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:
Articulated AFO
A patient is seen in clinic whom has been diagnosed with Guillain-Barre syndrome. The
patient has weak knee extensors, knee flexors, ankle plantarflexors, and ankle dorsiflexors.
What muscle groups would you expect to regain strength first if the syndrome begins to remit:
A) Knee extensors
D) Knee Flexors
Having a patient perform a heel raise, screens what myotomal level:
S1
You have provided a patient with an articulated AFO and PF stop. When the patient
ambulates you notice that they have pronounced knee flexion during loading response.
Choose the options that can cause this:
A) Firm extrinsic heel wedge
B) PF stop is too dorsiflexed
T/F - When designing a ground reaction ankle foot orthosis “GRAFO” foot plate length can
be full foot or sulcus length:
False
Damage to the femoral nerve will result in weakness of what main muscle group:
Knee extensors
Choose all that describe the design of a GRAFO:
A) Anterior/Distal and Posterior/Proximal openings
D) Posterior/Distal and Anterior/proximal areas of AFO contact
T/F - 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 shoes and or
cutting the foot plate to sulcus length would be appropriate (assuming they have good knee
stability in the sagittal plane):
True
T/F - The duration of double support varies inversely with the speed of walking and in
running double support is absent:
True
T/F - When fabricating a KAFO the distal/posterior thigh band and the proximal/posterior
calf band should be located equidistant from the knee axis:
True
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:
Tibial torsion was not built into the KAFO
In normal gait, maximum knee flexion reaches approximately:
60-65 degrees
When taking an impression and delineation for a KAFO what landmark represents knee
center:
The midpoint between MTP and the adductor tubercle.
A patellar tendon bearing AFO is indicated for which pathologies:
A) Charcot joint
B) Avascular necrosis of the talus
C) Osteoarthritis of the ankle joint
D) Calcaneal fracture
What is the primary function of brachioradialis:
Elbow flexion
A KAFO patient is seen in clinic for follow up. The patient has utilized 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 without slowing the
reversal of AVN:
Incorporate ischial weight bearing
T/F - An RGO allows forward progression by harnessing energy from one hip’s extension
and translating it into contralateral hip flexion:
True
The radial nerve is injured within the radial groove. What muscle would NOT be
paralyzed:
Triceps
When turning a conventional AFO into a dorsiflexion assist AFO, how would you set up
the double action ankle joint:
Springs in the posterior channels
A patient is seen in clinic with flaccid ankle plantarflexors and dorsiflexors. Choose
appropriate double action ankle joint configurations:
C) Pins in the anterior and posterior channels
D) Springs in the posterior channels and pins in the anterior channels
The clawhand appearance of the hand is due to damage to what nerve:
Ulnar nerve (flexion)
A 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 chosen to recommend
a conventional AFO with double action ankle joints. What would be the most appropriate
configuration of the ankle joints:
Springs in the posterior channels and pins in the Anterior channels
A patient with Duchennes Muscular Dystrophy is seen to ambulate with increased
lumbar lordosis secondary to which muscular weakness:
Hip extensor
A patient sustains a Hangman fracture. This fracture can cause quadriplegia. What
vertebrae and location of the fracture is damaged:
Atlas, lamina (pars interarticularis) C2
When designing a thermoplastic KAFO for a patient with severe genu recurvatum, what
can you incorporate that will help control the knee hyper extension:
A) Extending the dist/post thigh trimline more distally
B) Decreasing the depth of the thigh section
C) Extending the prox/post calf trimline proximally
D) Decreasing the depth of the calf section
A patient wearing a KAFO is seen in clinic. The patient complains of anterior thigh
pressure while sitting. What could be the cause:
Mechanical knee joint is too distal in relation to the anatomical joint
The erector spinae muscles are found in the intermediate layer of the muscles in the back.
When they act bilaterally, they extend the vertebral column. When they act unilaterally what
action do they perform:
Laterally bend the vertebral column
T/F - A child wearing a Pavlic harness in treatment for congenital dislocation of the hips
should have their hips oriented in flexion and adduction:
False (hip flexion and abduction)
A 240lbs female bears how much weight collectively through her right 2nd-5th MTP
joints while standing evenly on both feet:
40lbs ~ 16% body weight
The axillary nerve innervates teres minor. What other muscle does it innervate:
Deltoid
T/F - Guillain-Barre syndrome progresses in an ascending order
True
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) Duchennes muscular dystrophy
C) Gowers sign
The lumbricals act to:
Flex the MP joints and extend the IP joints
When fabricating an AFO the lateral proximal trimline is located approximately 1 inch
inferior to the fibular neck. What anatomical structure are you trying to avoid by doing this:
Common fibular nerve
The nominate bone of the pelvic girdle is known as:
Sacrum
The claw hand appearance is characterized by an injury to what nerve:
Ulnar nerve (Flexion)
Injury to the median nerve (flexors) will result in what characteristic appearance when a patient
tries to make a fist:
A) Ape hand
C) Hand of benediction
At heel strike the knee joint is at ____while the ankle joint is at _____:
At neutral/full extension, 90 degrees/neutral
Trendelenburg gait can be seen in patients after they have a total hip arthroplasty, injury
to the superior gluteal nerve, and poliomyelitis. This is caused by weakness in what muscle:
Gluteus medius
A patient with C6 quadriplegia is able to use a tenodesis grip. What is the action that
occurs:
Wrist extension which causes MP flexion
The deltoid muscle acts to abduct the shoulder with what other muscle:
Supraspinatus
You are seeing a patient in acute rehab with a physical therapist. This patient has had a
CVA. Upon examination you see foot drop during 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 solid ankle AFO
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:
Ambulation with bilateral AFOs and canes
Anterior displacement of the vertebral body on the lower vertebrae is called what:
Spondylolisthesis
