AAPMR QBank - Amputation, Equipment, and Assistive Technology

Bracing can help slow the progression of adolescent idiopathic scoliosis for Cobb angles of: A.20-39 degrees B.40-59 degrees C.60-79 degrees D.80-99 degrees

A. 20-39 degrees 88.29% A majority of adolescent idiopathic scoliosis can be controlled effectively with bracing for curves between 20 and 40 degrees. Bracing is recommended for curves over 20 degrees in a skeletally immature patient in whom only 5-10 degrees of progression has been noted over a six-month period. Brace wear is discontinued in lieu of surgical intervention generally if the curve reaches 40 degrees or rapid progression is noted. In neuromuscular scoliosis, while orthoses may improve trunk control and sitting posture, they less often slow curve progression and do not prevent the need for surgical intervention.

A resting wrist-hand-orthosis (WHO) has which of the following characteristics: A.Distal and proximal interphalangeal joint extension B.Thumb in maximum radial abduction C.Wrist in neutral position D.Metacarpal phalangeal joint extension

A. Distal and proximal interphalangeal joint extension 32.29% A resting hand orthosis is commonly prescribed for the hemiparetic, or mildly spastic distal upper extremity to maintain the hand in a functional position. This position includes the wrist slightly/moderately "cocked-up" between 10-30o hyperextension, the metacarpal phalangeal joints mildly flexed, the proximal and distal interphangeal joints in extension, and the thumb halfway between palmar and radial abduction. This position -- commonly referred to as a Functional "C" position -- reduces the stress on the respective joints, reduces hypertonicity, and permits greater opportunity for functional restoration.

Which of the following will result in an increased knee flexion moment during stance phase of a transtibial amputee? A.Foot aligned posterior to the socket B.Pistoning of the limb in the socket C.Insufficient anterior flexion in socket alignment D.Plantarflexion alignment of the prosthetic foot

A. Foot aligned posterior to the socket 70.29% Placing the socket anterior relative to the foot, or the foot posterior will result in an increased progression through loading response and midstance. This is due to an increased distance between the connection of the foot and pylon and the weight (force) line of the patient. Other potential causes of an increased knee flexion moment include dorsiflexion alignment of the foot, excessive anterior socket flexion, and a weak or broken prosthetic foot keel. Pistoning of the limb in a socket increases for vertical displacement, but has no effect on its horizontal displacement.

What is the primary advantage of a body powered upper limb prosthesis compared to a myoelectric prosthesis? A.Greater sensory feedback B.Moderate or no harnessing C.Less body movement to operate D.Enhanced cosmesis

A. Greater sensory feedback 80.29% The advantages of body powered upper limb prostheses include the following factors: moderate cost, most durability, highest sensory feedback, and a variety of prehensors available for various activities. Their disadvantages are that they require the most body movement to operate, have the most harnessing and require increased energy expenditure to use. Myoelectric and/or switch controlled upper limb prostheses have the following advantages: they require moderate to no harnessing, require fewer body movements to operate, have moderate cosmesis, provide more function in proximal areas and, in some cases, provide a stronger grasp. Battery powered prostheses are the heaviest and most expensive prostheses. They also require the most maintenance, provide limited sensory feedback and require extended therapy time.

What is the primary goal of treatment with orthotic bracing for scoliosis from neuromuscular disease? A.Improve sitting posture in wheelchair B.Arrest spinal curve progression C.Improve respiratory function D.Decrease falls in ambulatory patients

A. Improve sitting posture in wheelchair 28.86% Scoliosis in neuromuscular disease is very common and can begin early and progress quickly. Neuromuscular curve progression is rarely slowed by bracing. Orthoses may be beneficial because they can stabilize a weak trunk, and improve sitting posture in those using wheelchairs. Bracing may cause instability for ambulatory patients however, increasing the risk for falls. Rigid spinal bracing has a negative effect on vital capacity.

Prescribing power mobility in young children has been shown to: A.Increase receptive language level B.Decrease social functional skills C.Increase level of caregiver assistance D.Negatively impact self-care abilities

A. Increase receptive language level 58.86% Children, along with their families and therapists, may choose between different mobility options depending on the activity or the environment. For example, many children may use floor mobility at home, may use a walker at school, but need a wheeled mobility device outdoors or in the community. Medicaid typically covers wheeled mobility for community/school integration in children.In children who are typically developing, the ability to move independently has been shown to influence self-awareness, emotional attachment, spatial orientation, fear of heights and visual/vestibular integration as well as personality traits such as motivation and initiation. Children who have restricted mobility tend to have passive, dependent behavior and this can have long lasting cognitive, emotional, and social consequences. When children use great effort to move short distances, they will not be able to engage in play or have the same psycho-social experiences as their peers. For these reasons, therapists have begun to emphasize meaningful participation rather than exclusively focusing on development of normal movement patterns. No longer is power mobility only considered for older children, as a last resort, once all other forms of mobility had been found to be ineffective.

What is the function of the anterior pin in an ankle-foot orthosis (AFO) with a dual-channel ankle joint? A.Limits dorsiflexion B.Assists plantarflexion C.Corrects eversion D.Promotes inversion

A. Limits dorsiflexion 91.14% An anterior stop is used to substitute for the function of the gastrocnemius-soleus complex. It limits dorsiflexion based on the size of the pin (a longer pin permits LESS movement). Because of its effect on the knee, it is used in conditions of weak calf muscles or weak quadriceps. The anterior stop assists with push-off and assists the knee joint into extension.

Contralateral axillary and neck pain in a patient with a short transhumeral amputation is the result of the harness: A.Resting on or superior to the C7 spinous process B.Having a loose fit C.Limiting the use of the non-amputated extremity D.Having too large an axillary loop

A. Resting on or superior to the C7 spinous process 41.71% At midhumeral and higher levels of transhumeral amputation it is important that the harness be fitted as intimately as possible. Since a snug harness fit requires a relatively small axilla loop, the loop may tend to cause axillary discomfort on the non-amputated side. This discomfort is due, primarily, to vertical compression of the pectoral, teres major, and latissimus dorsi tendons by the axilla loop during strenuous prosthetic usage. If the posterior intersection of the harness is on or superior to the spinous process of C7, the amputee is uncomfortable, and the work efficiency of the entire harness and control system is diminished. Option D, a large axillary loop will not cause the vertical compression of the pectoral, latissimus and teres major muscles.

Which of the following accurately describes a Lisfranc amputation? A.Occurs between the tarsal and metatarsal bones B.Plantar flexion contractures are a common complication C.Requires a "stovepipe" design prosthetic socket D.Occurs more proximal than a Chopart amputation

A.Occurs between the tarsal and metatarsal bones 89.43% A Lisfranc partial foot amputation occurs in the midfoot, between the tarsal and metatarsals, essentially a disarticulation of all metatarsals. The length of the foot that remains is insufficient to wear a normal shoe alone, but a normal shoe can be worn with an appropriate AFO or full-length shoe insert with distal padding. Plantarflexion contractures occur after Chopart amputations from unopposed plantarflexion in view of the loss of dorsiflexor insertions. A stovepipe socket is a design associated with Syme's amputation. A Lisfranc amputation is more distal than a Chopart amputation.

What is the primary advantage of a 4-point crutch gait over a 2-point crutch gait? A.Stablity B.Speed C.Weight-bearing relief D.Efficiency of gait

A.Stablity 88% The 4-point crutch gait has stability as its primary advantage. At least 3 points are always in contact with the ground. It is more difficult to learn than the other gait patterns and is a relatively slow form of ambulation. The 3-point crutch gait is used by patients with lower limb fractures, amputations, or toe-touch weight-bearing. The 4-point gait pattern enables the crutch user to eliminate all the weight-bearing on the affected lower limb. The 2-point crutch gait is much faster than the 4-point gait and yet still provides some weight-bearing relief to both lower limbs

Spinal orthotic prescription for adolescent idiopathic scoliosis should be considered once the Cobb angle reaches: A.10o B.25o C.50o D.75o

B. 25o 87.14% Spinal orthotic prescription for adolescent idiopathic scoliosis should be initiated once the Cobb angle reaches 25o. Scoliotic curves less than 25o can be adequately managed with physical therapy. Curves greater than 45-50o generally are referred for surgical correction to prevent before cardiopulmonary complications.

In children, which of the following is an advantage of a through-joint disarticulation compared to a transection amputation? A.Reduced rotational control in the prosthesis B.Absence of terminal overgrowth C.Lower incidence of phantom pain D.Reduced epiphyseal growth

B. Absence of terminal overgrowth 75.43% erminal overgrowth is avoided in through-joint disarticulation. The most common surgical complication among traumatic juvenile amputees is terminal osseous overgrowth of the transected bone. In below-knee amputations overgrowth involves the fibula more often than the tibia. The phenomenon is best explained by high osteogenic activity of the child's periosteum-perhaps further stimulated by weight bearing within the prosthesis-resulting in a cartilaginous spike that slowly ossifies.With regards to phantom pain there is no difference between a through-joint disarticulation versus a transection. Rotational control in the prosthesis is supplemented in through-joint disarticulation. Epiphyseal growth is preserved in through-joint disarticulation.

Which of the following adjustments would correct the lateral whip observed in a transfemoral amputee as swing phase begins? A.Internally rotating the knee bolt B.Externally rotating the knee bolt C.Tightening the suspension socket D.Increasing the length of the prosthesis

B. Externally rotating the knee bolt 39.43% In a lateral whip the heel of the prosthetic foot moves in a lateral arc as swing phase begins. This is often caused by excessive internal rotation of the knee bolt, thus externally rotating the knee bolt should correct this gait deviation. Option A is incorrect as internally rotating the knee bolt will worsen the lateral whip. Option C is incorrect because making a too tight suspension socket increases the pressure from contracting muscle bellies which causes the prosthesis to rotate around its long axis worsening the whip. Option D is incorrect since a long prosthesis causes vaulting and circumduction gait deviations.

Which wheelchair would be most appropriate for a 50-year-old man who had a stroke with right hemiparesis? A.Power wheelchair with tilt-in-space system B.Manual wheelchair with lower seat height C.Manual wheelchair with fixed leg rests D.Power wheelchair with a headrest

B. Manual wheelchair with lower seat height 56% Patients with hemiplegia are often able to use their "good" leg to help propel the chair, but the seat height in a regular chair is too high for their legs to reach the floor. Hemi-height chairs are made lower to the ground and allow the user to propel the chair with the unaffected arm and leg. Fixed leg rests would be inappropriate for individuals propelling wheelchairs with their lower limbs. Tilt-in-space systems (entire seat and back are tilted posteriorly as a single unit) prevent shear stress during movement and help provide pressure relief. Headrests are indicated in patients with poor head control and for transportation in vehicles.

A 37-year-old male with Becker Muscular Dystrophy presents for a bracing evaluation. He is noted to have full passive range of motion in all lower extremity joints. Manual muscle testing shows 4/5 initial strength in hip flexors/extensors and knee flexors; 3/5 knee extensors, and flaccid dorsiflexors. The patient ambulates without assistive device for 20 feet with a hyperextended trunk, reciprocal gait pattern, and increased step height. Initial contact occurs through bilateral forefeet, with moderately severe bilateral knee hyperextension at midstance. Which bilateral AFO design will minimize weight, maximize compliance and prevent genu recurvatum? A.Carbon fiber ground force reaction spiral AFOs B.Molded articulated thermoplastic AFO with a plantarflexion stop set in slight dorsiflexion C.Solid thermoplastic AFO with anterior malleolar trim lines aligned in dorsiflexion D.Posterior leaf spring thermoplastic AFO aligned in a neutral ankle position

B. Molded articulated thermoplastic AFO with a plantarflexion stop set in slight dorsiflexion 45.14% Although a knee-ankle-foot orthotic would be the ideal choice, most patients with moderate to severe lower extremity weakness find them too heavy, and contribute to overall fatigue. Remembering closed chain kinetics, knee extension will be encouraged by plantarflexion of the ankle, and discouraged by dorsiflexion. The flexibility of a posterior Leaf Spring thermoplastic AFO or spiral AFO, though lightweight and assisting with foot drop, will not prevent this patient's knee hyperextension (genu recurvatum). A solid thermoplastic with anterior malleolar trim lines aligned in dorsiflexion will inhibit the knee hyperextension by promoting knee flexion. If too much dorsiflexion is permitted, his knee may buckle due to knee extensor weakness. Additionally, adjustments in ankle alignment will be difficult to achieve given the solid nature of this brace.

Which of the following would typically be found in the transfemoral prosthesis of a 7-month-old amputee? A.Multiaxial foot B.No knee component C.Socket in adduction D.Mechanical locking suspension

B. No knee component 80.29% Pediatric amputees are prescribed a prosthesis when they are at least 6 months old, and are starting to pull themselves to stand (fit to stand), in keeping with the timeline for developmental milestones. For a child learning their initial balance and ambulation, a simple and stable prosthesis is best. Progressing proximally to distally, the transfemoral prosthesis would have a solid ankle foot and no knee joint, since children cannot control the movement in an articulated knee until the age of three years, and an articulated foot will make balance difficult to learn and increase fall risk. The transfemoral socket is placed in abduction to match the increased hip abduction and external rotation found in children of this age. A total elastic suspension (TES) belt is the simplest for parents to learn, and is more easily adjustable as the child grows, and allows for (relatively) greater ease during diaper changes.

A 15-year-old patient diagnosed with Ewing sarcoma of the right tibia underwent right knee disarticulation 6 months ago. The patient reports continued discomfort in the area of the now absent right foot. Which of the following is the best description for this condition? A.Phantom limb sensation B.Phantom limb pain C.Residual limb disturbance D.Peripheral neuropathy

B. Phantom limb pain 83.43% Phantom limb sensation involves the perception of the presence of the missing limb, whereas phantom limb pain is the perception of pain in the missing limb. Residual limb pain refers to pain involving the residual limb site of the amputated limb; residual limb disturbance is not a medical term. Peripheral neuropathy may occur in an intact limb, not in an absent limb.

What is the MOST important biomechanical factor for decreasing the vertical loading of the lumbar spine using a TLSO or LSO? A.Application of a three-point pressure system for vertical stabilization B.Reinforce core musculature to distract vertebral bodies C.Pressure over the bony prominences D.Full immobilization of the thoracolumbar spine

B. Reinforce core musculature to distract vertebral bodies 44.86% Abdominal compression increases intracavitary pressure, which acts to unload the spine and its disks by transmitting load onto the soft tissues of the trunk. The application of a 3-point pressure system typically aims to restrict triplanar motion (flexion/extension/lateral flexion and trunk rotation). Pressure over the bony prominences provides a kinesthetic reminder to maintain or correct posture. No spine orthosis achieves complete immobilization of the spine.

Which of the following would typically be specified in a shoe prescription for a patient with a Charcot foot? A.Lace stays sown to the base of the throat (Balmoral throat) B.Rocker-bottom sole C.Laced closure across the throat D.Flexible heel counter

B. Rocker-bottom sole 76.29% The purpose of custom shoe prescription in someone with a Charcot foot is to minimize the forces the foot sees during standing/ambulatory activity. When entering the shoe, a large, wide throat assists in reducing trauma to the forefoot and heel by shearing forces. This can be done by prescribing that the shoe has a Blucher opening, where the bottom of the lace stays are not sewn together across the base of the throat (as is the case with a Balmoral opening). Using a Velcro strap in place of lacing across the throat reduced the static pressure the upper of the shoe places on the dorsal surface of the foot. A high and wide toe box reduces pressure around the toes and metatarsal heads (particularly #1 & #5), while a firm heel counter captures the heel to reduce movement of the foot within the shoe, and aids in controlling the shoe during activity. A custom insert to further relieve static pressure along the plantar surface of the foot and support the longitudinal and mediolateral arches can reduce further orthopedic injury. Finally, incorporating a rocker bottom into the rubber sole of the shoe will significantly reduce the dynamic pressure experienced by the foot during stance phase by minimizing the plantar area in contact with the ground at any one time.

Which of the following is a recommended static alignment for an uncomplicated transtibial amputee with no significant knee contracture? A.Socket positioned in 5° of abduction B.Socket positioned in 5° to 10° of anterior tilt (flexion) C.Patellar tendon bar positioned 0.5 inch above the tibial tubercle D.Posterior brim of the socket positioned 1 inch above the patellar tendon bar

B. Socket positioned in 5° to 10° of anterior tilt (flexion) 55.71% The socket is prepositioned in 5° of adduction and 5° to 10° of anterior tilt. The anterior tilt allows loading of the soft tissues of the anterior surface of the residual limb. The foot is slightly inset relative to the socket. The patella tendon bar is located halfway between the tibial tubercle and the distal end of the patella. The posterior brim of the socket should end about an inch below the patella tendon bar, with relief made for the hamstring tendons.

The function of a wrist cock-up splint is to: A.Gradually lengthen soft tissue structures that limit MCP joint flexion B.Stabilize the wrist in extension to increase the mechanical advantage for grasp C.Preserve balance between extrinsic and intrinsic musculature when the hand is at rest D.Provide a stable post against which the index finger can pinch

B. Stabilize the wrist in extension to increase the mechanical advantage for grasp 70.86% Wrist cock-up splints support or immobilize the wrist in extension. They maintain full MCP flexion and CMC motion of the thumb increasing the mechanical advantage for grasp. Option A describes a dynamic MCP extension splint. Option C describes a resting hand splint and option D describes a thumb spica splint.

Which of the following methods of controlling a myoelectric hook on a transradial prosthesis is the easiest to learn to operate functionally? A.Two-site/two-function with the electrodes placed over the flexors/extensors of the arm B.Two-site/two-function with the electrodes placed over the flexors/extensors of the forearm C.One-site/one-function with the electrode placed over the flexors of the arm D.One-site/one-function with the electrode placed over the flexors of the forearm

B. Two-site/two-function with the electrodes placed over the flexors/extensors of the forearm 37.71% There are three ways to control a myoelectric terminal device in an upper extremity prosthesis. One-site/two-function controls are typically difficult to control as each function is generated through different levels of muscular contraction for operation. For example, strong contraction of the residual flexor digitorum superficialis may close the terminal device, while a weaker contraction will open the device. A two-site/two-function control system can potentially utilize the appropriate physiologic muscles to control corresponding functional activity of the terminal device. Placing the voluntary opening electrode over the forearm extensors and the voluntary closing electrode over the forearm flexors will result in natural functional movement of the terminal device. Using the two-site/two-function control system with the arm flexor and extensor muscles of the residual limb would be more difficult to learn. This requires the patient to learn to isolate a portion of each muscle for device control, without flexing or extending the elbow- the normal function of the muscle groups.

The patellar tendon bearing (PTB) socket for a transtibial amputee is designed: A.To bear weight on the lateral tibial flare B.With alignment in 5° - 8° of anterior flexion C.For distal weight bearing D.With the posterior wall enclosing the hamstring tendons

B. With alignment in 5° - 8° of anterior flexion 52.86% The socket is aligned in approximately 5° - 8° of flexion to increase initial tension on the quadriceps tendon (discouraging knee hyperextension) and enhance weight bearing to the anterior aspect of the residual limb. The PTB socket is designed to accept weight at the patellar tendon, medial flare of the anterior tibia, lateral aspect of residual limb, pretibial muscle mass between the tibial crest and fibula and popliteal fossa. The posterior wall should provide relief for the hamstring tendons.

At what developmental stage should a child with congenital transverse radial limb deficiency be fitted for an initial prosthesis? A.At the time of starting kindergarten B.As soon as possible after birth C.At the time of first sitting independently D.At the time of initially walking

C. At the time of first sitting independently 89.43% Children with unilateral transverse radial limb deficiency should be "fit to sit," meaning fitted by 6 months of age with an initial prosthesis that has a passive terminal device.

The primary stabilizing effect of the flexible lumbosacral orthosis is its ability to: A.Restrict spinal extension B.Prevent atrophy of trunk muscles C.Elevate intra-abdominal pressure D.Diminish inhibitory feedback

C. Elevate intra-abdominal pressure 60.57% Although they do not effectively restrict motion to a significant degree, flexible lumbosacral orthoses elevate intra-abdominal pressure, thereby unloading the spine and supporting structures. This action also provides inhibitory kinesthetic feedback and warmth. Long-term use of binders and other flexible lumbosacral orthoses may, unfortunately, result in atrophy of trunk muscles.

Increasing the camber of a wheelchair will result in which of the following: A.Decreased side-to-side stability B.Decreased hand protection C.Increased propulsion efficiency D.Decreased turning radius

C. Increased propulsion efficiency 46.29% The camber of a wheelchair is the vertical tilt of the rear (main) wheels, so that the wheel bottoms are farther apart than the top. A normal wheelchair camber ranges from 0-9o, while high performance/sport chairs may have more than 25o. Increasing camber widens the wheelbase, making the chair more stable side-to-side and forward, increases the propulsion arc of the hands (increased propulsion efficiency), increases maneuverability in turning (decreased turning radius), and affords greater protection to the hand during propulsion, as they are closer to the chair. Disadvantages of increasing wheelchair camber include decreased maneuverability and pivoting indoors and on ramps, increased difficulty passing through standard indoor doorways, greater wear on the tires/rims, and reduced rear stability during wheelies.

Which of the following is true when the rear wheel camber of manual wheelchair is increased (angling the rear wheels so the top is tilted inward and the bottom outward)? A.Increases user shoulder abduction B.Reduces user lateral stability C.Increases user access to the pushrim D.Reduces user need for antitipper

C. Increases user access to the pushrim 71.92% Increasing rear wheel camber changes the structure of the wheelchair, which increases the lateral base for increased lateral stability. The superior aspect of the wheels is narrower, which allows the user increased access to the pushrim and reduces need for reduced shoulder abduction. Changing the rear wheel camber does not have an impact on the anterolateral stability that would impact the need for antitippers.

In patients with knee arthritis affecting mostly the medial compartment, which shoe insert will most effectively reduce the knee adduction moment? A.Carbon fiber plate B.Medial buttress C.Lateral heel wedge D.Accommodative

C. Lateral heel wedge 73.71% A lateral heel wedge can reduce the adduction moment at the knee and potentially reduce loading of the medial knee compartment. This may help reduce pain and improve function in some patients with knee arthritis.

Which of the following prosthetic knees facilitates flexion while weight bearing during the pre-swing phase (terminal stance) of the gait cycle? A.Single axis B.Stance-phase control C.Polycentric D.Manual locking

C. Polycentric 43.43% Many polycentric knees are designed so that the center of rotation moves anteriorly very rapidly during the first few degrees of knee flexion, quickly passing in front of the floor reaction line and facilitating the swing phase. Because the polycentric knee can be flexed under weight-bearing during the terminal stance, when properly dynamically aligned it can offer both excellent stance stability and ease of swing-phase flexion. All polycentric knees shorten mechanically to a slight degree during flexion, adding additional toe clearance during midswing.

Which characteristic of a prosthesis promotes knee stability during the gait cycle of a person with transfemoral amputation? A.Knee component placed anterior to the socket B.Hard heel in the prosthetic foot C.Polycentric 4-bar linkage prosthetic knee D.Anterior position of the shank on the prosthetic foot

C. Polycentric 4-bar linkage prosthetic knee 44.57% Flexion moment at the hip, a rigid heel in the solid ankle cushion heel (SACH) foot, and the anterior position of the shank all shift the ground reaction force behind the knee joint to produce a knee flexion moment. The 4-bar linkage with instantaneous center of rotation and the posterior location of instant center in extension creates knee stability, especially at heel strike.

The primary advantage of an ischial containment socket over a quadrilateral socket in a transfemoral amputee is: A.A narrower anterior-posterior dimension that contains the pubic ramus and ischial tuberosity B.A flat posterior shelf, ischial seat, which provides a primary weight bearing surface for the ischium and gluteal muscles C.Promotion of femoral adduction by distributing the pressure through the socket along the shaft of the femur D.Allowance of the gluteus medius to contract and force the femur into the distal-lateral wall of the socket

C. Promotion of femoral adduction by distributing the pressure through the socket along the shaft of the femur 28.57% An ischial containment socket is designed to stabilize the socket on the residual limb and to control socket rotation by containing the ischial tuberosity and the pubic ramus within the contours of the socket with a snug medio-lateral dimension. This socket has a sub-trochanteric contour that holds the femur in adduction and distributes the pressure through the socket along the shaft of the femur. Option A is incorrect because its anterior-posterior dimension is wider than the quadrilateral socket. Options B &D describe the quadrilateral socket.

The Philadelphia collar or similar hard cervical orthosis requires a thoracic extension to: A.Support the weight of the head in the sagittal plane B.Provide complete control in all 3 planes of motion C.Provide increased stabilization for cervicothoracic injuries D.Control lateral bending and axial rotation at C2-3 and C3-4

C. Provide increased stabilization for cervicothoracic injuries 60.86% C5-C6 are the levels of greatest flexion and extension in the cervical spine; addition of a thoracic extension to either a Philadelphia, Aspen, or Miami J collars increases immobilization in both flexion and extension. Option A describes a Philadelphia collar without the thoracic extension. Option B describes the control provided by a Halo cervical orthosis. Option D describes the motions that reinforced cervical collars cannot control.

A 28-year-old patient with a transradial amputation due to trauma presents two days after initial fitting of his prosthesis with complaints of discomfort. Your exam reveals that the discomfort arises over a bony prominence of the distal radius. Your initial recommendation is to: A.Add padding to the inner wall B.Line the inner wall with silicone C.Reshape the socket's inner wall D.Replace the socket

C. Reshape the socket's inner wall 55.14% A poorly fitting upper limb prosthetic socket can cause local irritation or discomfort. Bony prominences such as the radial and ulnar styloid processes and the humeral condyles are particularly vulnerable. Skillful reshaping of the socket's inner wall usually provides relief. Socket modification must redistribute pressure while maintaining a secure fit that can resist slippage and rotary forces. Adding padding or other materials in the area of irritation is not usually indicated, because the padding creates additional pressure. Lining the socket with silicone can reduce friction if shear is the culprit. If the prosthetist cannot relieve these areas by grinding or reshaping the socket, socket replacement is indicated.

The grip height of a rolling or standard walker: A.Should permit full weight bearing through the arms B.Should allow for at least 40o elbow flexion when the patient is using it C.Should be about even with the ulnar styloid/greater trochanter of the hip D.May vary depending on the underlying condition requiring its use

C. Should be about even with the ulnar styloid/greater trochanter of the hip 72% When properly fit, the height of the grips of a walker or cane should be near the level of the greater trochanter of the hip; this permits a 20o flexion in the elbow. This also corresponds to the position of the ulnar styloid with the arms in a comfortable position. A rolling or standard walker, in use for normal ambulation, is not meant to permit full weight bearing, but rather improve balance by providing a larger base of support. The proper height of an assistive ambulatory device does not change based upon its intended use.

What is the primary advantage of a soft insert fitted into the socket of a transtibial prosthesis? A.Perspiration resistant B.Easy to keep clean C.Skin protection D.Very durable

C. Skin protection 91.14% Soft inserts are fabricated to fit inside the socket. They are recommended for patients with thin, sensitive, or scarred skin, or peripheral vascular disease (PVD). They are easily modified. Hard sockets also have their advantages. They are perspiration resistant, less bulky than sockets fitted with a soft insert, easy to keep clean, and durable. Further, reliefs or modifications can be located with precision in the hard socket.

What is the minimal number of points of contact that an orthosis must have in order to exert rotational control? A. 1 B. 2 C. 3 D. 4

C. Three 78.57% Rotational control forces or moments across a joint are not effective unless there are at least 3 points of contact between the device and the limb segment.

The most effective nonsurgical treatment for de Quervain's tenosynovitis is: A.Relative rest and anti-inflammatories B.Splinting and ice packs 4 times a day C.Corticosteroid injection and splinting D.Corticosteroid injection alone

D. Corticosteroid injection alone 20.57% Local corticosteroid injection is proven effective as a treatment for de Quervain's tenosynovitis, both with and without splinting. Injection alone produced an 83% cure rate, with injection plus splinting producing a 61% cure rate. Splinting alone produced a 14% cure rate, and rest and anti-inflammatories were of no benefit.

Which of the following is true regarding the pylon of a lower extremity prosthesis? A.Exoskeletal is less durable B.Endoskeletal tends to require less maintenance C.Exoskeletal is easily adjusted after fabrication D.Endoskeletal tends to weigh less

D. Endoskeletal tends to weigh less 44% Exoskeletal prostheses are more rugged, require less maintenance, cannot be adjusted for alignment after fabrication, and can accommodate only a restricted number of foot and knee units. Furthermore, these prostheses tend to weigh more than the equivalent endoskeletal prostheses. For these reasons, exoskeletal prostheses are prescribed less often than endoskeletal prostheses. Endoskeletal prostheses are modular in design, allowing relative ease of adjustment of alignment and replacement of parts. They are also easier to suspend by virtue of their relatively lighter weight.

When looking at spinal orthoses effects on normal cervical motions from the occiput to the first thoracic vertebra, which device limits the most in all areas of flexion, extension, lateral side bending and rotation? A.Philadelphia collar B.Soft collar C.Four poster brace D.Halo device

D. Halo device 96.57% The Halo device limits the most movement in all areas, followed by the four-poster brace, and then Philadelphia collar. The soft collar allows for the most movement.

In an individual with a transfemoral amputation, which patient characteristic would most lead you to consider prescribing a weight-activated stance-control knee? A.Cognitive deficits B.Contralateral weak limb C.Unlimited ambulation D.Requires a preparatory prosthesis

D. Requires a preparatory prosthesis 18.57% Weight-activated stance-controlled knees are often used for individuals with a transfemoral amputation. They are especially useful as a preparatory prosthesis, because their simplicity and safety help new amputees learn to walk with a prosthesis. To flex the knee, the amputee must shift weight onto the opposite leg, which requires the opposite limb to accept increased weight. Additionally, the amputee must have the cognitive ability to learn to weight shift. The requirement to shift weight off of the prosthesis to allow knee flexion presents few problems at slow cadences, but if the amputee attempts to walk at a more normal speed, the gait pattern is disrupted by the premature weight shift. Because it is impossible to voluntarily bend the knees and control the direction of a fall when using bilateral friction knees, for a bilateral amputee, a stance-phase knee is best used only on one side, if at all.

Which of the following is a risk factor associated with increased incidence of phantom pain? A.Younger age B.Upper extremity amputation C.Early prosthesis fitting D.Short residual limb

D. Short residual limb 59.14%

What is the primary disadvantage of moving the rear axle of a wheelchair forward? A.Ascending curbs becomes more difficult B.It takes more muscle effort to propel the wheelchair C.More strokes are required to propel the wheelchair D.Ascending a ramp becomes more difficult

D.Ascending a ramp becomes more difficult 53.14% Moving a wheelchair's rear axle forward enables the user to propel the chair with less muscle effort and fewer strokes. Because the modification causes more weight to be centered over the rear wheels, it is easier to pop a wheelie, negotiate obstacles and ascend or descend curbs. However, moving the axle forward can also make the wheelchair more likely to tip backwards thus making it more difficult to propel the chair up a ramp.

In a patient with a Syme's residual limb, the following area would be considered non-pressure tolerant: A.Anterior tibialis B.Medial tibial flair C.Mid patella tendon D.Distal bony prominence

D.Distal bony prominence 69.43% The bony prominence around the distal expansion is considered a pressure sensitive area in a Syme disarticulation. Pain with or without associated skin breakdown over this area is a common problem in Syme residual limb. Options A, B & C are common primary tissues for weight bearing support in a socket design.

How are mobility devices paid for through Medicare? A.The patient must make a 50% down payment, with the rest covered by Medicare upon delivery of the device. B.Medicare part A pays 80% of the allowed purchase price and Medicare part B pays the remaining 20%. C.Medicare will pay for purchase but not rental of mobility devices. D.Medicare part B pays 80% of the allowed purchase price in one lump sum

D.Medicare part B pays 80% of the allowed purchase price in one lump sum 42.41% Medicare Part B pays 80% of the allowed purchase price in one lump sum payment if the patient chooses to purchase the device. The patient is required to pay 20% of the allowed purchase price. If the patient chooses to rent a wheelchair, Medicare part B will pay 80% of the allowed rental price for months 1 through 10 and the patient will pay 20% of the allowed rental charge.

How should the hand of a child with juvenile rheumatoid arthritis be positioned in splinting? A.Wrist in 0° extension, MCP joints in 25° of flexion, thumb in opposition B.Wrist in 0° extension, MCP joints in neutral, thumb in neutral position C.Wrist in 15° of extension, MCP joints in neutral, thumb in neutral position D.Wrist in 15° of extension, MCP joints in 25° of flexion, thumb in opposition

Wrist in 15° of extension, MCP joints in 25° of flexion, thumb in opposition 54.86% The correct position for splinting an involved hand in a child with juvenile rheumatoid arthritis is with the wrist in 15° of extension, the metacarpophalangeal joints in 25° of flexion, and the thumb in opposition. This position provides support for weakened structures and helps to reduce contractures.