the STARLING exam
157 The recommended orthosis for an adult hemiplegic with spastic gastrocnemius and soleus is:
AFO with plantarflexion stop
35 The muscles that boarder the anatomical "snuff box"
Extensor Pollicis Longus Extensor Pollicis Brevis ABductor Pollicis Longus
Extension at the MP joint is produced by:
Extensor digitorum communis
Which muscle most closely duplicates the function of the anterior tibialis?
Extensor hallucis longus
334 An orthosis having a pelvic band and twister cables may be used to :
Externally rotate lower limb
212 What orthosis would best treat Spondylolisthesis :
LSO ( Williams )
38 another name for a Knight orthosis is a
LSO sagittal/coronal control
300 Would you fit a tibial fracture brace on a patient with an open wound on the tibia.
NO, fracture bracing is contraindicated with open wounds
76 A pt is able to extend their knee against maximum resistance and passes the break test, what grade muscle does the pt have ?
NORMAL 5
250 The gelatinous center of the spinal disc is called the :
NUCLEUS PULPOSUS
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
The most commonly occurring curve pattern in idiopathic adolescent scoliosis is a:
Right thoracic, left lumbar
? Which body movement are typically used to power cable driven tenodesis orthosis
glenohumeral flexion and biscapular abduction
57 a Trendelenburg sign is caused by loss of the
gluteus medius
? all the following are possible causes to hyperpronation
tight achilles tendon posterior tibialis weakness forefoot varus
407 The RGO is not recommended for children with Duchenne's muscular dystrophy because :
these patients become progressively weaker .
The method used to find the baseline for corset measurements is:
(inferior costal margin to iliac crest) divided by two
**** NORTHWESTERN SPINAL EXAM ****
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**** NORTHWESTERN LOWER LIMB EXAM ****
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97 The correct location of the mechanical ankle joint is at the:
Distal border of the medial malleolus
38 when aligning the bail component of a cam lock knee joint for a KAFO the posterior aspect of the ball should be angled
Distally
293 Name 2 mechanical principles for treating heel spurs:
Distribute and reduce pressure in arch support UCB for hindfoot and forefoot control
140 Objectives of the treatment of Pes Cavus are:
Distribute weight over the entire foot Balance hindfoot-forefoot pressures reduce load on metatarsal heads
268 What type of ankle joint would you use to encourage PLANTARFLEXION ?
Do NOT need to encourage plantarflexion ; gravity helps with this unless patient has a tendency for knee buckling
391 A patient having a pathomechanical condition exhibiting weakness of the quadriceps, hip extensors, and ankle dorsiflexors would require what type of orthosis.
KAFO with offset knee joints and plantarflexion stops
111 Which muscle remains functional in a quadriplegic patient with a complete lesion below the C6 root?
Extensor Carpi Radialis Brevis
185 Which muscle extends the distal phalanx of the thumb?
Extensor Pollicis Longus
63 a posterior lean is most commonly seen with paralysis of which muscle group
Hip Extensors
288 Name 2 reasons why you might not use preTibial AFOs for a patient who walks with a crouched gait ?
Hip Flexion Contracture Lack of Ankle ROM Inability to donn
270 How do you determine if a patient requires locks on his KAFO versus free knee ?
Hip and/or Knee Extensor weakness
133 What is the best orthosis for a patient with a complete neurologic lesion just below T 12 ?
KAFO with double stop ankle joint Why?
106 The following can cause hip hiking
KAFO with knee locked in extension contralateral limb shortened knee ankylosis
265 What are the minimum clearances for ankle knee joints ?
KNEE: medial 1/4" or 6mm Lateral 1/8" or 3mm ANKLE: medial 1/4" or 6mm lateral 3/16" or 5mm
154 The gastrocnemius muscle produces what knee and ankle motions:
Knee Flexion and ankle Plantarflexion
161 High heeled shoes tend to increase
LORDOSIS
30 A patient with an inferior lumbar Myelomeningoccele may develop hip flexion contractures due to
Lack of hip extensors to act as antagonists Parental non-compliance with home stretching program
220 Spondylolisthesis is a condition best described as :
Lateral - Anterior migration of L5-S1 disc
59 Tennis elbow exhibits inflammation most commonly at what boney landmark?
Lateral Epicondyle
357 The grey matter of the spinal cord is found in the :
Lateral Horn Ventral Horn Dorsal Horn
10 Fro correction of GENU VALGUM, forces should be applied over the :
Lateral Thigh distal to the greater trochanter Lateral aspect of the foot Medial condyle of the femur
254 The erector spinae muscles are active as:
Lateral flexors of the spine Extensors of the spine
22 Unilateral contracture of the sternocleidomastoid that is indicative of torticollis would cause what clinical presentation?
Lateral head flexion to Ipsolateral side and rotation to the contralateral side
52 When fabricating an AFO to resist Genu Recurvatum, the orthotist should :
Maintain the ankle in DorsiFlexion
331 When fabricating an AFO to resist genu recurvattum the orthotist should :
Maintain the foot in DORSIFLEXION
36 in the WHO: Ratchet type tenodesis, the variable locking mechanism :
Maintains Prehension
39 When treating an adult patient with an anterior hip dislocation, it is important to:
Not allow hip to extend past 3o degrees of flexion
28 Why is a SOMI not effective in controlling cervical extension?
Occipital pad pivots in the sagittal plane Componentry is not rigid enough to stop extension
201 A guide in measuring the distance between posterior uprights on a LSO is the:
PARASPINAL muscles
338 What orthoses would be used for congenital hip dislocation:
PAVLIK Harness ILFELD orthosis Triple Diapers
99 It is important to place a calf band distal to the fibular head to avoid impingement on which nerve?
PERONEAL
66 The ACL (Anterior Cruciate Ligament) attaches the _____ aspect of the femur to the ______aspect of the tibia.
Posterior (femur) Anterior (Tibia)
310 Shortening the overall length of an AFO and using plantarflexion stop will serve to increase pressure at the :
Posterior Calf Band
253 C1 - C2 joint allows:
Rotation Flexion Extension
What structure assists the deltoid in glenohumeral abductions?
Rotator cuff
319 The Plantar Flexors are innervated by spinal level:
S 1
Having a patient perform a heel raise, screens what myotomal level
S1 having a patient plantarflex is a screening technique for S1 myotome. Often in the clinic a clinician will have a patient walk on their toes for S1 myotome screen and then walk on their heels for L4-5 screen
13 upon looking at the surface anatomy of the back, the spine of the scapula is at which approximate vertebral level ?
T 3
56 A COLLE's fracture is a fracture of the distal aspect of the ________ and the mechanism of injury is wrist ______ and _______.
RADIUS Extension , Radial Deviation
202 Lateral bending of the spine always includes what additional motion ?
ROTATION
262 A TLSO ( BOSTON ) is effective in controlling a curve as high as :
T 8
15 swan neck deformity causes the PIP joint to
hyperextend and the DIP joint to flex
? all of the following could be considered the fracture site for spondylolysis
isthmus, pars interarticularis, neural arch
1 A complete lesion of the femoral nerve as it leaves the lumbar plexus affects
knee extension
16 Secondary Lymphedema is caused by:
Radiation
54 For someone with weak or absent wrist extensors, the wrist can be positioned with a :
Ratchet type flexor hinge WHO Static positioning WHO External powered WHO
71 A pt demonstrating good hip strength, but Poor quadriceps and poor plantarflexors. What setting of a double action AFO would be the most appropriate treatment ?
anterior pins maintaining a few degrees of plantarflexion
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
True or false, when fabricating a williams flexion LSO for spondylolisthesis, the anterior corset panel should be fabricated out of an inelastic material
False, When fabricating a williams flexion LSO for spondylolisthesis, the anterior corset panel should be fabricated out of an elastic material so as not to limit sagittal plan flexion
select all that are found in scarpa's triangle (femoral triangle)
Femoral nerve, femoral artery, sartorius muscle inquinal lymph nodes are all found within the scarpa's triangle> it is also important to remember is sail: Sartorius, adductor longus, inquinal ligament
348 The anterior cruciate ligament attaches the :
Femur to the Tibia Anteriorly
An orthotic patient's wrist is positioned in ulnar deviation and flexion. You should try to reposition the patient's wrist
In 30 degrees of extension
341 The _____ are responsible for the majority of muscular activity in decelerating the limb at the end of swing.
HAMSTRINGS
60 Which of the following muscle groups are responsible for the majority of muscular activity in decelerating the limb at terminal swing?
HAMSTRINGS
375 All of the following are true of the diaphragm :
It is innervated by the phrenic nerve Its peripheral muscle fibers insert into a central tendon
HIV is present in blood, seaman, vaginal secretion, breast milk, amniotic fluid, cerebrospinal fluid, synovial fluid What is it NOT in?
HIV is not present in saliva, tears, blisters fluid, urine, facces, vomit, sweat
A hemiplegic patient presents with zero hip extensors, fair quadriceps, zero calf. Which of the following would you recommend?
HKAFO
168 The most appropriate device for a patient with a median and ulnar nerve laceration at the wrist is :
HO (short opponens with thumb post) HO (short opponens with MP stop)
For a median nerve injury at the wrist which is the most appropriate orthosis?
HO with thumb post
255 The position of the thoracic articular facets are most disadvantageously positioned to allow for :
HYPERextension
264 How do you determine band length :
Half circumference + 1 1/2" or 38mm
100 A dorsiflexion stop performs some of the functions of which muscle?
Hamstrings
31 Traumatic Spondylolisthesis of C2 is known as a _____. If it is unstable, it is best managed with a _______.
Hangman Fracture HALO
53 the greatest amount of dorsiflexion occurs during which part of stance
Heel Off
121 During which phase of locomotion is antero-rotary instability of the knee MOST evident?
Heel Strike
9 At which part of gait are the most number of muscles active?
Heel Strike
Maximum dorsiflexion occurs during which phase of gait?
Heel off
Gait cycle is described by the activity between
Heel strike on one side and the following heel strike on the same side
During which phase of gait are the hip extensors most active?
Heel strike to foot flat
93 A patient with a weak quadricep wearing a floor reaction orthosis will usually walk with a:
Heel-toe gait Flat foot gait
Abdominal muscles
Help increase intracavitary pressure Reduce loading on vertebral discs Decrease excessive lordosis
137 Pes Cavus is a condition in which the foot has a :
High Longitudinal Arch
41 the Coleman Lateral Block Test is used to assess mobility for which deformity
Hindfoot Varus
346 A posterior lean is most commonly seen in what type gait paralysis :
Hip Extensor weakness
A patient with Duchennes muscular dystrophy is seen to ambulate with increased lumbar lordosis secondary to which muscular weakness
Hip extensor. Individuals with duchennes muscular dystrophy often present with weakness of the hip extensors. By increasing lumbar lordosis the position of their center of mass is posterior to the hip joint which locks the hip against the Y-ligament allowing for stability in the sagittal plane.
405 Mechanically, the RGO creates :
Hip flexion via Contralateral Hip Extension
30 At the wrist, a WHO wrist driven flexor hinge orthosis functions to _____ motion in the coronal plan
Hold
23 What is true about the quadriceps femoris :
It is the primary extensor of the knee It inserts into the tibial tubersity it consists of four parts, only one of which acts across the hip joint
54 What is true statement about the Jewett style TLSO?
It stops Flexion and is free in extension
240 The MP extension stop should be placed :
Just Proximal to the PIP joints
39 The ideal placement of a MP extension stop is
Just proximal to the PIP joints
179 Which of the following is a birth injury to the Brachial Plexus?
KLUMPKE's palsy
134 A complete lesion of the femoral nerve at the level of the inguinal ligament would affect:
KNEE EXTENSION
Damage to the femoral nerve will result in weakness of what main muscle group.
Knee extensors The femoral nerve (L2, L3 and L4) innervates the quadriceps femoris muscle which serves to extend the knee. The hip extensors are innervated by the sciatic nerve. Hip abductors are innervated by the superior gluteal nerve. Ankle dorsiflexors are innervated by the tibial nerve
A patient is seen in clinic whom has been diagnosed with guillain-barre syndrome. The patient has weak knee extensors, knee flexors, and ankle plantarflexors, and ankle dorsiflexors. What muscle groups would you expect to regain strength first if the syndrome begins to remit.
Knee extensors Knee flexors .....will regain strength first as individuals recovering from guillian-barre regian motor function proximal to distal.
1 The TLSO; sagittal control is best suited to manage:
Kyphosis secondary to Osteoporosis
373 In an adult, the spinal cord terminates about the level of :
L 1
? In an adult the spinal cord terminates at about the level of
L1
45 hypokyphosis can be defined as having a sagittal curve magnitude in the rage of
0-20 degrees
244 The mobile segment of the transverse arch of the hand is formed by metacarpals :
1 - 4 - 5
? the mobile segments of the hand's transverse arch are metacarpals
1, 4, and 5
122 For an adult of average height, the knee joint in a KAFO should be located:
1.9 cm (3/4") proximal to the medial tibial plateau
36 during late stance phase of the gait cycle, the hip joint requires how much extension for normal function
10 degrees
12 What is the maximum acceptable malalignment of a tibial fracture that can be managed with an off the shelf fracture orthosis?
10 degrees of varus or valgus 20 degrees of anterior -posterior angulation
151 When a 120lb man is standing normally, how much weight is borne on his left first metatarsal head?
10 lbs
Normal cadence is about:
100-120 steps a minute
In an LSO what is the superior margin of the paraspinal bars?
10mm inferior angle of the scapula
11 what is the correct posterior superior trim line for a polymer TLSO ( not for scoliosis )
10mm inferior to the level of the spine of the scapula
6 the correct anterior pin placement for a HALO is ______ in the ______
10mm superior to the eyebrow, lateral 1/3 of the eyebrow
247 The second MP joint is ABducted by the
1st DORSAL Interosseous
5 A patient has suffered a radial nerve injury. Which component would you most likely add to your orthotic recommendation?
1st MP ABduction stop
When fabricating a rancho style HO (hand orthosis), what length would you terminate the thumb post at
1st digit mid finger nail bed. When fabricating a rancho style HO the thumb post is terminated at the 1st digit mid nail bed so as to avoid interference with prehensile activities
? the 2nd MP joint is abducted by the
1st dorsal interosseus
196 During human locomotion, how much does the center of gravity shift from side to side ?
2 "
245 The middle of the long finger has :
2 dorsal interossei and one radial lumbrical
263 How do you determine stirrup length :
2 times the height of the distal tip of the medial malleolus + width of heel + 1/4" or (6mm)
The range of motion at the ankle is:
20 degrees dorsiflexion, 50 degrees plantarflexion
During normal gait heel strike, the forward hip is how flexed?
25 degrees flexed
370 In fitting a Milwaukee CTLSO, the height of the neck ring is located _____in relation to the chin.
25 mm INFERIOR
22 In relation to the apex of the greater trochanter, where is the mechanical hip joint located?
25 mm proximal 12 mm Anterior
392 The medial proximal edge of the proximal thigh band on a standard metal KAFO should be positioned :
3 cm distal to the perineum
62 A pt presents with MORTON's Neuroma. Based on your knowledge of this pathology, the position of the met pad will most likely be proximal to the met head with the apex of the pad between the met heads # :
3 rd and 4 th
307 LEGG-CALVE-PERTHES' disease generally occurs in:
3 to 10 yo males and is a result of avascular necrosis of the femoral head
82 In picking up an object from a table what is the best position of the wrist?
30' Extension
40 when genu varum is present on a lower-limb schema, the mid sagittal line connects the perineum and the mark made
30mm medial to the knee ( ????? ANkle????)
61 A UniLateral pelvic band should be what percentage of the circumference ?
33 %
? in fitting milwaukee CTLSO, the height of the neck ring is located _____ to the mandible
36mm inferior
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)
A cycle of gait consists of
40% swing phase, 60% stance phase
A 240lbs female bears how much weight collectively through her right 2nd-5th MTP joints while standing evenly on both feet.
40lbs A 240lbs patient when standing evenly on both feet 120lbs on each foot. 50% goes through the calcaneus and 50% goes through the MTP joints. MTP's 2-5 receive 66.6% of the total weight on the forefoot. .666X60lbs=40lbs
172 an MP stop should stabilize the metacarpophalangeal joint in what degree of flexion ?
45 degree
251 The Lumbar spine consists of how many vertebrae
5
52 You fit a TLSO to a patient with idiopathic scoliosis. What is the minimum amount of correction that should be acceptable?
50 %
When a HALO application is finished all pins for an adult should be torqued to ______ and between 24-48 hours the pins should be______
6-8 inch pounds re-torqued When applying a HALO for an adult all pins should be torqued 6-8 inch pounds, and in the following 24-48hours should be re torqued to 6-8 inch pounds as the HALO may settle
In normal gait, maximum knee flexion reaches approximately
60 to 65 degrees knee flexion durning swing phase in normal gait
The stance phase of gait makes up what percent of the gait cycle durning ordinary swelling speeds
60% Stance phase makes of 60% oft the gait cycle while swing phase makes up the other 40%
35 if a patient is wearing a KAFO with bilateral ring locks engaged, the clearance at the knee joint should be
6mm medially and 3mm laterally
52 A patient suffered a mid shaft humeral fracture in an MVA. When are you most likely to initiate orthotic management of this fracture ?
7 days
? an individual with neuromuscular scoliosis will most likely exhibit cardiopulmonary compromise when the curve reaches what magnitude
70 Degrees
177 How many pairs of nerve roots arise from the cervical area of the spinal cord ?
8
101 The measured M/L at the ankle is 8.3cm (3.25"). what is the inside diameter of the mechanical ankle joint when laying out an AFO?
9.4 cm (3 11/16")
78 when fitting the orthosis for CDH which of the following fitting parameters is best indicated for this infant
90 degree hip flexion and 45 degree hip abduction
26 if the oblique diameter of the anatomical malleoli is 83mm, the inside diameter of the mechanical ankle joint is
94 mm
A swan neck deformity causes the PIP joint to:
Hyperextend and the DIP joint to flex
The soft tissue contracture of the hand which is likely to develop following paralysis of the ulnar and median nerves includes:
Hyperextension of the MP joints and Flexion of the IP joints of the 2nd, 3rd, 4th and 5th fingers
True or false, when designing a ground reaction AFO "GRAFO" foot plate length can be full or sulcus length
False GRAFO's tend to be fabricated with full foot plates so as to utilize a longer lever arm to resist knee instabilities throughout stance phase of gait
241 A dynamic IP extension assist with an MP stop should be used :
If patient has weakness of the lumbricals
105 the major flexor of the hip joint is the
Iliopsoas
291 Name 3 mechanical principles for treatment of CHARCOT joints :
Immobilize in total contact Minimal weight bearing Rocker Bottom
True or false. A child wearing a pavlic harness in treatment for congenital dislocation of the hips should have their hips oriented in flexion and adduction
False a child wearing a pavlic harness in treatment for congenital dislocation of the hips should have their hip oriented in flexion and abduction
363 The paraspinal muscles primarily consist of which of the 4 layers within the deep muscles of the back :
Longitudinal Group
360 The muscles that flex the neck are :
Longus Colli Rectus Capitis Lateralis Scalenes
362 The muscles make up the erector spinae group are:
Lonissimus Spinalis Iliocostolis
118 The measurements for a TLSO (anterior hyperextension orthosis) should be taken with the patient in what position?
Lying SUPINE
175 Articulation between the sternum and clavicle occurs at the :
MANUBRIUM
343 In the quadrilateral brim, the proximal self of the ____ should be parallel with the floor.
MEDIAL WALL
24 The most important sensory distribution in the hand when considering 3 pt palmar prehension is along the :
MEDIAN NERVE
217 Loss of the OPPONENS POLLICIS is the result of an injury to the :
MEDIAN nerve
33 The intrinsic muscles of the thenar eminence is mostly innervated by the :
MEDIAN nerve
260 A ________ orthosis is used to treat Kyphosis :
MILWAUKEE
171 The intrinsic muscles of the hand function to produce what actions at the metacarpophalangeal and interphalangeal joints?
MP joint FLEXION and IP joint EXTENSION
184 An orthosis to immobilize a fracture of the carpal navicular must include the:
MP joint of the thumb
the following 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
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. 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
94 What is a disadvantage of the round caliper shoe attachment?
Mechanical joint axis distal to anatomical axis
336 The Three points of pressure implemented with a SABOLICH trimline to correct a VARUS deformity of the ankle include pressure around the :
Medial aspect off calf Lateral aspect of ankle Medial aspect of foot
88 When measuring and fabricating a TLSO (Taylor orthosis), the superior end of the posterior uprights should terminate at the:
Medial border of the scapular spines
55 The 3 points of pressure implemented with a SABOLICH trimline to correct a VARUS deformity at the ankle include pressure around the medial aspect of the :
Medial calf Lateral Ankle Medial foot
147 The MAJOR weight bearing areas of a PTB orthosis are the patellar tendon and the :
Medial tibial Flare
Carpal Tunnel Syndrome results from compression of which nerve?
Median
169 ADduction and ABduction of the fingers occur at which joint :
MetacarpoPhalangeal
At what phase of gait is medial lateral stability of the knee most important?
Mid stance
74 the talocalcaneal or talocalcaneonavicular joint forms which joints
Midtarsal ( ??? subtalar ???)
329 The pelvic band on a HKAFO should be located :
Midway between the ILIAC CREST and the greater TROCHANTER of the femur
50 The pelvic band on a HKAFO should be located :
Midway between the iliac crest and greater trochanter of femur
295 What effect would posterior placement of knee joints have on a KAFO ?
Migrates Proximally Pressure on anterior calf cuff
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
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 andy potential dural punctures
327 You are asked to treat a patient with Genu Varum that cannot be corrected with moderate pressure. The orthosis should:
be fabricated to conform to the limb and prevent further deformity
47 What is the most likely mechanism of injury for a seatbelt fracture (CHANCE fracture)
flexion & distraction
22 a boutonniere deformity consists of PIP
flexion with DIP hyperextension
283 What implications do weak hip flexors have in your design of a KAFO ?
a lightweight design could encourage hip flexion at swing phase
? the nucleus pulposus of an intervertebral disc
absorbs shock and equalizes stress
37 for a typical right thoracic, left lumbar adolescent idiopathic scoliosis curve the superior aspect of the window should be ____ while the superior aspect of the axillary extension should be approximately at the level of ___
at least one rib superior to the apical rib, T5
298 How would you treat a stable, ten day old, distal 1/3 femoral fracture with acute signs of swelling and pain absent?
functional femoral fracture brace with free knee and ankle
? which test would be useless if the patient presents with bilateral CDH
galeazzi test
? which stage of menarche would be mast suitable for orthotic management
greater than six months pre-menarche
18 the proper location of the knee joint on a KAFO is
half the distance between the adductor tubercle and the medial tibial plateau
11 A dynamic IP extension assist with and MP extension stop should be used if a patient
has lumbrical weakness and has hyperextended MP's
In normal ambulation, the quadriceps are the most active At mid stance just after:
heel strike
4 a cycle of gait may be defined as all activity that occurs between
heel strike on one limb and subsequent heel strike on the same limb
The cane can substitute for which of the following muscle weaknesses
hip extensors and hip abductors
? two adjacent vertebrae and their intervening tissue are known as a
motion segment
? which one is not considered neuromuscular scoliosis
neurofibromatosis
68 A favorite outcome in orthotic management of a tibial fracture is:
no more than 5 Degrees of angulation in any plane
34 In dupuytren's contracture, the ______ is most often involved
palmar aponeurosis
19 What does it mean when there is a grade II pedicle rotation
pedicle is rotated 2/3 toward midline
43 the schema for a conventional KAFO should indicate the knee and ankle joint axes to be
perpendicular to the mid sagittal line
A patient is seen in clinic with flaccid ankle plantarflexors and dorsiflexors. Choose appropriate double action joint configurations
pins in the anterior and posterior channels or springs in the posterior channels and pins in the anterior channels both these configurations will provide anterior and posterior support for flaccid ankle plantarflexors and dorsiflexors
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
344 In the treatment of burns you must :
Minimize hypertrophic scarring Contain edema Prevent flexion contracturess
110 A soft cervical collar is most effective in:
Minimizing forward flexion
8 In the WHO wrist driven, the ratchet box does what?
Modulates the amount of wrist extension to achieve prehension
Sarmiento style fracture orthoses utilize which biomechanical principles for fracture management. Choose all that apply:
Multiple 3-point pressure systems total contact long level arms hydrostatic tissue loading Because the orthoses are typically bi-valved hydrostatic loading can be maintained as swelling or muscular atrophy occurs by simple modifications to tighten the orthosis versus a fiberglass/plaster cast which has a fixed volume
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
? where should the metatarsal pad be located in relation to the metatarsal heads
Proximal
278 A patient's KAFO has free motion knee, but the mechanical joint is 1" distal to the anatomical joint. In flexion the resulting pressures will be :
Proximal posterior thigh Distal anterior thigh braces migrates proximally
13 The correct distal trimline of the opponens bar is :
Proximal to 1st MCP
170 A properly fitted C-bar terminates on the thumb just:
Proximal to the MP joint
141 Where should a metatarsal pad be located ?
Proximal to the met heads
The distal transverse arch of the foot is:
Proximal to the metatarsal heads
The opponens bar should be located
Proximal to the thumb MP joint
279 What is the advantage of an offset knee joint for treating recurvatum?
Puts the WEIGHT LINE ANTERIOR to the knee joint, making it unnecessary to lock the knee
14 Who would would most likely use a balanced forearm orthosis?
Quadriplegics with fair shoulder power
45 A WHO: wrist extension assist could be used for nerve damage at what level ?
Radial Nerve at Mid-Humeral Level
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. The radial nerve innervates the wrist extensors and injury will cause wrist drop. If the injury causes triceps weakness hen the clinician would conclude that the injured nerve occurred proximal to the triceps brachii muscles, injury within the radial groove the triceps usually is not completely paralyzed
403 The fundamental principle of the RGO is:
Reciprocating Hip motion is induced
33 Intra-abdominal pressure is used in spinal orthotics to:
Reduce AXIAL load on lumbar vertebrae/ intervertebral disc
152 What is the primary purpose of a PTBBB orthosis?
Reduce weight bearing through the tibia
102 What is a characteristic of an ankle valgus correction strap?
Reduces foot eversion
20 Metatarsal pads function to _____as well ass _____.
Relieve metatarsal heads Elevate the transverse arch
361 The intermediate muscle group of the back is primarily responsible for :
Respiratory function
206 Wearing a spinal orthosis may have what effect on the trunk muscles ?
Results in DISUSE atrophy
12 A 30 yo patient with a C1 fracture has been referred to you. It is 6 weeks post injury and the physician has deemed that the involved area is relatively stable and shows signs of callous formation with return, of neurological function. The orthosis of choice at this point would be:
Rigid Cervical Orthosis
Parkinson's diseases 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. Rigidity, bradykinesia known as slowed movement, tremors usually pull rolling tremors, and impaired postural reflexes are the classic symptoms of parkinson's disease. Radiculopathy is a peripheral nervous system dysfunction. Lhermitte's sign can be seen with upper motor neuron disorders such as MS but not PD
7 an adolescent female with idiopathic scoliosis presents in your facility with a prescription for orthotic management. Base on the prescription how is the patient most likely to present
Risser sign of 1+, cobb angle of 25 degrees
55 Which orthosis for idiopathic scoliosis, uses a dynamic strap attached to a pad to increase corrective forces ?
Rosenberger
142 Which shoe modification is designed to simulate dorsiflexion?
SACH heel
232 What is primarily a sensory nerve :
SAPHENOUS
237 A mobile base of support for the arm is the :
SCAPULA
91 Which nerve divides into the common peroneal and tibial nerves in the distal thigh?
SCIATIC
81 When presented with a 5 yo pediatric pt whoo has CP and Plantar Flexion Contractures. The best recommendation is :
SERIAL CASTING
23 You are assessing a patient at a rehab hospital for possible upper extremity management. The patient presents with a tight web space that the therapist says he/she will stretch. What component will you include in your recommendation?
Thumb ADduction Stop
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
44 tibialis posterior is innervated by which nerve
Tibial Nerve
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 build into the KAFO. If premature wear is notice in a KAFO ankle joint that is located at the proper height often times tibial torsion was not build into the othosis causing a lick of congruency between the anatomical and mechanical ankle joint
67 Muscles that assist in ankle dorsiflexion :
Tibialis Anterior Extensor Hallucis Longus Peroneus Tertius
200 A patient returns to you complaining that her LS corset is sliding up. Your initial recommendation should be to:
Tighten the straps distally to proximally
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
26 What is the most important biomechanical principle when managing a neuromuscular spine ?
Total Contact
In a right thoracic curve, the spinous processes rotate:
Towards the concavity
381 A lumbar pad for a CTLSO should be placed over the:
Transverse Processes of L2 / L3
Bunnell (cock-up) splints are frequently used for
Trauma
the radial nerve is injured within the radial groove. What muscle would not be paralyzed.
Triceps the triceps muscle is innervated by the radial nerve, but when injury occurs at the radial groove usually it is just weakness not paralyzed. All the muscles in the posterior compartment will be paralyzed leading to wrist drop
True or false, guillain-barre syndrome progresses in a ascending order
True Guillian-barre syndrome progresses in an ascending order "distal to proxi
True or false, when fabricating a KAFO the distal/posterior thigh band and the proximal/posterior calf band should be located equidistant from the knee axis
True When fabricating a KAFO the distal/posterior thigh band and the proximal/posterior calf band should be located equidistant from knee axis so as not to impede knee flexion and soft tissue impingement in the popliteal fossa
True or false, an RGO allows forward progression by harnessing energy from one hip extension and t
True by harnessing energy from one hip's extension and translating it into contralateral hip flexion and RGO can facilitate forward progression
True or false, the duration of double support varies inversely with the speed of walking and in running double support is absent
True in slow walking double support increase compared to the swing phase.
166 In a HO, which component holds the thumb in ABduction ?
C-bar
162 Volar surface is the same ass :
PALMAR surface
198 A CHARCOT joint results from :
Disruption of the sensory pathways to the joint
257 the TAYLOR spinal orthosis would be classified as a:
A/P TLSO
231 The normal hip reaches maximum extension during :
PUSH OFF
377 The motor neuron cell body is found in the :
ANTERIOR horn cell
120 The PRIMARY purpose of the axillary straps on a TLSO (Taylor) is to resist:
Thoracic extensionnnnnnn
The pad most commonly used in conjunction with a CTLSO is a:
Thoracic pad
41 In scoliosis an apical vertebra at T12 would indicate what kind of curve pattern
Thoracolumbar
29 solid stirrup length is determined by calculating the height to the
(Distal tip of medial malleolus to floor + sole thickness ) x 2 + heel width +6
315 Stirrup length is determined by calculating the height to the :
(Medial Malleolus + shoe thickness) x 2 + heel width
A knight taylor TLSO is classified as _______ where a taylor TLSO is classified as _____
AP, ML, control AP control A knight taylor is an AP, ML, control TLSO, while a taylor is an AP control TLSO
27 Name the most characteristic clinical sign of Left CVA, right-sided hemiplegia.
APHASIA
51 a burst fracture if the vertebral body is most likely associated with which mechanism of injury
AXIAL load
What is the best position for managing the chronically dislocating gleno-humeral joint?
Abducted and externally rotated
The first dorsal interosseous assist
Abducts the second digit to oppose the thumb
Injury to the tibial nerve on the right leg, would cause which gait deviation
Absent push off durning 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 will cause decrease push off durning gait along with shortened step length on the contralateral side. Foot drop would be seen with injury to common fibular nerve which innervates anterior tibialis
174 The most prominent and highest point on the shoulder girdle is the:
Acromion Process
146 Corrugations are incorporated in plastic orthotic designs to:
Add RIGIDITY
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 AFO's and canes. A lesion at the level of L2 would be a lower motor neuron lesion as it is a cauda equina injury. You would expect that the patient would have intact hip flexion, hip adduction, and knee extension. This patient would only need AFO's as bracing for the knee is not needed due to knee extension is still intact
313 A stirrup that hinges or rotates at the base of the sole instead of the ankle joint would cause :
Calf band migration during plantarflexion & dorsiflexion
87 A 56 yo CVA patient with left hemiparesis arrives in your office with an RX for a left PLS AFO. Upon gait analysis, you notice the patient has 15 degrees of knee hyperextension as well as a drop foot. You should.
Call the physician to suggest a solid ankle AFO
354 The bony matrix that is know as "trabeculae" is most prominently formed in :
Cancellous bone
In a fixed equinus deformity, which of the following shoe modifications is most likely to be used?
A heel elevation
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
17 What shoe modification is most likely used for a fixed equinus deformity?
A Heel Lift
16 A Flexible varus hindfoot might be corrected using
A Lateral Heel Wedge
195 Which of the following describes aponeurosis?
A Thin flattened tendon
256 SCHEUERMANN's disease typically produces :
A Thoracic Kyphosis
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 you coverage spanning 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
You are seeing a patient in acute rehab with a physical therapist. The patient has had a CVA. Upon examination you see foot drop durning gait, weak dorsiflexors grade 2, weak inversion and eversion grade 2, and increased tone in her plantar flexors. What would be and appropriate orthotic devise.
A solid ankle AFO. A solid ankle AFO is indicated for a patient with drop who is also has spasticity as a spiral AFO and dorsiflexion assist AFO might increase her tone and are not sufficient to control spasticity.
125 The orthosis for a patient with good hip control but fair minus quadriceps is:
AFO with dorsiflexion stop
299 What would you recommend for a three week old tibial plateau fracture ?
AK fracture brace with free knee and ankle
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
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. Amyotrophic lateral sclerosis is a progressive motor neuron disease where the goal for mobility are to maximize current function and provide access to devices that allow for independence including orthosis.
356 The polio virus attacks the _____ of the spinal cord
ANTERIOR Horn Cells
233 A metal single axis (free motion) orthotic hip joint will control what motions at the hip :
ABduction ADduction External Rotation Internal Rotation
229 The Serratus Anterior performs what action :
ABduction and Upward rotation
178 What is a function of the Serratus Anterior muscle?
ABduction of the Glenohumeral joint
The "unhappy triad" includes injury to what structures
ACL, MCL, Medial meniscus. The unhappy triad includes injury to ACL, MCL and medial meniscus from forces that cause genu valgum, flexion and external rotation applied at the knee when the foot is planted.
218 The primary purpose of a C-bar is:
ADduction stop
127 The OBTURATOR nerve innervates what muscle?
ADductor longus
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 degree genu recurvatum and a 15 degree fixed plantarflexion contracture. The patient 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
Add a 15 degree tapered heel wedge to the foot plate and add a contralateral heel lift. By adding a 15 degree tapered heel wedge you will neutralize the KAFO in the sagittal plane allowing for a smoother rollover at midstance. It will also be necessary to add a contralateral shoe lift equal to the height of the tapered heel wedge to maintain a level pelvis as well as to assure proper clearance of the KAFO durning swing phase of gait.
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 resulting 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.
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
155 In a metal AFO with a locked ankle joint, what could help diminish a knee flexion moment at heel strike?
Adding a SACH heel wedge
What are the symptoms of erb's palsy?
Adduction and internal rotation of the humerus
351 Which muscles are hip ADductors :
Adductor Longus Pectineus Gracilis
The femoral or Scarpa's triangle is bordered by
Adductor longus, sartorius and inguinal ligament
A muscle grade of "fair" means that the person is able to get through complete range of
Against gravity
236 When taking plaster bandage impressions for upper extremity orthoses :
Align the second MP joint posterior to the first
2 The greatest advantage the a dorsal style WHO has over a volar style is :
Allows TACTILE sensation
287 Six weeks post ACL repair - how do you cast? What two mechanical principles do you want?
Cast in SLIGHT FLEXION * Prevent HyperExtension * Control Rotation
197 Spasticity does NOT result from which condition :
Cauda Equina Injury (does NOT cause spasticity)
261 What is a GOLDTHWAITE's orthosis primary function:
An EXTENSION brace
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 he spinal cord
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
317 A compound fracture :
Causes a break in the skin either from within or without
The placement of the mechanical hip joint is 25 mm proximal
And 12 mm anterior to the greater trochanter
305 A lesion in the vertebral canal involving the S1 nerve root would generally affect :
Ankle PLANTARFLEXION
23 A 31 yo female presents with an L1 burst fracture. Before taking the impression and maintaining optimal sagittal alignment, you would first want to know the status of which ligament?
Anterior Longitudinal ligament
208 The purpose of the anterior hyperextension orthosis is to reduce pressure on the :
Anterior Vertebral Body
321 A correct statement about the popliteal artery is that it divides into the :
Anterior and Posterior TIBIAL arteries
During swing phase of the gait cycle what muscle 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
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 degree relative to the inferior vertebrae are indications to discontinue bracing and explore alternative treatment and or surgical intervention
Choose all that describes the design of a GRAFO
Anterior/distal and posterior/proximal openings Posterior/distal and anterior/proximal areas of AFO contact. NOTE: it is important to make sure the patient can fit their foot and lower leg through the opening which tends to be narrow, but it is important to trim carefully so as not to lose the supportive structure of the GRAFO
380 The hip flexor muscles :
Anteriorly tilt the pelvis
Injury to the medium nerve will result in what characteristic appearance when a patient tries to make fist app
Ape hand hand of benediction Injury to the median may result in loss of opposition and flexion of the thumb resulting in the ape hand deformity. Also the of benediction results from injury of the median nerve at the elbow or upper arm.
75 Where should an arch support pad be placed ?
Apex of the medial Longitudinal arch, Beneath the Sustententaculum Tali, & Proximal to the 1st Met head
Choose all answers that are clinical "visible by the eye" signs of scoliosis
Arm gap, shoulder asymmetry, pelvic obliquity, rib hump, and prominent scapula
32 The UCBL is contraindicated for which condition?
Arthritis at ankle joint
77 Talipes Equinovarus can present in which Pathology?
Arthrogryposis
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 Given that UCBL's were ineffective, articulated AFO's would be appropriate as they grasp the lower legs and can help to modify internal tibial rotation. By decreasing internal tibial rotation, pronation will decrease whereby decreasing the work load of tibialis posterior muscle
At heel strike the knee joint is at ____ while the ankle joint is at_____
At neutral/full extension, 90 degrees/neutral. At heel strike the knee is at neutral or full extension while the ankle is at 90 degrees/neutral
30 In SCHEUERMANN's disease, where should the thoracic pd for a CTLSO: Milwaukee style be placed ?
At the APEX of the curve
368 The placement of the inferior border of the pelvic band should be :
At the Sacrococygeal junction
272 Name 3 orthoses used for Legge-Calve-Perthes?
Atlanta ( SCOTTISH RITE ) TORONTO NEWINGTON
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. Hangman's fracture occurs from fracture through the lamina of the axis. Another injury to the axis is displacement of the den
271 What is LEGGE-CALVE-PERTHES disease ?
Avascular Necrosis of the femoral head, usually occurring in boys ages 9-14. Femoral head will return to normal if the leg is ABDUCTED & INTERNALLY ROTATED to place the femoral head into the acetabulum.
The superior portion of a Milwaukee CTLSO should be carefully fabricated so as to...
Avoid excessive pressure on the mandibular angle
224 In fabricating a PTB type orthosis, it is necessary to carefully form the material in the popliteal area to:
Avoid pressure against the posterior tibial artery
57 in a JEFFERSON fracture, what is the primary mechanism of injury?
Axial load to skull
A patient is seen in clinic, DX: sheurmann's kyphosis apes=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
The most effective orthosis to prevent rotation is:
Custom molded TLSO body jacket
180 A Musculocutaneous nerve lesion will cause loss of function of which muscle ?
BICEPS
6 What deformity in the fingers is most similar to a hammer toe?
BOUTONNIERE
55 _______is where the patient can understand what is being said to him, knows what he wants to say, but cannot verbalize it .
BROCA's Aphasia
47 you are asked to treat a patient genu varum that cannot be corrected with moderate pressure, the orthosis should
Be fabricated to conform to to the limb and prevent further deformity
56 In the lumbar spine, where does most of the sagittal motion occur?
Between L5 and S1
A heel wedge is placed:
Between the shoe and the stirrup
326 Which muscles of the thigh LATERALLY rotates the thigh :
Biceps Femoris
A cable-driven tenodesis orthosis is activated by:
Biscapular abduction
73 a condition where there is growth disturbance on the medial proximal aspect of the tibia is
Blount's disease
183 Which of the following muscles in the forearm do NOT cross the wrist joint ? Flexor Carpi Radialis Extensor Pollicis Longus Abductor Pollicis Longus Brachioradialis Extensor Indicis Proprius
Brachioradiallis
42 Which level quadriplegic would benefit from the use of a balanced forearm orthosis ?
C 5
189 Which component is the most effective for a hand lacking thumb ABductor strength ?
C-bar
36 Which Cervical level exhibits the most sagittal motion?
C0-C1
? a jefferson fracture is a fracture of _____ while a hangman fracture is a fracture of____
C1 and C2
29 the following nerves roots form the brachial plexus
C5-T1
138 The subtalar joint is an articulation between the talus and the:
CALCANEUS
1 Inflammation anterior to the flexor retinaculum is called:
CARPAL TUNNEL
371 The most common pathology causing a paralytic scoliosis is :
CEREBRAL PALSY
49 Flexion and extension of the 1st MP occur in which plane ?
CORONAL
216 ABduction and Adduction occurs in the :
CORONAL PLANE
130 Anteroposterior instability of the knee is caused by a tear of which ligament?
CRUCIATE
89 Which orthosis is the MOST effective for scoliotic curves with the apex above T7?
CTLSO (Milwaukee)
90 Which orthosis will will MOST effectively treat juvenile epiphysitis of thee spine ( SCHEURERMANN'S Disease)?
CTLSO (Milwaukee)
113 The orthotic treatment indicated for a fracture of T3 is:
CTO (SOMI)
Choose 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 jones fracture All of these pathologies can be treated with a decreased in MLA support and increase in 1st MTP relief with a lateral extrinsic wedge. Provides neutral alignment to decrease likelihood of multiple pathologies. 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
204 What pathologies can result in Upper Motor Neuron Lesion?
Cerebral Vascular Accident Multiple Sclerosis Spinal cord transaction
378 In general, the greatest amount of rotational motion occurs in the :
Cervical Spine
355 The orthotic management of T3 level fracture will have its best 3 point pressure system via :
Cervical orthosis with thoracic extension
396 What are indications for an axial resist AFO?
Charcot Joint Degenerative arthritis of the ankle joint
Patellar tendon bearing AFO is indicated for which pathologies
Charcot joint, avascular necrosis of the talus osteoarthritis of the ankle joint calcaneal fracture are all pathologies potentially utilize a PTB AFO to un-weight the affected area during weight bearing
A patient is seen in clinic for a follow up appointment and is disappointed with the results of his custom solid ankle 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 and 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. Often times practitioners add a heel wedge to an SAFO to decrease knee hyperextention thrust but, the durometer of the heel wedge is most important as a soft heel wedge will cause ground reaction forces to remain anterior to the knee durning loading response whereby increasing knee hyperextention. By utilizing a firm durometer for the heel wedge you can promote knee flexion. Note: check quadriceps strength prior to doing this as they must be able to control the flexion moment.
404 In general, the RGO is recommended for:
Children or young adults with lower trunk and lower limb paralysis
When fabricating and AFO the lateral proximal trim lines is located approximately 1 inch inferior to the fibular neck. What is the anatomical structure are you trying to avoid by doing this
Common fibular nerve. The common fibular nerve "common peroneal nerve" runs just inferior to the fibular head superficially. Trim lines should be design to avoid impingement of this nerve when fabricating a AFO
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 accounted be what most likely
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
64 The most important principle in orthotic management of fractures is :
Compression of soft tissue
397 When is an axial resist AFO contra-indicated ?
Condition of the leg in which pressure around the knee cannot be tolerated.
85 A patient wearing a Dennis Brown Orthosis exhibits undesirable Eversion, you should
Contour the crossmember convex to the patient to supinate the feet
What are the characteristics of the congenital abnormality in infants called torticollis
Contracture of the sternocleidomastoid, ipsilateral head tilt, and contralateral head rotation.
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 will present with
Contralateral hemiparesis, leg more affected than the arm. Anterior cerebral stroke results in the leg more affected than the arm and contralateral sensory loss. 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 bet preserved consciousness
When examining a scoliosis radiograph, the vertebral body is seen to rotate toward the ____ in relation to the curve and the spinous process in seen to rotate toward the _____ in relation to the curve
Convexity, concavity. Scoliosis radiographs confirm that rotation of the vertebral body is toward the convexity of the curve and rotation of the spinous process is toward the concavity of the curve
135 Functions of a UCBL are :
Corrects Pes Planus Holds the calcaneus in a neutral position Adducts the forefoot
117 In which condition is a Milwaukee CTLSO NOT recommended?
Curve greater than 60 degrees
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. 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
238 The muscle that can flex, abduct, extend, and support the shoulder joint is :
DELTOID
32 In what order should the HALO pins be tightened
DIAGONALLY opposed pins together
320 When aligning a cam lock for a KAFO, the posterior aspect of the bail should be ______ to the anterior aspect.
DISTAL
226 The sensory distribution of the spinal nerves is :
DORSAL
194 Sensation is transmitted through which of the following structures ?
DORSAL branch of the nerve roots
96 Which metal ankle joint is the functional equivalent of a plastic AFO trimmed anterior to the malleoli?
DOUBLE STOP
369 For the initial fitting of the TLSO : anterior control : the overall height measure should be :
Decreased by 72 mm (2 3/4 ")
79 Which of the following is a contra-indication for a plastic AFO?
Deep Peroneal nerve injury
The muscles in the anterior compartment of the leg are innervated by:
Deep peroneal nerve
145 What adjustment to a metal AFO would best accommodate 1 1/2" of tibial torsion?
Deflection of stirrup extensions
The axillary nerve innervates teres minor. What other muscles does it innervate
Deltoid The axillary nerve also innervates the deltoid. At times there is injury to this nerve with shoulder dislocation
249 What are the parts of a typical nerve cell:
Dendrite Axon Nucleus
311 What can be used to correct congenital equinovarus :
Dennis Browne Orthosis plaster Cast BiCAAL AFO
367 The cortico (brain) spinal tract is known as a :
Descending Pathway Motor Tract
In scoliosis management, lateral flexion radiographs are used to:
Determine if the curve is structural
In what order should the halo pins be tightened?
Diagonal pins together
379 The articular facets are classified as :
Diarthroidial
148 The major problem with using TWISTERS to correct for excess rotation of the leg is :
Difficulty with localizing rotary forces
84 What best describes the orthotic objective of the UCBL FO?
Diminish Calcaneus ML instability
58 A technician asks where to place the wrist joint on a WHO, you respond :
Distal Tip of Radial Styloid
365 The motor innervation of the deep muscles of the back along with sensory supply is provided by the :
Dorsal Rami of the THORACIC nerves
Which nerve innervates the rhomboid muscles and levator scapulae
Dorsal scapular nerve innervates rhomboids and levator scapulae while long thoracic nerve innervates serratus anterior. Axillary nerve innervates deltoid and teres minor muscles, suprascapular innervates supraspinatus and infraspinatus muscles on the rotator cuff
The _____________ interossei abduct, while the __________________ interossei adduct.
Dorsal/palmar
You are seeing a patient with diagnosis of peripheral vascular disease. What is the common artery that you can palpate to asses blood flow
Dorsalis pedis. Clinicians at times will want to assess blood flow in a patient foot. One way it to palpate the dorsalis pedis pulse along with capillary refill
387 A patient with weak quadriceps wearing a KAFO without ring locks at the knee will need a _______ at the ankle .
DorsiFlexion stop (i.e. ground reaction AFO)
312 What ankle joint controls would be indicated for flaccid isolated paralysis of the plantar flexors ?
Dorsiflexion STOP
103 What are the major functions of the tibialis anterior muscle
Dorsiflexion and inversion
159 The primary purpose of a plastic AFO with trim lines posterior to the malleoli is to provide :
Dorsiflexion assist
45 Patient is a 20 yo male with a diagnosis of T10 incomplete spinal cord injury in 2007. Ambulation exhibits moderate extensor spasticity with 10 degrees of genu recurvatum. Ankle control of choice in the AFO is:
Dorsiflexion stop and Plantarflexion Stop
Excessive hip circumduction may result from:
Dorsiflexor weakness and Hip flexor weakness
83 What muscles contribute to spinal extension?
Erector Spinae Quadratus Lumborum Latiissimus Dorsi
24 which motion component is not considered part of supination
Eversion
Gower sign is seen when a person gets up from the floor, walking hands up his legs to upright. Choose 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.
324 What movement would be lost if the superficial branch of the common peroneal nerve is injured ?
EVERSION of the foot
158 If the patient has more internal tibial torsion than a KAFO allows, the foot will be forced to do what?
EVERT
3 The Extensor Carpi Ulnaris works synergistically with the ____ to provide wrist extension.
EXTENSOR DIGITORUM
136 Compared to the Balmoral style, the major advantage of the Blucher style shoe is:
Easier donning
Which of the following is a contra-indication for a spiral AFO?
Edema with frequent volume changes
Primary function of the brachioradialis is
Elbow flexion
The primary function of the brachialis is
Elbow flexion
What structure is at the distal end of the humerus?
Epicondyle
79 Possible causes for hip circumduction during gait are :
Equinus Knee Arthrodesis Extensor Synergy pattern
Which of the following is often the result of an irregular birth?
Erb's palsy
42 Which motion would be lost if the superficial branch of the common Peroneal nerve is injured?
Eversion of the SubTalar joint
The lateral side bar on a conventional AFO should deflect posteriorly if the amount of external ankle rotation:
Exceeds 28 mm
219 The distal edge of the C-bar should :
Extend just proximal to the Pollicis IP
57 A person presents with mallet finger will be UNable to
Extend the PIP joint
214 What is the best means to accommodate valgus in a patient's lower limb ?
Extend the medial stirrup extension
When designing a thermoplastic KAFO for a patient with severe genu recuravatum, what can you incorporate that will help control the knee hyperextension
Extending the distal/posterior thigh trim lines more distally decreasing the depth of the thigh section extending the proximal posterior calf trim line proximally decreasing the depth of the calf section. All of these design modifications will aid in decreaseing genu recurvatum
The iliofemoral ligament limits:
Extension of the hip joint
164 Which of the following muscles do NOT abduct the thumb: Extensor Pollicis Brevis Opponens Pollicis Extensor Pollicis longus Flexor Pollicis Brevis
Extensor Pollicis Longus
What additions can you make to an AFO to decrease excessive pronation within the AFO.
Extrinsic medial wedge medial sabolich tab or trim line sustentaculum tali "ST" pad
48 True or False The Finkelstein test is used to asses the ABducctor Pollicis Brevis and Extensor Pollicis longus
FALSE its abductor pollicis LONGEST and extensor pollicis BREVIS
276 Evaluation of a patient with a gunshot wound to the hip reveals weak HIP FLEXORS. What Peripheral nerve is injured ?
FEMORAL NERVE
126 Which nerve innervates the Sartorius muscle of the thigh?
FEMORAL nerve
115 When casting for the Milwaukee CTLSO, the patient's pelvis should be what position?
FLEXED
49 Posterior hip dislocations may occur in a MVA. What position of the hip has the highest risk of dislocation?
FLEXED, INTERNALLY ROTATED, & ADducted
187 When a patient wearing a WHFO (wrist driven) dorsiflexes his wrist, it will cause what finger motion ?
FLEXION
49 What deformity is most likely to result from ankylosing spondylitis ?
FLEXION
5 A patient presents with disruption of the supraspinous ligament, interspinous ligament, posterior longitudinal ligament, ligamentum flavum, capsular ligament and the intervertebral disc. There is sparing of the anterior longitudinal ligament and thee patient is neurologically intact. What is the most likely mechanism of injury?
FLEXION
333 An HKAFO with free hip motion in sagittal plane is used primarily to enhance :
FLEXION & EXTENSION
273 Name 3 orthoses for the treatment of Hip Dysplasis?
FREJKA Pillow PAVLIK harness LLFELD splint
You have provided a patient with and articulated AFO and PF stop. When that patient ambulates you notice that they have pronounced knee flexion during loading response. Choose the options that can cause this
Firm extrinsic heel wedge PF stop is too dorsiflexed Both of these can cause ground reaction forces to translate posterior to the knee joint rapidly causing abrupt knee flexion during loading response
176 A complete Brachial Plexus injury results in:
Flaccid Paralysis
165 The actions of the first dorsal interosseous muscle on the index metacarpophalangeal joint are to:
Flex & ABduct
The lumbricals act to
Flex the MP joints and extend the IP joint. Lumbrials act to flex the MP joint and extend IP joints. The interossei muscles act to either adduction or abduct the digits along with pairing with the lumbricals to flex the MC joints and extend the IP joint
222 The Optimum hip angle of the patient during casting for a Milwaukee TLSO is :
Flexion Commensurate with minimum lordosis
234 An infant with bilateral dislocated hips is usually fitted with an orthosis that will hold the hips in:
Flexion and ABduction
163 Which muscle exerts its primary action on the proximal interphalangeal joint?
Flexor Digitorum Longus
191 Flexion of the distal interphalangeal joints is accomplished by which muscle ?
Flexor Digitorum Profundus
215 Which muscle flexes the middle phalanx ?
Flexor Digitorum Profundus
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. Flexor carpi ulnaris in 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
144 Which muscles pass directly posterior to the medial malleolus ?
Flexor hallucis longus tibialis posterior Flexor digitorum longus
34 A polymer AFO is contraindicated for which condition:
Fluctuating edema of foot and leg
43 Where is the appropriate placement of the paraspinal bars for a LSO
Follow the apices of the paraspinal muscles
48 Which is the only orthosis known to control motion at the Atlanto-Occipital joint
HALO
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. This orthosis spans a long distance to maximize end point control
114 What offers the greatest protection or immobilization for a fracture of the odontoid ?
HALO-jacket
160 The Peroneus Longus muscle causes what motions of the foot and ankle?
Foot Eversion & Ankle Plantarflexion
139 Reverse last or "OUTFLARE" shoes are generally prescribed to control:
Forefoot ADduction the shoes are turned outward
What is a Colle's fracture?
Fracture of distal radius
337 Fracture bracing may not be indicated for :
Fractures of the mid-shaft of the femur
92 Which component is NOT appropriate in a KAFO designed to unweight the limb?
Free ankle joint
A single cycle of gait is defined as the time
From heel off of one foot to heel off of the same foot
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.
384 A mid-sagittal line falling more than 15 mm medial from the knee indicates:
GENU VARUM
A patient has failed conservative treatment for plantar fasciitis including foot orthotics, physical therapy, shoe wear modification. Choose all that are common surgical interventions
Gastroc lengething Plantar fascia release Ankle fusion and triple arthrodesis surgeries are not performed for plantar fasciitis. Usually treated arthritis with fusion of the calcanealcuboid, talonavicular, and talocalcaneal joints of the foot.
98 A patient with soleus contracture is likely to exhibit what characteristic during weight bearing?
Genu RECURVATUM
27 What is a contraindication for a floor reaction AFO?
Genu Recurvatum Coronal instability of the knee
399 Where does "unloading" occur in an axial resist KAFO ?
Gluteal Fold
Trendeleburg gait can be seen in patients after they have total hip arthroplasty, injury to the superior gluteal nerve, and poliomyelitis. This is caused by weakness in what muscle
Gluteus medius. Weakness of the gluteus medius results in trendelenburg gait. durning the stance phase the pelvis on the opposite side drops due to weakness on the stance side
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
Gowers sign Duchennes muscular dystrophy Duchennes muscular dystrophy is most common in you males and is characterized by the gowers sign "walking of the hands up lower extremities while standing" which is compensating for proximal lower extremity weakness
394 Pertinent lateral anatomical landmarks to be identified on the hip and pelvis when measuring for a HKAFO include:
Greater Trochanter and Iliac Crest
318 What are the principles of fracture orthoses :
Incompressibility of fluids Maintenance of total contact Stimulation of bone healing through early ambulation
A KAFO patient is seen in clinic for follow up. The patient has utilize 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 with out slowing the reversal of AVN
Incorporate ischial weight bearing. By fabricating an ischial weight bearing brim you can load proximally while unloading distally at the femoral condyles whereby allowing for minimal ambulation while treating AVN
294 How would elevating the shoe heel effect a solid ankle AFO ?
Increase Knee Flexion moment at Heel Strike
What modification can you make to and ulnar fracture orthosis to increase its effectiveness at immobilizing a distal 2/3 ulnar fracture
Increase pressure A/P for increased immobilization. Increased pressure A/P "interosseous membrane" creates tension between the radius and ulna. This tension is an effective immobilizer for ulnar fracture
143 The wire coil spring AFO (Matrix) is contraindicated for patients with moderate gastrocnemius spasticity because of:
Induced reflex contraction of the muscle
280 Describe GUILLAIN BARRE and it's effects on the patient?
Infectious PolyNeuritis with progressive muscle weakness distal to proximal, which may lead to paralysis. Prognosis usually full recovery, though in more severe cases the patient may have some residual weakness in distal extremities
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. LSO trim lines are chosen to span a distance above and below the pathological area to maximize control and or guide motion "longer lever arm = better control"
34 what is the method used to find the baseline for corset measurement
Inferior costal margin to iliac crest divided by two
258 The proper length measurement for a TAYLOR orthosis is:
Inferior scapular angle to inferior edge of the sacrum
95 What is the MOST important measurement of a quadrilateral brim?
Inguinal Ligament to Posterior
29 (3) fracture patterns indicated for orthotic management:
Inherently stable two column Single Column, one level with 25% compression All single column, multiple level fractures
309 The purpose of measuring tibial torsion is to:
Insure that the anatomical axis coincides with the mechanical ankle axis
11 The purpose of measuring external rotation of the ankle joint is to:
Insure that the mechanical ankle axis coincides with the anatomical ankle axis in the transverse plane
107 To promote healing in case of LEGG-PERTHES' disease, an orthosis should hold the hip joint in:
Internal rotation & ABduction
235 Combined MP flexion and IP extension are performed primarily by the
Interossei and Lumbricals
Simultaneous MP flexion and IP extension are performed primarily by the
Interossei and lumbricals
131 Fracture bracing is NOT indicated for :
Intertrochanteric fractures Fractures of the miid shaft of the femur
366 The dorsal and ventral roots unite as a mixed spinal nerve and emerge from the :
Intervertebral Foramen
400 What are 3 designs of axial resit KAFO's.
Ischial Ring Quadrilateral brim Normal shape, Normal alignment
you are working with a therapist on gait training for a patient that has a L1 complete spinal cord injury along with another patient hat 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 and 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
A patient is seen in clinic. The patient is utilizing foot orthotics with 3/8" heel lifts to decrease inflammation of her cord "achilles tendonitis". What lumbar pathologies could this aggravate.
L5-S1 spondylolisthesis DJD of the lumbar facet joints lumbar spondylolsis When recommending heel lifts for achilles tendonitis recognize that it will increase lumbar lordosis. The listed lumbar lumbar pathologies are all treated by decreasing lumbar lordosis and can be aggravated by heel lifts on a relative scale.
58 A patient exhibits Hallux Rigidus, which part of stance phase will the patient have the most discomfort :
LATE STANCE phase
248 A patient with a lesion located in the ____ would probably be aphasic :
LEFT brain lobe
8 ____ disease is an Osteochondrosis of the capital femoral epiphysis that generally occurs in ________.
LEGG_CALVE_PERTHES 3 to 10 yo males
316 A patient with a lower lumbar myelomeningocoele may develop hip flexion contractures due to:
Lack of hip extensors to act as antagonist Parental non-compliance with home stretching program
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 choosing anterior pin placement for a HALO 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.
44 A patient presents with C6 quadriplegia. He will not be able to manipulate objects with 3 point prehension. What other type of prehension will he use ?
Lateral pinch (key grip))
The erector spine muscles are found in the intermediate layer of the muscle layers 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. The erector spine muscles act to extend the vertebral column and unilaterally act to laterally bend the column. Stabilize vertebrae durning local movements of the vertebral column is performed by the deep layer known as transversospinal muscles (multifidi, semispinalis, rotatores).
156 In constructing a metal AFO, fixed varus at the subtalar joint may be accommodated by:
Lengthening lateral stirrup extension
364 The superficial muscle group of the back consists of :
Levator Scapulae Rhomboideus Major and Minor Trapezius Latissimus Dorsi
223 The Pelvic band for an LSO or TLSO should :
Lie Halfway between the iliac crest and the greater trochanter
285 A polio patient has a FLAIL ANKLE, good knee muscles, good hip muscles, full ROM at knee with 25' RECURVATUM. Knee buckles when tired. What orthosis do you recommend? Describe the mechanical principles.
Lightweight KAFO Offset or Drop Lock knee Solid Ankle AFO section Rocker bottom shoe or double adjustable ankle joint
193 A patient with a well fitted orthosis for a wrist level median nerve injury does not use his hand functionally. This is most likely due to :
Limited ROM
211 Increasing intra-abdominal pressure by using spinal orthoses has the effect of:
Limiting diaphragmatic respiration
32 The main reason the thumb ADduction stop is placed on a wrist driven flexor hinge orthosis is because it ..
Prevents Chaffing into the web space
Which of the following nerves innervates all of the anterior muscles of the arm?
Musculocutaneous
203 Hydrocephalus may accompany :
Myelodysplasia
406 Three common pathologies for which the RGO is recommended include :
Myelodysplasia Muscular Dystrophy Spinal Cord Injury
269 How much plantarflexion would you allow a patient who has suffered a CVA ?
NEUTRAL
303 Should you put a femoral fracture brace on a proximal femoral fracture ?
NO never brace femoral fractures above the distal 1/3 rd
53 A major source of pain for the brachial plexus patient due to shoulder subluxation is :
Nerve Traction
210 The term CAUDA EQUINA refers to the:
Nerve roots below the level of the spinal cord
Mobile arm supports balanced forearm orthosis would be indicated for which patient?
Non-ambulatory patient with minimal shoulder power
345 The Primary nerve of the hip adductors is:
OBTURATOR
10 Which degenerative joint disease first affects thee articular cartilage ?
OSTEOARTHRITIS
*** O R T H O T I C BOARD PREP EXAM ***
OandPboardPrep
289 Give 4 contraindications for RGOs
Obesity Hip Flexion Contracture +20 degrees Spasticity Non-plantargrade foot Hip dislocation
53 A 13 yo female is seen for the first time in scoliosis. The curve span is from T7 - L1 and presents with a curve magnitude of 20 degrees. What should be the initial treatment?
Observation to prove progression
112 The superior articulating surfaces of the Atlas articulate with the:
Occipital Condyles
282 When would you recommend a bail lock on a KAFO instead of drop locks ?
Only one functional hand When crutches or canes are used with bilateral KAFOs
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
14 Congenital Osetoporosis, along with fractures before and during birth is indicative of which condition?
Osteogenesis Imperfecta
What would you recommend for addition to and articulated AFO for drop foot and posterior lateral hyperextension thrust of the knee (mild tone is present)
PF stop will decrease drop foot in swing 1/4" heel/lateral wedge will negate the posterior lateral knee extension thrust the metatarsal pad in combination with elevation of the 2nd-5th MTP's and digits have been shown to decrease tone on a relative scale
323 At the time of "midstance" during gait, the floor reaction is :
POSTERIOR & MEDIAL to the HIP joint
221 In order to treat kyphosis with a Milwaukee TLSO the pads should be placed :
POSTERIORLY
35 if you use a TLSO sagittal control and found the patient could not tolerate the strap pressure in the axilla what might be done?
Pad the straps Use a harness chest strap with sternal plate
376 I you used a TLSO: A/P control (TAYLOR) and found the patient could not tolerate the strap pressure in the axilla you might :
Pads the straps Use a harness chest strap with sternal plate
230 The hand orthosis ( HO ) controls :
Palmar arch and thumb position
186 Which muscles are supplied by the median nerve ?
Palmaris Longus Flexor Pollicis Longus Pronator Teres Flexor Digitorum Superficialis
395 The mechanical hip joint axes must be aligned. ____ to the ______ line.
Parallel, MidSagittal
A positive trendelenburg sign is an indication of:
Paralysis of hip abductors
398 What landmarks are required for the fabrication of an axial resist AFO ?
Patella Medial flare of the Tibia Crest of the Tibia
When taking and impression for a custom polymer LSO for patient with L5, S1 spondylolisthesis, How you position the patient if they were allowed to stand though 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
322 When Genu Varum is present on a lower limb schema, the mid-sagittal line connects the :
Perineum and a mark made 30 mm MEDIAL to the ANKLE
383 The average midsagittal line for a "normal" limb will intersect at what three points
Perineum bisect a point 15 mm medial to the leg at the knee joint axis a point 30 mm medial to the medial malleolus at the ankle joint axis
104 Foot drop is caused by a lesion of which nerve
Peroneal Nerve
267 What problems could you encounter in moving the bands ?
Peroneal nerve impingement Limited knee flexion of orthosis
349 Which muscles assist in dorsiflexion of the ankle :
Peroneus Tertius Tibialis Anterior Extensor Hallucis Longus
All of the following muscles are posterior to the medial malleolus EXCEPT:
Peroneus brevis
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. Please circle on choice that would be part of the 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 a AFO 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
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
70 The ligament on which the talus rests and which helps support the medial Longitudinal arch of the foot is the :
Plantar CalcaneoNavicular Ligament
During quiet standing, what muscles are acting on the ankle joint in the sagittal plane
Plantar flexors
A 20 year old female patient presents with flaccid anterior compartment and medial lateral instability in her right lower limb. Which of the following would you recommend?
Polypropylene AFO with trim anterior to the malleoli
81 What is the purpose of a thumb post?
Positioning for palmer prehension
228 The main reason for using a wrist hand orthosis instead of a hand orthosis is :
Positioning the wrist
40 all of these are clinical signs of scoliosis
Positive adams test asymmetrical gapping between arm and waist shoulder asymmetry.
132 What function should the knee component provide in a cast brace following repair of a torn anterior cruciate ligament?
Prevent full flexion Prevent full extension
207 A good purchase on the pelvis is required in spinal orthotics to:
Prevent increased motion at the Lumbosacral Junction
The goal(s) of treatment for Marie-Strumpell arthritis (ankylosing spondylitis) are:
Prevention of further deformity and Relief of pain
A patient in 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 in 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.
9 how is the subluxed shoulder typically managed in hemiplegia
SLING
150 When selecting an AFO for a patient who has both knee instability at heel strike and genu recurvatum at midstance, the most effective ankle joint to use would be :
SOLID ANKLE
347 The best gait pattern that can be achieved with poor grade dorsi and plantar flexors has the most desirable control in a metal AFO with a :
SOLID ANKLE
358 A 30 yo patient with a C1 fracture has been referred to you. It is 5 weeks post injury and the physician has deemed that the involved area is relatively stable and shows signs of callous formation with return, of neurological function. The orthosis of choice at this point would be:
SOMI
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" of 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
119 Anterior displacement of one vertebra is called:
SPONDYLOLISTHESIS
372 The most important goal when managing a paralytic spine is :
STABILIZATION
149 Inversion and eversion of the hindfoot occur at which joint:
SUBTALAR
339 In normal human locomotion, at heel strike the ____ are in a(n) ______position
SUBTALAR joint , LOCKED
173 The deltoid muscle will NOT initiate ABduction unless it is assisted by the:
SUPRASPINATUS
50 A patient presents with a grade 3 spondylolisthesis and a 45' slip angle. Based on this information what would likely be the most effective treatment?
SURGERY
213 For Maximum leverage with an LSO, it should extend from the:
Sacrococcygeal area to 1" below the inferior angle of the scapula
The nominate bone of the pelvic girdle is known as
Sacrum The pelvic girdle is mad up of the innominate bones of the iliums that articulate with the sacrum known as the nominate bone
20 The 1st CMC is what type of joint ?
Saddle Joint
A patient is seen in clinic. The patient presents with a midshaft humeral (10 degree of varus is noted at the fracture sight). What orthosis would you recommend
Sarmiento humeral fracture orthosis. Midshaft humeral fracture can be manged with a sarmiento humeral fracture orthosis. Long term benefits of the sarmiento: Micro motion at the fracture sit 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
325 Which muscles originate on the ASIS :
Sartorius Tensor Fasciae Latae
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. "Longer lever arm = better control"
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
Scoliotic curve of a magnitude less than 25 degrees indicate a treatment plan of 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
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 and orthosis immediately, regardless of progress
388 What special adaption should be incorporated in KAFOs for children ?
Segmental Length Adjustments
15 What is the best initial recommendation for a new born patient with talipes equino varus?
Serial Cast
Anterior displacement of the vertebral body on the lower vertebrae is called what
Spondylolisthesis. Spondylolisthesis is described by the percentage of the anterior displacement of the vertebral body described by 4 grades (grade 1 0-25%, grade 2 25-50%, grade 3 50-75%, grade 4 75-100%) Spinal stenosis is the narrowing of the spinal column. Spondylosis is a term for osteoarthritis of the spinal column or neutral foramen. Spondylitis is inflammation of the vertebra
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
266 In a conventional KAFO what changes would you use to reduce recurvatum?
Shallow Bands Move calf band up distal thigh down increase heel height
386 What additional modification can be incorporated to a metal KAFO for Genu Recurvatum ?
Shallow distal Thigh Band Ankle Joint Positioned in 5' of dorsiflexion Shallow calf band
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 making it relatively more difficult to manage with an orthosis
7 A complete lesion of the tibial nerve on one leg will result in what gait deviation?
Shortened step length on contralateral side
47 Which type of orthosis would be used to manage a patient with skin grafts in the axillary region ?
Shoulder ABduction Orthosis
182 What problems can be anticipated fitting a complete brachial plexus injury with a functional orthosis ?
Shoulder Subluxation is difficult to control
Which types of scoliotic curves would you expect to progress more given only the location of the curve
Single lumbar, thoracolumbar. Single lumbar and thoracolumbar scoliotic curves have been shown to progress more in relation to thoracic and double major curves.
302 What is the best position for a patient to be in when being fitted with a tibial fracture brace ?
Sitting with legs dangling at 90'
393 In a two-stage impression for a plastic KAFO, it is helpful for the patient to be ______ in the first stage:
Sitting with their knee flexed and a partial weight bearing force applied.
242 Ideally, how soon after injury should a quadriplegic patient be fitted with an upper limb orthosis ?
Six Weeks
225 As an orthotist, your primary concern with a spinal injury patient is :
Skin Sensitivity to pressure
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. By placing the posterior pins of a HALO, slightly superior to ear, opposing the anterior pin directly, inferior to equator of the cranium you will optimize placement to avoid nervous system structures as well as superior migration of the HALO
16 List in order from least to most effective in controlling the cervical spine?
Soft Collar, SOMI, four poster CTO, HALO
277 Describe Chondromalacia and possible Orthotic tx.
Softness of the articular cartilage usually involving the patell-femoral joint. PALUMBO orthosis or other patellar stabilizing orthosis
65 with poor grade dorsi and plantar flexors, the most desirable control in a metal AFO is
Solid Ankle
286 How would you trim the AFO section for the above polio patient? WHY ?
Solid Ankle, Anterior Trim Flail ankle needs stability in all planes
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. The muscles around the ankle provide ankle strategies, the gastrocnemius-soleus moves the body posterior while the anterior tibialis helps move the body anterior
21 What condition should be positioned in sagittal flexion when managing with ann orthosis ?
Spinal Stenosis
56 SPASTIC Paralysis may result from :
Spinal cord or Brain injury Poliomyelitis
? The following make up the erector spinae
Spinalis, longissimus, lliocostalis
What is the superior margin of the paraspinal bars in a Taylor TLSO
Spine of the scapula
When turning a conventional AFO into a dorsiflexion assist AFO, how would you set up double action ankle joint
Springs in the posterior channel will produce dorsiflexion assist in double action ankle joint
The 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 choose to recommend a conventional with double action ankle joint. What would be the most appropriate configuration of the ankle joints
Springs in the posterior channels and pins in the anteriors channels. By having springs in the posterior channels and pins in anterior channels you will provide adequate anterior posterior support to the lower leg muscular imbalance but the posterior springs will allow controlled plantarflexsion during loading response whereby keeping the ground reaction forces anterior to the knee joint to decrease knee buckling
128 What is the MAJOR function of a parapodium?
Stabilizes the lower limbs and spine
48 You have assessed a spina bifida patient that would benefit from bilateral KAFOs. Which type of knee joint does not require the patient to manually lock the knee but would allow the patient to use their upper extremities to get to an erect posture.
Step lock Knee Joint
The axial skeleton is attached to the appendicular skeleton at the:
Sternoclavicular and sacroiliac joints
301 What could you do to a fracture brace to better align a lateral or medial tibial plateau fracture ?
Stress brace into Varus or Valgus (if directed by M.D.)
227 What is the affect of fitting a KAFO on a patient with insufficient external rotation?
Supination
The secondary function of the biceps brachii is
Supination
In general terms, the radial nerve of the brachial plexus innervates:
Supinators and extensors
The TLSO: Anterior control should be fitted with the patient in a
Supine position
296 How can you prevent a knee orthosis from migrating down ?
SupraCondylar Wedge SupraPatellar Strap Attach to foot plate lightweight belt
26 Which muscle ABducts the scapula.
Supraspinatus
50 two muscles function to ABduct the shoulder, one is the deltoid, the other muscle is :
Supraspinatus
The deltoid muscle acts to abduct the shoulder with what other muscle
Supraspinatus Supraspinatus part of the rotator cuff assists with a abduction of th
290 Name 3 clinical signs of Charcot Joints at ankle mortise.
Swelling instability Excessive joint mobility anaesthetic foot visual deformity
What is the primary target organ in rheumatoid arthritis?
Synovium
108 A KAFO is seldom prescribed for paraplegic patients with lesions above :
T 12
359 Upon looking at the surface anatomy of the back, it can be said that the spine of the scapula is at the approximate vertebral level :
T 3
What level of paraplegia seldom gets braced
T6 & L5
167 The natural opposition of the thumb and fingers occurs when the wrist is in extension is known as :
TENODESIS
10 The most common etiology of a stroke is:
THROMBOTIC
4 A patient presents with no volitional strength to the thumb. What component will you recommend?
THUMB POST
153 Loss of power in the gastrocnemius soleus group indicates injury to which nerve?
TIBIAL
353 The orthosis best suited to manage a T7 anterior compression fracture with fractures of the posterior vertebral arch is :
TLSO : APL with rotary control
46 A 35 yo male is seen at a local hospital with an anterior compression fracture of L1. Based on the diagnosis, what is the best orthotic recommendation ?
TLSO ; ANTERIOR control
4 which orthosis is best suited to manage a compression fracture 20% anterior compression at T11
TLSO anterior control
2 You are asked to recommend an orthosis for a 20 year old male how has sustained a L1 burst fracture. What is the best orthotic recommendation
TLSO polymer
3 Which orthosis is best suited to manage a T6, 1 column compression fracture
TLSO sagittal and coronal contral
What orthosis would be used to manage a patient with a T3 compression fracture?
TLSO: anterior control with cervical extension
109 The deformity caused by unilateral contracture of the sternocleidomastoid is known as :
TORTICOLLIS
44 A lumbar pad for a scoliosis TLSO should be placed over the
TRANSEVERSE processes of lumbar vertebrae
82 A fusion of the Talocalcaneal, Talonavicular & Calcanealcuboid is called ?
TRIPLE ARTHRODESIS
46 True or False. A patient presents with rheumatoid arthritis could also have carpal tunnel syndrome.
TRUE
? the troclea is found on the superior border of which bone
Talus
78 In addition to the deltoid, the axillary nerve innervates the
Teres minor
259 The greatest amount of rotation occurs in :
The THORACIC spine
The sciatic nerve innervates all these muscles except
The gluteus medius is innervated by the superior gluteal 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.
308 For correction of Genu Valgum, forces should be applied over the :
Thigh distal to the greater trochanter lateral aspect of the foot Medial condyle of the femur
390 During evaluation of a KAFO, a patient exhibits pressure from the calf band while sitting, but does not have any problems standing. What could be a possible cause ?
The mechanical knee axis is anterior to the anatomical
When taking and impression and delineation for a KAFO what landmark represents knee enter
The midpoint between medial tibial plateau and adductor tubercle. When taking and impression and delineation for a KAFO, knee center is represented by the midpoint between MTP and the adductor tubercle
42 Why is a CTLSO: Milwaukee NOT recommended for a person with a paralytic spine?
The person cannot provide active forces necessary for correction
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 he 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.
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,, form 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
246 Upward rotation of the scapula is produced by:
The upper & middle segments of the TRAPEZIUS and SERRATUS ANTERIOR
A median nerve injury at the wrist clinically presents with:
Thenar atrophy, loss of thumb opposition, flexion and abduction
314 Why is more ankle joint clearance allowed for the medial malleolus ?
There is a valgus moment at the ankle during standing
37 The TIRR system is different from the IRM or Rancho systems in that it is usually made of
ThermoSet material
True or false, a patient with pes plano valgus foot and peroneal tendonitis should utilize their functional fort 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.
true or false, 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 shoe and or cutting the foot plate to sulcus length would be appropriate (assuming the have good knee stability in the sagittal plane)
True sulcus length foot plates and rocker shoes can both contribute to a relatively smooth roll over in stance phase
80 a SPINA BIFIDA child presents with S1 intact. The orthosis indicated at this time would be :
UCBL
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.
190 Metacarpophalangeal hyperextension and interphalangeal semi-flexion of the ring and little finger characterizes a lesion of which nerve at the wrist ?
ULNAR
43 A physician uses the FROMENT's test to assess which nerve injury?
ULNAR nerve lesion
The claw hand appearance of the hand is due to damage to what nerve.
Ulnar nerve Damage to the ulnar nerve commonly occurs where it passes posterior to the medial epicondyle on the humerus. The patient is likely to have difficulty making a fist due to paralysis of the intrinsic muscles of the hand. Claw hand comes from inability to flex the 4th and 5th MCP joint
The claw hand appearance is characterized by an injury to what nerve
Ulnar nerve Ulnar nerve injury will result in 4th and 5th MCP joints exten
19 What are contraindications for an RGO ?
Unreliable family support Poor upper extremity strength Obesity
181 ERB's Palsy refers to paralysis from injury to the :
Upper Trunk of the Brachial Plexus
297 What is the basic theory of FRACTURE bracing ?
Using Hydrostatic pressure to stabilize the fracture micro motion at fracture site promotes healing mobilization of joints above and below fracture decreases rehab time
389 A torn medial collateral ligament MCL of the knee would create a moment, and tendency for the knee to move _______ in a KAFO .
VALGUM / MEDIALLY
292 Name 3 signs in evaluation of heel spur pain
Valgus foot Pes Planus Localized pain at loading
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
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
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
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
80 Which orthosis would you recommend to a mid-humerus fracture which included injury to the radial nerve
WHO with thumb extension and finger extension assist
18 the axillary's extension of a boston brace style scoliosis for a double curve should extend from the
Window to about T5
A patient with C6 quadriplegia is able to use a tenodesis grip. What is the action that occurs
Wrist extension which causes MP flexion. C6 quadriplegic patients functionally uses tenodesis grasp. This is caused by wrist extension which allows passive MP flexion
13 for most patients the paraplegia to stand in KAFO's they must be allowed to rest on their iliofemoral ligaments. In order to facilitate this posture, how should the ankles be positioned in the sagittal plane
a few degrees of dorsiflexion
33 When using an AFO with a solid ankle joint, a smoother gait may be achieved thorough use of
a CUSHIONED heel
192 Patients who have good extensor digitorum communis function but loss of intrinsics would require a hand orthosis with what component ?
an MP stop
46 at heel strike the ground reaction line passes
anterior to hip and posterior to knee
275 What is the cause of CHARCOT joints in the feet and ankle ?
any NEUROPATHIC Disease can have Charcot joints associated with it ( diabetes , herpes , syphilis )
54 Functionally, double action ankle joints can be effectively used in treating patients with paraplegia because they :
are highly adjustable
31 when putting a heel wedge on a shoe for a conventional AFO the wedge should be placed
between the stirrup and the sole
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
by adding a ratchet lock at the wrist 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
330 in fitting an AFO, the orthotist must insure the calf band :
cannot impinge on the PERONEAL nerve
9 the orthotic management of a T1 level fracture will have its best 3 point pressure system with which orthosis?
cervical thoracic orthosis (CTO)
3 paralytic equinus during swing phase is often caused by injury to the
common peroneal nerve
27 in a scoliotic curve the spinous processes rotate toward the
concavity
? wedge vertebra bar vertebra and hemi vertebra are seen most frequently in which type of scoliosis
congenital
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 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
24 for the assembly of the TLSO anterior control what should be done to the overall height measurement
decreased by 72mm
58 ( ?? ) What effect does reducing decompensation have on the critical load of the spine
decreases ( ??? test said Increases )
274 What is TIBIAL TORSION and how is it measured?
difference between KNEE and ANKLE joint Axes as viewed in the TRANSVERSE plane. with the knee at 90' - measure apex of each malleolus to a surface behind leg
19 A humeral fracture can be managed orthotically if it is in the ____ of the humerus. The most important biomechanical principle when managing these fracture is______
distal 2/3s, soft tissue compression
51 When fitting a conventional AFO, you must ensure the calf band :
does NOT impinge on the Common PERONEAL nerve
? during closed kinetic chain supination the talus is in what position
dorsiflexed and abducted
21 which of the following ankle joint controls would be indicated for flaccid isolated paralysis of the plantarflexors
dorsiflexion stops
What is the primary function of brachioradialis
elbow flexion Brachioradialis muscle serves to flex the elbow
31 The two functions of the bicep brachii are
elbow flexion and forearm supination
? the TLSO anterior control has two anterior pads that provide a posteriorly directed force. The anteriorly directed force by the posterior pad should provide what amount of force
equal to that posteriorly directed force
? Causes for circumduction during gait is
equinus knee arthrodesis extensor synergy pattern
20 Which of the following is a modification that should be made to a scoliosis orthosis for a patient with hypokyphosis
extend the posterior superior trim line to T3
? and idiopathic scoliotic curve with an apex of T-12 should be managed with which type of pad
extended lumbar pad
18 in using the wrist driven tenodesis orthosis, wrist
extension causes MP flexion
17 Wrist driven orthoses in a C-6 quadriplegic are powered by
extensor carpi radialis longus and brevis
? A C6 Quadriplegic would have all the following muscles intact except
extensor carpi ulnaris
2 the primary flexor of the hip is the
iliopsoas
14 Which biomechanical principle would be most effective in unloading an intervertebral disc?
increased INTRAcavity pressure
72 a young boy with early signs of muscular dystrophy comes into your office. Since one of the first stages of this disease is weakness of the hip extensors, you would expect him to walk with
increased lordosis
25 Placement of a thoracic band on a conventional orthosis should be 10mm
inferior to the most inferior inferior angle of the scapula
281 Describe CHARCOT-MARIE TOOTHE disease
inherited NEUROMUSCULAR atrophy characterized by progressive weakness of the distal muscles of arms and feet, usually develops in childhood
41 abduction and adduction occur within the hand at
metacarpophalangeal joint
37 which phase of gait does a rocker sole most closely simulate
midstance to toe off (????? heel????)
15 the end point vertebrae in a scoliosis curve are the
last convergent vertebrae most superior and inferior to the null point
69 a varus control strap on a conventional AFO attaches to the ___ aspect of the shoe and wraps around the ____ side bar
lateral, medial
5 toe-out or toe-in is the relationship of the long axis of the foot to the
line of progression
? while under axial loading there is pressure on the nucleus pulposus which in turn causes the annulus fibrosis to stretch this phenomenon is most consistent which biomechanical mechanism
load sharing
40 the claw hand deformity is the result of injury to which nerve
medial and ulnar
Choose all 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 pes plano valgus. 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
? one action of the peroneus longus is to
plantarflex the first ray
25 what motion does a cushioned heel simulate
plantarflexion at heel strike
Consists of four parts, only one of which acts across the hip joint Is the chief extensor of the knee Inserts into the tibial tuberosity
quadriceps femoris muscle
335 Functionally, adjustable dorsi and platar flexion stops can be effectively used in treating patients with paraplegia because they :
reduce the possibility of incorrect alignment
51 A patient is wearing a WHO: MP stop, IP extension assist for a median nerve lesion. If the patient had recovery of the ulnar nerve, how would you modify the orthosis ?
remove MP stop and IP extension assist fro MPs 4 and 5
? in which condition would the fat pad plantar to the metatarsal heads migrate into the sulcus
rheumatoid arthritis
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
? what measurements are needed to fabricate a milwaukee CTLSO
sagittal diameter of neck, coronal diameter of neck, height to mandible
25 A peripheral nerve injury at the wrist of the ulnar nerve could be orthotically managed with a
short opponens HO with a MP extension stop
21 the most important motor acquisition of the C5 quadriplegic is
shoulder and elbow flexion
284 What is the Rx rational for a rocker bottom shoe ?
simulate normal foot biomechanics promote even weight-bearing distribution ....in a patient with limited or no ankle motion
? Spastic paralysis may result from
spinal cord injury and brain injury
17 Which of the following conditions should be positioned in sagittal flexion when managing with a orthosis
spinal stenosis
The paraspinal bars of a TLSO: sagittal control should extend superiorly to the
spine of the scapula
6 the motion of inversion and eversion occurs primarily at which joint
subtalar joint
39 in what position should spinal orthoses be tightened on a patient
supine
? the medial column of the foot consists of which bones
talus, cuneiforms, navicular, metatarsals 1-3
a patient wearing a KAFO is seen in clinic. The patient complains of anterior thigh pressure while sitting. What could be the cause.
the mechanical knee joint is too distal in relation to the anatomical joint. If the mechanical knee joint of a KAFO is too distal in relation to the anatomical joint the patient will experience pressure on the anterior portion of the thigh while sitting
28 More ankle joint clearance is allowed for the medial malleolus because :
the medial malleolus is more prominent
7 Volar surface of the forearm contains the ____ muscles, which, as a group, originate at the ______ humeral epicondyle
wrist flexor, medial
8 On which side of the orthosis should the trochanteric extension be placed
the side of decompensation
350 Just Prior to heel strike :
there is a KNEE EXTENSION moment
Why is a Milwaukee brace carefully molded superior to the iliac crests?
to Prevent distal migration
38 The desirable length of a thumb post is
to mid nail bed
? your patient has suffered a single level burst fracture. The greatest instability, given the nature of the fracture, would be in which plane
transverse
? what characteristic is unique to the cervical spine
transverse foramen
374 The thoracic pad for a CTLSO should fit :
two vertebral levels INFERIOR to the apex of the curve
? Of the three types of odontoid fractures, which is most common and tends to have the least favorable outcome
type 2
? the lower motor neuron cell body is found in the _____ while the upper motor neuron cell body is found in the ____
ventral horn of the spinal cord, motor cortex of the brain
12 The most common MP joint deformity in rheumatoid arthritis is
volar subluxation and ulna deviation
? All if these are characteristics of Sheuermann's Kyphosis
wedged vertebrae, schmoris nodes, osteochondrosis, self limiting disease