Boards
What would you recommend for additions to an articulated AFO for foot drop and posterior lateral hyperextension thrust of the knee (mild tone present)
- elevation of the 2nd-5th MTP joints and digits and a met pad to decrease tone - PF stop to allow clearance in swing = stop drop foot - 1/4in heel/lateral wedge to negate the posterior lateral hyperextension
A bk is seen stating they have posterior knee or hamstring discomfort. What can you do?
- lower the posterior medial brim on the prosthetic socket - flex the socket to decrease tension on - move foot posterior to decrease toe lever whereby decreasing the extension moment
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Placement of thoracic band on spinal orthoses =
1 inch below the inferior angle of scapula (T7) - terminates at MSL
What is ML foot placement in bench alignment for a TT?
1/2-1/4 in inset
A TT amputee has an anatomical A-P of 93mm or 3-3/4in, what should be the A-P mx of the positive model for a PTB hard socket?
101 mm or 4in -1/4 more
When taking a cast of a TT, their knee should be how flexed?
15-20 degrees flexed
Normal lumbar curvature is:
45 degrees of lordosis
what is the normal range of pro/supination of the forearm?
80 and 80
ML of an anatomical ankle joint is 8.3cm (3 3/4in). what should the inside measurement of the mechanical ankle joint be?
9.2cm or 3 5/8cm
After providing a device for a medicare beneficiary, the practitioner must provide any adjustments or repairs without charge for:
90 days
Choose which apply to GRAFO design: a. anterior/distal and posterior/proximal openings b. anterior/distal and posterior/proximal areas of AFO contact c. posterior/distal and anterior/proximal openings d. posterior/distal and anterior/proximal areas of contact
A and D
If a pt cannot tolerate a CASH due to an ostomy, what would be a different orthosis to suggest?
A jewett
In TF px alignment the relationship between the posterior socket shelf and the lateral wall is referred to as:
Adduction angle
The only vertebra without a body is the:
Atlas - C1
A pt with a diagnosis of Brown Sequard Syndrome (SCI) which occurs at C4 affecting his upper rt extremity and rt lower extremity comes to your clinic for an LE orthosis. He is ambulatory but requires minimal assistance. Initially, what assistive device would be most appropriate on what extremity?
Just a cane on the left side
Which of the following is designed to manage spondylolisthesis is an active teenager?
LSO - anterior overlap
The orthotic recommendation for treating a patient with an ulnar nerve lesion at the wrist is an opponens orthosis plus what component add on?
MP stop
In the cobbing process, individual vertebral tilt is noted by drawing a line across the inferior end plates. The point at which the line is most horizontal indicates the ____ of the curve.
Null point
A TT px pt is seen and has successfully used a prosthesis for 10 years but has grade 1 osteochondral defect "OCD" to his medial femoral condyle that is painful in weight bearing. What alignment change could you incorporate to assist in the clients discomfort?
Outset the foot -by outsetting the foot you create an external genu valgum moment at the knee in weight bearing, this assists in opening the medial knee compartment and pressure over the OCD
Brachycephaly
Short head - less than 80% length
aponeurosis is:
a flat broad tendon
Ankle valgus
ankle rolls inward - toward the arch
L5-S1 spondylolisthesis - LSO aligned?
decrease lumbar lordosis
Gowers sign is seen when a person gets up from the floor, walking hands up his legs to get upright. Choose the most common diagnosis where this is seen:
duschenne muscular dystrophy
how many pairs of nerve roots arise from the cervical area of the spinal cord?
eight
Where do axillary straps go on a spinal orthoses?
in the deltopectoral groove, does not impinge on axilla
a hand orhtosis controls:
palmar arch and thumb position
The typical timing to fit a child for a TT px is:
pulling up to stand - approx. 12-13 months
A bk amputee is wearing a PTB style endoskeletal prosthesis with general knee pain and distal end pressure. Upon examination of the limb you note redness on distal tibia and inferior aspect of the patella bone. What can you do?
- add a gastroc pad - try a 1 ply/or combo of socks
Patient population who could benefit from the krukenberg procedure
- blind pts with bilateral b.e amputations - failed prosthetic use for bilateral b.e amps
When designing a KAFO for a pt with severe genu recurvatum, what can you do to help control knee hyper extension?
- extend distal/posterior thigh trimline more distal - decrease depth of thigh section - extend proximal/anterior calf trimline more proximal - decrease depth of calf section
A bk amputee is seen for follow up and states he feels pain anterior/distal. What can you do?
- extend the socket - add pre-tib pads
What would be a good quality(s) to look for in a px foot for a TT amputee who is a K2 designated household ambulator that utilizes his px efficiently during the day but fatigues in the evening and buckles at the knee secondary to the quadriceps weakness
- feet the planarflex rapidly from heel strike to foot flat keep the ground force anterior to the knee joint whereby increasing knee stability - feet with soft heels or plantarflexion bumper keep the ground reaction forces anterior
Hand and glove measurement
- metacarpal circumference - length of middle finger
Sarmiento style fx orthosis utilizes which biomechanical principles for fx management:
- multiple 3 pt pressure systems - total contact - long lever arm -hydrostatic tissue loading
Possible causes of circumducted gait in a TF amputee
- px is too long: pt must circumduct to clear the foot - poor suspension: again clear foot - inadequate hip flexor strength: other muscles must be recruited to advance the leg - px foot is excessively plantarflexed: creates a leg length discrepancy, too long
Elbow disartic (class I) trimlines
- trimlines allow adequate stabilization of proximal socket but free motion of GH joint - rotation control by asymmetrically shaped distal end
A TT pt is seen with PVD is now experiencing ischemic pain within his px socket in what seems to be his gastroc muscles. What should be the most logical plan of action?
-decrease pressure adjacent to the popliteal artery we can minimize ischemic pain as blood flow will be less restricted -and seen by a vascular doctor
What are simple options for increasing the ease of pre-positioning the prosthetic elbow in flexion, for a TH amputee utilizing a body powered prosthesis who lacks glenohumeral flexion strength and biscapular abduction strength but can operate a elbow lock:
-have the forearm lift tab located distally/anterior: you move the pull angle anterior to bridge the elbow joint whereby decreasing force necessary to move the forearm section - check the resistance in the cable housing
What are two advantages of myodesis over myoplasty with regards to amputation?
-myodesis provides an anchor for a muscle to pull against which encourages hypertrophy - most joints in the body operate with the cooperation of antagonistic muscle groups, imbalances in these groups causes dysfunction in movement, myodesis try's to maintain muscle balance
Control of socket rotation for a transhumeral
-proximal D shape -proximal socket can be extended to control axial socket rotation -flattened side of D shape goes against the chest wall to minimize impingement
TF socket biomechanical goals
-weight bearing will occur on the ischial seat -hydrostatic loading over the whole limb, as well as gluteal loading -by containing the isch we can decrease lateral discomfort in weight bearing
Standard bench alignment for a TT px with a SACH foot in the coronal plane is:
0-12mm inset - helps to aid in mild genu varum moment at midstance which keeps the body's center of mass over the base of support
When establishing the static alignment for a TF px with a microprocessor hydraulic knee component, the TKA line should be:
0-5mm posterior to the mechanical knee joint axis
Wagner ulcer grades (0-5)
0. no ulcer but high risk foot 1. superficial/skin thick ulcer 2. deep, penetrating down to muscle/tendon 3. deep with cellulitis, often with osteomyelitis (infected bone) 4. localized gangrene 5. extensive gangrene
The retainer on a 50% length Class II AE amputee is placed where?
1'' proximal to the cut end of the bone
For a TF name a amputee cause and a px cause for each: 1. Lateral trunk bending 2. Circumduction 3. Vaulting 4. Excessive heel rise 5. Goose stepping 6. Long px step 7. Lateral whip 8. Medial whip
1. Lateral trunk bending - Amp: bad balance. Px: too short, improper lateral wall 2. Circumduction - Amp: no confidence in leg, abduction contracture. Px: too long, excessive knee friction 3. Vaulting - Amp: pain/fear. Px: too long, inadequate suspension, excessive knee flexion resistance 4. Excessive heel rise - Amp: excessive hip flexion. Px: insufficient knee friction 5. Goose stepping - Amp: waits for impact. Px: too much knee friction 6. Long Px step - Amp: flexion contracture. Px: insufficient intial flexion 7. Lateral whip - Amp: donned incorrectly. Px: knee too internally rotated 8. Medial whip - Amp: gait habit. Px: knee to externally rotated
prehension patterns in upper limb px (name all 5)
1. lateral/kep 2. cylindrical 3. tip 4. palmer 5. spherical
types of spina bifida:
1. occulta - mild, skin covers 2. meningocele - meninges pushed through opening but spinal cord intact 3. myelomeningocele - most severe surviving type, portion of spinal cord protrudes through back 4. myelocele - most severe, spinal cord exposed
Types of px knees (6)
1. outside hinge 2. single axis 3. stance control 4. polycentric 5. manual lock 6. microprocessor
Types of KAFOs
1. single axis - mild to moderate genuvarum/valgum control 2. offset - axis posterior, for moderate to severe genurecurvatum 3. polycentric - more closely simulate anatomical, more common to support KO 4. stance control - knee extensor paralysis 5. bale/wedge/ring - locking
how much length beyond the toes should be allowed when mx in non-weight bearing for diabetic extra depth shoes?
1/2 in
Corset placement for spinal =
1/2 inch below xiphoid and 1/2 inch above pubic symphosis
Where should a hip joint be placed for an AK amputee?
12mm anterior and 25.4mm superior to the greater trochanter
When fabricating a rancho style HO, what length would you terminate the thumb post at?
1st digit mid finger nail bed
For a 7'' long TT residual limb, initial ear trimlines for a TSB socket should be ____ inches proximal to the MPT level
2 1/2 inches
Elbow flexion requires ___" of cable excursion
2 1/2"
Placement for paraspinal bars on spinal orthoses =
2 inches plus or minus 1/2 inch on either side of apices chairback or knight - terminate below inferior angle knight taylor or taylor - terminate at end of spine of scapula
Complete opening of the terminal device requires an addition __" of cable excursion
2"
what is the approximate amount of the able bodied foot/ankle PF at toe-off
20 degrees
The proximal edge of the calf band of a metal AFO system should be ____mm ____ to the neck of the fibula
20 mm distal
what percentage of the gait cycle is spent in double limb support?
20%
During normal heel strike, the forward hip is how flexed:
25 degrees
What is the max amount of knee flexion contracture that could be fit with a traditional TT PTB socket?
25 degrees
What percentage of the iliac crest would be ossified with a Risser grade 2?
26-50%
The standard lateral inferior trimline for a single piece anterior opening custom LSO is:
2cm (3/4in) superior to the greater trochanter
the medial edge of an adult KAFO should terminate proximally?
3.8cm or 1.5" distal to the perineum
what position is the hip typically in during heel strike?
30 degrees of flexion
What is the proximal clearance for a KAFO from the perineum?
30 mm or 3 cm
what is standard clearance for knee joints on a KAFO?
3mm laterally, 6 mm medially
One ply sock thickness is equal to what in circumference?
4mm or 1/8in
how long does medicare require medical records to be retained for medicare beneficiaries?
5 years
The range of motion at the ankle joint is:
50 planarflexion and 20 dorsiflexion
TH px pt is seen and wants a terminal device for their body powered px to hold a broom
555 - symmetrically shaped lyre hook is ideal for round objects
Which terminal device would be best to pick up a small coin from a table?
5XA - because it has a canted shape which would allow an ease to seeing the object it is picking up
When HALO application is finished, pins for an adult should be torqued to ____ and between 24-48 hours the pins should be ____.
6-8 inch pounds; re-torqued
The stance phase of gait makes up what percent of the gait cycle during ordinary walking speeds
60%
in normal gait, maximum knee flexion reaches approximately?
60-65 degrees
A force of 9lbs is applied at the harness in the TR px, in order to maintain the minimum acceptable efficiency of the cable/housing, how much force must be needed in order to open the px hook:
70% is minimally accepted - so 9x.7= 6.3 lbs
how many CEUs must a single discipline ox earn every 5 years? how many must be scientific?
75:50
what is the appropriate torque for halo pins in an adult?
8 inch lbs
Carlyle index (upper-arm px length)
= height (in) x 0.19
Carlyle index (px forearm length)
= height (in) x 0.21
A pt is seen with an instable odontoid fx, what orthosis would you recommend?
A Halo
The ertl procedure is known as a osteomyoplastic amputation reconstruction that performs:
A bone bridge between the tibia with the fibular -uses an osteoperiosteal graft which is used for arthrodesis, offers improved weight distribution and is thought to add pain control
During swing phase, a tendency for the TF px to make a marked inward rotation of the knee accompanied by an outward rotation of the heel is called:
A lateral whip
A pt is seen in the hospital. The pt presents with a L1 burst fx. Which ox would be most appropriate ?
A polymer TLSO - burst fractures are most unstable in the transverse plane and a polymer tlso has most effective rotational contro
Which of the following is not a nocturnal scoliosis orthotic treatment system? a. Wilmington b. Charleston bending brace c. Providence orthosis
A. Wilmington
The unhappy triad consists of:
ACL, MCL, medial meniscus
When choosing if a px pt is a gel liner candidate, which of the following option(s) would assist you in this decision: general hygiene hand dexterity k-level allergies
ALL
The pavlic harness puts the patients hips in what position?
Abducted and flexed
Injury to the tibial nerve would cause what gait deviation?
Absent push off
When ftting a GRAFO, the pt complains of difficulty initiating swing on the side with the orthosis. What is the most appropriate modification?
Add a 1/4in heel wedge under the AFO
At a follow up visit for a pt who has bilateral solid ankle AFOs you note redness at the navicular on the right side. What modifications should you make?
Add a ST pad and padding just superior to the medial malleolus
Anterior compression fxs of the spine involve the:
Anterior column
During swingphase of gait what muscles are active to achieve dorsiflexion?
Anterior tibialis, extensor hallucis longus, extensor digitorum longus
With regards to spondylolisthesis, what are the radiographic signs that contraindicate orthotic intervention and indicate surgical candidate?
Anterior translation of the superior vertebrae over the inferior vertebrae greater than 50% superior vertebrae angulations of 50 degrees relative to the inferior vertebrae
What nerve innervates the deltoid and teres minor?
Axillary nerve
C2 is also called the:
Axis - because it along with C1 rotate the head
A pt is seen with a hangmans fx, this fx can cause quadriplegia. What vertebrae and location of the fx is damaged?
Axis C2, through both pars interarticularis/lamina
A pt is utilizing foot orthotics with 3/8in heel lifts to decrease inflammation of their heel chord, "achilles tendonitis". What lumbar pathologies could this aggravate? a. anterior compression fx of lumbar b. L5-S1 spondylolisthesis c. DJD of the lumbar facet joints d. lumbar spondylolysis
B,C,D heel lifts will increase lumbar lordosis and all of these pathologies are aggravated by this
Landmarks that match with spinal vertebra
C1- atlas C2 - axis C3/4 - hyoid bone C7 - most prominent of neck T2 - sternal notch T3/4 - spine of scapula T7/8 - inferior angle of scapula T9/10 - xiphoid L2/3 - waist crease, end of spinal cord L4 - iliac crest S2 - center of gravity S3 - ASIS
During casting of an ambulatory child with cerebral palsy for custom bilateral solid ankle AFOs you note that the right side lacks dorsiflexion range of motion (-5 degrees) with the knee extended. The most appropriate way to address this is to:
Cast in -5 degrees and plan to add an external heel wedge
Which amputation level is MOST likely to develop a equinus contracture?
Chopart
A bilateral upper extremity px pt often needs what added to the harness system to keep it from riding up?
Cross back strap
All of the following make up the pes anserinus except: a. sartorius b. gastrocnemius c. semitendinosus d. semimembranosus
D. semimembranosus: it inserts along he posterior aspect of the medial condyle where as the pes anserinus inserts on the medial surface of the superior part of the tibia
HCPCS procedure & supply code E500 is:
DME: durable medical equipment
When treating a pt with a knee flexion contracture, what is the most appropriate knee joint to use when designing a KAFO?
Dial lock joints
Which nerve innervates the rhomboid muscles and levator scapulae?
Dorsal scapula
When aligning the px socket posterior in relation to the px foot, forces present in the socket will increase where:
Due to the extension moment this causes; pressure will increase anterior/proximal and posterior/distal
A pt is seen in clinic. The pt presents with a separated connective tissue in her symphysis pubic. What orthosis is recommended and what hormone can cause the elasticity of the symphysis pubis during pregnancy?
Elastin hormone and an SI belt
An AK complains of knee instability while ambulating what alignment change can be made?
Extend the socket
during dynamic alignment of a TT px, how would you correct: knee jack knifes at loading response?
Extend the socket
T/F: A pt with cavo varus foot and peroneal tendonitis should utilize their functional foot orthosis (1st ray relief, extrinsic lateral wedge) with a pronator motion control type shoe
False. Needs supinator control shoe
The most appropriate control system for a pt with a self-suspending TR px would be:
Figure 9 harness with a single control cable
Deltoid action
Flex and extend the glenohumeral joint, and should abduction
If the curve of scoliosis corrects on a lateral flexion it is:
Flexible -not structural
What is Adam's test?
Forward bending to screen for structural or functional scoliosis
The clinical test performed to assess for paralysis of the ulnar nerve, specifically the adductor pollicus is called:
Froments test/sign
If the left/right markers are not on the scoliosis x-ray, we can still orient the film by looking for:
Gas bubbles in the colon and the heart shadow
Excessive adduction in a TT px pylon would cause what at midstance?
Genu varum - the foot would be too far inset
In TF applications, when inadequate socket flexion is incorporated into the px, what will the pt be unable to do without a gait deviation?
Have even step lengths
A TT px pt is seen and at heel strike the SACH px foot rotates externally, what is a cause of this deviation?
Heel is too firm, instead of absorbing the energy the force is translated laterally causing the rotation. (note: this can also be caused if the foot is squeezed into a shoe that is too small, falsely creates a firm heel)
A TT pt immediately after amputation keeps a pillow under his knee; what contractures can we expect to see if this continues?
Hip and knee flexion
A pt is experiencing recurrent positional posterior dislocation after hip replacement surgery. The primary goal of a hip abduction orthosis is to block:
Hip flexion
name the periods of the gait cycle and their respective percentages
IC 0-2 LR 2-12 Mst 12-31 Tst 31-50 Psw 50-62 Isw 62-75 Msw 75-87 Tsw 87-100
What modification can you make to an ulnar fx orthosis to increase its effectiveness at immobilizing a distal 2/3 ulnar fx:
Increase AP pressure - creates tension between the radius and ulna to further immobilize
A pt is seen at follow up in their PTB-SC px with pelite liner. The alignment is correct but now there is a gap between the socket and the residual limb at the lateral proximal brim. What is the most appropriate adjustment to address this problem?
Increase pelite thickness of the medial proximal aspect
Cauda Equina Syndrome
Injury at nerve root level - not actual spinal cord C6 - partial paralysis of upper extremity, possibility of using wrist driven WHO for tendesis grip C7 - similar to C6, but a little more finger function C8 - lacks fine finger movement T1-T12 and L1 - Normal upper extremity, complete paralysis of lower L2 and below - partial paralysis of lower extremity (could use AFO or KAFOs)
A brachial plexus injury occurs resulting in decreased wrist and hand function. Choose which type of brachial injury would likely be the cause:
Klumpkes palsy
Genu valgum is:
Knock kneed - gum makes your knees stick together
at which verterbral level does the cauda equina begin?
L2
A pt with semi rigid foot orthotics is complaining of discomfort on the plantar aspect of their feet just proximal to the 1st met head. What is most likely the cause?
Lack of relief for the flexor hallicus longus tendon
Short transhumeral trims
Lateral: over the acromion, flared to relieve the clavicle and spine of scapula Anterior: past the deltopectoral groove Posterior: to the medial border of the scapular -rotation controlled by brim
Long transhumeral (class II) trims
Lateral: to the acromion Anterior: to the deltopectoral groove Posterior: in line with the lateral border of the scapula - rotation controlled by socket brim, extended to cover shoulder
With respect to the TF quad socket measurements, which measurement would the following calculations be used for? - mx the ischial level circumference and divide it by three, then subtract 6mm
M/L
Genu valgum/abduction angulation of the knee may result from an injury to which ligament?
MCL
which components of an upper ext ox would best aid in prevention of claw hand deformity?
MCP ext stop and IP ext assist
What anatomical landmark is used when establishing the height of a TT px?
Medial tibial plateau
When fabricating a KAFO, how do you find knee center?
Midpoint between MTP (medial tibial plateau) and adductor tubercle
A scoliosis pt is seen, with a radiograph reading the thoracic curve apex is located at T6. Which orthosis is appropriate:
Milwaukee CTLSO
When flexing an AK socket what concurrent alignment adjustment should also be made
Move the prosthetic knee posterior - flexing the socket moves the weight line posterior to the knee which decreases knee stability
Spinal stenosis is:
Narrowing of the spinal canal
Spinal cord injuries
No function below level C6 - supposedly able to use tenodesis grip T6-8 - swing to gait in KAFO short distance, more common standing frame T9-12 - swing to gait in walker T12-L3 - community ambulator with assistive devices - L1 ends spinal cord - clonus medularis L1 - KAFO due to iliopsoas weakness L2 - bilateral AFOs L3 - complete lesion. spastic bladder, some recovery expected. L4-5 - AFO for foot drop
The main functional goal of posterior off-set unlocked knee joints is to:
Provide increased stability during stance
Damage to the femoral nerve will result in weakness to what main muscle group:
Quads - knee extenders note: hip extensors - sciatic hip abductors - superior gluteal ankle plantarflexors - peroneal
A pt utilizing a wrist driven flexor hinge, but they fatigue easily. What addition can be put on to allow for longer prehensile periods?
Ratchet lock at the wrist
What muscle is primarily an extensor of the knee that becomes a major hip flexor in TF amputations?
Rectus femoris
Parkinson's disease is a chronic, progressive disease of the CNS with degeneration of dopaminergic neurons. What are the four hallmark symptoms of PD?
Rigidity, brakykinesia, tremor and impaired postural reflexes
Having a pt perform a heel raise, screens what myotomal level:
S1
5 categories of px feet:
SACH, single axis, flexible keel, multiaxial, dynamic response
A pt presents with a midshaft humeral fx (10 degrees of varus) What orthosis would you recommend?
Sarmiento humeral fx orthosis - allows for micro motion at the fx site that promotes bone growth, circulation and allows movement at the elbow to minimize stiff elbows that would require more rehab
A pt has sustained a stroke and you note that he has a flexion synergy pattern in his upper extremity and lower extremity. Describe the synergy patterns:
Shoulder abduction, external rotation, elbow flexion, forearm supination, wrist flexion hip flexion, abduction, external rotation, knee flexion, ankle dorsiflexion, inversion
Double action ankle joint (DAAJ) setups:
Solid ankle - all pins Dorsi assist - free ant/springs post Plantar assist - springs ant/free post Dorsi stop - pin ant/free post Plantar stop - free ant/pin post
Early in recovery phase of a L3 complete spinal cord injury, what would be the most likely expected outcome?
Some recovery of function since damage is to peripheral nerve roots
A pt with upper motor neuron disorder has a posterior loss of balance with immediate sit to standing due to either tight muscles or weakness. What would most likely cause this?
Spasticity of the gastrocnemius-soleus
A pt has flaccid ankle PF and DF, also buckles at the knee during loading response/heel strike. What would the most appropriate DAAJ setup?
Springs posterior channel and pins in the anterior channels - the springs will allow for controlled plantarflexion
BK - lateral gapping in stance phase, what would reduce this?
Start by tightening the medial wall
A transtibial pt was seen presenting with a traditional exoskeletal PTB prosthesis with a SACH foot. Pt says she feels the prosthesis is throwing her knee forward as soon as the heel is firmly on the ground, it was fine up until a month ago. What could be the reason?
Switching to a higher heel shoe - would dorsiflex the foot relatively which would induce a flexion moment at the knee
Cowhorn spinal orthosis =
TLSO triplanar control - has subclavicular extensions which wrap anteriorly around axilla to the clavicle for more rotational control
Amputation that removes the midfoot and forefoot saving the talus and calcaneus is called:
The chopart
In the coronal plane, a plumb line dropped through the acromion of the Class II AE socket should fall through what landmark in a person with normal weight?
The medial border of the turntable
A TF pt is seen in clinic and exhibits lateral/proximal loss of contact in stance. Upon px fit examination it is noted the lateral wall is superior to the greater trochanter, the anterior wall contours to the adductor longus tendon, the posterior socket does not encompass the ischial tuberosity, the medial wall is located 65mm inferior to the perineum. What do you attribute to the cause of this deviation:
The medial wall is located too far inferior to the perineum - when a medial wall is located too far distal, the counter force with the lateral wall is lost causing a gap laterally, impinging the adductors, and losing optimal grasp of the ischial tuberosity
For a px user in rehab, what hand should a cane be held in?
The opposite of the px, to give tripod base for support, facilitate natural arm swing, facilitate normal px step length, and encourage knee stability and confidence
Many px knees require the toe to be loaded and un-weighted in order to transition from stance to swing features. Why would recommending two knees that function this way to a bilateral TF amputee to be contraindicated:
The pt would be unable to sit
You see a pt with wrist drop, paralysis of the triceps, brachio radialis, supinator and extensor muscles of the wrist and digits. What nerve is likely responsible for this?
The radial nerve
The distal aspect of the tibia articulates with:
The talus and the fibula
When designing a thermoplastic solid ankle afo, trimming the footplate proximal to the metatarsal heads will mostly effect:
The third rocker
What muscle is responsible for scapular elevation?
Trapezius
Injury to the superior gluteal nerve will result in what gait deviation:
Trendelenburg gait - because the superior gluteal nerve innervates the gluteus medius and minimus
True/false: Kinesthetic reminder cannot be applied to pts with spinal cord injury or scoliosis
True
difference between type 1 and type 2 diabetes and gestational diabetes
Type 1-Must have insulin because body is not producing it, cannot be prevented Type 2- Body not producing enough and body needs the glucose for energy (you fat, can prevent this) Gestational - fat prego women
A TF client is seen in clinic, upon doffing the suction socket you notice a red, wart like formation and cracked skin distally. Choose the name of this condition and the cause
Verrucous hyperplasia - caused by lack of contact
A torn posterior cruciate ligament will result in what motion of the tibia?
a backward gliding of the tibia on the femur
Kydek TLSO is:
a bivalve custom fabricated body jacket which offers rotational control, anterior, lateral and posterior control. uses: support compression fxs by holding pt in slight hyperextension, scolosis management, fusions (note: may require rib expansion allowance)
a pt comes into the office exhibiting lasting redness on the navicular and the medial malleolus after wearing her new AFO. what adjustment is most likely to correct this problem?
a firm sustentaculum tali pad
Describe a hydraulic single axis knee
a px knee that utilizes fluid resistance to modify TF prosthetic swing
which diagnosis would be most appropriate to fit with a CASH or Jewett style ox? a. T12 compression b. L3 burst c. T6 compression d. T11 chance
a. T12 compression
which of the following would not be affected by a proximal lesion of the musculocutaneous nerve? a. brachioradialis b. biceps brachii c. coracobrachialis d. brachialis
a. brachioradialis
a pt with spina bifida comes into your office after utilizing bilateral AFOs for six weeks. After re-evaluating their muscle strength you will likely tell them which of the following? a. continue AFO use b. AFOs can be cut to SMOs c. Add anterior panels as pts weakness progressed d. add padding to calf as pts sensation deficit progressed
a. continue AFO use the same
During the initial dynamic alignment of a TF px with an ischial containment socket you note a lateral shift of the socket during midstance. What is most likely the cause? a. lack of ischial containment b. foot too far outset c. AP dimension too long d. px is too short
a. lack of ischial containment
poliomyelitis is what type of pathology? a. lower motor neuron b. upper motor neuron c. progressive d. sensory
a. lower motor
While working with a pt with left hemiplegia you would expect that they would be least likely to respond if you were emphasizing: a. max use of demonstration and gesture b. simple verbal commands c. minimizing open ended questions d. simplification treatment
a. max use of demonstration and gesture because they have difficulty with sequencing, processing information and visuospatial deficits
A pt is seen with fixed forefoot varum, all of the following are considered compensatory strategies for this malalignment except: a. subtalor supination b. plantar flexed first ray c. subtalor pronation d. tibial internal rotation
a. subtalor supination
Which is not considered a carrier of blood borne pathogens? a. sweat b. cerebrospinal fluid c. semen d. synovial fluid
a. sweat
to prevent glenohumeral subluxation, what positions should the shoulder be placed in?
abduction and internal rotation
to promote healing in the case of legg calve perthes disease, the hip should be positioned in:
abduction and internal rotation
In a transmet amputation you would expect to see what gait deviations:
absent push off
taking assignment from medicare means the provider will:
accept the amount medicare approves as payment in full
Venous return of the blood to the heart is assisted by:
action of skeletal muscles
A pt with mortons neuroma utilizes a custom foot orthotic that has MLA support and Carlson modification. What other modification can increase the effectiveness?
add a metatarsal pad to increase distance between each met whereby decreasing pressure or shear against Morton's neuroma
What does scarpa's triangle consist of?
adductor longus sartorius inguinal ligament
The normal double S curve (lordosis/kyphosis) as seen in the sagittal plane is usually fully developed by:
age 6
A PTB bearing AFO could be indicated for which pathologies: a. charcot joint b. avascular necrosis of the talus c. osteoarthritis of the ankle joint d. calcaneal fx
all of the above
Choose all the pathologies that indicate the need for first ray relief and a lateral wedge in a functional foot orthotic: a. cavo varus foot b. peroneal tendon dysfunction c. chronic lateral ankle sprains d. jones fracture
all of the above - cavo varus = provides a neutral alignment - peroneal tendon = decreases tendon workload - ankle sprains = decrease tendency to laterally roll - jones fx = decreases pressure under 5th met
Choose all the pathologies that indicate the need for medial longitudinal arch support in a functional foot orthotic: a. plantar fasciitis b. posterior tibialis tendon dysfunction c. knee osteoarthritis in the lateral compartment d. pes plano valgus
all the above
What is the advantage of having the NW ring of the fig 8 harness slightly toward the sound side?
allow for most excursion, optimal location for control cable
why are flexible hinges recommended for a longer TR amputee?
allow for natural pronation and supination without impeding motion
the most appropriate orthotic treatment for a pt with a T12 compression fx is:
an anterior control hyperextension orthosis
When evaluating the mechanics of the px foot, it could be said that the resistance of the px keel is acting like which muscular group and what type of muscular contraction?
ankle plantarflexors and eccentric contraction - whereby controlling the anterior translation of the px pylon and socket over the foot in stance (note: eccentric related to braking/slowing down the progression of the leg and controlling it)
the axis of rotation of the hip joint is located where in comparison to the greater trochanter:
anterior and superior to the greater troch
an orthosis for a pt post ACL ligament reconstruction should primarily control ?
anterior displacement of the tibia on the femur
TT px sockets that are excessively extended cause excessive pressure in what areas:
anterior proximal and posterior distal
a pt with hyperkyphosis is placed in a milwaukee CTLSO for treatment. where should the corrective pressures be placed?
anterior throat ring and posterior thoracic pad
During swing phase of gait what muscles are active to achieve dorsiflexion?
anterior tibialis, extensor hallucis longus, extensor digitorum longus
In bench alignment of the TSB TT px, the accepted anterior-posterior location of the lateral reference point of the socket over a SACH foot is:
anterior to the ankle bolt by 1''
When standing still, the TF amputee's ischial tuberosity in a quad socket is held in place by what?
anterior wall
A forequarter amputation removes:
arm, clavicle, scapula
A pt presents with severe chronic bilateral posterior tibialis tendon dysfunction, she has worn UCBLs but were ineffective. What would you suggest?
articulated AFOs - they would further grasp the lower leg and can help lessen internal tibial rotation which would decrease the workload of the tibialis posterior muscle
In bench alignment of the TSB TT px, the accepted anterior-posterior location of the lateral reference point of the socket over a J-shaped foot is:
at the junction of the posterior and middle 1/3 of the foot
Legg-Calve-Perthes Disease is:
avascular necrosis of the femoral head types of orthoses- atlanta/Scottish rite, Toronto and Newington - all hold hips in 45 degrees abduction with internal rotation - can be worn continually for over 12 months
spondylolisthesis is a condition best described as: a. a fx of the pars articularis b. anterior displacement of the L5 vertebra in relation to the sacrum c. anterior displacement of the sacrum in relation to L5 d. a subluxation of the superior facet
b
which of the following is charged with regulating workplace safety and health legislation? a. HIPAA b. OSHA c. AAOP d. CMs
b. OSHA
you see a pt post triple arthrodesis. what device is best to provide? a. a negative heel shoe modification b. a rocker sole with sach heel wedge c. a corrective foot orthosis d. a crow boot
b. a rocker sole with a sach heel wedge
to best minimize gait deviations in a pt with right gluteus maximus and gluteus minimus weakness a pt requires: a. a cane on the right b. a cane on the left c. a walker d. a KAFO on the right
b. cane on the left
which of the following is not a prehension pattern? a. hook b. dorsal c. cylindrical d. lateral
b. dorsal
a pt presents in your office for treatment of knee pain due to medial OA, which is most likely to improve your pts symptoms? a. neoprene knee sleeve with hinges to limit flexion to 60 b. double upright knee ox aligned in valgus c. double upright knee ox with the corrective pressure on the medial condyle pad d. a solid ankle AFO with medial rearfoot wedge
b. double upright in valgus
Which of the following muscles are transected in a transmetatarsal amputation? a. peroneus longus b. extensor hallicus longus c. tibialis posterior d. tibialis anterior
b. extensor hallicus longus
which of the following is not a part of the humerus? a. trochlea b. pectineal line c. capitulum d. radial groove
b. pectineal line
Number one advantage of a knee disartic amputation:
bear weight on distal end
Which muscle is the primary forearm supinator?
biceps brachii - supinates and also helps flex the elbow
In myoelectric controlled upper extremity px: flexor muscle group produces a __ colored line and will cause the TD to __
blue, close
Genu varum is:
bow-legged - rum makes you open your legs
what is the prime elbow flexor?
brachialis
What is the lubricant filled sac, which, if removed, results in increased friction?
bursa
When modifying a TF quad socket plaster mold, if you are trying to increase the amount of adduction on the mold what must you do to maintain a level posterior shelf
by increasing the adduction angle the medial posterior shelf is relatively raised, by removing plaster laterally you can level out the shelf and maintain proper ischial tuberosity-distal end length
which of the following statements is most accurate? a. coding should be done based on your experience as a clinician b. it is the office admins responsibility c. coding decisions should accurately reflect provided services d. correctly completed coding should generate the max revenue
c
Which of the following ankle joint configurations would be most appropriate for a pt with fair (2/5) PF strength and good DF strength (4/5)? a. anterior spring/posterior pin b. anterior and posterior pins c. anterior pins, posterior springs d. anterior and posterior springs
c. anterior pins ad posterior springs
which motion is viewed in the coronal plane? a. elbow flex/ext b. forearm sup/pronation c. cervical lateral flexion d. ankle plantar/dorsiflexion
c. cervical lateral flexion
which is not a part of the scapula? a. glenoid cavity b. coracoid process c. coronoid process d. acromion process
c. coronoid process
which is not considered an upper motor neuron disease or injury? a. ms b. cerebral palsy c. diabetic neuropathy d. cva
c. diabetic neuropathy
Damange to which of the following structures leads to sensation deficits? a. golgi tendon organ b. vertebral branch of nerve roots c. dorsal branch of nerve roots d. sympathetic ganglia
c. dorsal branch of nerve roots
pressure is determined by: a. force divided by torque b. torque divided by area c. force divided by area d. area divided by force
c. force divided by area
active plantarflexion of the ankle is strongest when: a. hip is extended b. hip is flexed c. knee is extended d. knee is flexed
c. knee is extended
greatest cable excursion and force occurs when the control strap crosses the: a. upper 1/4 of scapula b. mid-scapula c. lower 1/3 of scapula d. spine of scapula
c. lower 1/3 of scapula
which of the following is not a sesamoid bone? a. patella b. pisiform c. lunate d. hyoid
c. lunate
which of the following is not a biarticular muscle? a. semitendinosis b. biceps femoris c. vastus medialus d. rectus femoris
c. vastus medialus
the subtalar joint is an articulation between the talus and the _____ and primarily allows _____
calcaneus and inversion/eversion
Mallet finger is:
cannot extend DIP joint
The movement of the thumb called opposition occurs at which joint?
carpo-metacarpal
opposition of the thumb occurs at which joint?
carpometacarpal
What is the primary target organ in rheumatoid arthritis?
cartilage
The _____ portion of the spine is the most flexible
cervical
What is an option for pre positioning the prosthetic elbow in flexion, for a TH amputee utilizing a triple control body powered prosthesis who lacks glenohumeral flexion strength and biscapular abduction strength but can operate an elbow lock:
change triple control to dual control, switch the split housing to single housing and utilize ballistic motion for the forearm lift
A hereditary disease that affects both sensory and motor peripheral nerves?
charcot marie tooth
an involuntary oscillating movement elicited by a rapid stretch is:
clonus
A hemi-vertebra is an indication that the scoliosis is ____
congenital
What is torticollis
contracture of the sternocleidomastoid, ipsilateral head tilt, and contralateral head rotation
A pt is diagnosed with an anterior cerebral artery stoke, what can you expect the pt to present with:
contralateral hemiparesis, leg more affected than the arm - middle artery stroke = hemiplegia, arm more than leg - basilar artery = quad, only preserved conciousness
The purpose of skirting in the shorter AE amputees is what?
control internal/external rotation at the GH joint
When examining a scoliosis radiograph, the vertebral body is seen to rotate toward ____ in relation to the curve and the spinous process is seen to rotate toward the ____ in relation to the curve.
convexity; concavity
Lateral flexion of the trunk occurs in which plane?
coronal
The posterior opening of the boston brace:
corresponds to the width of the 5th lumbar vertebra
which of the following is least likely to increase the likelihood of an infant developing a positional deformation of the cranium? a. infant is a twin b. low amniotic fluid in utero c. diagnosis of osteogensis imperfecta d. below 50% on weight chart at 4 months of age
d
In which of the following conditions is a Milwaukee ctlso contraindicated? a. skeletal immaturity b. idiopathic scoliosis c. thoracolumbar curves d. curves greater than 60 degrees
d - curves greater than 60
Which of the following has its insertion at the adductor tubercle? a. adductor longus b. adductor brevis c. semitendinosis d. adductor magnus
d. adductor magnus
A pt has medial nerve lesion, you would expect that they will have loss of all functions EXCEPT which of the following: a. abductor pollicis brevis b. flexor pollicis brevis c. opponens pollicis d. flexor carpi ulanris
d. flexor carpi ulnaris -which is innervated by the ulnar nerve, it is the only flexor the median nerve does not innervate
which of the following muscles inserts on the lesser trochanter? a. adductor longus b. gluteus medius c. tensor fasciae latae d. iliopsoas
d. iliopsoas
the adductors of the scapula include all but the: a. middle trapezius b. rhomboids c. latissimus dorsi d. serratus anterior
d. serratus anterior
The location of the AE forearm lift loop is moved distally. What will this do to the force and excursion required for elbow flexion?
decrease force, increase excursion
Lumbar DJD, aligned LSO how?
decrease lumbar lordosis
___ is the amount paid to an insurance company at the beginning of the year, and before the insurance company starts paying a percentage of the medical bills
deductible
a pt wearing a metal and leather KAFO with double adjustable ankles experiences excessive knee flexion during standing. to reduce this the orthotist should:
deepen the calf band
a pt presents with excessive tibial torsion. how should this be incorporated into a conventional double upright afo?
deflect the sidebars
why was the l-code established?
develop unified method of describing products/services to payers
What is tibial torsion?
difference between knee and ankle axes as viewed in the transverse plane
A pt with positional plagiocephaly has been wearing a custom cranial remolding orthosis for the past eight months. The pt is now 15 months old and has outgrown the orthosis. The practitioner should expect the physician to:
discontinue orthotic treatment since head growth has plateaued anyway
pt is in your office for a scoliosis TLSO adjustment. You note the orthosis is too small and her latest x-ray shows a risser sign of 4, what action should you take?
discuss weaning out wearing the orthosis and refer back to physician for end of treatment
KAFO mechanical knee center problems: distal proximal posterior anterior
distal = anterior pressure on thigh/brace migrates proximally proximal = posterior pressure on thigh/brace migrates distally posterior = pressure on anterior calf cuff and thigh/brace migrates proximally anterior = pressure on posterior calf/brace migrates distally
With upper extremity, supination and pronation occur at what joint:
distal and proximal radioulnar
When fabricating a thermoplastic articulated AFO, the mechanical ankle joints should be placed at the level of:
distal border of the medial malleolus
the correct height of a mechanical ankle joint is:
distal tip of medial malleolus
A 23yr old wrist disartic intends to return to work as a carpenter. Which terminal device would offer him the largest range of tool handling capabilities?
dorrance 7
which muscles serves to abduct the phalanges away from the 3rd digit?
dorsal interossi
You are seeing a pt with PVD, what is the common artery that you can palpate to assess blood flow?
dorsalis pedis
the primary purpose of an AFO with trimlines posterior to the malleoli is:
dorsi-assist
The trim lines of a ground reaction AFO should be anterior to the malleoli to serve as a:
dorsiflexion stop
A pt is seen with flaccid ankle plantarflexors and dorsiflexors. Appropriate DAAJ setup?
either pins in both channels or springs in posterior channel and pins in the anterior channel
Class I transhumeral
elbow disarticulation condylar flares to full length humerus
Primary function of the brachioradialis:
elbow flexion
the primary function of the brachioradialis is:
elbow flexion
What are the two controls in the dual control system of the body powered TH px?
elbow flexion and TD activation
What is the most important factor in decreasing the vertical loading of the lumbar spine?
enhancement of the abdominal hydropneumatic mechanism
When evaluating a new trans-met amputee, what deformity of the foot and ankle complex is typical without tendon transfer?
equino varus - peroneus longus is transected and this causes weakness of pronators allowing supinator muscles to override
Which is often the result of an irregular birth?
erb's palsy
Pronation of the foot equals what movements
eversion, abduction and dorsiflexion
A visible medial whip during swing phase of TF gait may be caused by?
excessive external rotation of the knee
a pt with complete c6 spinal cord injury powers a wrist driven flexor hinge tendosis by using the - what muscles?
extensor digitorum communis and extensor carpi ulnaris
which muscle most closely duplicates the function of the tibialis anterior?
extensor hallicus longus
A TF px pt is seen with a lateral whip, what adjustment may be done?
externally rotate the knee
adhesive capsulitis:
extreme stiffness of the shoulder joint (a.k.a. frozen shoulder)
What additions can you make to an AFO to decrease excessive pronation within the AFO:
extrinsic medial wedge medial sabolich trim sustentaculum tali pad
True/false: when fabricating a px socket in general it is necessary to have all 'like' fibers directly adjacent to aid in strength
false
True/false: Unilateral BK amputees should be instructed to ascend stairs with the prostheses leading first and descend stairs with the sound limb leading first
false - up with the good and down with the bad
T/F: A GRAFO can have a sulcus length foot plate
false: GRAFOs tend to be full foot plates so to utilize a longer lever arm to resist knee instabilities
True/False: when fabricating a TR fig 8 harness it is necessary to incorporate elastic materials in the control strap
false: inelastic to make sure to capture maximum cable excursion
DDH (developmental dysplasia of the hip)
femoral head outside acetabulum socket/dislocation or riding laterally/just outside socket - infant can be treated with Pavlik harness - hip positioned flexed and abducted
Most common congenital absence of a long bone in the extremities is:
fibular hemimelia
You notice a pt with an articulated AFO and PF stop ambulating has a pronounced knee flexion moment during loading response, what could cause this?
firm extrinsic heel wedge or PF stop too dorsiflexed
Plagiocephaly
flat head - usually back or side of head asymmetry
What do the lumbricals do?
flex the MP joints and extend the IP joints
dorsiflexing the prosthetic foot is synonymous with:
flexing the prosthetic socket
what compensatory motion would you most likely see in an individual with quadriceps weakness?
forward trunk lean
What is the most appropriate foot orthotic for a type 2 diabetic?
functional and accommodative - fabricated out of diabetic multi-density tri lam foam with a medicare approved foam base layer
A pt had failed conservative treatment for plantar fasciitis including foot orthotics, physical therapy, shoe wear mods. What are surgical interventions that can be done next?
gastroc lengthening and plantar fascia release
dorsiflexion stop performs the function of which muscle?
gastroc/soleus
Which would you most expect to see in a pt with plantarflexion contracture? a. late heel rise b. genu recurvatum at midstance c. increased flexion at loading response d. reduced knee flexion at midswing
genu recurvatum at midstance
Which pathology is most likely to be fit with free knee joints?
genu varum deformity
During gait you see the pelvis drop at midstance. What muscle weakness could this be?
gluteus medius
The sciatic nerve innervates all the muscles except: a. semitendinosis b. biceps femoris c. semimembranosis d. gluteus medius
gluteus medius
lateral stability of the pelvis in stance phase is accomplished through the action of which muscle?
gluteus medius
What muscles are transected in a knee disartic?
gracilis, along with sartorius and hamstrings
In TF gait, what muscle group acts to decelerate the leg before initial contact?
hamstrings
Milwaukee orthosis -
has neck ring, corrective spinal orthosis to treat scolosis or scheuermann's kyphosis
your pt is experiencing pressure at the proximal posterior of the afo he wears to control mild genu recurvatum. what is the best choice to eliminate this pressure?
heat and flare proximal trim
The gait cycle is composed of:
heel strike on one side followed by heel strike by that same foot
Gait cycle is described by the activity of:
heel strike on one side to heel strike on the same side
The congenital abnormality of the spine in which one side of the vertebra is incompletely developed is:
hemivertebra
A UCBL achieves greater control than a conventional FO on which part of the foot?
hind foot/calcaneus
What muscle group would you expect to be the weakest in an above knee amputee?
hip adductors
The biceps femoris causes what motion at the hip and knee respectively:
hip extension and knee flexion
what are the actions of the sartorius?
hip flexion, external rotation and knee flexion
A pt with bilateral pars fxs at L5 is currently utilizing a custom polymer overlapping LSO with decreased lumbar lordosis. How can you further immobilize the fx site?
hip spicas to adjust hip flexion and extension
The elbow lock control is activated through what movement?
humeral extension, abduction and downward rotation of the scapula
When evaluating for a fluid TF px knee, which type is adversely effected by cold environmental temperature changes:
hydraulic
C.A.S.H:
hyperextension spinal orthoses
Jewitt is:
hyperextension spinal orthoses -can effectively control/influence T10-L3
What is Elhers-Danlos Syndrome?
hypermobility of tissue, joints. May dislocate joints easily. Bracing may be used to stabilize joints
With hip disartics, what is used for suspension?
iliac crest
What is the anatomical name for the Y ligament?
iliofemoral ligament
the primary hip flexor is the:
iliopsoas
which ligament prevents hyperextension of the hip joint?
illiofemoral ligament
A TF pt is seen and exhibits the px foot 'smears' externally as she simultaneously abducts her px whereby advancing forward in the sagittal plane and as well, complains of low back pain. What is a px cause?
inadequate flexion is built into the socket - pt must use compensatory motions for forward progression. inadequate flexion can cause hyperlordosis which would account for the low back pain
Pelvic band on a spinal orthoses placement =
inbetween greater troch and iliac crest and terminates at midsagittal line
A KAFO pt has utilized the same device for 3 years but now developed avascular necrosis of the femoral condyles. What changes could be made to the current KAFO to allow for minimal ambulation without slowing the reversal of AVN?
incorporate ischial weight bearing
During the initial dynamic alignment of a TT px there is an excessive varus moment at midstance. This can be resolved by:
increase the adduction of the socket
Referring to knee stability in TF px, what would the effect of lowering the vertical height of the instant center of rotation?
increase the hip moment required to maintain stability
What material should a cross back strap on a fig 8 harness be made of?
inelastic/cotton webbing
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
maximum able-bodied knee flexion occurs during which period of the gait cycle?
initial swing
A TH px pt is seen in clinic: the pt utilizes a body powered px with a hosmer mechanical elbow and complains he can operate it but it requires too much effort. What can be done to remedy this?
install a spring lift assist
A TF px pt is seen with a medial whip, what adjustment may be done?
internally rotate the knee
what do the lumbricals do?
intrinsic muscles of the hand that flex the metacarpophalangeal joints and extend the interphalangeal joints (flex MCP, and extend PIP)
Supination of the foot equals what movements
inversion, adduction and plantarflexion
What bony landmark is utilized for weight bearing prosthesis in a hip disartic?
ischial tuberosity
When the TT pylon leans laterally in static alignment, what is the cause?
it means you are too ADducted and need to ABduct the socket and/or outset the foot
Why is choosing a SACH foot with a firm heel durometer not advised for TT pts with poor px side knee stability
it will decrease knee stability - a SACH foot with a firm heel moves the ground reaction force posterior to the knee inducing a flexion moment
With a knee disartic what is a cosmetic concern?
knee extends out too far while seated or kneeling
you are testing a pts L3, L4 and L5 myotomes. what motions are you testing?
knee extension, dorsiflexion and great toe extension
A pt with guillian-barre syndrome. The pt has weak knee extensors, knee flexors, ankle planarflexors and dorsiflexors. What muscles groups would you expect to regain strength first if the syndrome begins to remit?
knee extensors and flexors - as syndrome remits pts begin to regain function proximally to distally
At heel strike the knee joint is at ___ while the ankle joint is at ____
knee is at neutral and ankle is at full extension or 90 degrees
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
The length of the forearm section of a TR px is determined by measuring the sound side from the:
lateral epicondyle to the ulnar styloid
What is a possible cause of external rotation of the AE px during humeral flexion?
lateral suspension strap too posterior or humeral retainer too far lateral
If a px foot is too inset on a TT pt, socket pressure increases where?
lateral/distal and medial/proximal
A pt presents to your office with bossing of the right posterior cranium and flattening on the left posterior cranium. How would you classify this?
left posterior brachycephalic
Which slide direction of the socket to decrease hyperextension of the knee?
lengthen the heel lever arm so slide foot posterior
Which levels of amputation will lead to an equinus gait deformity?
lisfranc chopart transmetatarsal
during which phase of gait are the hip extensors most active?
loading response
Class II transhumeral
long TH between deltoid insertion and humeral condylar flares
Marfan Syndrome
long arms and legs, bony fingers, tallness, weak aorta, curved spine, may cause chest wall to protrude and calls for pectoral compression brace or something to correct overly curved spine
Schaphocephaly
long narrow head
What nerve innervates the serratus anterior?
long thoracic nerve
Persons with short TF residual limbs generally exhibit lateral bending of the trunk due to:
loss of an adequate lever arm
flaccid paralysis is most often seen in:
lower motor neuron injuries
When measuring for a TLSO, what position should the pt be in?
lying supine
articulation between the sternum and the clavicle occurs at the:
manubrium
How do you find the anatomical waist?
measure the distance between the inferior costal margin and the iliac crest and divide it by 2
When fabricating a TH px it is important to add pre-flexion to the px elbow; why is this?
mechanical advantage is placed into the px system that will decrease the force necessary to initiate elbow flexion whereby increasing the ease of operation on theamputee
A pt wearing a KAFO, complains of anterior thigh pressure while seated. What could be the cause?
mechanical knee joint is too distal in relation to anatomical joint
In pronation, the thumb tip of the 5XA terminal device is located on the ____ side of the wrist unit?
medial
Hamstring relief on the posterior aspect of the socket is typically seen with medial relief being how much lower?
medial 1/4 to 3/8 inches lower than the lateral relief
What is the easily palpable tendon in the popliteal area when the knee is flexed?
medial hamstring -semitendinosis/semimembrinosus
The minimal clearance for a mechanical knee joint on a metal double upright KAFO is:
medially 5mm and laterally 6mm
what is an inflammation of the outer coverings of the brain and spinal cord?
meningitis
Which column(s) of the spine do you expect to see damaged in a burst fracture?
middle and anterior
during ambulation the body's center of mass reaches its highest point at:
midstance
Pronounced impact shock at full extension of the px knee indicates a need for:
more extension dampening controls
What is scheuermann's kyphosis?
mostly male 12-17 progressive structural kyphosis
What is a simple option for pre-positioning the px elbow in flexion, for a TH amputee utilizing a body powered px who lacks glenohumeral flexion strength and biscapular abduction strength but can operate an elbow lock:
move the proximal base plate and retainer on the humeral section anterior, by doing this you move the pull angle anterior to bridge the elbow joint whereby decreasing the force necessary to move the forearm section about
What is canting and preflexion of the forearm in px?
movement of forearm/wrist placement to make it easier for pt to reach mouth
When recommending a px for a bilareral TR pt what style of suspension is not recommended?
munster self suspending - because they require a pull sock to don
Myodesis:
muscle to bone
Myoplasty:
muscle to muscle
Which style of muscular tissue management in an TH amputation would be of greatest advantage to a myoeletric prosthesis candidate:
myodesis - can provide anchors for muscles innervated by the musculcutaneous and radial nerves. this provides palpable, separable, antagonistic muscular contractions which are most likely to exhibit strong myo-signals
the able bodied foot/ankle is ____ during terminal swing
neutral
Charleston bending brace
nighttime brace for early idiopathic scoliosis, seeks to control scoliosis by over correction - molded while standing and bending towards the convex side of the primary curve, most effective with single curves below T7
Providence brace
nocturnal scolosis brace - utilizes precise grid and cad/cam to create device
which type of scoliosis is most likely the result of a leg length discrepancy?
nonstructural scoliosis
the gelatinous center of a spinal disc is the:
nucleus pulposus
The rules relating to the safe use of potentially hazardous materials in the fabrication of orthoses are under the jurisdiction of the:
occupational safety and health admin
The trochanter extension and pad of the boston brace are placed:
on the side L5 tilts towards
The muscle that has the primary responsibility of rotating the thumb to touch the tips of the index and middle fingers is the:
opponens pollicis
Brittle bone disease is also called:
osteogenesis imperfecta
Normal aging of the joints is known as _____ and is more likely to appear in _____ and _____
osteoporosis; cancellous bone and elderly
A elbow disartic pt is seen in clinic for px replacement, what type of articulation at the elbow would be indicated?
outside locking hinge
Osgood-Schlatter disease:
painful, bony bump on the shinbone just below the knee. It usually occurs in children and adolescents experiencing growth spurts during puberty. Osgood-Schlatter disease occurs most often in children who participate in sports that involve running, jumping and swift changes of direction — such as soccer, basketball, figure skating and ballet - more in boys -treatment: a knee brace with lateral supports and silicone/padding near body prominence underneath knee
what muscles close/adduct spread fingers?
palmar interossi
a young child with a T12 myelomeningocele is seen in your office for a device that will help pt ambulate and allow hands free standing. what device would you evaluate for?
parapodium
Axial rotation of each vertebral segment can be noted on an x-ray by the location of the:
pedicles
The keel of the SACH foot partially replaces the function of which muscle group?
planarflexors
the muscles that pass posterior to the lateral malleolus act to:
plantarflex and evert
At heel strike what type of movement is present at the ankle in the sagittal plane?
plantarflexion
The functions of the tibialis posterior muscle are:
plantarflexion and inversion
In a TT px pt you observe the toes of the px foot are more than 1.5 in above the floor at initial contact, what alignment adjustment is needed?
plantarflexion the foot or extend the socket
What muscle group does the anterior stop in a single axis foot substitute for?
plantarflexors
when the limb moves from midstance to terminal stance what muscle group contracts and in what manner?
plantarflexors, concentric
clubfoot
pointed downward and inward
In general polycentric knees are considered inherently stable, why is this:
polycentric knees have a theoretical knee center which is located posterior and superior
A TF px pt is utilizing suction suspension you can best differentiate the socket pressure as ___ in stance phase and ___ in swing phase
positive pressure in stance and negative in swing
A pt reports pain at the navicular and posterior to the medial malleolus. what is the most likely pathology?
posterior tibial tendon dysfunction
A pts chief complaint is of pain on the medial side of their ankle just below the medial malleoli. On a clinical examination the pt has slight weakness with inversion, pes planus, pain with heel raises and tenderness and swelling under the medial malleoli. The most likely cause of the symptoms are:
posterior tibial tendonitis
which muscle inserts on the navicular and medial cruneiform?
posterior tibialis
At initial contact the body weight line is what to the ankle and knee?
posterior to knee and ankle
the lower extremity is most stable in stance when the weight line falls: _____ to the hip and _____ to the knee
posterior to the hip and anterior to the knee
max plantarflexion occurs at which phase of gait:
pre swing
The ultimate goal of orthotic treatment of scoliosis is:
prevent progression of the curve/s
charcot joint/Neuropathic arthropathy:
progressive degeneration of weight bearing joint
With a krukenberg procedure what muscle is the driver of the pincer grip:
pronator teres
Hueter-volkmann law
proposes that growth is reduced by increased mechanical compression, and accelerated by reduced loading in comparison to normal values
Flexible elbow hinges on a long TR allow for rotation and:
provide suspension
you deliver a device to a hospital pt unable to communicate, you should?
provide the nurse or caregiver with verbal instructions and leave written instructions
which scenario is best to test differential between grade 3 and 4 psoas major strength?
pt lies supine with knee extended and examiner resists hip flexion
a pt has wears a ground reaction AFO, recently switched shoes and is experiencing his knee being forced backward. what would you most expect and how will you fix it?
pt switched to lower heel height, add a heel wedge
A pt with an above knee amputation has a px, during gait analysis you find she has knee instability while standing and you see knee buckling with any weight shift, you suspect the cause is:
px knee is too far anterior to the TKA line
name the group of muscles and the type of contraction that provide control and stability of stance phase knee flexion
quads - eccentric
at which joint does upper extremity pronation and supination occur?
radioulnar
Which muscle of the quadriceps femoris group will steady the hip joint and help iliopsoas to flex the thigh?
rectus femoris
In myoelectric controlled upper extremity px: extensor muscle group produces a ___ colored line and will cause the TD to ___
red, open
Onion skin lamination is:
removable multiple layers of a socket to accommodate for growth - used mostly with children
Volnar subluxation and ulnar deviation of the MP joints for digits 2-5 is indicative of what?
rheumatoid arthritis
What are signs of neuromuscular scoliosis:
right lumbar and left thoracic curve
a pt comes into your office for ox treatment for a right thoracic scoliosis brace, what are you most likely incorporate into the ox? ____ axillary ext ___ pad
right thoracic pad left axillary extension
Partial foot amputees often present with a lack of controlled third rocker late in stance. What options can assist with this other than a partial foot insert with a toe filler?
rigid sole shoe rocker addition to shoe carbon insert OTS carbon AFO
The erector spinae muscles are found in the intermediate layer of the muscles in the back. When they act bilaterally, they extend the spinal column. When they act unilaterally what action do they perform?
rotate
The position of the thoracic facets most easily allows for which movements?
rotation and lateral flexion
If a scoliotic curve is non-structural what will you notice with forced lateral side-bending:
rotational components of the curve will correct themselves
True dorsi and plantarflexion occur in which plane?
sagittal
The taylor TLSO:
sagittal control - flexion/extension of spine - common pathologies - kyphosis, thoracolumbar pain, fxs due to osteoporosis
The knight-taylor TLSO:
sagittal/coronal control - flexion/extension and lateral movement
what nerve divides into common peroneal and tibial?
sciatic
Which muscles aid in stabilizing the scapula and is important in motions such as pushing and punching?
serratus anterior
Class III transhumeral
short TH between deltoid insertion and axilla (humeral neck)
When external rotation of the px foot is needed the toe lever or keel of the foot is relatively:
shortened
When selecting posterior pin placement in a HALO CTLSO application, where is proper starting position:
slightly superior to the ear, opposing the anterior pin directly, inferior to equator of the cranium
Benefit of a knee disartic over a above knee amputation
socket rotational control natural weight bearing surface muscular balance equalized with abductors and adductors larger surface area for prosthetic socket
AK with medial leaning pylon can be what alignment cause?
socket too adducted
Elbow disartic suspension
socket- bulbous distal end anterior suspension strap lateral suspension strap
TT pt during gait is seen with a mild extension moment at the knee in stance phase, what could be the cause? (note: alignment is right)
soft prosthetic heel
hydrocephalus often accompanies which of the following? a. meningitis b. positional plagiocephaly c. elhers-danlos syndrome d. spina bifida
spina bifida
Williams LSO is:
spinal orthoses; posterior and coronal control - has oblique lateral uprights: placement - inferior attachment points are rigidly attached to pelvic bands and superiorly pivoting on lateral bars - spondylolisthesis can be treated/controlled with this due to anterior slippage being limited: the Williams lso allows for free lumbar flexion but limits extension three pt pressure - posteriorly directed force from attached corset and adjustment strap while the stabilizers are the thoracic and pelvic bands
What is the superior margin of the paraspinal bars on a taylor TLSO?
spine of the scapula
A raney flexion jacket can be used to treat:
spondylolithesis
When turning a conventional AFO into a dorsiflexion assist AFO, how would you set up the DAAJ?
springs in the posterior channel
Infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin and mucous membranes are referred to as:
standard precautions
a pt with quadriplegia resulting from a lesion at C7 neurosegmental level is most likely to benefit from which of the following? a. cock up splint b. wrist driven who c. mobile arm support d. static ho
static ho
A shoulder abduction rotation orthosis is also referred to as:
statue of liberty orthosis
SOMI brace
sternal occipital mandibular immobilizer - cervical extension not controlled with this
the muscle length-tension relationship describes:
strength of a muscle changes depending on the affected joint's position through its arc of motion
Transverse tarsal joints allow inversion and eversion of the foot. What other joints allow this:
subtalor, talocalceonavicular and transverse tarsal
what are the two origins of the biceps brachii?
supraglenoid tubercle and coracoid process
What nerve innervates supraspinatus and infraspinatus?
suprascapular nerve
With a below elbow amputation all of these muscles would be transected except: a. flexor carpi radialis b. supraspinatus c. brachioradialis d. pronator quadratus
supraspinatus - on scapula
Hyperextension of the PIP joint and flexion of the DIP joint constitutes a ____ deformity
swan neck
the space between the axon and the dendrite is called the?
synapse
in addition to the deltoid, the axillary nerve innervates the: a. teres minor b. teres major c. short head of the triceps brachii d. subscapularis
teres minor
Maximum dorsiflexion occurs during which phase of gait?
terminal stance
max able bodied foot/ankle dorsiflexion occurs during which period of the gait cycle
terminal stance
max able bodied hip extension occurs during which period of the gait cycle?
terminal stance
The talus does not articulate with: a. cuboid b. tibia c. navicular d. fibula
the cuboid
If the sciatic nerve is severed at the level of the tibial tuberosity, muscle function will NOT be impaired at what joints:
the hip - it will contribute to knee, ankle and foot disfunction
Craniosynostosis
the premature fusing of the skull bones
The nominate bone of the pelvic girdle is known as the:
the sacrum
Posterior trim lines on a TLSO extend from the sacrococcylgeal joint to just inferior to ____. Anterior trim lines extend from symphysis to the ____.
the scapular spine; sternal notch
Benefits of polycentric knees:
they relatively shorten in swing- greater foot clearance they provide cosmesis when sitting - fold compact they are inherently stable - more superior and posterior knee center
where are pressures directed in almost all cases with a milwaukee tlso?
thoracic and lumbar pads should be anteromedial
Which type of scoliotic curves would you expect to progress more given only the location of the curve:
thoraclumbar and single lumbar
The c-bar on a hand orthosis acts as a:
thumb adduction stop
blounts disease is also known as:
tibia vara
The tibial nerve innervates muscles to the ___ portion of the leg, while the deep fibular nerve innervates muscles on the ___ portion of the leg
tibial nerve = posterior muscles deep fibular nerve = anterior and dorsum of the foot
A pt is seen for the fourth time for ankle joint replacement on their KAFO for post polio, what could be the cause if ankle joint height is correct?
tibial torsion was not built into the KAFO
in a double action ankle joint the pins in the posterior channel best simulate what muscle?
tibialis anterior
Why do the proximal trims of an AFO terminate 1in inferior to the fibular neck?
to avoid impinging on the common fibular nerve
When an oval wrist unit is used, its long axis is rotated internally for what reason?
to permit the TD to pick up articles from a flat surface
Thomas test is:
to rule out hip flexor contracture - pt lies supine and tries to bring one knee up to chest, trying to keep back flat to the surface and if back/other leg lift up there is sign of tightness or possible contracture
If an individual utilizing a metal double upright AFO system present with flexible valgus condition, you can use a valgus corrective strap secured where?
to the lateral upright
multiplying lever arm length by force applied =
torque
The radial nerve is injured within the radial groove. What muscle would not be paralyzed? a. triceps b. supinator c. brachioradialis d. extensor carpi ulnaris
triceps - higher than injured area
T/F: A pt with pes plano valgus foot and peroneal tendonitis should utilize their functional foot orthotics (MLA support, extrinsic medial wedge, and or Carlson modifications) with a pronator motion control type shoe
true
T/F: An RGO allows forward progression by harnessing energy from ones hip extension and translating it into contralateral hip flexion
true
T/F: The retainer and base plate on the TR prosthesis holds the control cable to the px in a position for the most efficient transmission of power
true
True/False: When fabricating a TR fig 8 harness the inverted Y strap should be located in the delto-pectoral groove
true
during IC through early LR, the DR muscle group is acting eccentrically to control PF on the foot until foot flat occurs (t/f)
true
True/False: Outsetting the px foot on a TT px increases socket pressure medial/distal and lateral/proximal
true - will cause a valgus moment at the knee
True/false: in a TT amputee when trying to increase the energy return of a dynamic response foot it may be necessary to increase plantarflexion
true: by plantarflexing the foot, forefoot pressure increases relatively earlier in stance which allows greater energy to build up and be released during terminal stance
a pt presenting with hyperextension of the 4th and 5th metacarpal phalangeal joints and flexion of the interphalangeal joints likely has a wrist level lesion of which nerve? and what is this presentation called?
ulnar - claw hand
The clawhand appearance is due to what nerve damage?
ulnar nerve
cubital tunnel syndrome, what nerve is affected?
ulnar nerve
what gait deviation would you primarily expect to see with a tibial nerve lesion?
uncontrolled tibial advancement during stance phase
When applying a pediatric HALO, how may protocol differ from adults?
use more pins, less torque
what is the term that best pertains to the palm of the hand and sole of the foot?
volar
A TR px pt needing the ability to vary grip force on small delicate objects would benefit from which terminal device
voluntary closing hook
A pt with duchennes muscular dystrophy is seen to ambulate with increased lumbar lordosis secondary to which muscular weakness?
weak hip extensors
What are signs of congenital scoliosis:
wedged, bar and hemi vertebrae
Perry and burnfield describe 3 gait cycles synergies. Name the three synergies
weight transfer, transition, progression
what is most appropriate for a median nerve injury at the wrist?
who with a thumb post
A pt presents with right radial nerve intact and severed median and ulnar nerves. What orthosis would you recommend ?
wrist driven flexor hinge WHFO
what orthosis would best restore upper extremity function for a pt with a spinal cord injury above the C6 level?
wrist driven who
Radial nerve damage =
wrist drop
can a device that is delivered prior to admission to a hospital be billed to medicare?
yes but only if medical necessity for device is independent of pts admission to the hospital
If the practitioner's facility is designated as a participating supplier, this means that:
you must accept the medicare allowable amount as payment in full
