Chapter Two

Question 1

What is the first phase in formulating the prescription for a patient?

Answer 1

It involves evaluatiion of the patient to identify the underlying problems, disease, and disability and to establish a prognosis for future expectations.

Question 2

What is the second phase in formulating the prescription for a patient?

Answer 2

it includes the actual treatment plan of wirting prescriptions for the orthosis, therapy and medication that may be appropriate for the underlying diease process.
This also includes alternative measures: surgery or injections, to improve the underlying condition prior to fitting the brace.
Education of patient and team members also take place.

Question 3

What is phase 3 in formulating the prescription for a patient?

Answer 3

Follow-up to assess for functional outcome.

Question 4

What is functional outcome?

Answer 4

It can be measured as the patient’s improved mobility , self-care, and reintegration into the community or as improved quality of life for the patient and caregivers.

Question 5

What is the role of the orthotist?

Answer 5

Participate in patient eval. 
Act in consulting role
Educate patient regarding device
Fabricate the device
Deliver and check device
Modify and repair orthosis
Follow-up with patient
Share knowledge with team

Question 6

Special attention must be given to issues such as what?

Answer 6

Biomechanics of the device
Durability of the device
Tolerance to pressures

Question 7

What does static mean?

Answer 7

There is no motion across the joint. Therefore stabilization is the goal

Question 8

What does dynamic mean?

Answer 8

There is motion across the joint
This could mean no motion in one plane, and free motion in others. 
Limited motion with fixed endpoints
Free motion
Augmented motion
Resistance to motion

Question 9

What might an orthosis have at one joint, and what else might be at another joint.

Answer 9

Static motion at one joint and dynamic motion at the other.

Question 10

What is the foundation for generating the appropriate prescription for the orthotic device?

Answer 10

A clear understanding of the patient’s disease process.

Question 11

What are key compoents of the history of a patient that should be written down?

Answer 11

Initial presentation of the disease, trauma, or problem, the course of the disease to date, and other treatments applied.

Question 12

What should be discussed in detail with patient?

Answer 12

Patient’s functional status, and patient’s expectations or functional goals.
Comorbid conditions.

Question 13

What are examples of comorbid conditions?

Answer 13

Diabetes
Neurologic disease, 
Vascular disease
Visual impairment
Hand dysfunction.

Question 14

The physical examination of the patient should include what?

Answer 14

MMT
ROM
Sensation
Tone
Skin interity 
Presence of edema
All of these in both limbs

Question 15

What is the definition of ataxia?

Answer 15

A dysfunction of the cerebellar system that impairs coordination of muscular activities during functional tasks

Question 16

What is the definition apraxia

Answer 16

A failure of sequencing and timing of existing muscle activity that may impair functional activity, such as ambulation and self-care tasks.

Question 17

What should be included on the orthotic prescription?

Answer 17

Patient name
Date of birth
Other identifying information
Name of practition or company
Body of prescription should include:
Details of orthosis
Each segment or component
Materials
Joints
corrective straps, flangs or wedges. 
Special features: tone reducing contours or inversion control
The prescription should be so detailed that another orthotist could create this custom device.

Question 18

A letter of medical neccesity may include what?

Answer 18

Specifics regarding the patients current functional status,
how the orthotic device may lead to improvement
Prevention of falls or other conditions because of safety to the patient.