Exam 3: Chapter 10 Flashcards
What does the pyramidal system involve
cortex-volitional movement
What would happen if the pyramidal system is damaged
Isolated/fractionated movement would be disrupted and initial neurogenic shock following the injury
What does the extrapyramidal system involve
subcortical systems/basal ganglia
What is the function of the extrapyramidal system
muscle tone, movement strategies, anticipatory/reactionary postural control, sequencing, orientation of head and body
What does the coordination systems involve
error control
What is the function of the coordination systems
feedback/feedforward
Accuracy of movement via purkinje fibers
What does the somatosensory perceptual systems involve
ascending pathways
What is the function of the somatosensory perceptual systems
body schema
proprioception
body position in space
What does the visual and perceptual systems involve
central processing of figure ground, depth perception, optical flow
What does the executive function motivation system involve
judgement
What is the function of the executive function and motivation system
problem solving
planning movement
dual task
What does the consciousness/homeostasis system involve
arousal levels/attention
orientation
The (CNS/PNS) collects sensory information about the body and the environment
PNS
The PNS is classified by what two things
- Involvement of sensory, motor, or both
2. The location of the involvement
What are the three determinants of effective movement
Muscle tone and performance
Postural Control
Movement and coordination
Flaccidity is velocity (dependent/independent)
independent
Rigidity is velocity (dependent/independent)
independent
Spasticity is velocity (dependent/independent)
dependent
Flaccidity is on the end of (hypotonia/hypertonia)
hypotonia
Spasticity is on the end of (hypotonia/hypertonia)
hypertonia
Rigidity is on the end of (hypotonia/hypertonia)
hypertonia
Hypokinetic muscle performance and low compliance results in what type movement dysfunctions
- Inadequate force production
- Slow movement
- Poor segmentation
- Poor eccentric control
- Moves in mid-range
Hypertonic muscle tone is the result of (hypokinetic/hyperkinetic) muscle performance and (low/high) compliance
hypokinetic; low
Hypokinetic muscle performance and high compliance results in what type of movement dysfunction
- Poor force production
- poor eccentric and isometric control
- Tends to move in end range
Hypotonic muscle tone is the result of (hypokinetic/hyperkinetic) muscle performance and (low/high) compliance
hypokinetic; high
Hyperkinetic muscle performance and high compliance results in what type of movement dysfunctions
- Excessive extensibility
- Quick, imprecise movement
- Burst of power with difficulty sustaining force
- Tendency to move through extremes of range
Hyperkinetic muscle performance and low compliance results in what type of movement dysfunctions
- Excessive force production
- Excessive power with difficulty adapting or dampening force
- All or nothing force with ballistic tendency
- Poor accuracy and precision
What muscle tone and muscle performance correlates with hyperextensibility
Hypokinetic muscle performance and high tone
What muscle tone and muscle performance correlates with hypoextensibility
Hypokinetic muscle performance and low tone
What types of muscle performance and muscle tone have impaired force production
- Hypokinetic muscle performance with low tone
2. Hypokinetic muscle performance with high tone
What type of muscle performance or tone has excessive force production
Hyperkinetic muscle performance with high tone
Which muscle performances and tone correlate with movement in end ranges
Hypokinetic muscle performance with low tone
Which muscle performances and tone correlate with movement in mid range
Hypokinetic muscle performance with high tone
Which muscle performances and tone correlate with movement through extremes of range
Hyperkinetic muscle performance with low tone
What are 6 common impairments seen in patients with neurological deficits
- Impaired muscle performance
- Abnormal underlying tone
- Inadequate force generation
- Poor postural control
- Deficits in timing and sequencing
- Disassociation of limb and body segments
What 4 compensations on functional movement are typically made in a patient with neurological deficits
- Rely on abnormal tonal patterns/synergies
- Strong burst of initial movement but unable to sustain the contraction throughout activity
- Uses end ranges to stabilize a joint
- Postural changes to adjust to balancing GRF’s
What type of splinting is only worn at night or part of the day
Ultraflex dynamic splints
The ultraflex dynamic splint provides a (low/high) load (short/long) duration stretch
low load, long duration
An ultraflex dynamic splint provides a low load long duration stretch that stimulates the production of _____ in series
sarcomeres
What is basic contractile unit of skeletal muscle and what is it made up of
A muscle fiber is the basic contractile unit of skeletal muscle and it is made up of parallel bundles of myofibrils
Explain the entire structure of skeletal muscle. (myofibril, sarcomeres, endomysium….)
- Sarcomeres are lined up in a series that make a myofibril
- Myofibrils are surrounded by the endomysium
- several myofibrils come together to form a bundle called a fascicle
- A fascicle is surrounded by perimysium
What are the aspects of thinking and treatment in making orthotic intervention in the order that they occur
- ROM
- Strength/Endurance
- Postural Control
- Coordination
True or False:
If a patient has inadequate ROM, we can strengthen their muscles and postural control to make up for the lack of ROM to improve gait during orthotic intervention
False, it may not impact gait at all because inadequate ROM would impact the GRF before they can use strength to respond
If a patient has inadequate postural control, what must first be worked on when it comes to orthotic intervention
ROM and strengthening
What influences how the acetabulum is formed
The femoral neck to shaft angle relationship and transverse planes
How are many of the tubercles and tuberosities formed in infancy
Through the stresses that are imposed on the bone through muscle action (Learning to crawl, walk, jump, etc..)
Which three bone cells are stimulated during weight bearing to control bone growth and proliferation
osteophytes, osteoblasts, and osteoclasts
Weight bearing stimulates osteophytes, osteoblasts, and osteoclasts to control ____ ____ and ____
bone growth and proliferation
____ ____ stimulates osteophytes, osteoblasts, and osteoclasts to control bone growth and proliferation
weight bearing
Bone ____ is also influenced by early weight bearing forces on long bones and joints
shape
Bone shape is influenced by early weight bearing forces on ____ bones and ___.
long; joints
Muscle (performance/tone) can be conceptualized as the interplay of compliance and stiffness of muscle as influenced by the CNS
tone
What does compliancy mean
flexibility
If a patient has low muscle tone and high compliance, what will be the main challenges that the individual faces
postural control and inability to support proximal joints
If a patient has high muscle tone and low compliance, what challenge will the individual endure the most
freedom and flexibility of movement are compromised
When does effective purposeful movement occur
When muscle performance meets the demands of the movement task
Would an individual with down syndrome have low tone or high tone
low tone
Give an example of an individual that may have high muscle tone and hyperkinetic muscle performance that eludes the “all or nothing” concept
A child with spastic CP doing a sit to stand
When is a KAFO indicated
When there is not antigravity with some resistance (less than 3+) and if proprioception is not intact bilaterally
When is an AFO indicated
If a patient has an impairment of ankle strength and proprioception
If a patient has hypertonicity of the plantar flexors
Or there’s a combination of the list above
What is one reason why bones change shape
Because of the forces exerted on them
When does bone growth stop
When the epiphyseal plates calcify and the child reaches skeletal maturity
When do females and males reach skeletal maturity
FM: adolescence
M: early adulthood
By the end of puberty, ___% of bone mass has accumulated
90
How is bone health maintenance maintained
Through a balance between osteoblasts developing new bone and osteoclasts resorbing/getting rid of existing bone
Bone is restructured/replaced at a rate of __% per year in cortical bone and __% per year in cancellous bone
5% in cortical bone
20% is cancellous bone
Bone is restructured/replaced at a rate of 5% per year in ____ bone and 20% per year in _____ bone
cortical; cancellous
list the factors that influence the rate of formation/resorption of bone (There’s 4)
hormones
vitamins
availability of essential minerals
enzymes
What is the synovial hip joint formed by
the acetabulum and femoral head
What is the function of the synovial hip joint
- Support weight of the upper body in functional tasks
2. Transmit forces from the pelvis to the lower extremities
What is the orientation of the acetabulum
Primarily in the sagittal plane while also facing laterally and slightly inclined inferiorly and anteriorly
How is the depth of the acetabulum formed and shaped
By the motion of the femoral head during weight bearing and movement
The acetabulum ossifies in (early/late) adolescence
late
What term can be described by the orientation of the head and neck of the femur in the frontal plane also known as coxa vara or coxa valga
angle of inclination
coxa (vara/valga) is less than 120 degrees
vara
Coxa (vara/valga) more than 135 degrees
valga
(antetorsion/anteverison) is the orientation of the neck and head of the femur in relation to the femoral condyles in the transverse plane (rotation of bone)
antetorsion
(antetorsion/anteverison) is the orientation of the neck and head of the femur in relationship to the frontal plane
anteversion
When are ortheses of the hip indicated
If there is an inadequate or ineffective development of the acetabulum and head of the femur in infancy
Avascular necrosis of the femoral head is associated with what pathology
Inadequate blood supply in childhood
Loss of cartilage/abnormal bone deposition is associated with what
osteoarthritis
Loss of bone strength and density is associated with what
osteoporosis
Hip dysplasia is classified by a _____ and ____ of the hip
subluxations and dislocations
What is typically associated with torticollis, and metatarsus varus clubfoot
hip dysplasia
What is the name of the test that can be performed to identify DDH and what is a positive sign
Ortolani
A positive test is an audible or palpable click
If an infant has DDH what are the two orthotic interventions in order from when they would be used
Early stage use Pavlik Harness
Late stage use Static Hip abduction/Rhino brace
Use the (Pavlik Harness/Rhino Brace) if a child is under 6 months of age. This should be worn for ___ hours a day
Pavlik Harness; 24
What is the position of the hip in a Pavlik brace. This means which motions are limited
100-120 degrees of flexion and 30-40 degrees of abduction
Extension and adduction are limited
Use the (Pavlik Harness/Rhino Brace) if a child is older than 6 months or didn’t progress well with the first brace.
Rhino Brace with is custom fit, pre fabricated abduction orthosis
What is the position of the hip in a Rhino Brace
90 Hip flexion and 120 hip abduction
How often should the Rhino brace be worn
Day and night, but typically just for naps and night time
What population does Legg-Calve Perthes avascular necrosis typically affect
Boys that are ages 4-8 that are otherwise healthy individuals.
Do girls or boys typically have better outcomes in Legg-Calve Perthes avascular necrosis
boys
What are the three controversial causes of Legg-Calve Perthes avascular necrosis
- trauma that leads to avascularization (compromised BF to femoral head)
- Abnormal thrombolysis leading to avascularization
- genetic predisposition
What are the signs and symptoms of Legg-Calve Perthes avascular necrosis
A noticeable limp and a positive trendelenburg
Pain in the hip, groin or both
Loss of ROM in the hip
How is Legg-Calve Perthes avascular necrosis diagnosed
X ray, ultrasound, or MRI
What are the three stages of Legg-Calve Perthes avascular necrosis
- Necrotic stage
- Fragmentation stage -resorption of damaged bone
- Healing and reparative stage - revasculariztion, reossification and bony remodeling
If a patient has Legg-Calve Perthes avascular necrosis what type of casting could be done? What is the goal of this type of casting?
Petrie casting can be done initially to lengthen the adductors
What is goal of orthotic management with Legg-Calve Perthes avascular necrosis
To facilitate revascularization of the femoral head and to restore the shape of the femoral head and alignment of the hip
What is the position of the hip with petrie casting to aid in the pathology Legg-Calve Perthes avascular necrosis. How long will a child wear this type of brace and can they ambulate
45 degrees of abduction
Worn for 1-2 years
Yes a child can still ambulate
What is the most common congenital orthopedic deformity
Talipes Equinovarus (Clubfoot)
What type of casting works extremely well with club foot and at what age does casting start. How often is this cast changed
Ponseti casting is started at 5 weeks old and is changed every week
If a child has clubfoot, what type of casting will be worn after a series of casting? How long and often will this brace be worn and at what age can a child discontinue this brace
A dennis browne bar or Dobbs bar is worn for 6-9 months, 24 hours a day.
After 6-9 months, the brace is worn at night until age 4
What is the position of the hip in a Dobbs bar brace
70 degrees of abduction if bilateral
40 degrees of abduction if unilateral
When are adult hip orthoses used and why
After surgery (THA) to allow soft tissue to heal
Following complex hip or proximal femur fracture
Commonly used with patients with neuromuscular involvement and are at increased risk for skin issues
Significant osteoarthritis
True or False:
An adult hip orthoses is typically used following elective hip arthroplasty
False
Why would an adult hip orthoses include a pelvic band
To control rotation
(open/closed) fracture is when the soft tissue and skin remain intact although there is still damage to the tissue
closed
(open/closed) fracture is when the soft tissue “envelope” is broken and the muscle and bone are open to the environment
open
True or False:
An open fracture is considered a medical emergency.
True
Why is an open fracture considered a medical emergency
Because of the risk of infection
What is the treatment of an open fracture
Immediate treatment with sterile debridement and stabilization of the fracture
How is a simple fracture reduced
closed reduction followed by casting or splinting
How are complex fractures reduced
By open reduction with either internal or external fixation
How many classifications of fractures are there
3
Which class of fractures is the most severe
3
Which classification of fracture severity involves a small wound with minimal soft tissue damage
1
Which classification of fracture severity involves a wound between 1-12mm with significant soft tissue damage
2
Which classification of fracture severity involves and open fracture with a wound greater than 12mm with significant damage to the periosteal stripping
3
What are the subcategories of a class 3 fractures and how are they divided
A, B, and C subcategories based on the amount of soft tissue available to cover the bone and how involved the vascular and neuro components are
What is the goal of fracture management by immobilization
To restore musculoskeletal limb function with optimal alignment functional strength, sensory function, and pain free motion
To stabilize a fracture, does the device need to encompass the joints above or below the fracture
both above and below
How long is a fracture need to be immobilized
6-8 weeks
What are some disadvantages of immobilization after a fracture
- Joint stiffness
- Muscle atrophy
- Skin breakdown
What are the characteristics of a cast
They are circumferential, not easily removed, and can be bi-valved to fit limb volume
What are the characteristics of a splint
Temporary, can be removed, made of rigid material and formed to the patient
How are casts removed
Hard fiberglass casts are removed with a cast saw. Soft fiberglass can be peeled off
What is a hybrid cast brace and where is it commonly seen
It is a cast broken up into two sections with a joint between the sections.
Commonly seen at the knee or elbow
What is a fracture orthoses designed to do
maintain alignment
limit joint motion
unload weight bearing forces
What are the characteristics for a fracture orthoses
Circumferential but allows functional mobility
Can be removed for wound and skin care
Hydrostatic forces and the length of the lever arm stabilize fracture
What are the two categories of UE orthoses
articular and non articular
What category of UE orthoses crosses a joint or a series of joints
articular
Is articular or non articular orthoses more common
articular
Wrist immobilization, thumb spica, and a posterior long arm orthoses are examples of what category of UE orthoses
articular
What category of UE orthoses does not cross a joint but rather stabilizes the body segment to which they are applied
non articular
A humeral cuff orthoses is an example of what category of UE orthoses
non articular
What are the two main purposes for UE orthoses
Immobilization and mobilization
A static orthosis (mobilizes/immobilizes)
immobilizes
What type of orthosis is used to provide protection and to restrict motion while maintaining tissue length at constant force
Static immobilizing orthoses
What type of orthosis is used to move or stretch soft tissues or joint to create a change with various forces
Mobilizing orthoses
What are the three types of mobilizing orthoses
dynamic
serial static
static progressive
Which type of UE orthoses has a rigid base and immobilizes the joints they cross while maintaining the joint in one position
static
What is the most commonly used UE orthoses
Static
What type of UE orthoses provides a constant force to the joint when worn and uses a static base that allows for outrigger components to increase ROM of specific tissues
Dynamic
What type of UE orthoses is intended to be worn for an extended period of time to lengthen the soft tissue while held in most tolerable end range position
Serial static
True or False:
In a serial static UE orthoses, because the force is evenly distributed over the surface are, these braces are frequently remolded to reflect the gains the person makes
True
If a patient has a fracture/trauma to the hand or just had botox, what type of UE orthoses would be best to use
Serial static
What type of UE orthoses applies a low load stretch to the soft tissue and joint at its end range of motion in one direction
Static progressive
What type of UE orthoses are typically nonelastic methods to apply force such as strapping materials, screws, hinges, turnbuckles, etc.
Static progressive
What are the advantages of a prefabricated UE orthoses
Ready to use
Easy to adjust
Less expensive
What are the disadvantages of a prefabricated UE orthoses
May interfere with other joints
Difficult to attain a good fit
Generally less comfortable
What are the advantages of a custom UE orthoses
More specific to the person
More comfortable
Least restrictive of uninvolved joints
Best option for a complex diagnosis
What are the disadvantages of a custom UE orthoses
more expensive
more time consuming
may be bulkier material
What part of the forearm would a circumferential UE orthoses encompass
The entire forearm (around the top and bottom)
What part of the forearm would a volar UE orthoses encompass
The bottom of the forearm - palmer side
What part of the forearm would a dorsal UE orthoses ecompass
The top of the forearm -back hand side
A (circumferential/volar/dorsal) UE orthoses design leaves the palmar sensory surface exposed for input and has stronger mechanical support of the wrist
dorsal
A (circumferential/volar/dorsal) UE orthoses design is tolerated better by edematous hands but requires more padding of the radial and ulnar styloids
dorsal
A (circumferential/volar/dorsal) UE orthoses design is best for extension outrigger
dorsal
A (circumferential/volar/dorsal) UE orthoses design is best for those with adequate muscle control of the wrist because it uses the natural padding of the hand
volar
A (circumferential/volar/dorsal) UE orthoses design has less sensory stimulation on the palmar surface of the hand and can impede lymphatic and venous flow with dorsal strapping
volar
A (circumferential/volar/dorsal) UE orthoses design is best for flexion outrigger
volar
A (circumferential/volar/dorsal) UE orthoses design is the most stable with forearm support, has the least migration, and controls edema while providing good pressure distribution
circumferential
A (circumferential/volar/dorsal) UE orthoses design is more complex and bulkier with less opportunity for skin to breathe
circumferential
(high/low) temp thermoplastic materials are commonly used to fabricate UE orthoses
low
What temp of water does thermoplastic UE orthoses soften in
135 to 180 F
True or False:
If orthotic material is left in hot water too long, it can become too soft and stretchy
true
True or False:
We need to be careful when applying orthotic material to skin because some materials hold heat longer and could burn a patient
true
What term describes the ability for orthotic material to return to its original shape
memory
What term describes the ease of conformity or how well an orthotic material stretches
drape
What term describes an orthotic material’s resistance to stretch and tendency to return to original shape, and is more forgiving
Elasticity
What term is described by an orthotic material’s ability to stick to itself
bonding
What landmarks are important to be cautious of in an UE orthosis
- Do not cover distal palmer crease for finger flexion
- Do not cover thenar crease for thumb movement
- Cover the wrist crease to stabilize forearm
- Don’t cover the MTP joints
