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Prosthetics & Orthotics > Exam 3: Chapter 10 > Flashcards

Exam 3: Chapter 10 Flashcards

1
Q

What does the pyramidal system involve

A

cortex-volitional movement

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2
Q

What would happen if the pyramidal system is damaged

A

Isolated/fractionated movement would be disrupted and initial neurogenic shock following the injury

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3
Q

What does the extrapyramidal system involve

A

subcortical systems/basal ganglia

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4
Q

What is the function of the extrapyramidal system

A

muscle tone, movement strategies, anticipatory/reactionary postural control, sequencing, orientation of head and body

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5
Q

What does the coordination systems involve

A

error control

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6
Q

What is the function of the coordination systems

A

feedback/feedforward

Accuracy of movement via purkinje fibers

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7
Q

What does the somatosensory perceptual systems involve

A

ascending pathways

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8
Q

What is the function of the somatosensory perceptual systems

A

body schema
proprioception
body position in space

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9
Q

What does the visual and perceptual systems involve

A

central processing of figure ground, depth perception, optical flow

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10
Q

What does the executive function motivation system involve

A

judgement

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11
Q

What is the function of the executive function and motivation system

A

problem solving
planning movement
dual task

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12
Q

What does the consciousness/homeostasis system involve

A

arousal levels/attention

orientation

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13
Q

The (CNS/PNS) collects sensory information about the body and the environment

A

PNS

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14
Q

The PNS is classified by what two things

A
  1. Involvement of sensory, motor, or both

2. The location of the involvement

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15
Q

What are the three determinants of effective movement

A

Muscle tone and performance
Postural Control
Movement and coordination

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16
Q

Flaccidity is velocity (dependent/independent)

A

independent

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17
Q

Rigidity is velocity (dependent/independent)

A

independent

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18
Q

Spasticity is velocity (dependent/independent)

A

dependent

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19
Q

Flaccidity is on the end of (hypotonia/hypertonia)

A

hypotonia

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20
Q

Spasticity is on the end of (hypotonia/hypertonia)

A

hypertonia

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21
Q

Rigidity is on the end of (hypotonia/hypertonia)

A

hypertonia

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22
Q

Hypokinetic muscle performance and low compliance results in what type movement dysfunctions

A
  1. Inadequate force production
  2. Slow movement
  3. Poor segmentation
  4. Poor eccentric control
  5. Moves in mid-range
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23
Q

Hypertonic muscle tone is the result of (hypokinetic/hyperkinetic) muscle performance and (low/high) compliance

A

hypokinetic; low

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24
Q

Hypokinetic muscle performance and high compliance results in what type of movement dysfunction

A
  1. Poor force production
  2. poor eccentric and isometric control
  3. Tends to move in end range
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25
Q

Hypotonic muscle tone is the result of (hypokinetic/hyperkinetic) muscle performance and (low/high) compliance

A

hypokinetic; high

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26
Q

Hyperkinetic muscle performance and high compliance results in what type of movement dysfunctions

A
  1. Excessive extensibility
  2. Quick, imprecise movement
  3. Burst of power with difficulty sustaining force
  4. Tendency to move through extremes of range
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27
Q

Hyperkinetic muscle performance and low compliance results in what type of movement dysfunctions

A
  1. Excessive force production
  2. Excessive power with difficulty adapting or dampening force
  3. All or nothing force with ballistic tendency
  4. Poor accuracy and precision
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28
Q

What muscle tone and muscle performance correlates with hyperextensibility

A

Hypokinetic muscle performance and high tone

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29
Q

What muscle tone and muscle performance correlates with hypoextensibility

A

Hypokinetic muscle performance and low tone

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30
Q

What types of muscle performance and muscle tone have impaired force production

A
  1. Hypokinetic muscle performance with low tone

2. Hypokinetic muscle performance with high tone

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31
Q

What type of muscle performance or tone has excessive force production

A

Hyperkinetic muscle performance with high tone

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32
Q

Which muscle performances and tone correlate with movement in end ranges

A

Hypokinetic muscle performance with low tone

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33
Q

Which muscle performances and tone correlate with movement in mid range

A

Hypokinetic muscle performance with high tone

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34
Q

Which muscle performances and tone correlate with movement through extremes of range

A

Hyperkinetic muscle performance with low tone

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35
Q

What are 6 common impairments seen in patients with neurological deficits

A
  1. Impaired muscle performance
  2. Abnormal underlying tone
  3. Inadequate force generation
  4. Poor postural control
  5. Deficits in timing and sequencing
  6. Disassociation of limb and body segments
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36
Q

What 4 compensations on functional movement are typically made in a patient with neurological deficits

A
  1. Rely on abnormal tonal patterns/synergies
  2. Strong burst of initial movement but unable to sustain the contraction throughout activity
  3. Uses end ranges to stabilize a joint
  4. Postural changes to adjust to balancing GRF’s
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37
Q

What type of splinting is only worn at night or part of the day

A

Ultraflex dynamic splints

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38
Q

The ultraflex dynamic splint provides a (low/high) load (short/long) duration stretch

A

low load, long duration

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39
Q

An ultraflex dynamic splint provides a low load long duration stretch that stimulates the production of _____ in series

A

sarcomeres

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40
Q

What is basic contractile unit of skeletal muscle and what is it made up of

A

A muscle fiber is the basic contractile unit of skeletal muscle and it is made up of parallel bundles of myofibrils

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41
Q

Explain the entire structure of skeletal muscle. (myofibril, sarcomeres, endomysium….)

A
  • 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
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42
Q

What are the aspects of thinking and treatment in making orthotic intervention in the order that they occur

A
  1. ROM
  2. Strength/Endurance
  3. Postural Control
  4. Coordination
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43
Q

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

A

False, it may not impact gait at all because inadequate ROM would impact the GRF before they can use strength to respond

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44
Q

If a patient has inadequate postural control, what must first be worked on when it comes to orthotic intervention

A

ROM and strengthening

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45
Q

What influences how the acetabulum is formed

A

The femoral neck to shaft angle relationship and transverse planes

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46
Q

How are many of the tubercles and tuberosities formed in infancy

A

Through the stresses that are imposed on the bone through muscle action (Learning to crawl, walk, jump, etc..)

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47
Q

Which three bone cells are stimulated during weight bearing to control bone growth and proliferation

A

osteophytes, osteoblasts, and osteoclasts

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48
Q

Weight bearing stimulates osteophytes, osteoblasts, and osteoclasts to control ____ ____ and ____

A

bone growth and proliferation

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49
Q

____ ____ stimulates osteophytes, osteoblasts, and osteoclasts to control bone growth and proliferation

A

weight bearing

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50
Q

Bone ____ is also influenced by early weight bearing forces on long bones and joints

A

shape

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51
Q

Bone shape is influenced by early weight bearing forces on ____ bones and ___.

A

long; joints

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52
Q

Muscle (performance/tone) can be conceptualized as the interplay of compliance and stiffness of muscle as influenced by the CNS

A

tone

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53
Q

What does compliancy mean

A

flexibility

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54
Q

If a patient has low muscle tone and high compliance, what will be the main challenges that the individual faces

A

postural control and inability to support proximal joints

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55
Q

If a patient has high muscle tone and low compliance, what challenge will the individual endure the most

A

freedom and flexibility of movement are compromised

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56
Q

When does effective purposeful movement occur

A

When muscle performance meets the demands of the movement task

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57
Q

Would an individual with down syndrome have low tone or high tone

A

low tone

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58
Q

Give an example of an individual that may have high muscle tone and hyperkinetic muscle performance that eludes the “all or nothing” concept

A

A child with spastic CP doing a sit to stand

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59
Q

When is a KAFO indicated

A

When there is not antigravity with some resistance (less than 3+) and if proprioception is not intact bilaterally

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60
Q

When is an AFO indicated

A

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

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61
Q

What is one reason why bones change shape

A

Because of the forces exerted on them

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62
Q

When does bone growth stop

A

When the epiphyseal plates calcify and the child reaches skeletal maturity

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63
Q

When do females and males reach skeletal maturity

A

FM: adolescence
M: early adulthood

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64
Q

By the end of puberty, ___% of bone mass has accumulated

A

90

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65
Q

How is bone health maintenance maintained

A

Through a balance between osteoblasts developing new bone and osteoclasts resorbing/getting rid of existing bone

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66
Q

Bone is restructured/replaced at a rate of __% per year in cortical bone and __% per year in cancellous bone

A

5% in cortical bone

20% is cancellous bone

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67
Q

Bone is restructured/replaced at a rate of 5% per year in ____ bone and 20% per year in _____ bone

A

cortical; cancellous

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68
Q

list the factors that influence the rate of formation/resorption of bone (There’s 4)

A

hormones
vitamins
availability of essential minerals
enzymes

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69
Q

What is the synovial hip joint formed by

A

the acetabulum and femoral head

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70
Q

What is the function of the synovial hip joint

A
  1. Support weight of the upper body in functional tasks

2. Transmit forces from the pelvis to the lower extremities

71
Q

What is the orientation of the acetabulum

A

Primarily in the sagittal plane while also facing laterally and slightly inclined inferiorly and anteriorly

72
Q

How is the depth of the acetabulum formed and shaped

A

By the motion of the femoral head during weight bearing and movement

73
Q

The acetabulum ossifies in (early/late) adolescence

A

late

74
Q

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

A

angle of inclination

75
Q

coxa (vara/valga) is less than 120 degrees

A

vara

76
Q

Coxa (vara/valga) more than 135 degrees

A

valga

77
Q

(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)

A

antetorsion

78
Q

(antetorsion/anteverison) is the orientation of the neck and head of the femur in relationship to the frontal plane

A

anteversion

79
Q

When are ortheses of the hip indicated

A

If there is an inadequate or ineffective development of the acetabulum and head of the femur in infancy

80
Q

Avascular necrosis of the femoral head is associated with what pathology

A

Inadequate blood supply in childhood

81
Q

Loss of cartilage/abnormal bone deposition is associated with what

A

osteoarthritis

82
Q

Loss of bone strength and density is associated with what

A

osteoporosis

83
Q

Hip dysplasia is classified by a _____ and ____ of the hip

A

subluxations and dislocations

84
Q

What is typically associated with torticollis, and metatarsus varus clubfoot

A

hip dysplasia

85
Q

What is the name of the test that can be performed to identify DDH and what is a positive sign

A

Ortolani

A positive test is an audible or palpable click

86
Q

If an infant has DDH what are the two orthotic interventions in order from when they would be used

A

Early stage use Pavlik Harness

Late stage use Static Hip abduction/Rhino brace

87
Q

Use the (Pavlik Harness/Rhino Brace) if a child is under 6 months of age. This should be worn for ___ hours a day

A

Pavlik Harness; 24

88
Q

What is the position of the hip in a Pavlik brace. This means which motions are limited

A

100-120 degrees of flexion and 30-40 degrees of abduction

Extension and adduction are limited

89
Q

Use the (Pavlik Harness/Rhino Brace) if a child is older than 6 months or didn’t progress well with the first brace.

A

Rhino Brace with is custom fit, pre fabricated abduction orthosis

90
Q

What is the position of the hip in a Rhino Brace

A

90 Hip flexion and 120 hip abduction

91
Q

How often should the Rhino brace be worn

A

Day and night, but typically just for naps and night time

92
Q

What population does Legg-Calve Perthes avascular necrosis typically affect

A

Boys that are ages 4-8 that are otherwise healthy individuals.

93
Q

Do girls or boys typically have better outcomes in Legg-Calve Perthes avascular necrosis

A

boys

94
Q

What are the three controversial causes of Legg-Calve Perthes avascular necrosis

A
  1. trauma that leads to avascularization (compromised BF to femoral head)
  2. Abnormal thrombolysis leading to avascularization
  3. genetic predisposition
95
Q

What are the signs and symptoms of Legg-Calve Perthes avascular necrosis

A

A noticeable limp and a positive trendelenburg
Pain in the hip, groin or both
Loss of ROM in the hip

96
Q

How is Legg-Calve Perthes avascular necrosis diagnosed

A

X ray, ultrasound, or MRI

97
Q

What are the three stages of Legg-Calve Perthes avascular necrosis

A
  1. Necrotic stage
  2. Fragmentation stage -resorption of damaged bone
  3. Healing and reparative stage - revasculariztion, reossification and bony remodeling
98
Q

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?

A

Petrie casting can be done initially to lengthen the adductors

99
Q

What is goal of orthotic management with Legg-Calve Perthes avascular necrosis

A

To facilitate revascularization of the femoral head and to restore the shape of the femoral head and alignment of the hip

100
Q

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

A

45 degrees of abduction
Worn for 1-2 years
Yes a child can still ambulate

101
Q

What is the most common congenital orthopedic deformity

A

Talipes Equinovarus (Clubfoot)

102
Q

What type of casting works extremely well with club foot and at what age does casting start. How often is this cast changed

A

Ponseti casting is started at 5 weeks old and is changed every week

103
Q

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

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

104
Q

What is the position of the hip in a Dobbs bar brace

A

70 degrees of abduction if bilateral

40 degrees of abduction if unilateral

105
Q

When are adult hip orthoses used and why

A

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

106
Q

True or False:

An adult hip orthoses is typically used following elective hip arthroplasty

A

False

107
Q

Why would an adult hip orthoses include a pelvic band

A

To control rotation

108
Q

(open/closed) fracture is when the soft tissue and skin remain intact although there is still damage to the tissue

A

closed

109
Q

(open/closed) fracture is when the soft tissue “envelope” is broken and the muscle and bone are open to the environment

A

open

110
Q

True or False:

An open fracture is considered a medical emergency.

A

True

111
Q

Why is an open fracture considered a medical emergency

A

Because of the risk of infection

112
Q

What is the treatment of an open fracture

A

Immediate treatment with sterile debridement and stabilization of the fracture

113
Q

How is a simple fracture reduced

A

closed reduction followed by casting or splinting

114
Q

How are complex fractures reduced

A

By open reduction with either internal or external fixation

115
Q

How many classifications of fractures are there

A

3

116
Q

Which class of fractures is the most severe

A

3

117
Q

Which classification of fracture severity involves a small wound with minimal soft tissue damage

A

1

118
Q

Which classification of fracture severity involves a wound between 1-12mm with significant soft tissue damage

A

2

119
Q

Which classification of fracture severity involves and open fracture with a wound greater than 12mm with significant damage to the periosteal stripping

A

3

120
Q

What are the subcategories of a class 3 fractures and how are they divided

A

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

121
Q

What is the goal of fracture management by immobilization

A

To restore musculoskeletal limb function with optimal alignment functional strength, sensory function, and pain free motion

122
Q

To stabilize a fracture, does the device need to encompass the joints above or below the fracture

A

both above and below

123
Q

How long is a fracture need to be immobilized

A

6-8 weeks

124
Q

What are some disadvantages of immobilization after a fracture

A
  1. Joint stiffness
  2. Muscle atrophy
  3. Skin breakdown
125
Q

What are the characteristics of a cast

A

They are circumferential, not easily removed, and can be bi-valved to fit limb volume

126
Q

What are the characteristics of a splint

A

Temporary, can be removed, made of rigid material and formed to the patient

127
Q

How are casts removed

A

Hard fiberglass casts are removed with a cast saw. Soft fiberglass can be peeled off

128
Q

What is a hybrid cast brace and where is it commonly seen

A

It is a cast broken up into two sections with a joint between the sections.
Commonly seen at the knee or elbow

129
Q

What is a fracture orthoses designed to do

A

maintain alignment
limit joint motion
unload weight bearing forces

130
Q

What are the characteristics for a fracture orthoses

A

Circumferential but allows functional mobility
Can be removed for wound and skin care
Hydrostatic forces and the length of the lever arm stabilize fracture

131
Q

What are the two categories of UE orthoses

A

articular and non articular

132
Q

What category of UE orthoses crosses a joint or a series of joints

A

articular

133
Q

Is articular or non articular orthoses more common

A

articular

134
Q

Wrist immobilization, thumb spica, and a posterior long arm orthoses are examples of what category of UE orthoses

A

articular

135
Q

What category of UE orthoses does not cross a joint but rather stabilizes the body segment to which they are applied

A

non articular

136
Q

A humeral cuff orthoses is an example of what category of UE orthoses

A

non articular

137
Q

What are the two main purposes for UE orthoses

A

Immobilization and mobilization

138
Q

A static orthosis (mobilizes/immobilizes)

A

immobilizes

139
Q

What type of orthosis is used to provide protection and to restrict motion while maintaining tissue length at constant force

A

Static immobilizing orthoses

140
Q

What type of orthosis is used to move or stretch soft tissues or joint to create a change with various forces

A

Mobilizing orthoses

141
Q

What are the three types of mobilizing orthoses

A

dynamic
serial static
static progressive

142
Q

Which type of UE orthoses has a rigid base and immobilizes the joints they cross while maintaining the joint in one position

A

static

143
Q

What is the most commonly used UE orthoses

A

Static

144
Q

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

A

Dynamic

145
Q

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

A

Serial static

146
Q

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

A

True

147
Q

If a patient has a fracture/trauma to the hand or just had botox, what type of UE orthoses would be best to use

A

Serial static

148
Q

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

A

Static progressive

149
Q

What type of UE orthoses are typically nonelastic methods to apply force such as strapping materials, screws, hinges, turnbuckles, etc.

A

Static progressive

150
Q

What are the advantages of a prefabricated UE orthoses

A

Ready to use
Easy to adjust
Less expensive

151
Q

What are the disadvantages of a prefabricated UE orthoses

A

May interfere with other joints
Difficult to attain a good fit
Generally less comfortable

152
Q

What are the advantages of a custom UE orthoses

A

More specific to the person
More comfortable
Least restrictive of uninvolved joints
Best option for a complex diagnosis

153
Q

What are the disadvantages of a custom UE orthoses

A

more expensive
more time consuming
may be bulkier material

154
Q

What part of the forearm would a circumferential UE orthoses encompass

A

The entire forearm (around the top and bottom)

155
Q

What part of the forearm would a volar UE orthoses encompass

A

The bottom of the forearm - palmer side

156
Q

What part of the forearm would a dorsal UE orthoses ecompass

A

The top of the forearm -back hand side

157
Q

A (circumferential/volar/dorsal) UE orthoses design leaves the palmar sensory surface exposed for input and has stronger mechanical support of the wrist

A

dorsal

158
Q

A (circumferential/volar/dorsal) UE orthoses design is tolerated better by edematous hands but requires more padding of the radial and ulnar styloids

A

dorsal

159
Q

A (circumferential/volar/dorsal) UE orthoses design is best for extension outrigger

A

dorsal

160
Q

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

A

volar

161
Q

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

A

volar

162
Q

A (circumferential/volar/dorsal) UE orthoses design is best for flexion outrigger

A

volar

163
Q

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

A

circumferential

164
Q

A (circumferential/volar/dorsal) UE orthoses design is more complex and bulkier with less opportunity for skin to breathe

A

circumferential

165
Q

(high/low) temp thermoplastic materials are commonly used to fabricate UE orthoses

A

low

166
Q

What temp of water does thermoplastic UE orthoses soften in

A

135 to 180 F

167
Q

True or False:

If orthotic material is left in hot water too long, it can become too soft and stretchy

A

true

168
Q

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

A

true

169
Q

What term describes the ability for orthotic material to return to its original shape

A

memory

170
Q

What term describes the ease of conformity or how well an orthotic material stretches

A

drape

171
Q

What term describes an orthotic material’s resistance to stretch and tendency to return to original shape, and is more forgiving

A

Elasticity

172
Q

What term is described by an orthotic material’s ability to stick to itself

A

bonding

173
Q

What landmarks are important to be cautious of in an UE orthosis

A
  1. Do not cover distal palmer crease for finger flexion
  2. Do not cover thenar crease for thumb movement
  3. Cover the wrist crease to stabilize forearm
  4. Don’t cover the MTP joints

Prosthetics & Orthotics (7 decks)

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