Orthotics Flashcards
A force containing both direction and magnitude is called what?
A vector
The resultant force is a combination of what?
Two other vectors
The study of the path of motion is called…
Kinematics
The study of motion and the forces that produce it is called…
Kinetics
What is the name of a disease the presents as avascular necrosis of the femoral head?
Legg-Calve-Perthes disease
Who is most commonly affected by Legg-Calve-Perthes disease?
9-14 year old boys
Positioning the leg in what position can return the femoral head back into the acetabulum in Legg-Calve-Perthes disease?
Abduction and internal rotation
The difference between knee and ankle joint axis in the transverse plane is called what?
Tibial Torsion
What causes Charcot joint in the lower limb?
Neuropathic disease. Commonly diabetes. It is a progressive condition that involves the gradual weakening of bones, joints, and soft tissues of the foot or ankle.
The rapid, alternating involuntary movement elicited by a passive stretch in patients with spasticity is called what?
clonus
A patient presents with volar subluxation, ulnar deviation, and swan neck deformity in her fingers. What is a possible diagnosis?
Rhumatoid arthritis
A swan neck deformity presents as…
The PIP joints in hyperextension and the DIP joints are flexed.
Lateral epicondylitis is caused by what repetitive motion?
Repetitive extension of the wrist.
Carpel Tunnel Syndrome may result in numbness, tingling, and weakness in which part of the hand?
Thenar emminence, thumb, and digits 2 and 3.
The median nerve innervates which muscles of the hand?
- Lateral two lumbricals
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis
True or False: A patient with a left sided CVA may experience right sided hemiplegia and aphasia.
True.
A child presents with a drooping eyelid, internal rotation of the shoulder, scapular winging, and and a flexion deformity of the wrist. What is a likely diagnosis for this child?
Erbs palsy
What is the etiology of Erbs Palsy?
It is an avulsion injury to the C5-C6 nerve roots of the brachial plexus caused most commonly during child birth from excessive pulling on the neck and head.
True or False: Guillian Barre is an infectious polyneuritis that leads to progressive muscular weakness that is usually fatal.
False: Prognosis is usually full recovery. Motor return is experienced proximally to distally.
A progressive neuromuscular atrophy characterized by weakness of the distal muscles of the arms and feet.
Charcot-Marie-Tooth Disease
True or False: Cerebral Palsy is the most common motor disability in children.
True
What is the most common type of Cerebral Palsy?
Spastic
How may a patient with spastic diplegia cerebral palsy present?
Muscle stiffness primarily in the legs with the upper extremities being less affected or not affected at all.
Tightness in the hip and leg muscles may result in a scissoring gait.
True or False: A child with spastic hemiplegia will generally present with more spasticity in the leg than the arm.
False: Those with spastic hemiplegia experience spasticity only on one side of the body and typically the arm is more affected.
True or False: CP patients with spastic quadriplegia will often have additional medical concerns such as intellectual disability and seizures.
True.
What movement patterns can you expect from a patient with Dyskinetic (athetoid) CP?
- Inability to control movement.
- Can present with low or high tone intermittently.
- The movements are uncontrollable and can be slow and writhing or rapid and jerky
Which type of CP results in primarily difficulty with balance and coordination?
Ataxic
Which ankle joint controls would be indicated for a patient with plantarflexion paralysis?
Dorsiflexion stop
A patient presents in gait with ankle in dorsiflexion, hips flexed, hyperlordosis, back extension and knees flexed. What type of gait is this?
Crouch gait
What population is crouch gait common among?
Cerebral Palsy
What are two reason an orthotist may not use a pretibial AFO to address crouch gait?
- Hip flexion contracture
- Lack of ankle range of motion
Contraindications for a floor reaction AFO.
- Genurecurvatum
- Coronal instability
A patient presents with 0/5 plantarflexion strength, 3/5 dorsiflexion strength and uncontrolled fluctuating edema. What type of brace would be appropriate for this patient?
Classic metal and leather with double action ankle joints.
A Sabolich trimline on an AFO is used to correct a varus deformity. Where should the three point pressure system be to correct the deformity?
- Medial aspect of the foot
- Lateral aspect of the ankle
- Medial aspect of the calf
A T-strap used for supination should be attached to which side bar?
Medial.
What is the minimal clearance for conventional ankle joints?
Lateral: 5 mm
Medial: 6 mm
Increasing the stiffness of a patients heel would have what effect on the knee at initial contact in a solid ankle AFO?
Increase knee flexion moment at heel strike.
In normal gait at heel strike, what angle is the knee in?
Complete extension (0)
In normal gait at heel strike, what angle is the hip in?
25-30 flexion
In normal gait at heel strike, what angle is the ankle in?
Neutral (90)
In normal gait at heel strike, where is the ground reaction force relative to the ankle and what moment is being executed in the joint?
- Posterior
- Plantarflexion
In normal gait at heel strike, where is the ground reaction force relative to the knee and what moment is being executed in the joint?
- Posterior
- Flexion
In normal gait at heel strike, where is the ground reaction force relative to the hip and what moment is being executed in the joint?
- Anterior
- Flexion
In normal gait at loading response, what angle is the hip in?
25-30 degrees
In normal gait at loading response, what angle is the knee in?
20 degrees of flexion
In normal gait at loading response what angle is the ankle in?
8 degrees of plantarflexion
In normal gait at loading response, where is the ground reaction force relative to the hip and what moment is being executed in the joint?
- Anterior
- Flexion
When is peak contraction of the knee extensors being fired during a normal gait cycle?
Loading response
When does peak dorsiflexion take place during normal gait?
Terminal stance
How far does the center of gravity shift vertically during ambulation?
2 inches
Where is the center of gravity located on the human body?
Anterior to the 2nd sacral bone
At what point during normal gait does the center of gravity reach its apex?
Midstance
A patient presents in your clinic with a dispensing prescription for a wrist hand orthosis. The patient has no volitional control of the thumb. Which component should be added to the WHO to control the thumb?
Thumb post.
A patient presents in your clinic with a shoulder subluxation secondary to hemiplegia. What orthotic option would best relieve pain and reduce further subluxation?
Hemisling or should subluxation splint.
A patient presents with C6 quadrilegia. Which muscle group can be used for prehension on a wrist-driven WHO?
The extensor muscles of the wrist.
- Extensor carpi radialis
- Extensor carpi longus
- Extensor carpi brevis
A ratchet type tenodesis orthosis with a locking mechanicsm would benefit what type of patient?
One who does not have volitional control to maintain prehension.
Which nerve would be damage in a patient who would benefit from a wrist extension orthosis?
Radial nerve
What is a colles fracture?
A fracture of the distal radius caused by wrist extension and radial deviation.
How would you treat a mid-humeral fracture with a radial nerve lesion?
Humeral fracture brace with a positional cock up wrist splint and sling.
What is a smith fracture?
A fracture of the distal radius caused by falling on a flexed wrist.
Which type of hip dislocation is more common, anterior or posterior?
Posterior
What is the MOI for a posterior hip dislocation?
Hip flexion, adduction, and internal rotation.
A patient presents with a prescription for a hip abduction brace following a posterior hip dislocation. The physician states “set to standard ROM”. What range of motion do you set the brace in?
- Abduction fixed at 15 degrees.
- Hip flexion set to 0-60 degrees.
What is the standard ROM for a hip abduction brace following an anterior hip dislocation?
- Abduction fixed at 20 degrees
- Extension blocked at 20 degrees of flexion.
A patient presents with a thickened nodule and band in the palmar aponeurosis of his 4th and 5th digit. What is the name of the associated pathology?
Dupuytrens Contracture
At which degree of burn does a patient become insensate?
3rd degree (full thickness) burn
A patient has experienced a 2nd degree burn, what signs and symptoms would you expect to see?
Redness, blistering, and pain.
What are the most common orthoses used following a rotator cuff tear?
Slings and Airplane SEWHOs
What is the ideal placement of an MP stop?
Just distal to the MP joints.
What position is the hand in when it is in “functional position”?
30 degrees of extension at wrist
35-40 degrees of MP flexion
15 degrees of DIP flexion
Thumb opposed with webspace maintained.
List the purpose of a functional static orthosis.
Enables ADLs while being worn. Maintains webspace and three point prehension.
What is the benefit of a dorsal style WHO orthosis?
Allows volume fluctuation
A patient presents with a boxers fracture. Which bone may be broken and what style orthosis would be the most appropriate?
- Most commonly the 5th metacarpal.
- Ulnar gutter splint
What are the four goals of a hand orthosis?
- Maintains palmar arch
- Maintains opposition
- Maintains webspace
- Attachment site for components
An aluminum style hand orthosis that is easily contoured and acts as an attachment sight for components is called a…
Rancho style
A patient presents with a median nerve injury with resulting injury to the abductor pollicis brevis. What component of a WHO would best benefit the patients presentation?
An adductor stop (c-bar) to increase webspace.