Orthotics Foundations and Principles Ch. 9

Question 1

What are common patient conditions/diagnoses that orthotics may be used for?

Answer 1

• cerebral palsy
• post stroke
• obesity
• polio
• spinal cord compression
• multiple sclerosis
• diabetic amyotrophy
• Gillian barre syndrome
• neuromuscular or musculoskeletal issue

Question 2

What are important considerations when determining if a patient is appropriate for an orthotic?

Answer 2

1. Advantages/ positive outcomes expected
2. Disadvantages or concessions associated
3. Indications and Contraindications

Question 3

“The orthotist strives to select an orthotic that provides __________ stability so that ____________ will be the least compromised.”

Answer 3

• minimum necessary stability
• mobility

Question 4

What components of an AFO control (dec/inc action) ankle DF and
PF?

Answer 4

Tamarack Joints: allow 17-24 degrees of df
Gillete Joints: flexible joint
Double Action Ankle Joints
Oklahoma Joint
Pins & Springs
Trim Lines

Question 5

The axis of the ankle joint is slightly _____________, running in an __________________ to ________________ direction.

As a result, DF is accompanied by some degree of forefoot ____________and ___________ along with hind foot _________.

PF is accompanied by forefoot ___________with ______________ and hind foot ______________.

Answer 5

• oblique
• anteriomedial to posteriolateral
• forefoot pronation and abduction
• hindfoot valgus
• forefoot supination and adduction
• hind foot varus

Question 6

What is the difference between a dynamic and static AFO. Which ones fall into each category?

Answer 6

Dynamic: DAFO, Supramalleolar, Post Leaf Spring, Carbon Graphite AFO, Neuro-orthoses, Articulating ankle

Static: SAFO, UCBL orthosis, Tone-inhibiting AFO, Anterior Floor reaction AFO, Weight Relieving AFO

Question 7

What should the PT assess when working with a patient with an orthosis?

Answer 7

• appropriate RX
• pt needs
• muscle performance and motor control
• ROM
• alignment of limbs
• gait cycle/pattern
• primary impairments
• compensations
• ability to perform a motion
  -activity & participation level

Question 8

What is necessary for the patient to know (Patient Education/Intervention) when providing a patient with an orthosis?

Answer 8

Orthotic training: instruct the pt how and when to use it and endure that they will use it and teach how to take care of it

Question 9

Which type of AFO provides the most stability in all planes of ankle motion?

Answer 9

Static AFO

Question 10

What type of AFO is indicated for quad weakness?

Answer 10

Solid AFO

Question 11

Which AFO would be best for a patient with fluctuations in edema 2nd to conditions such as Congestive Heart Failure (CHF) or Kidney Failure requiring dialysis?

Answer 11

traditional or conventional double upright orthoses

Question 12

What type of AFO, shown by evidence, can lead to improvements in temporal and spatial characteristics of walking, as well as safety with walking for patients diagnosed with: Stroke, TBI, Multiple Sclerosis (MS) and Parkinson’s Disease?

Answer 12

functional neuromuscular electrical stimulation (neuroprosthesis)

Question 13

Which AFO allows for a smooth ankle rocker while holding the foot in a maximally aligned position in the case of the patient with equinovarus?

Answer 13

Hinged thermo plastic AFO

Question 14

In the presence of excessive knee varus/valgus angulation during the stance phase which orthosis would be indicated?

Answer 14

KAFOs

Question 15

When musculoskeletal or neuromuscular impairment alters limb position or muscle activity at any LE joint, the _______________
force system is no longer in equilibrium and ______________ of ___________ and stability in stance is ________________.

Answer 15

• internal external force system
• efficiency of walking
• compromised

Question 16

Related to the KAFO ankle system what is the key consideration in deciding which ankle system is most appropriate?

Answer 16

how orthotic control at the ankle and the GRF will impact knee function and forward progression during stance phase

Question 17

In the case where ankle motion must be limited by the orthosis to protect the joint, what can an orthotist add to a patient’s shoe to control the impact of abnormal tone and simulate the normal rockers of gait?

Answer 17

A Rocker Sole: to facilitate forward progression during stance by reducing the toe lever of the orthosis and therefore improving the smoothness of the patients gait and reducing any deviations

Question 18

True or False: Compensatory strategies reduce the energy cost of walking?

Answer 18

FALSE

Question 19

How does the medially linked bilat. KAFO work during gait and for which type of patient is this indicated?

Answer 19

• for patients with mid to low thorasic and lumbar SCI
• limits abnormal abduction of the limbs during gait
• swing limb has an exaggerated lean and uses hip hiking or hip flexion ability

Question 20

What are limiting factors that would prevent a patient from being a good candidate for a HKAFO?

Answer 20

• those with incontinence
• increased energy expenditure
• position transfers more complex
• responses to perturbations wont respond on its own

Question 21

Typically, HKAFO’s require an ____________ _________ to use UE and trunk compensatory mechanisms to __________ the orthosis.

Answer 21

• assisted device
• advance

Question 22

Which 2 gait patterns are used with crutches for propulsion with patients wearing bilateral HKAFO orthoses?

Answer 22

• step to
• step through

Question 23

True or False: The orthotic knee joint of HKAFO’s is always locked in extension to provide stability.

Answer 23

FALSE

Question 24

True or False: A patient with a severe hip flexion contracture could achieve positioning from an HKAFO that would improve their gait.

Answer 24

TRUE