Ox Exam Practice Flashcards
Patient recovering from Guillian-Barre syndrome experience motor function return in which pattern
Proximal to distal
Inadequate strength of gastrocnemius results in which gait deficiencies
Excessive DF at midstance
Atlanoaxial instability is common in
Rheumatoid arthritis
Function of tibialis anterior
DF and inversion
Excessive knee flexion when standing in a locked metal KAFO results when
Calf band is too shallow
Poliomyelitis results from an acute viral infection of the
Anterior horn cells
When fitting a thermoplastic AFO, which helps diminish a moment at heel strike
Decreasing heel height of shoe
Which adjustment to a metal AFO would best accommodate excessive tibial torsion
Deflection of sidebars
Quadriplegic Pt with a functioning C7 will lose
Finger flexion
C7= Elbow extensors
Hemivertebrae is a ______ spinal deformity
Congenital
Pt with KAFO due to dropfoot and painful knee hyperextension states that knee pain has decreased and foot clearance has improved, but she fell twice when descending a ramp. How to modify KAFO
Decreasing PF resistance
Mechanical knee joint that is too distal to the anatomical knee
Anterior distal pressure on the thigh to increase when the knee is flexed
Primary goal of lower extremity Ox management in children with hypertonia is to
Decrease spasticity
Cauda equina comprises the
Nerve roots below the level of the spinal cord (L2 and down)
In treatment of kyphotic deformity with CTLSA (Milwaukee), where in relation to the apical vertebra should the kyphosis pads be placed
Adjacent and one vertebral body inferior
Which nerve innervates peroneus brevis
Superficial peroneal
The ACL attaches to the non articular aspect of the tibia and to the posterior aspect of the
Lateral surface of the lateral femoral condyle
Anatomical landmark for locating the mechanical ankle joint axis is the
Distal border of the medial malleolus
Dorsiflexion stop performs the primary function of which muscles at midstance
Gastrocnemius/soleus
Primary goal in using a CTLSO (Milwaukee) in cases of Scheuermanns disease (juvenile apophysitis) is to
Reduce kyphosis
Most appropriate Ox for a Pt with a median and ulnar nerve laceration at the wrist
A WHO (long oppones with thumb adduction stop)
Pt has strong extensor spasticity secondary to brain pathology. The best ankle joint configuration for the Pt would be one with a/an
Plantar flexion stop
(PF stop = effective for absent PF spasticity or absent DF muscle group)
MMT grade of fair (3/5) is assigned for a range
Against gravity
Primary action of the brachioradialis muscle
Flex the elbow
Radial n. C5-6
Gastrocnemius and soleus group are innervated by what nerve
Tibial nerve
S1, S2
Appropriate Ox for a radial nerve injury at mid-humerus
WHFO (dynamic Ox to assist thumb, finger, and wrist extension)
-Radial n. at elbow = loss of wrist and MCP extension
What is MS
Demyelinating disorder of the white matter in the CNS
If a Pt is a Medicare beneficiary with no secondary coverage and has met the deductible for the year, the practioner may collect what percentage of Medicare allowable at time of service
20%
Flexion of the distal IP joints is accomplished by which muscle
Flexor digitorum profundus
Vastus medialis muscle acts as
An extensor of the knee
Femoral n. L2-4
Muscles innervated by the obturator n.
Adductor magnus
Piriformis
Gracilis
(Lumbar Plexus = L2-4)
During normal gait, the hip reaches maximum extension at
Terminal stance
8 yo boy underwent surgical fusion of a congenital distal tibial pseudarthrosis. 6 weeks post-op, the plaster cast is removed and clinical stability is improved. Which Ox would be BEST to protect the fusion until complete healing take place
Thermoplastic PTB with anterior shell
Rate of foot drop during the heel rocker is controlled by
Pre-tibial muscles
Which type of force will cause bending of the sidebars
Lateral
Most common form of CP
Spastic
Pt with soleus Cx is likely to exhibit which gait deviation
Genu recurvatum in midstance
In the stance phase of gait, a solid ankle plastic AFO set at neutral with a rigid pull length footplate would
Increase the knee extension moment at terminal stance
Muscles that pass posterior to the medial malleolus act to
Invert and plantar flex the foot
Solid ankle floor reaction AFO will assist knee extension by
Restricting anterior tibial advancement over the foot
Crouch gait describes a pattern of
Flexed hip
Flexed knees
DF ankles
What 2 attachments used with static WHFO to help prevent claw hand deformity
MCP extension stop and IP extension assist
Wrist driven flexor hinge Ox converts wrist extension to
MCP flexion
When fabricating an Ox for Tx of radial nerve palsy, in which position would the wrist be maintained
20-40 degrees of extension
Pt wearing a KAFO with a locked knee will have improved knee stability during stance
Compromised shock absorption during loading response
Chronic subtalar pronation frequently leads to Hip ______ rotation
External
Pt with PTTD, one objective of fitting a UCBL is to the mechanics of the _____ muscles
Inverter
Most common congenital abnormality of the spine
Spina Bifida
Normal gait, hip reaches maximum flexion during
Terminal swing (30 deg)
Poor hip extensors will result in what postural deviation
Backward trunk lean
Most appropriate Tx for Pt with rigid forefoot deformity
Medial forefoot post
50 yo male presents with flair ankle and a flexible varus deformity, physician request eval for Ox that will provide ML stability. Most appropriate Ox recommendation would be a:
Thermoplastic AFO with free DF and a 90 degree PF stop
Muscular dystrophy is defined as
Progressive degeneration of the muscle fibers
Pt with MS presents with script for a KAFO to control knee recurvatum. Muscle strength of knee is fair plus (3+/5) with no history of falling due to knee buckling. Most appropriate knee joint
Posterior offset
When a posterior rigid frame TLSO is being fit, the superior end of the paraspinal bars terminate 1” (25mm) inferior to the
Inferior angle of the scapula
Erbs palsy refers to paralysis from injury to the
Upper trunk of the brachial plexus
Adduction and ABduction of the fingers occurs at what joint
Metacarpophalangeal
Patient who present with a left thoracic curve with the apex at T3 will have an elevated _____ shoulder
Left
Primary purpose of a medial extrinsic heel post is to
Control rearfoot eversion in the frontal plane
During normal human locomotion, the GRF of the hip and knee between initial contact and foot flat
Hip flexion, knee flexion
Hydrocephalus may accompnay
Myelomeningocele
During stance, the hip joint is MOST stable when weight line is
Posterior to the hip
Function of the serratus anterior
Upward rotation of the scapula
Long thoracic n. C5-7
Articulation between the sternum and the clavicle occur at
Manubrium
The strength of a muscle is generally proportional to its
Cross sectional area
A KO for medial compartment syndrome should provide which forces
Medial thigh, lateral knee joint, medial calf
A musculocutaneous nerve lesion will cause loss of function of which muscle:
Subscapularis, Biceps, Deltoid, Triceps
Biceps
MS is a ____ motor neuron lesion
Lower
Unique characteristic of AFO’s that are designed to inhibit spasticity/tone
A toe extension pad
Pretibial muscle group nerve innervation
Deep fibular n (L5, S1)
Single-axis, unlocked knee joints are indicated for Pts with
Genu varum
Result of an irregular birth
Klumpke’s palsy
Pt with paraplegia, standing balance in bilateral KAFOs is achieved by
Fixed ankle DF, locked knee, hip hyperextension
Medicare define “accepting assignment” as accepting
The medicare Fee Schedule allowable amount as payment
Coding verification requests are submitted to the
PDAC
Sensation is transmitted through which stucture
Dorsal branch of the nerve roots
Side bending films are used to demonstrate which curves
Curve magnitude
During normal gait at initial contact, the GRF tends to do what at the ankle and knee
Ankle PF and Knee extension
Which muscle groups controls forward movement of the tibia
Posterior calf
It is important to create adequate relief proximal to the 1st metatarsal head due to Cx of which muscle during the heel off phase of gait
Flexor hallucis longus
Maximum DF occurs during which phase of gait
Terminal stance
During which phase of gait are the hip extensors most active
Loading response
Inflammation of the outer covering of the brain and spinal cord
Meningitis
What is the superior margin of the paraspinal bars on a Taylor TLSO
Spine of the scapula
Which type of scoliosis is most likely the result of a LLD
Nonstructural scoliosis
-Caused by reversible changes to posture and function. Can be straightened voluntarily or when non-WB
Ox to best restore upper extremity function for a Pt with a SPI above the C6 nerve root
Wrist Driven WHO
-C6 = innervates extensor carpi radialis longus/brevis
Most appropriate Ox for a median nerve injury at the wrist
WHO with thumb post
Primary function of the brachioradialis
Elbow flexion
Axillary nerve innervates
Deltoid and Teres minor
Upper motor neuron disease
Originate in the cerebral cortex and travel down to the brain stem or spinal cord
Lower motor neuron disease
Begins in spinal cord and goes on to innervate muscles/glands throughout the body
-Muscle atrophy, muscle twitching, decrease reflexes, decrease tone, neg. Babinsky sign, and flaccid paralysis
Upper motor neuron disease/injury examples
Multiple Sclerosis, Cerebral Palsy, Cerebrovascular Accident
Aponeurosis is
Flat broad tendon
Spondylolisthesis
Anterior displacement of the L5 vertebra in relation to the sacrum
Hand Ox controls
Palmar arch and thumb position
Flaccid paralysis is most often seen in
Lower motor neuron injuries
Which muscle inserts on the navicular and medial cuneiform
Posterior tibialis
Space between an axon and a dendrite is called the
Synapse
Gelatinous center of a spinal disc
Nucleus pulposus
Muscle serves to abduct the phalanges away from the 3rd digit
Dorsal interossei
Poliomyelitis is what type of pathology
Lower motor neuron
Pt with a complete C6 SPI powers a wrist-driven flexor hinge tenodesis Ox by using the
Extensor digitorum communis and extensor carpi ulnaris
Ligament that prevents hyperextension of the hip joint
Iliofemoral ligament
*The ischiofemoral ligament prevents excess extension
Position of the thoracic facets most eaily allows for which movements
Rotation and lateral flexion
Most appropriate Ox Tx for a Pt with a T12 compression Fx
Anterior control hyperextension Ox
What gait deviation would you primarily expect to see with a tibial nerve lesion
Uncontrolled tibial advancement in stance phase
(Tibial nerve innervates gastroc, soleus, plantaris, politeus, Tib post, flexor digitorum, and flexor halllucis longus)
Landmarks of the scapula
Glenoid cavity, coracoid process, and acromion process
Young child with a T12 myelomeningocele is looking for device that will help Pt ambulate in the home and classroom and will allow hands free standing. What device do you evaluate for
Parapodium
Compensatory motion would most likely be seen in an individual with quads weakness
Forward trunk lean
Pt with hyperkyphosis is placed in a Milwaukee CTLSO for treatment. Where should the corrective pressures be placed
Anterior throat ring
Posterior thoracic pad
Pt comes into the office exhibiting lasting redness on the navicular and medial malleolus after wearing her new AFO. What adjustments could correct this problem
Add a firm pad to increase pressure under the sustentaculum tali
Prime elbow flexor
Brachialis
Hydrocephalus often accompanies
Spina bifida
Lumbricals function to
Flex the MCP joints and extend the PIP joints
The muscle length-tension relationship describes
The concept that strength of a muscle changes depending on the affect joint’s position through its arc of motion
Adductos of the scapula include
Middle trapezius, rhomboids, latissimus dorsi
Prehension patterns
Hook, cylindrical, tip, palmar, spherical, lateral
Term that best pertains to the palm of the hand and the sole of the foot
Volar
Sartorius action
Hip flexion and external rotation; knee flexion
Pt is experiencing pressure at the proximal posterior of the AFO that the Pt wears to control mild genu recurvatum. Best choice to eliminate this pressure
Heat and flare the proximal trimline
Best way to test to differential between a grade 3 and a grade 4 psoas major strength
Patient lies supine with knee extended; examiner resists hip flexion
How to ascend/descend stairs with unilateral weakness
Ascend leading with sound side; descend leading with the affected side
Gluteus maximus innervation/action
Inferior gluteal nerve
Internal rotator of the hip
Positive Trendelenburg sign
The sound side pelvis drops upon WB on the affected side
Pt comes into your office stating low back pain caused by hyperlordosis. What advise might you give your patient to reduce symptoms
Avoid wearing shoes with a heel higher than 3/8”
What is a sensory nerve
Saphenous
Maximum PF occurs at which phase of gait
Pre swing
Pt wearing a metal and leather KAFO with double adjustable ankles experiences excessive knee flexion during standing. How to reduce this
Deepen the calf band
Primary hip flexor
Iliopsoas
al stability of the pelvis in stance phase is accomplished through the action of which muscle
Gluteus medius
Which muscle would not be affected by a proximal lesion of the musculocutaneous nerve:
-Brachioradialis, Biceps brachii, Coracobrachialis, Brachialis
Brachioradialis
Humerus landmarks
Trochlea, capitulum, radial groove
Posterior channel best simulates what muscle in the double action ankle joint
Tibialis anterior
Columns of the spine you expect to see damaged in a burst Fx
Middle and anterior
Pt presenting with hyperextrension of the 4th and 5th metacarpal phalangeal joints and flexion of the interphalangeal joints likely has a wrist level lesion of which nerve
Ulnar
What vertebral level does the cauda euina begin
L2
mage to which structures leads to sensation deficits
Dorsal branch of the nerve roots
During ambulation, the body’s center of mass reaches its highest point at
Midstance
When the limb moves from midstance to terminal stance what muscle group Cx and in what manner
Plantarflexors: eccentric
Torque is calculated by
Multiplying lever arm length by force applied
What position is the hip typically in during heel strike
30 deg flexion
Pt states her AFO causes her knee to buckle each time she walks down the hill by her house. How will you adjust her AFO to reduce this
Reduce the PF resistance
Active PF of the ankle is strongest when
Knee is extended
Iliopsoas insets on the
Lesser trochanter
2 origins of the biceps brachii
Supraglenoid tubercle and coracoid process
Opposition of the thumb occurs at which joint
Carpometacarpal joint
Medial edge of an adult KAFO should terminate proximally
3.8cm (1.5”) distal to the perineum
Standard clearance for knee joints on a KAFO
3mm laterally, 6mm medially
lower extremity is most stabile in stance when the weight line falls
Posterior to the hip and anterior to the knee
What percent of the gait cycle is spent in double limb support
20%
Pt comes in with a right thoracic scoliosis, what are you most likely to incorporate into the orthosis
Right thoracic pad and left axillary extension
Normal ROM for pronation and supination of the forearm
Pronation 80 deg, Supination 80 deg
DF stop performs the function of which muscles
Gastrocnemius/Soleus
Which components of an upper extremity Ox would best aid in prevention of a claw hand deformity
MCP extension stop and IP extension assist
Pt with quadriplegia resulting from a lesion at C7 neurosegmental level is most likely to benefit from which Ox
Static HO
Non-WB length beyond toes in DM shoes
1/2”
Benefit of fitting a SOMI CTO
It can be fit with the Pt in a supine position
Proper placement of the proximal edge of the calf band on a conventional AFO
20mm below fibular neck
