Prosthesis and Gait Flashcards
1
Q
A horizontal amputation through the calcaneus is better known by which of the following names?
A Chopart
B Syme
C Boyd
D Pirogoff
A
Answer: C
Explanation:
• A Boyd amputation is is a horizontal amputation through the calcaneus.
• A Pirogoff amputation is a vertical amputation through the calcaneus.
• A Syme amputation spares the tibia, fibula, and calcaneal fat pad (all other bones are removed).
• A Chopart amputation is an amputation that removes all foot bones except tibia, fibula, and talus.
• A Lisfranc amputation is a pre-metatarsal foot amputation (sparing all bones proximal to the foot metatarsals).
2
Q
The hyperlordosis observed in a myopathic gait pattern is due to which of the following? A. Tight quadriceps B. Weak quadriceps C. Weak hip extensors D. Tight plantarflexors
A
Answer: C
• Hyperlordosis occurs due to hip extensor weakness (e.g. gluteus maximus). The patient “throws” their body posteriorly over the weak muscles (just as they throw their body laterally over the weak hip abductors in a compensated trendelenburg gait), resulting in the hyperlordosis posture.
3
Q
A patient’s center of gravity is located at which of the following locations? A. 5 inches anterior to the S2 vertebra B. 2 inches anterior to the S1 vertebra C. 5cm anterior to the S2 vertebra D. 2cm anterior to the S1 vertebra
A
Answer: 5cm anterior to the S2 vertebra
• The center of gravity is located 5cm anterior to the S2 vertebra.
4
Q
Which of the following is the most common type of amputation? ATransfemoral BTranstibial CTransradial DTransmetatarsal
A
Answer: D
• Of those listed, transmetatarsal amputations are the most common. Consider that in lower limb amputations, dysvascular disease (the most common cause of lower limb amputations) tends to affect the limb distally > proximally.
5
Q
- Which of the following may result in a prosthetic limb exhibiting excessive knee extension during ambulation?
A. Too little friction in the prosthetic knee
B. Excessive prosthetic foot dorsiflexion
C. Foot placed too far anteriorly
D. Socket placed too far anteriorly
A
Answer: C
• Of the answer choices, only a too-anterior foot would cause excessive knee extension, by forcing the line of gravity to tend to extend the knee.
• An anterior socket, excessive dorsiflexion, and too little knee friction would all cause knee flexion moments.
6
Q
You are considering how to treat your patient’s knee pain. During their gait you notice that their knee hyperextends during stance phase, and this causes pain to the patient. Which of the following do you recommend as the most reasonable next step to improve your patient’s pain?
AIbuprofen
BTENS unit
CSwedish knee cage
DKnee immobilizer
A
Answer: C
• This gait describes genu recurvatum (the knee bending backwards); the cause of this is weak or excessively tight quadriceps. It can lead to increased knee pain and instability. Treatment involves physical therapy for quadriceps and knee/hip girdle strengthening, as well as the use of a Swedish knee cage or similar type of brace that prevents knee hyperextension during gait
7
Q
Which of the following is not a determinant of gait? A. Hip mechanisms B. Foot mechanisms C. Pelvic rotation D. Pelvic lateral excursion
A
Answer: Hip mechanisms
• The 6 determinants of gait are as follows: pelvic tilt, pelvic rotation, pelvic lateral excursion, foot mechanisms, knee mechanisms, knee flexion.
8
Q
Gait that exhibits the foot slapping on the ground at the start of each stance phase?
A
• Steppage gait: This is a foot drop. It is due to ankle dorsiflexion weakness.
9
Q
Time spent in stance vs swing phase?
A
60:40
10
Q
Time spent in single vs double-limb support during gait?
A
80:20
11
Q
A 6 month-old female is found to have myelomeningocele at the S1 level. Which of the following is most likely to be true?
A Knee-ankle-foot orthosis (KAFO) will most likely be required for ambulation
B There will be little impact, if any, on function
C Ankle-foot orthosis (AFO) will most likely be required for ambulation
D Bowel/bladder function will be spared
A
Answer: C
Explanation:
• This patient will theoretically have normal myotomal function through L5, but disrupted function at the S1-S5 levels.
• The S1-S2 myotomes control plantarflexion and intrinsic foot muscle function, but spares the quadriceps, hamstrings, and other L2-L5 muscles.
• Thus, KAFO is NOT needed, but AFO would be useful to stabilize the ankle and allow for modified independent ambulation.
• Bowel/bladder dysfunction is expected to occur; for example, the parasympathetic and somatic control of the bladder arises from the sacral nerve roots.
12
Q
Which of the following amputee K levels describes a patient who is capable of unlimited household ambulation and limited community ambulation at a fixed cadence?
A K4
B K3
C K2
D K1
A
Answer: C
Explanation:
• Medicare’s K levels are defined as follows.
• K0: nonambulatory - “K0 = zero prosthesis”.
• K1: limited household ambulator at a fixed cadence.
• K2: unlimited household ambulator and limited community ambulator at a fixed cadence.
• K3: unlimited community ambulator with a variable cadence.
• K4: high impact sports activities, unlimited community ambulation, variable cadence.
13
Q
The optimal wheelchair cushion utilized for maximal pressure relief is which of the following? A. Visco-elastic B. Air-villous C. Fluid-filled D. Foam
A
Answer: Air-villous
• Air-villous cushions are the most popular wheelchair cushion for their excellent pressure relief, light weight, and reduced risk of pressure ulcers/injuries. They require more maintenance than other types of cushions.
• Foam cushions are good for softening impacts, but are poor at heat transfer.
• Fluid cushions are heavier, but conform nicely to a patient’s shape.
• Visco-elastic cushions are good for heat transfers, but do not soften impacts well.
14
Q
The optimal wheelchair backrest height in a manual wheelchair is at which location?
A At the level of the neck
B At the thoracolumbar junction
C Just above the spine of the scapula
D Just below the inferior angle of the scapula
A
Answer: D
Explanation:
• The optimal position for a MWC backrest height is just below the inferior angle of the scapula; this corresponds to the T8 vertebra. In a power wheelchair, the optimal backrest height is to the top/spine of the scapula.
15
Q
Which of the following is NOT a characteristic of pneumatic wheelchair tires?
A. They perform better on carpeted surfaces than solid rubber tires
B. They require less maintenance than solid rubber tires
C. They have increased risk of a flat tire
D. They provide a generally smoother ride
A
Answer: B
• Pneumatic tires are rubber tires with an inner air-filled tube. They provide a smooth, cushioned ride, and are better on carpets than solid rubber tires, but require more maintenance and have greater risk of popping and “going flat”.
• Solid rubber tires produce a less smooth ride, but require less maintenance, and have virtually no risk of “going flat”.
16
Q
You are prescribing a cane for an 84 year-old male with left groin pain due to hip osteoarthritis. On which side of the body should the cane be used, and which leg should advance along with the cane? A. Right side; right leg advances B. Left side; right leg advances C. Right side; left leg advances D. Left side; left leg advances
A
Answer: C
• When using canes for hip osteoarthritis, the purpose is to offload the painful hip so that it no longer hurts as much during weight-bearing. This is accomplished by using the cane in the opposite hand of the painful hip.
• In other words, left hip pain requires a right hand cane, and right hip pain requires a left hand cane. When advancing the cane, the opposite leg advances.
• In summary, the painful leg needs an opposite-handed cane, and the two advance together during gait. This achieves a wider base of support for stability, and helps to offload the painful hip joint.
17
Q
Which of the following is the most common activation method for an upper limb body-powered terminal device of a prosthesis?
A Voluntary closing
B Voluntary opening
C Proximity closing
D Proximity opening
A
Answer: B
Explanation:
• The most common activation method for an upper limb body-powered terminal device is voluntary opening.
• The terminal device remains closed at rest (safer than open at rest), and only by force from the patient does the terminal device open and allow the patient to grasp something.
• Voluntary closing is the opposite, and is less common.
• Proximity opening/closing is not a method.
18
Q
Regarding limb amputation, in general, which of the following applies?
A The longer the residual limb, the better the patient’s function
B The longer the residual limb, the more likely cancer was the reason for amputation
C The longer the residual limb, the higher the cost of ambulation
D The longer the residual limb, the healthier the skin
A
Answer: A
Explanation:
• The longer the residual limb, the more functional a patient can be with that limb (for example, comparing a shoulder disarticulation with a transmetacarpal amputation).
• The shorter the limb, the higher the cost of ambulation, and the more likely cancer was involved as the reason for amputation.
19
Q
You are prescribing a cane for an 84 year-old male with left groin pain due to hip osteoarthritis. On which side of the body should the cane be used, and which leg should advance along with the cane?
A Right side; right leg advances
B Left side; right leg advances
C Right side; left leg advances
D Left side; left leg advances
A
Answer: C
Explanation:
• When using canes for hip osteoarthritis, the purpose is to offload the painful hip so that it no longer hurts as much during weight-bearing. This is accomplished by using the cane in the opposite hand of the painful hip.
• In other words, left hip pain requires a right hand cane, and right hip pain requires a left hand cane.
• When advancing the cane, the opposite leg advances.
• In summary, the painful leg needs an opposite-handed cane, and the two advance together during gait. This achieves a wider base of support for stability, and helps to offload the painful hip joint.
20
Q
Which of the following may result in a prosthetic limb exhibiting excessive knee extension during ambulation?
A Too little friction in the prosthetic knee
B Excessive prosthetic foot dorsiflexion
C Foot placed too far anteriorly
D Socket placed too far anteriorly
A
Answer: C
Explanation:
• Of the answer choices, only a too-anterior foot would cause excessive knee extension, by forcing the line of gravity to tend to extend the knee.
• An anterior socket, excessive dorsiflexion, and too little knee friction would all cause knee flexion moments.
21
Q
Which of the following is the most common cause of upper extremity amputation?
A Hypercoagulable state
B Trauma
C Diabetes
D Cancer
A
Answer: B
Explanation:
• Trauma is the most common cause of upper limb amputation.
• Dysvascular disease due to hypertension, diabetes, factor 5 leiden mutation, etc.) is the most common cause of lower limb amputation.
22
Q
Regarding socket dimensions, which of the following socket designs is generally preferred for transfemoral amputation patients receiving a prosthesis?
A Wide superoinferior
B Wide mediolateral
C Narrow superoinferior
D Narrow mediolateral
A
Answer: D
Explanation:
• Ischial containment socket is preferred for transfemoral amputees. This involves a socket that is narrow in the mediolateral plane and wider in the anteroposterior plane; weight is borne by the ischia.
• Quadrilateral socket has wide mediolateral dimensions and narrow anteroposterior dimensions.
23
Q
Which of the following will assist dorsiflexion of an ankle-foot orthosis (AFO)?
A Spring placed in the posterior channel
B Pin placed in the posterior channel
C Spring placed in the anterior channel
D Pin placed in the anterior channel
A
Answer: A
Explanation:
• In an Ankle-Foot-Orthosis (AFO):
• A pin placed in the anterior channel will prevent dorsiflexion.
• A spring in the anterior channel will assist plantarflexion (will not prevent dorsiflexion, but will assist the opposite movement - plantarflexion).
• A pin in the posterior channel will prevent plantarflexion.
• A spring in the posterior channel will assist dorsiflexion.
24
Q
A vertical amputation through the calcaneus is better known by which of the following names?
A Chopart
B Syme
C Boyd
D Pirogoff
A
Answer: D
Explanation:
• Pirogoff amputation is a vertical amputation through the calcaneus.
• Boyd amputation is is a horizontal amputation through the calcaneus.
• Syme amputation spares the tibia, fibula, and calcaneal fat pad (all other bones are removed).
• Chopart amputation is an amputation that removes all foot bones except tibia, fibula, and talus.
• Lisfranc amputation is a pre-metatarsal foot amputation (sparing all bones proximal to the foot metatarsals).
25
In preparation for the residual limb to accept a prosthesis, which of the following is the ideal shape of the residual limb following a transtibial amputation?
A Cylindrical
B Ovoid
C Conical
D Rhomboid
Answer: A
Explanation:
• Cylindrical is the ideal shape for a transtibial residual limb.
• Conical is the ideal shape of a transfemoral residual limb.
26
In a patient with terminal transradial deficiency, surgically separating the radius and ulna to allow the patient to use them like a pincer to grasp objects is sometimes performed. This surgery is known by which of the following names?
A Krukenberg procedure
B Still’s surgery
C Schismatic osteotomy
D Van Ness surgery
Answer: A
Explanation:
• Krukenberg procedure: separating the radius and ulna to allow their use like a pincer to grasp objects in terminal transradial deficiency
• Van Ness Rotation is sometimes performed for patients with partial proximal femoral focal deficiency (PFFD), which involves rotating the foot around so that the ankle is effectively the new “knee”, and the patient can be fitted for a lower limb prosthesis for ambulation.
• "Shismatic osteotomy" and "Still's surgery" are fictional.
27
Which of the following will prevent plantarflexion of an ankle-foot orthosis (AFO)?
A Spring placed in the posterior channel
B Pin placed in the posterior channel
C Spring placed in the anterior channel
D Pin placed in the anterior channel
Answer: B
Explanation:
• In an AFO:
• A pin placed in the anterior channel will prevent dorsiflexion.
• A spring in the anterior channel will assist plantarflexion (will not prevent dorsiflexion, but will assist the opposite movement - plantarflexion).
• A pin in the posterior channel will prevent plantarflexion.
• A spring in the posterior channel will assist dorsiflexion.
28
Which of the following is the most common type of wheelchair hand brake?
A Lock-and-key
B Twist-to-lock
C Push-to-lock
D Pull-to-lock
Answer: D
Explanation:
• Pull-to-lock is the most common method for locking a wheelchair’s wheels in place to prevent inadvertent wheelchair movement.
• Push-to-lock is risky when the patient is rising to attempt a transfer, as they may inadvertently bump against the lock while rising, accidentally unlocking the wheelchair in the process.
• Twist-to-lock and lock-and-key mechanisms do not exist.
29
Which of the following is not characteristic of a myopathic gait?
A Knee flexion
B Plantarflexion
C Trendelenburg gait abnormality
D Hyperlordosis
Answer: A
Explanation:
• A myopathic gait involves hyperlordosis, trendelenburg abnormality, and plantarflexed ankles.
30
Which of the following is the primary advantage of prescribing a prosthetic socket with a total contact fit?
A It pairs better with existing suspension systems than a partial contact fit
B It is more comfortable
C It is cheaper
D Reduced risk of venous choking
Answer: D
Explanation:
• The primary reason for prescribing a total contact socket is so that the residual limb remains healthy.
• If the distal part of the residual limb is NOT in contact with the socket wall, then the distal limb venous return is at risk for being choked off, leading to pain, skin breakdown, and other abnormal skin changes.
31
In preparation for the residual limb to accept a prosthesis, which of the following is the ideal shape of the residual limb following a transfemoral amputation?
A Cylindrical
B Ovoid
C Conical
D Rhomboid
Answer: C
Explanation:
• Cylindrical is the ideal shape for a transtibial residual limb.
• Conical is the ideal shape of a transfemoral residual limb.
32
Which of the following statements could be used to describe a power wheelchair’s tilt-in-space mechanism?
A All of these statements could describe the tilt-in-space mechanism
B Is more expensive
C Does not increase shear forces
D Enables independent pressure relief
Answer: A
Explanation:
• Tilt-in-space wheelchairs have all of the mentioned features.
• Recline is a different feature, essentially in which the chair does not totally tilt, but the backrest itself tilts backwards, enabling the patient to create a larger angle between their torso and their legs.
• Recline alone increases shear forces, but provides improved access for clean intermittent catheterization.
33
For a patient in a power wheelchair, the optimal seat width should be:
A The distance between the greater trochanters +2 inches
B The distance between the greater trochanters +1 inch
C The distance between the greater trochanters +0.5 inches
D The distance between the greater trochanters
Answer: B
Explanation:
• Proper seat width measurements can be vital to ensuring stability of the patient within the chair without risking skin breakdown at the greater trochanters.
• This optimal width for power wheelchairs is the intertrochanteric distance + 1 inch (this would be adding 0.5 inches on either side of the body for a total increased width of 1 inch).
34
You are discussing your patient’s new knee-ankle-foot orthosis (KAFO) with the patient’s orthotist. She mentions that she intentionally offset the KAFO’s hinge joint to sit posterior to the patient’s knee. Which of the following is the most likely purpose of offsetting the hinge posterior to the patient’s knee?
A To promote knee flexion
B To cause the line of gravity to fall anterior to the knee
C To counteract spastic quadriceps
D To offset the anteriorly placed AFO components
Answer: B
Explanation:
• Offsetting the hinge joint of a KAFO serves the purpose of moving the line of gravity anterior to the patient’s knee, which then tends to lock the knee in extension, producing a stable knee during ambulation that locks appropriately and will not buckle.
• This is useful in patients with weak quadriceps (not spastic quadriceps) who need extra assistance in extending/locking the knee during ambulation.
• Promoting knee flexion would occur if the hinge were fixed anteriorly to the patient’s knee.
35
Which of the following is not a determinant of gait?
A Hip mechanisms
B Foot mechanisms
C Pelvic rotation
D Pelvic lateral excursion
Answer: A
Explanation:
• The 6 determinants of gait are as follows: pelvic tilt, pelvic rotation, pelvic lateral excursion, foot mechanisms, knee mechanisms, knee flexion.
36
You are observing a patient’s gait. You notice that during stance phase of the right leg, the patient leans their torso laterally over the right leg. Which of the following is the name of this type of gait?
A Myopathic
B Steppage
C Compensated trendelenburg
D Uncompensated trendelenburg
Answer: C
Explanation:
• Compensated trendelenburg gait involves the patient essentially throwing their torso laterally over their weak leg (the right leg in this case) to compensate for the hip abductor weakness.
• Uncompensated trendelenburg gait involves the weak right leg hip abductors (gluteus medius) cause the left pelvis to drop during stance phase of the right leg.
• Steppage gait is due to ankle dorsiflexion weakness and involves an audible foot slap during gait.
• Myopathic gait involves myopathy causing proximal muscle weakness leading to a combination of hyperlordosis, trendelenburg gait, and excessive plantarflexion during gait.
37
A foot amputation that involves removing the metatarsals and all bones distal to them is also known by which of the following names?
A Lisfranc
B Syme
C Boyd
D Chopart
Answer: A
Explanation:
• Lisfranc amputation is a pre-metatarsal foot amputation (sparing all bones proximal to the foot metatarsals).
• Boyd amputation is a horizontal amputation through the calcaneus.
• Pirogoff amputation is a vertical amputation through the calcaneus.
• Syme amputation spares the tibia, fibula, and calcaneal fat pad (all other bones are removed).
• Chopart amputation is an amputation that removes all foot bones except tibia, fibula, and talus.
38
Which of the following motions activates a body-powered upper extremity terminal device?
A Scapular retraction with elbow extension
B Humeral flexion and scapular abduction
C Scapular retraction
D Humeral flexion
Answer: B
Explanation:
• An upper limb body-powered prosthesis is activated with biscapular abduction and humeral flexion, which first flexes the elbow into place, then the elbow position is locked into place with biscapular depression and humeral extension, and then this sequence is repeated to open and close the terminal device.
39
Which of the following correctly names the gait which exhibits the foot slapping on the ground at the start of each stance phase?
A Toe drop
B Steppage gait
C Ankle drop
D Slappage gait
Answer: B
Explanation:
• This is a foot drop, or steppage gait. It is due to ankle dorsiflexion weakness. Slappage and toe drop gaits are fictional.
40
In a Chopart amputation, which of the following bones is spared?
A Medial Cuneiform
B Cuboid
C Navicular
D Talus
Answer: D
Explanation:
• A Chopart amputation is an amputation that removes all foot bones except tibia, fibula, and talus.
• A Lisfranc amputation is a pre-metatarsal foot amputation (sparing all bones proximal to the foot metatarsals).
• A Boyd amputation is a horizontal amputation through the calcaneus.
• A Pirogoff amputation is a vertical amputation through the calcaneus.
• A Syme amputation spares the tibia, fibula, and calcaneal fat pad (all other bones are removed).
41
Which of the following orthoses would be most appropriate in the setting of a type 2 dens fracture?
A Minerva jacket
B None of these answers is correct
C Philadelphia collar
D Jewett brace
Answer: A
Explanation:
• Halo vest and Minerva jacket are the appropriate orthoses for use in unstable cervical spine fractures, such as a type 2 dens fracture.
• Philadelphia collar is useful for stable cervical spine fractures.
• Jewett brace is a thoracolumbosacral orthosis (TLSO) and not useful for cervical spine fractures.
42
A very active 52 year-old is competing in his first triathlon. The swim portion of the race takes place in the Atlantic Ocean, and he unfortunately is bitten in the right lower extremity by a shark which necessitates a right transfemoral amputation due to significant neurovascular trauma. He successfully undergoes the amputation and is subsequently fitted for an ischial containment socket 4 months later after the incision is healed and edema is controlled. Which of the following is not a typical component of an ischial containment socket?
A Maintains slight abduction and extended position of the hip
B Weight borne by ischium
C Narrow mediolateral diameter
D Wide AP (anteroposterior) diameter
Answer: A
Explanation:
• Ischial containment socket is the typical preferred socket following transfemoral amputation.
• Weight is borne by the ischium.
• This is a wide A-P and narrow mediolateral diameter socket.
• The usual positioning is slight hip adduction and flexion; this positioning places the hip abductors and hip extensors in a mild stretch which is mechanically advantageous.
43
Which of the following is a true statement about caster wheels?
A None of these statements is true
B Caster tires are always solid rubber
C The larger the caster, the more difficult it is to maneuver and turn the wheelchair
D They are the larger, rear wheels of a wheelchair
Answer: C
Explanation:
• Wheelchair casters are the tiny wheels in the front of the wheelchair near the foot plate.
• They are used for steering purposes.
• Casters are typically in the 6-8 inch diameter range and can be solid rubber or pneumatic for the most part.
• The smaller the caster, the easier it is to steer and maneuver a wheelchair, but the more likely a patient is to get caught on small pebbles and rocks.
• The opposite is true for larger casters.
44
Which of the following muscles should be strong in order to properly operate axillary crutches?
A Both pectoralis major and triceps brachii
B Neither of these muscles is important
C Triceps brachii
D Pectoralis major
Answer: A
Explanation:
• Adequate strength of pectoralis major and triceps brachii are necessary to operate axillary crutches.
• Other muscles involved (but not all) are latissimus dorsi and deltoids.
45
If the large, rear wheels of a wheelchair are placed more anteriorly, the result is:
A More difficult to ascend incline ramps
B Less stable wheelchair
C More difficult to perform wheelies
D Larger turning radius
Answer: B
Explanation:
• Moving the rear wheels more anteriorly produces a smaller turning radius (tighter turns), easier wheelies, and easier ascension of ramps.
• The reason these freedoms are granted to the wheelchair user is because the wheelchair is now inherently less stable, thus allowing such freedom of motion.
46
Which of the following sentences describes a K3 ambulator?
A Unlimited community ambulation with a variable cadence
B High impact sports activity and unlimited community ambulation
C Limited community ambulation at a fixed cadence
D Limited household ambulation at a fixed cadence
Answer: A
Explanation:
• Medicare’s K levels are defined as follows.
• K0: nonambulatory - “K0 = zero prosthesis”.
• K1: limited household ambulator at a fixed cadence.
• K2: unlimited household ambulator and limited community ambulator at a fixed cadence. K3: unlimited community ambulator with a variable cadence.
• K4: high impact sports activities, unlimited community ambulation, variable cadence.
47
You examine a patient’s gait following right transfemoral prosthesis fitting. During ambulation the patient’s left foot plantarflexes excessively during left leg stance phase, vaulting the right lower limb above the ground as it advances through swing phase. Which of the following is a potential cause of this gait abnormality (vaulting on the right side)?
A Excessive prosthetic foot dorsiflexion
B Prosthetic foot is set too far laterally
C Prosthesis is too short
D Excessive prosthetic knee friction
Answer: D
Explanation:
• Of the answer choices, only excessive knee friction would result in a straight limb which, unable to flex at the knee and clear the foot from the ground, must result in being vaulted up into the air (or perhaps circumducted) in order to clear the ground.
• A prosthesis being too long, not too short, could also cause vaulting.
• A prosthetic foot set too far laterally would cause a valgus knee moment.
• Excessive foot dorsiflexion would cause excessive knee flexion, not extension as observed in this patient.
48
A 25 year-old male is brought by ambulance to the emergency department after he was an unrestrained driver in a motor vehicle accident. He is awake, alert, and answering questions upon arrival. He complains of severe pain in his neck and is unable to move his lower extremities; he is able to flex his elbows and extend his wrists bilaterally against resistance, but he has 0/5 strength in elbow extension, finger flexion, and finger abduction. He is found to have an ASIA A spinal cord injury that corresponds with his motor level. He does not gain any further motor function during his acute hospitalization or acute rehabilitation stay compared to his initial emergency department physical exam. What orthosis may promote improved functionality of his upper extremities?
A Flail arm splint
B Shoulder-elbow-wrist-hand-orthosis (SEWHO)
C Opponens orthosis
D Tenodesis splint
Answer: D
Explanation:
• This patient has a C6 SCI and we are told the grading is ASIA A.
• The mechanism of his SCI is an MVA, which is the most common cause of SCI overall and for his age group.
• Patients with C6 tetraplegia may benefit from a tenodesis orthosis, which utilizes the patient’s ability to extend their wrist to induce passive finger flexion and hand-grasp. This allows patients to hold objects even though they lack the muscle activation required for finger function.
• An opponens orthosis is used to immobilize the thumb to allow for healing of various musculoskeletal injuries.
• A flail arm splint is used after brachial plexus injuries.
• A shoulder-elbow-wrist-hand-orthosis (SEWHO) can be used if there is some degree of remaining elbow flexion to allow a patient to feed themselves.
49
A 25 year-old male is brought by ambulance to the emergency department after he was an unrestrained driver in a motor vehicle accident. He is awake, alert, and answering questions upon arrival. He complains of severe pain in his neck and is unable to move his lower extremities; he is able to flex his elbows and extend his wrists bilaterally against resistance, but he has 0/5 strength in elbow extension, finger flexion, and finger abduction. He is found to have an ASIA A spinal cord injury that corresponds with his motor level. He does not gain any further motor function during his acute hospitalization or acute rehabilitation stay compared to his initial emergency department physical exam. What orthosis may promote improved functionality of his upper extremities?
A Flail arm splint
B Shoulder-elbow-wrist-hand-orthosis (SEWHO)
C Opponens orthosis
D Tenodesis splint
Answer: D
Explanation:
• This patient has a C6 SCI and we are told the grading is ASIA A.
• The mechanism of his SCI is an MVA, which is the most common cause of SCI overall and for his age group.
• Patients with C6 tetraplegia may benefit from a tenodesis orthosis, which utilizes the patient’s ability to extend their wrist to induce passive finger flexion and hand-grasp. This allows patients to hold objects even though they lack the muscle activation required for finger function.
• An opponens orthosis is used to immobilize the thumb to allow for healing of various musculoskeletal injuries.
• A flail arm splint is used after brachial plexus injuries.
• A shoulder-elbow-wrist-hand-orthosis (SEWHO) can be used if there is some degree of remaining elbow flexion to allow a patient to feed themselves.
50
A 6 year-old boy undergoes a transtibial amputation for a malignant bone tumor in his distal tibia and is fitted with a below-knee prosthesis. At his current age, how often can his prothesis be replaced?
A Every 24 months
B Every 18 months
C Every 12 months
D Every 6 months
Answer: B
Explanation:
• Until age 5, a prosthetic device should be replaced annually.
• From age 5-12, a prosthetic device can be replaced every 18 months.
• From age 12-21, a prosthetic device can be replaced every 2 years.
51
In an amputation surgery, which of the following surgical techniques is most appropriate in patients with severe dysvascular disease?
A Myodesis
B Myoplasty
C Myofasciotomy
D Myotomy
Answer: B
Explanation:
• Myoplasty involves suturing the muscles to each other, and is technically easier.
• Myodesis involves suturing the muscles into the bone, produces a more stable surgical result, but is contraindicated in patients with severe dysvascular disease, as it will not heal properly due to the poor blood supply.
52
For a patient in a power wheelchair, the optimal seat width should be:
A The distance between the greater trochanters +2 inches
B The distance between the greater trochanters +1 inch
C The distance between the greater trochanters +0.5 inches
D The distance between the greater trochanters
Answer: B
Explanation:
• It may seem pedantic, but proper seat width measurements can be vital to ensuring stability of the patient within the chair without risking skin breakdown at the greater trochanters.
• This optimal width for power wheelchairs is the intertrochanteric distance + 1 inch (this would be adding 0.5 inches on either side of the body for a total increased width of 1 inch).
53
The most common wheelchair armrest contains all of the following features except:
A Full-length
B Desk-length
C Removable
D Tubular
Answer: A
Explanation:
• Wheelchair armrests are usually tubular (easier transfers, less bulky), removable (easier transfers), and desk-length (shorter armrest length, granting easier access to sink, table, desk, etc.).
54
Regarding a transtibial prosthesis, all of the following are pressure-tolerant areas except which?
A Fibular head
B Fibular shaft
C Popliteal fossa
D Medial tibial flare
Answer: A
Explanation:
• Pressure-tolerant areas include the patellar tendon, medial tibial flare, medial tibial shaft, anterior tibial muscles, fibular shaft, and popliteal fossa.
• All other areas are pressure-intolerant.
55
You are observing a patient’s gait. You notice that during stance phase of the right leg, the left pelvis drops inferiorly. Which of the following is the name of this type of gait?
A Compensated trendelenburg
B Uncompensated trendelenburg
C Reverse trendelenburg
D Steppage
Answer: B
Explanation:
• Uncompensated trendelenburg gait: the weak right leg hip abductors (gluteus medius) cause the left pelvis to drop during stance phase of the right leg.
• Compensated trendelenburg gait: involves the patient essentially throwing their torso laterally over their weak leg (the right leg in this case) to compensate for the hip abductor weakness.
• Steppage gait is due to ankle dorsiflexion weakness and involves an audible foot slap during gait.
• There is no reverse trendelenburg gait.
56
You want to prescribe a cane for your patient. You tell them that the optimal height for this cane will be at the level of:
A The hand when the elbow is flexed 10 degrees
B The greater trochanter
C The iliac crest
D The hip
Answer: B
Explanation:
• The proper cane height is at the level of the patient’s greater trochanter or the level of the hand when the elbow is flexed 20-30 degrees.
57
What is the most optimal method for a C4 tetraplegic patient to independently operate a power wheelchair?
A Both "sip and puff" or "head controls" are reasonable options
B Head controls
C Sip and puff
D Joystick
Answer: A
Explanation:
• Most power wheelchairs are driven by joystick controls.
• If the patient lacks arm or hand function, joystick control may not be practical.
• Sip and puff (breathing controls) or head controls (moving the head to tell the chair where a patient wants to go) would be useful in these cases.
58
Regarding limb amputation, in general, which of the following applies?
A The longer the residual limb, the better the patient’s function
B The longer the residual limb, the more likely cancer was the reason for amputation
C The longer the residual limb, the higher the cost of ambulation
D The longer the residual limb, the healthier the skin
Answer: A
Explanation:
• The longer the residual limb, the more functional a patient can be with that limb (for example, comparing a shoulder disarticulation with a transmetacarpal amputation).
• The shorter the limb, the higher the cost of ambulation, and the more likely cancer was involved as the reason for amputation.
59
Moving the rear wheels of a wheelchair more posteriorly will cause which of the following?
A Easier to perform wheelies
B Easier to ascend ramps
C Less stable wheelchair
D Larger turning radius
Answer: D
Explanation:
• Moving the rear wheels more posteriorly broadens the base of support for the wheelchair, thus making it inherently more stable.
• However, this increased stability comes at the cost of decreased maneuverability (larger turning radius, more difficult to perform wheelies and ascend ramps).
60
Which of the following orthoses would be most appropriate for an unstable bony fracture at C4?
A Halo vest
B Knight-Taylor brace
C Philadelphia collar
D Sterno-occipital mandibular immobilizer (SOMI)
Answer: A
Explanation:
• Halo vest and Minerva jacket are the appropriate orthoses for use in unstable cervical spine fractures.
• Philadelphia collar and SOMI (sterno-occipital mandibular immobilizer) are useful for stable cervical spine fractures.
• Knight-Taylor brace is a thoracolumbosacral orthosis (TLSO) and NOT useful for cervical spine fractures.
61
59. In a prosthesis, the socket should exhibit which of the following characteristics?
A Self-suspension capability
B Triple-walled construction
C Soft, elastic fit
D Total contact fit
Answer: D
Explanation:
• Total contact fit is important for every socket prescription; without total residual limb contact with the socket interior, the patient risks having skin breakdown, venous choke points, warts, and other abnormal limb problems.
62
Which of the following braces is most appropriate for a patient with severe plantarflexion spasticity? AFO: ankle-foot orthosis. KAFO: knee-ankle-foot orthosis.
A KAFO
B Rigid AFO
C Posterior leaf spring (PLS)
D Semirigid AFO
Answer: B
Explanation:
• Rigid AFO = Solid AFO prevents any motion at all of the ankle and foot; this is most useful in cases of severe spasticity that needs to be controlled more firmly with a rigid orthosis.
• Posterior leaf spring (PLS) and semirigid AFOs are more useful if severe spasticity is NOT present, as the spasticity will inappropriately overpower these orthoses.
• Knee-ankle-foot orthosis (KAFO) is useful in cases of impaired muscular control of the knee and ankle, NOT the ankle alone.
63
Running begins the moment a patient’s gait exhibits which of the following?
A None of these answers is correct
B 90/10 swing vs. stance phase
C 80/20 swing vs. stance phase
D Exclusively single-limb support
Answer: D
Explanation:
• Running is defined as the period of exclusively single-limb support.
• No double-limb support is taking place.
64
In a patient with a congenital terminal left transradial limb deficiency, which of the following points in time would be most appropriate to first prescribe a prosthesis?
A 12 months
B 9 months
C 6 months
D 3 months
Answer: C
Explanation:
• 6 months is when an upper limb prosthesis might be first prescribed, and 12 months is typical for the first lower limb prosthesis prescription.
65
64. A patient with a traumatic bilateral transtibial amputation status post bilateral transtibial prostheses would be expected to ambulate with which of the following energy costs of ambulation above normal?
A 80% above normal
B 60% above normal
C 40% above normal
D 20% above normal
Answer: C
Explanation:
• Energy costs of ambulation as a percentage above normal values for various traumatic amputation levels are as follows:
• Unilateral transtibial amputation: 20%
• Bilateral transttibial: 40%
• Unilateral transfemoral: 60%
• Bilateral transfemoral: 200%
• These values are approximations and will vary depending on the patient.
66
Which of the following is an advantage of elbow disarticulation over transradial amputation?
A “Prehabilitation” for the prosthesis is less necessary
B Prosthesis fitting is easier
C Surgery is easier and less bloody
D More pronation/supination is preserved
Answer: C
Explanation:
• The main advantage of elbow disarticulation over transradial amputation is that surgery is easier and less bloody.
• Prehabilitation is always very important for every type of amputation.
• Transradial amputation results in easier prosthesis fitting and more pronation and supination preserved than elbow disarticulation.
67
You want to prescribe a straight cane for a patient with right hip pain and an antalgic gait. How do you instruct your patient to use the cane properly?
A In the left hand, advancing the cane simultaneously with the left lower limb
B In the right hand, advancing the cane simultaneously with the left lower limb
C In the left hand, advancing the cane simultaneously with the right lower limb
D In the right hand, advancing the cane simultaneously with the right lower limb
Answer: C
Explanation:
• Canes are generally properly used on the contralateral side of the patient’s pathology.
• For example in this patient with right hip pain, the purpose of the cane is to provide pressure relief by bearing some of the weight-bearing forces through the cane instead of solely through the right lower limb, and to broaden the patient’s base of support to improve stability and reduce fall risk.
• Using the cane in the right hand while advancing the cane simultaneously with the right lower limb would reduce right lower limb weight-bearing forces, but would decrease stability by providing a narrow base of support.
• Only using the cane in the left hand, advancing the cane simultaneously with the right lower limb provides both pain relief and a wider base of support.
• The other two remaining options would have no effect on the right lower limb, defeating the purpose of the cane.
68
Which of the following sentences describes a K0 ambulator?
A Unlimited community ambulator
B Nonambulatory
C Limited community ambulation at a fixed cadence
D Limited household ambulation at a fixed cadence
Answer: B
Explanation:
• Medicare’s K levels are defined as follows.
• K0: nonambulatory - “K0 = zero prosthesis”.
• K1: limited household ambulator at a fixed cadence.
• K2: unlimited household ambulator and limited community ambulator at a fixed cadence.
• K3: unlimited community ambulator with a variable cadence.
• K4: high impact sports activities, unlimited community ambulation, variable cadence.
69
Which of the following sentences describes a K0 ambulator?
A Unlimited community ambulator
B Nonambulatory
C Limited community ambulation at a fixed cadence
D Limited household ambulation at a fixed cadence
Answer: B
Explanation:
• Medicare’s K levels are defined as follows.
• K0: nonambulatory - “K0 = zero prosthesis”.
• K1: limited household ambulator at a fixed cadence.
• K2: unlimited household ambulator and limited community ambulator at a fixed cadence.
• K3: unlimited community ambulator with a variable cadence.
• K4: high impact sports activities, unlimited community ambulation, variable cadence.
70
Which of the following is the correct method by which a myoelectric prosthesis causes activation of the terminal device?
A None of these answers is correct
B A separate handheld device is used by the intact limb to operate the prosthetic terminal device
C Surface electrodes respond to intact muscle belly activation by sending signals to terminal device
D Electrodes stimulate the median, ulnar, radial, and interosseous nerves
Answer: C
Explanation:
• With a myoelectric prosthesis, surface electrodes are placed over intact muscle bellies and respond to the activation of these muscle bellies by sending signals to the terminal device when these muscle bellies are activated voluntarily.
For example, surface electrodes placed over the wrist flexor group will respond to wrist flexor activation by causing the terminal device to close.
71
Which of the following is the most common type of amputation?
A Transfemoral
B Transtibial
C Transradial
D Transmetatarsal
Answer: D
Explanation:
• Transmetatarsal amputations are the most common.
• Consider that in lower limb amputations, dysvascular disease (the most common cause of lower limb amputations) tends to affect the limb distally > proximally.
72
A 65-year-old previously retired businessman with uncontrolled diabetes (hemoglobin A1C 12%) has developed significant radiating pain down his distal right forearm into his 5th finger. He notices this pain is worse when he flexes his right elbow. The patient is right-handed. EMG/NCS shows severe ulnar neuropathy at the level of the elbow. An orthopedic surgeon recommends against surgery until his diabetes is better controlled and refers the patient to you for further treatment options. What bracing would be most appropriate?
A Thumb spica splint
B Long arm splint
C Ulnar gutter splint
D Flail arm splint
Answer: B
Explanation:
• Long arm splint: the most appropriate bracing option for ulnar neuropathy at the elbow
• Functions to keep the elbow in 45 degrees flexion.
• This helps to prevent impingement at the cubital tunnel which would reproduce the patient’s symptoms.
• Flail arm splint is used after brachial plexus injuries.
• Ulnar gutter splint immobilizes the 4th and 5th fingers, often to allow for healing after 4th/5th metacarpal or phalange fractures.
• Thumb spica splint limits thumb ROM, and can be used for DeQuervain tenosynovitis, skier’s thumb, distal 2/3 scaphoid fractures, and 1st CMC arthritis.
73
Which of the following orthoses would be most appropriate for a patient with 27 degrees of thoracic scoliosis?
A Milwaukee brace
B Jewett brace
C Minerva jacket
D Knight-Taylor brace
Answer: A
Explanation:
• Milwaukee brace is essentially a cervicothoracolumbosacral orthosis (CTLSO) whose function is to correct a scoliotic curve by maintaining postural control of essentially the entire spine.
• It must be worn at all times, except for bathing, and is typically indicated for a scoliotic curve between 20-40 degrees.
• Jewett and Knight-Taylor braces are TLSOs that are most useful in preventing thoracic hyperflexion, notably after suffering from a vertebral body compression fracture.
• Minerva jacket is useful in cases of unstable cervical spine fractures.
74
Which of the following orthoses would be most appropriate for a patient with 27 degrees of thoracic scoliosis?
A Milwaukee brace
B Jewett brace
C Minerva jacket
D Knight-Taylor brace
Answer: A
Explanation:
• Milwaukee brace is essentially a cervicothoracolumbosacral orthosis (CTLSO) whose function is to correct a scoliotic curve by maintaining postural control of essentially the entire spine.
• It must be worn at all times, except for bathing, and is typically indicated for a scoliotic curve between 20-40 degrees.
• Jewett and Knight-Taylor braces are TLSOs that are most useful in preventing thoracic hyperflexion, notably after suffering from a vertebral body compression fracture.
• Minerva jacket is useful in cases of unstable cervical spine fractures.
75
One advantage of tilt-in-space power wheelchairs vs. recline-only power wheelchairs is:
A Able to perform independent pressure relief
B Able to reach higher places
C More durable wheelchair
D Improved access for urinary catheterization
Answer: A
Explanation:
• Tilt-in-space power wheelchairs provide excellent independent pressure relief by reducing shear forces upon the sacrum.
• Recline-only wheelchairs do NOT offer this type of pressure relief.
• Recline functionality is what provides improved access for bladder catheterization.
76
While observing a patient’s gait, you notice that their right knee hyperextends during right leg stance phase. Which of the following is the most likely cause of this problem?
A Weak quadriceps
B Greater trochanter inflammation
C Tight hip flexors
D Spastic hamstrings
Answer: A
Explanation:
• Genu recurvatum (the knee bending backwards): the cause of this is weak or excessively tight quadriceps
• It can lead to increased knee pain and instability.
• Treatment involves physical therapy for quadriceps and knee/hip girdle strengthening, as well as the use of a Swedish knee cage or similar type of brace that prevents knee hyperextension during gait.
77
How does one measure for a true leg length discrepancy?
A Measure distance from ASIS to lateral malleolus
B Measure distance from umbilicus to lateral malleolus
C Measure distance from ASIS to medial malleolus
D Measure distance from umbilicus to medial malleolus
Answer: C
Explanation:
• Compare the distance from ASIS (anterior superior iliac spine) to the medial malleolus on both legs.
• In patients with a leg length discrepancy, these measurements will differ.
78
A 28-year-old patient with a transradial amputation due to trauma presents two days after initial fitting of his prosthesis with complaints of discomfort. Your exam reveals that the discomfort arises over a bony prominence of the distal radius. Your initial recommendation is to:
A. Add padding to the inner wall
B. Line the inner wall with silicone
C. Reshape the socket's inner wall
D. Replace the socket
Answer: C
A poorly fitting upper limb prosthetic socket can cause local irritation or discomfort. Bony prominences such as the radial and ulnar styloid processes and the humeral condyles are particularly vulnerable. Skillful reshaping of the socket's inner wall usually provides relief. Socket modification must redistribute pressure while maintaining a secure fit that can resist slippage and rotary forces. Adding padding or other materials in the area of irritation is not usually indicated, because the padding creates additional pressure. Lining the socket with silicone can reduce friction if shear is the culprit. If the prosthetist cannot relieve these areas by grinding or reshaping the socket, socket replacement is indicated.
79
Which of the following adjustments would correct the lateral whip observed in a transfemoral amputee as swing phase begins?
A. Internally rotating the knee bolt
B. Externally rotating the knee bolt
C. Tightening the suspension socket
D. Increasing the length of the prosthesis
Answer: B
In a lateral whip the heel of the prosthetic foot moves in a lateral arc as swing phase begins. This is often caused by excessive internal rotation of the knee bolt, thus externally rotating the knee bolt should correct this gait deviation. Option A is incorrect as internally rotating the knee bolt will worsen the lateral whip. Option C is incorrect because making a too tight suspension socket increases the pressure from contracting muscle bellies which causes the prosthesis to rotate around its long axis worsening the whip. Option D is incorrect since a long prosthesis causes vaulting and circumduction gait deviations.
80
Which of the following is a risk factor associated with increased incidence of phantom pain?
A. Younger age
B. Upper extremity amputation
C. Early prosthesis fitting
D. Short residual limb
Answer: D
The pathophysiology of phantom pain is not entirely understood. Postulated mechanisms include changes in the central nervous system, such as cortical reorganization in the primary somatosensory cortex, and alterations in the peripheral nervous system, such as increased sodium channel expression in nerves causing spontaneous evoked potentials and increased presence of substance P in dorsal horns. Regardless of cause, phantom pain is experienced in the majority of patients following amputation. It is more commonly seen in patients with shorter residual limbs (D), lower extremity amputation, bilateral amputees, patients with history of infection, and patient with pain in the amputated limb prior to amputation. Phantom pain is not common in children or congenital amputees. In adults, etiology of amputation, age, gender, and laterality of amputation do not have a correlation with occurrence of phantom pain.
81
How should the hand of a child with juvenile rheumatoid arthritis be positioned in splinting?
A. Wrist in 0° extension, MCP joints in 25° of flexion, thumb in opposition
B. Wrist in 0° extension, MCP joints in neutral, thumb in neutral position
C. Wrist in 15° of extension, MCP joints in neutral, thumb in neutral position
D. Wrist in 15° of extension, MCP joints in 25° of flexion, thumb in opposition
Answer: D
The correct position for splinting an involved hand in a child with juvenile rheumatoid arthritis is with the wrist in 15° of extension, the metacarpophalangeal joints in 25° of flexion, and the thumb in opposition. This position provides support for weakened structures and helps to reduce contractures.
82
What is the minimal number of points of contact that an orthosis must have in order to exert rotational control?
A. One
B. Two
C. Three
D. Four
Answer: C
Rotational control forces or moments across a joint are not effective unless there are at least 3 points of contact between the device and the limb segment.
83
What is the MOST important biomechanical factor for decreasing the vertical loading of the lumbar spine using a TLSO or LSO?
A. Application of a three-point pressure system for vertical stabilization
B. Reinforce core musculature to distract vertebral bodies
C. Pressure over the bony prominences
D. Full immobilization of the thoracolumbar spine
Answer: B
Abdominal compression increases intracavitary pressure, which acts to unload the spine and its disks by transmitting load onto the soft tissues of the trunk. The application of a 3-point pressure system typically aims to restrict triplanar motion (flexion/extension/lateral flexion and trunk rotation). Pressure over the bony prominences provides a kinesthetic reminder to maintain or correct posture. No spine orthosis achieves complete immobilization of the spine.
84
The patellar tendon bearing (PTB) socket for a transtibial amputee is designed:
A. To bear weight on the lateral tibial flare
B. With alignment in 5° - 8° of anterior flexion
C. For distal weight bearing
D. With the posterior wall enclosing the hamstring tendons
Answer: B
The socket is aligned in approximately 5° - 8° of flexion to increase initial tension on the quadriceps tendon (discouraging knee hyperextension) and enhance weight bearing to the anterior aspect of the residual limb. The PTB socket is designed to accept weight at the patellar tendon, medial flare of the anterior tibia, lateral aspect of residual limb, pretibial muscle mass between the tibial crest and fibula and popliteal fossa. The posterior wall should provide relief for the hamstring tendons.
85
Which characteristic of a prosthesis promotes knee stability during the gait cycle of a person with transfemoral amputation?
A. Knee component placed anterior to the socket
B. Hard heel in the prosthetic foot
C. Polycentric 4-bar linkage prosthetic knee
D. Anterior position of the shank on the prosthetic foot
Answer: C
Flexion moment at the hip, a rigid heel in the solid ankle cushion heel (SACH) foot, and the anterior position of the shank all shift the ground reaction force behind the knee joint to produce a knee flexion moment. The 4-bar linkage with instantaneous center of rotation and the posterior location of instant center in extension creates knee stability, especially at heel strike.
86
Which of the following would typically be found in the transfemoral prosthesis of a 7-month-old amputee?
A. Multiaxial foot
B. No knee component
C. Socket in adduction
D. Mexhanical locking suspension
Answer: B
Pediatric amputees are prescribed a prosthesis when they are at least 6 months old, and are starting to pull themselves to stand (fit to stand), in keeping with the timeline for developmental milestones. For a child learning their initial balance and ambulation, a simple and stable prosthesis is best. Progressing proximally to distally, the transfemoral prosthesis would have a solid ankle foot and no knee joint, since children cannot control the movement in an articulated knee until the age of three years, and an articulated foot will make balance difficult to learn and increase fall risk. The transfemoral socket is placed in abduction to match the increased hip abduction and external rotation found in children of this age. A total elastic suspension (TES) belt is the simplest for parents to learn, and is more easily adjustable as the child grows, and allows for (relatively) greater ease during diaper changes.
87
What is the primary advantage of a body powered upper limb prosthesis compared to a myoelectric prosthesis?
A. Greater sensory feedback
B. Moderate or no harnessing
C. Less body movement to operate
D. Enhanced cosmesis
Answer: A
The advantages of body powered upper limb prostheses include the following factors: moderate cost, most durability, highest sensory feedback, and a variety of prehensors available for various activities. Their disadvantages are that they require the most body movement to operate, have the most harnessing and require increased energy expenditure to use. Myoelectric and/or switch controlled upper limb prostheses have the following advantages: they require moderate to no harnessing, require fewer body movements to operate, have moderate cosmesis, provide more function in proximal areas and, in some cases, provide a stronger grasp. Battery powered prostheses are the heaviest and most expensive prostheses. They also require the most maintenance, provide limited sensory feedback and require extended therapy time.
88
Bracing can help slow the progression of adolescent idiopathic scoliosis for Cobb angles of:
A. 20-39 degrees
B. 40-59 degrees
C. 60-79 degrees
D. 80-99 degrees
Answer: A
A majority of adolescent idiopathic scoliosis can be controlled effectively with bracing for curves between 20 and 40 degrees. Bracing is recommended for curves over 20 degrees in a skeletally immature patient in whom only 5–10 degrees of progression has been noted over a six-month period. Brace wear is discontinued in lieu of surgical intervention generally if the curve reaches 40 degrees or rapid progression is noted. In neuromuscular scoliosis, while orthoses may improve trunk control and sitting posture, they less often slow curve progression and do not prevent the need for surgical intervention.
89
Which wheelchair would be most appropriate for a 50-year-old man who had a stroke with right hemiparesis?
A. Power wheelchair with tilt-in-space system
B. Manual wheelchair with lower seat height
C. Manual wheelchair with fixed leg rests
D. Power wheelchair with a headrest
Answer: B
Patients with hemiplegia are often able to use their “good” leg to help propel the chair, but the seat height in a regular chair is too high for their legs to reach the floor. Hemi-height chairs are made lower to the ground and allow the user to propel the chair with the unaffected arm and leg. Fixed leg rests would be inappropriate for individuals propelling wheelchairs with their lower limbs. Tilt-in-space systems (entire seat and back are tilted posteriorly as a single unit) prevent shear stress during movement and help provide pressure relief. Headrests are indicated in patients with poor head control and for transportation in vehicles.
