Prosthetic Orthotics Flashcards
A child with a congenital transverse radial limb deficiency should have an initial prosthesis fit at what developmental stage?
(a) At the time of starting kindergarten
(b) As soon as possible after birth
(c) At the time of first sitting independently
(d) At the time of initially walking
Answer: c
Children with unilateral transverse radial limb deficiency should be “fit to sit,” meaning fitted by 6 months of age with an initial prosthesis that has a passive terminal device.
Reference: (a) Gaebler-Spira D, Uellendahl J. Pediatric limb deficiencies. In: Molnar GE, Alexander MA, editors. Pediatric rehabilitation. Philadelphia: Hanley & Belfus; 1999. p 333-50 ; (b) Fisk JR, Smith DG. The limb-deficient child. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies: surgical, prosthetic and rehabilitation principles. 3rd Edition. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p 773-7.
The primary advantage of a 4-point crutch gait over a 2-point crutch gait is
(a) stability.
(b) speed.
(c) weight-bearing relief.
(d) efficiency of gait.
Answer: a
The 4-point crutch gait has stability as its primary advantage. At least 3 points are always in contact with the ground. It is more difficult to learn than the other gait patterns and is a relatively slow form of ambulation. The 3-point crutch gait is used by patients with lower limb fractures, amputations, or toe-touch weight-bearing. The 4-point gait pattern enables the crutch user to eliminate all the weight-bearing on the affected lower limb. The 2-point crutch gait is much faster than the 4-point gait and yet still provides some weight-bearing relief to both lower limbs.
Reference: Ogle AA. Canes, crutches, walkers, and other ambulation aids. Phys Med Rehabil State Art Rev 2000;14(3):485-92.
he individual with a transfemoral amputation for whom a weight-activated stance-control knee would be most indicated is one who
(a) has cognitive deficits.
(b) has a contralateral weak limb.
(c) is an unlimited ambulator.
(d) requires a preparatory prosthesis.
Answer: d
Weight-activated stance-controlled knees are often used for individuals with a transfemoral amputation. They are especially useful as a preparatory prosthesis, because their simplicity and safety help new amputees learn to walk with a prosthesis. To flex the knee, the amputee must shift weight onto the opposite leg, which requires the opposite limb to accept increased weight. Additionally, the amputee must have the cognitive ability to learn to weight shift. The requirement to shift weight off of the prosthesis to allow knee flexion presents few problems at slow cadences, but if the amputee attempts to walk at a more normal speed, the gait pattern is disrupted by the premature weight shift. Because it is impossible to voluntarily bend the knees and control the direction of a fall when using bilateral friction knees, for a bilateral amputee, a stance-phase knee is best used only on one side, if at all.
Reference: Michael JW. Prosthetic suspensions and components. In: Smith DG, Michael JW, Bowker JH, editors. Atlas amputations and limb deficiencies. 3rd ed. Rosemont: AAOS ;2004. p 420.
What is the primary disadvantage of moving the rear axle of a wheelchair forward?
(a) Ascending curbs becomes more difficult.
(b) It takes more muscle effort to propel the wheelchair.
(c) More strokes are required to push the wheelchair.
(d) Ascending a ramp becomes more difficult.
Answer: d
Moving a wheelchair’s rear axle forward enables the user to propel the chair with less muscle effort and fewer strokes. Because the modification causes more weight to be centered over the rear wheels, it is easier to pop a wheelie, negotiate obstacles and ascend or descend curbs. However, moving the axle forward can also make the wheelchair more “tippy” (likely to tip backwards) and that tendency to tip backwards makes it more difficult to push the chair up a ramp.
Reference: Koontz AM, Spaeth DM, Sichmeler MR, Cooper RA. Prescription of wheelchairs and seating systems. In: Braddom RL. Physical medicine and rehabilitation. Philidelphia: Elsevier; 2007. P 381-411.
Which factor 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 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.
Reference:(a) Michael JW. Prosthetic suspensions and components. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies. 3rd ed. Rosemont. AAOS; 2004. p 421. (b) Schuch CM, Pritham CH. Transfemoral amputation: prosthetic management. In: Smith GD, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies. 3rd ed Rosemont: AAOS; 2004. p 541-2.
What is the function of the anterior pin in an ankle-foot orthosis (AFO) with a dual-channel ankle joint?
(a) It limits dorsiflexion.
(b) It assists plantarflexion.
(c) It corrects eversion.
(d) It promotes inversion.
Answer: a
An anterior stop is used to substitute for the function of the gastrocnemius-soleus complex. It limits dorsiflexion based on the size of the pin (a longer pin permits LESS movement). Because of its effect on the knee, it is used in conditions of weak calf muscles or weak quadriceps. The anterior stop assists with push-off and assists the knee joint into extension.
Reference: Shurr D, Michael JW. Prosthetics and orthotics. 2nd ed. Harrisonburg. Pearson Education; 2002. p 176.
The primary advantage of a soft insert fitted into the socket of a transtibial prosthesis is that it is
(a) perspiration resistant.
(b) easy to keep clean.
(c) easily modified.
(d) very durable.
Answer: c
Soft inserts are fabricated to fit inside the socket. They are recommended for patients with thin, sensitive, or scarred skin, or peripheral vascular disease (PVD). They are easily modified. Hard sockets also have their advantages. They are perspiration resistant, less bulky than sockets fitted with a soft insert, easy to keep clean, and durable. Further, reliefs or modifications can be located with precision in the hard socket.
Reference: Kapp SL, Fergason JR. Transtibial amputation: prosthetic management. In: Smith GD, Michael JW, Bowker JH, editors. Atlas amputation and limb deficiency. 3rd ed. Rosemont: AAOS; 2004. p 508.
How are mobility devices paid for through Medicare?
(a) The patient must make a 50% down payment, with the rest covered by Medicare upon delivery of the device.
(b) Medicare part A pays 80% of the allowed purchase price and Medicare part B pays the remaining 20%.
(c) Medicare will pay for purchase but not rental of mobility devices.
(d) Medicare part B pays 80% of the allowed purchase price in one lump sum.
Answer: d
Medicare Part B pays 80% of the allowed purchase price in one lump sum payment if the patient chooses to purchase the device. The patient is required to pay 20% of the allowed purchase price. If the patient chooses to rent a wheelchair, Medicare part B will pay 80% of the allowed rental price for months 1 through 10 and the patient will pay 20% of the allowed rental charge.
Reference: www.cms.hhs.gov/apps/media/press/release.asp Accessed May 15, 2008.
At mid stance, where is the ground reaction force vector located?
(a) Anterior to ankle, posterior to knee
(b) Anterior to ankle, anterior to knee
(c) Anterior to knee, anterior to hip
(d) Posterior to knee, posterior to hip
Answer: (b)
Commentary: In mid stance, the ground reaction vector lies anterior to the ankle, anterior to or through the knee axis, and posterior to the hip center. The passive torques created by this vector alignment are ankle dorsiflexion, knee extension and hip extension.
Ref: Rab GT. Muscle. In: Rose J, Gamble JG. editors. Human walking. 2nd Ed.Baltimore :Williams & Wilkins; 1994. p 114.
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 deg – 8 deg of flexion.
(c) for distal weight bearing.
(d) with the posterior wall enclosing the hamstring tendons.
Answer: (b)
Commentary: 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.
Ref: Schurr D, Michael JW. Prosthetics and orthotics. 2nd ed. Harrisonburg: Prentice-Hall; 2002. p 75.
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)
Commentary: 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.
Ref: Gitter A, Bosker G. Upper and lower extremity prosthetics. In: DeLisa JA, Gans BM, Walsh NE, editors. . Physical medicine and rehabilitation. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p 1342.
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)
Commentary: 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.
Ref: Shurr DJ, Michael JW. Prosthetics and orthotics. 2nd ed. Harrisonburg: Pearson Education; 2002. p 34.
- The primary stabilizing effect of the flexible lumbosacral orthosis is its ability to
(a) restrict spinal extension.
(b) prevent atrophy of trunk muscles.
(c) elevate intra-abdominal pressure.
(d) enhance kinesthetic feedback.
Answer: (
Answer: (c)
Commentary: Although they do not effectively restrict motion to a significant degree, flexible lumbosacral orthoses elevate intra-abdominal pressure, thereby unloading the spine and supporting structures. This action also provides inhibitory kinesthetic feedback and warmth. Long-term use of binders and other flexible lumbosacral orthoses may, unfortunately, result in atrophy of trunk muscles.
Ref: Pomerantz F, Durand E. Spinal orthotics. In: DeLisa JA, Gans BM, Walsh NE, editors. Rehabilitation medicine: principles and practice. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p 1362 -3.
Which of the following measures of the extremity arterial blood supply is predictive of a favorable outcome in the healing of a foot sore?
(a) Toe blood pressure of 20mmHg
(b) Absent dorsalis pedis and posterior tibial pulses
(c) Ankle-brachial index less than .45
(d) Transcutaneous oxygen tension greater than 35mmHg
Answer: (d)
Commentary:Various methods for the vascular assessment of the lower extremity are available for predicting healing of foot sores. The ankle-brachial index > 0.45 is the cornerstone of non-invasive vascular testing; however the transcutaneous oxygen saturation greater than 35mmHg is a more specific indicator of tissue perfusion and viability. Absolute toe blood pressures and distal foot pulses are also used for screening. Absent distal pulses and low absolute toe blood pressures are poor prognostic indicators.
Ref: Lazarides MK, Giannoukas AD. The role of hemodynamic measurements in the management of venous and ischemic ulcers. Int J Low Extrem Wounds. 2007 Dec;6(4):254-61
Which of the following would be an important consideration in the use of total-contact casting for a diabetic patient with a nonhealing foot ulcer?
(a) Active soft tissue infection is a contraindication to casting.
(b) The initial cast is typically left in place for approximately 14 days.
(c) Casting is designed to distribute pressures over the heel pad and metatarsal heads.
(d) Casting is only effective for ulcers that have been present for 3 weeks or less.
Answer: (a)
Commentary: Total-contact casting is an effective method to facilitate wound healing in persons with neuropathic foot ulcers, especially those located on the plantar surface of the foot. It accomplishes this by off-loading the sore and distributing pressures over the entire surface of the foot. Osteomyelitis and active soft tissue infection are contraindications to casting. The initial cast is changed within 2 to 7 days, and then approximately every 7 days if no complications develop. Casting can be effective even for chronic foot ulcers if the vascular supply is adequate.
Ref: Bus SA, Valk GD, san Deursen RW, Armstrong DG, Caravaggi C, Hlavacek P, Bakker K, Cavanagh PR. The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabets Metab Res Rev. 2008 May-Jun;24 Suppl 1:S162-80.
Which of the following is true regarding the design of a lower extremity prosthesis?
(a) Exoskeletal is less durable.
(b) Endoskeletal tends to require less maintenance.
(c) Exoskeletal is easily adjusted after fabrication.
(d) Endoskeletal tends to weigh less.
Answer: (d)
Commentary: Exoskeletal prostheses are more rugged, require less maintenance, cannot be adjusted for alignment after fabrication, and can accommodate only a restricted number of foot and knee units. Furthermore, these prostheses tend to weigh more than the equivalent endoskeletal prostheses. For these reasons, exoskeletal prostheses are prescribed less often than endoskeletal prostheses. Endoskeletal prostheses are modular in design, allowing relative ease of adjustment of alignment and replacement of parts. They are also easier to suspend by virtue of their relatively lighter weight.
Ref: Kuiken TA, Miller L, Lipschutz R, Huang ME. Rehabilitation of People with Lower Limb Amputation. In: Braddom RL, Buschbacher RM, Chan L, Kowlaske K., Laskowski ER, Matthews DJ, Ragnarrson KT, editors. Physical Medicine & Rehabilitation Third Edition. Saunders-Elsevier; 2007. pp. 296-7.
Which of the following prosthetic knees provides good stability in early stance phase and facilitates flexion while weight bearing during the pre-swing phase (terminal stance) of the gait cycle?
(a) Single axis
(b) Stance-phase control
(c) Polycentric
(d) Manual locking
Answer: (c)
Commentary: Many polycentric knees are designed so that the center of rotation moves anteriorly very rapidly during the first few degrees of knee flexion, quickly passing in front of the floor reaction line and facilitating the swing phase. Because the polycentric knee can be flexed under weight bearing during the terminal stance, when properly dynamically aligned it can offer both excellent stance stability and ease of swing-phase flexion. All polycentric knees shorten mechanically to a slight degree during flexion, adding additional toe clearance during midswing.
Ref: Kuiken TA, Miller L, Lipschutz R, Huang ME. Rehabilitation of People with Lower Limb Amputation. In: Braddom RL, Buschbacher RM, Chan L, Kowlaske K., Laskowski ER, Matthews DJ, Ragnarrson KT, editors. Physical Medicine & Rehabilitation Third Edition. Saunders-Elsevier; 2007. pp. 310-12.
A 28-year-old patient with a transradial amputation due to trauma presents 2 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
Commentary: 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.
Ref: Spires MC, Miner L, Colwell M. Upper extremity amputation and prosthetic rehabilitation. In: Grabois M, Garrison SJ, Hart KA, Lehmkuhl LD, editors. Physical Medicine and rehabilitation, the complete approach. Malden (MA): Blackwell Science; 2000. p 549-82
1.A 16-year-old male with a right above-knee amputation presents to your clinic to get your opinion on operating a motor vehicle. You advise him that he would be required to
(a) strengthen his hip extensors.
(b) change the position of the car’s accelerator and brake.
(c) obtain a special driving prosthesis.
(d) install a handbrake on the vehicle’s left floor.
- (b)The only situation that applies in this scenario is changing the position of the pedals in order to operate the vehicle with the left lower limb. Installing a handbrake is reserved for persons with right upper limb amputations. Other acceptable recommendations could include automatic transmission and/or hand controls.
- In which circumstance is supracondylar suspension on a transtibial prosthetic socket most indicated?
(a) A 4-centimeter residual limb length below the tibial tubercule
(b) A residual limb with mildly adherent distal scar tissue
(c) A cylindrical-shaped residual limb
(d) A residual limb with poor definition above the femoral condyles
- (a)Supracondylar suspension would be most indicated for an individual with a short transtibial residual limb to provide additional mediolateral support and to increase the weight-bearing surface area for more even pressure distribution. A cylindrical-shaped transtibial limb is ideal for allowing total contact between the residual limb and the socket and is not an indication for supracondylar suspension. Supracondylar suspension is also not specifically indicated for mildly adherent scar tissue. Supracondylar suspension would be difficult to utilize in a residual limb that has poor definition above the femoral condyles.
- What is the shortest functional level for a transtibial amputation?
(a) Just proximal to the tibial tuberosity
(b) Just distal to the tibial tuberosity
(c) Six centimeters distal to the tibial tuberosity
(d) Ten centimeters distal to the tibial tuberosity
b)The shortest functional amputation level for a transtibial amputation is just distal to the tibial tuberosity. Knee flexion and extension can occur with this level of amputation because the patella tendon and hamstring tendon attachments are still present. Control of knee flexion and extension of the knee is lost with amputations proximal to the tibial tuberosity.
4.What is the best-established benefit of a microprocessor-controlled knee unit, compared to a conventional pneumatic knee unit?
(a) It provides both swing and stance phase control.
(b) It allows greater knee flexion to perform bending and lifting activities.
(c) It allows running at faster speeds.
(d) It provides a more natural and symmetric gait pattern.
- (d)Microprocessor controlled knee units use a computerized system to automatically adjust the knee unit’s resistance over a wide range of gait speeds. With this automatic control, there is greater consistency and reliability in the knee movement during the gait cycle. These benefits give the amputee greater confidence and improve swing phase responsiveness and gait symmetry, as well. Negative aspects of the microprocessor controlled knee units are heavier weight and greater expense. These units have not been shown to improve running speed.
- Regarding energy expenditure during prosthetic ambulation,
(a) at self selected walking speeds, someone ambulating with a transtibial prosthesis has a higher rate of metabolic energy expenditure [mlO2/(kg•meter)] compared with normal human locomotion.
(b) whether a person has a transtibial or transfemoral prosthesis, the metabolic cost [mlO2/(kg•meter)] of ambulation is the same.
(c) at self selected walking speeds, cardiac work load during transtibial prosthetic ambulation is comparable to that in normal human locomotion.
(d) gait velocity [meters/min] during transtibial prosthetic ambulation is comparable to that in transfemoral prosthetic ambulation.
- (c)The rate of metabolic energy expenditure–mlO2/(kg•minute)–represents energy expenditure per unit of time in comparison to metabolic cost–mlO2/(kg•minute)–which is a measure of energy expenditure per unit distance, a meter. The metabolic cost of prosthetic ambulation is greater than that used in normal human locomotion and the metabolic cost of transfemoral prosthetic ambulation is greater than that in transtibial prosthetic ambulation. Because individuals who ambulate witha prosthesis slow their gait velocity, their rate of metabolic energy expenditure is relatively unchanged compared to normal ambulation at self-selected walking speeds. Because the rate of metabolic energy expenditure is maintained at a level comparable to ambulation without a prosthesis, cardiac work load is also unchanged during ambulation with either a transtibial or transfemoral prosthesis, if subjects are allowed to walk at their self-selected walking speed.
- Which circumstance is most likely to result in left knee hyperextension at initial contact (heel strike) in a patient with spastic left hemiparesis?
(a) Solid ankle, double-metal, upright ankle-foot orthosis set in 5° of plantar flexion
(b) Addition of a solid one-quarter inch heel to the left shoe
(c) Addition of ankle dorsiflexion spring assistance to a dual-channel, double-metal, ankle-foot orthosis
(d) Addition of a T-bar strap to a double-metal upright ankle-foot orthosis to reduce foot inversion.
a)Placing a solid ankle, double-metal, upright ankle-foot orthosis in 5° of plantarflexion will increase the extension moment (forces) at the knee and this can result in knee hyperextension, especially at the time of initial contact (heel strike). Addition of a T-bar strap should not effect the knee and the addition of dorsiflexion spring assistance or a one-quarter inch heel will reduce the tendency to have knee hyperextension.
- Which spinal orthosis is used to prevent thoracic spinal flexion by providing 3-point pressure over the sternum and pubis anteriorly and the upper lumbar spine posteriorly?
(a) Custom molded, plastic thoracolumbosacral orthosis
(b) Lumbosacral corset with posterior metal stays
(c) Jewett orthosis
(d) Taylor orthosis
- (c)Several different types of thoracolumbosacral (TLSO) orthoses are available to control segmental spine motion in this region. A custom molded plastic TLSO provides almost total contact support for uniform pressure distribution and control of motion in all plains. A lumbosacral corset with metal stays provides support circumferentially and helps reduce spine motion primarily in the lumbosacral region. A Taylor orthosis also provides circumferential support with the addition of axillary straps. The Taylor orthosis is primarily designed to resist flexion and extension. A Jewett brace is designed to limit thoracic spine flexion by providing 3-point pressure over the sterum and pubis anteriorally and the upper lumbar spine posteriorally. This type of brace is used most commonly for individuals with thoracic spine anterior compression fractures.
- For which individual would a high-profile, dynamic elastic response (energy-storing) prosthetic foot and ankle mechanism be most indicated?
(a) 75-year-old man with a transtibial amputation who lives in a nursing home
(b) 53-year-old woman with a transfemoral amputation who is a recreational swimmer
(c) 60-year-old man with a transtibial amputation who enjoys jogging
(d) 43-year-old man with a transfemoral amputation who farms
c)High-profile, dynamic elastic response prosthetic feet and ankle components such as the Flex-Foot and Springlite are primarily indicated for individuals who are expected to be community ambulators and are able to ambulate at variable cadences. This class of prosthetic components is also used for individuals participating in running and sports activities. Therefore, this class of components would be most indicated for the individual with a transtibial amputation interested in returning to running. An individual who farms would likely benefit from a prosthetic foot and ankle system which is more accommodative over uneven surfaces.
- At which location is a Syme amputation performed?
(a) A
(b) B
(c) C
(d) D
- (a)A Syme amputation (A) is ankle disarticulation with tapering of the medial and lateral malleoli and preservation of the heel pad for soft tissue coverage and distal weight bearing. A Boyd hindfoot (B) amputation is a talectomy and calcaneal-tibial arthrodesis after forward translation of the calcaneus. A Chopart level (C) amputation is performed at the mid-tarsal level with sparing of the talus and calcaneus. A tarsal-metatarsal disarticulation (D) is also referred to as a Lisfranc amputation.
- In an upper-extremity prosthesis, an advantage of a voluntary-closing hook terminal device that a voluntary-opening device does not have is
(a) the ability to carry objects with less fatigue.
(b) improved ability to manipulate fragile objects.
(c) an adjustable pinch force effected by changing the number of elastic bands.
(d) a better ability to visualize the object being manipulated.
- (b)One advantage of a voluntary-closing hook terminal device is the ability to adjust the amount of pinch force by adjusting pressure on the cable control. This improves the ability to manipulate fragile objects. A voluntary opening terminal device uses elastic bands to determine the pinch force and the number of bands would have to be reduced to decrease the pinch force. When carrying objects, voluntary-closing terminal devices require constant cable tension and this can result in quicker fatigue. The ability to visualize the object being manipulated would not be dependent upon whether the terminal device is voluntary closing or voluntary opening.
11.What is the primary motion used to open a voluntary-opening terminal device in a body-powered transradial prosthesis?
(a) Glenohumeral flexion
(b) Glenohumeral extension
(c) Biscapular elevation
(d) Biscapular adduction
- (a)The control cable for opening the terminal device of a standard transradial prosthesis using a voluntary-opening terminal device passes posterior to the elbow joint, along the posterior arm, and attaches to the posterior support strap of a figure-of-8 harness. This arrangement allows glenohumoral flexion to produce tension in the cable and open the terminal device. Glenohumoral extension and biscapular adduction decrease tension on the control cable. Biscapular elevation would not produce cable tension required for terminal device operation.
- Regarding acquired upper extremity amputation in adults,
(a) the most common level is transhumeral.
(b) they account for approximately 50% of all acquired major limb amputations.
(c) they are most common in the 20- to 40-year-old age group.
(d) their most common cause is malignancy.
- (c)Trauma is the most common cause of upper extremity amputation in adults. Malignancy is a more common cause of amputation in the pediatric population. Upper extremity amputations occur most commonly in the 20- to 40-year-old age group, as a result of trauma and work related accidents. The dominant extremity is affected more commonly and amputations at the transradial level are the most common level of upper extremity amputation. Upper extremity amputations occur much less frequently than lower extremity amputations. Upper extremity amputations account for approximately 20% of all major limb amputations.
- One advantage of a small diameter caster (front wheelchair wheel) is
(a) greater ability to traverse rough terrain.
(b) better stability on steep inclines.
(c) less frequent maintenance.
(d) greater maneuverability.
- (d)Small diameter casters on a wheelchair reduce the chair’s turning radius, which gives it greater maneuverability. These casters frequently are mounted on wheelchairs used for sports such as basketball. Smaller diameter casters are less well suited for outdoor activities over rough terrain. The size of the caster does not affect the maintenance required and does not improve wheelchair stability on inclines. Hard, narrow casters are typically recommended for mobility over smooth, level surfaces whereas wider, larger casters are better for mobility over uneven, rough surfaces.
- Which shoe modification would NOT be appropriate for an individual with loss of protective sensation on the foot secondary to diabetes?
(a) Wide toe box
(b) Rocker bottom
(c) Soft inner shoe liner
(d) Solid steel shank
- (d)All of the shoe modifications listed would be appropriate for an individual with loss of protective sensation except for the use of a solid steel shank built into the sole of the shoe. This modification would decrease the accommodative properties of the shoe and may increase the potential for skin breakdown.
- In which case would a wrist-hand-finger orthosis utilizing dynamic metacarpophalangeal extension assistance be most indicated?
(a) Complete radial nerve injury at the level of the mid-humerus
(b) Partial ulnar nerve injury at the level of the elbow
(c) Complete median nerve injury in the forearm
(d) C5 level ASIA class A spinal cord injury
- (a)With a radial nerve injury at the level described, there is loss of wrist and metacarpal extension because of denervation of the forearm extensor muscles. A dorsal wrist-hand-finger orthosis that holds the wrist, fingers, and thumb in extension and permits flexion of the digits with a low-profile outrigger is used to substitute for this loss of function. This type of orthosis would be inappropriate for the other conditions described.
- Which knee component is preferred in the prosthetic prescription for an 80-year-old debilitated, dysvascular, diabetic transfemoral amputee?
- (a) Single axis
- (b) Polycentric
- (c) Pneumatic
- (d) Manual locking
- (d)A manual-locking knee is indicated for new unstable amputees and those who need utmost stability because of muscular weakness or poor coordination. The other components are generally used in persons with less risk of falling.
What acquired upper extremity amputation is most common in adults?
(a) Dominant extremity at the transradial level
(b) Dominant extremity at the transhumeral level
(c) Non-dominant extremity at the transradial level
(d) Non-dominant extremity at the transhumeral level
- (a)Acquired upper limb amputations in adults occur most commonly in males between the ages of 21 and 64 years. These amputations result frequently from work-related accidents or trauma and are most common in the dominant limb at the transradial level. In contrast, congenital upper limb deficiencies occur most commonly on the left side at the transradial level.
- When applying a static resting hand splint to a person who had a stroke with upper limb paralysis, what is the appropriate joint position to maintain the hand in a functional position?
- (a) 20° of wrist flexion
- (b) 90° of metacarpophalangeal flexion
- (c) Neutral position or slight flexion of the distal interphalangeal joints
- (d) 30° of thumb opposition across the palm
- (c)A resting hand splint is designed to maintain a position of function in a hand that is weak or paralyzed. It is applied on the volar surface and extends from the fingertips to the proximal third of the forearm. The wrist is typically placed in slight extension. The metacarpophalangeal joints are placed in slight flexion and the interphalangeal joints are placed in a neutral position or in slight flexion. The thumb is supported in a position between palmar and radial abduction.
- A person with diabetes presents with an area of nonblanching erythema on the plantar surface of the foot at the first metatarsal head. Recommendations for footwear would include
a. custom-molded shoe insert.
b. narrow toe box shoe.
c. heel lift on the affected side.
d. calcaneal bar added to the sole of the shoe.
- (a)Footwear for the person with diabetes and grade 1 skin changes on the plantar aspect of the foot should be designed to relieve pressure over the affected site while evenly distributing pressure over the remaining foot surface to prevent other skin breakdown. A typical prescription would include an extra-depth shoe with a wide toebox and a total-contact, custom-molded insert with pressure relief at the area of skin irritation. Further shoe modifications with a metatarsal bar and rocker bottom sole could also be considered, especially if the patient had grade 2 skin changes or more severe foot deformities. A calcaneal bar or heel lift would not be appropriate considerations in this case.
