Test 1 Flashcards
1
Q
The three “activation methods for stance control ox:
A
Weight, Ankle, Gait
2
Q
T or f: ankle motion is required for all SCO’s?
A
False
3
Q
The stance phase of gait is___% of gait cycle?
A
60%
4
Q
Normal gait has how many phases?
A
8
5
Q
Name one of the three different weight activated SCO’s
A
Horton SCPKJ, Becker e-knee, otto bock SensorWalk
6
Q
T or f: Gait activated SCO’s require a reciprocal gait pattern
A
True
7
Q
T or f: Spasticity is a contraindication for SCO’s
A
True
8
Q
T or f: a knee flexion moment at terminal stance is required for SCO’s?
A
False: a knee flexion moment at terminal stance will prevent the SCO from unlocking at TS, except with the SensorWalk
9
Q
What MMT grade at the hip flexor is normally required for SCO’s?
A
Gr. 3, unless patient has a compensatory pattern that is equal to a gr. 3 in motion
10
Q
What are two of the effects of locking a knee in normal gait
A
Hip hiking, circumspection, vaulting, excessive lateral trunk lean, increased energy consumption, decreased cadence
11
Q
The ankle is in what position durning the swing phase of gait
A
Neutral to 5 degrees pf
12
Q
T or f: Locking the knee during normal gait is always safer for the patient
A
False
13
Q
How do you determine stirrup length?
A
2 times height of distal tip of medial malleolus + SOLE THICKNESS + width of heel +1/4” or 6mm
14
Q
How doe you determine band length
A
Half circumference pulse 1.5” or 38mm
15
Q
What are the min. Clearance for ankle joints and knee joints?
A
Ankle: lateral side 3/16” or 5mm- medial 1/4” or 6mm
Knee: lateral side 1/8” or 3mm- medial 1/4” or 6mm
16
Q
A conventional KAFO what changes could you use to reduce recurvatum?
A
Shallow bands, move calf band up-distal thigh down-move theses two closer, increase heel height
17
Q
KAFO, what problems could you encounter in moving the bands?
A
Peroneal nerve impingement, limited knee flexion of orthosis
18
Q
How much pf would you allow a patient who has suffered a CVA?
A
Neutral
19
Q
How do you determine if a patient requires locks on his KAFO vs. free knee?
A
Hip and or knee extensor weakness
20
Q
What do you recommend for a patient who exhibits foot slap at heel strike
A
AFO- Conventional or plastic w/ Dorsi-assist and or plantar stop
21
Q
What is Legge-calve-perches disease?
A
A vascular necrosis of the femoral head usually occurring in boys ages 9-14. Femoral head will return to normal if the leg is abducted and internally rotated to place the femoral head in the accetabulem
22
Q
Name 3 ox used for legge-calve-perthes?
A
Atlanta (scottish rite), toronto, newington
23
Q
3 ox for the treatment of Hip dysplasia
A
Frejka pillow, pavlik harness, llfeld splint
24
Q
What is tibial torsion?
A
Difference between knee and ankle joint axes as viewed in the transverse plane
25
How is tibial torsion measured
With knee at 90- measure apex of each malleolus to the surface behind the leg.. subtract the two numbers the difference is TT.
26
WHAt type(s) of functional devices can be used for excessive pronation of the foot?
Foot ox, UCBL
27
A UCBL is used for more control of what part of the foot?
Hindfoot (calcaneus), sub-Talar joint
28
What is the cause of Charcot joints in the feet and ankle?
Any neuropathic disease can have Charcot joints associated with it ( diabetes, herpes, syphilis)
29
Eval. Of a patient with a gunshot wound to the hip revivals a weak hip flexors. What peripheral nerve is injured?
Femoral nerve
30
What is your ox recommendation for damage to femoral nerve with weak hip flexors?
Cane used on the contralateral side
31
What is the name for contralateral pelvis drop?
Trendeleberg sign, gluteus medius limp
32
Describe condromalacia
Softness of the articulate cartilage usually involving patella-femoral joint
33
What is your ox recommendation for condromalacia?
Palumbo ox or other patellar stabilizing ox
34
A patient's KAFO has free motion knee but the mechanical joint is 1" distal to the anatomical joint. In flexion the resulting pressure will be?
Proximal posterior thigh, distal anterior thigh- ox migrates proximally
35
Toe drag is a bigger problem in what phase of gait? Why?
initial swing- if the toe does not clear the floor the patient takes short steps and may trip
36
Why do diabetics get foot ulcers?
Loss of sensation- patient cannot tell when he is getting blisters or pressure sores that can develop into ulcers if not detected in time
37
What is the advantage of an offset knee joint for treating recurvatum
Puts the weight bearing line anterior to the knee joint, making it unnecessary to lock the knee
38
Describe guillian barre and its effects on the patient
Infections polyneuritis with progressive muscular weakness, distal to proximal, which may lead to paralysis. Prognosis usually full recovery, though in more severe cases the patient may have some residual weakness in distal extremities
39
Describe charcot-marie-tooth
Inherited progressive neuromuscular atrophy characterized by progressive weakness of the distal muscles of arms and feet usually develops in childhood
40
When would you recommed a bail lock on a KAFO instead of drop lock?
Only one functional hand, when crutches or cane are used with bilateral KAFOs
41
Name two contraindications for plastic AFOs
Uncontrolled edema, sensitive skin
42
Name two methods of minimizing knee flexion torque at initial contract in a lower extremity ox.
Beveled, undercut, or SACH heel
43
What implications do weak hip flexors have in your design of a KAFO
A Lightweight design could encourage hip flexion at swing phase
44
For what diagnoses would you recommend a rocker bottom shoe?
Diabetes, arthritis, ankle fusion, etc.
45
What is the RX rational for a rocker bottom shoe
Simulate normal foot biomechanics and promote even weight bearing distribution in a patient with limited or no ankle motion
46
A polio patient has a flail ankle, good knee muscles, good hip muscles, full ROM at knee with 25° recurvatum. Knee buckles when tired what ox do you recommend? Describe the mechanical principles.
Light weight KAFO, offset or drop lock knee, solid plastic AFO section w/ rocker bottom shoes or double adjustable ankle joints
47
Six weeks post ACL repair-how do you cast? What two mechanical principles do you want?
Cast in slight flexion
1. Prevent hyperextension
2. Control rotation
48
Name two reasons why you night not use pretibial AFO's for a patient who walks with a crouched gait
Hip flexion contracture, lack of ankle ROM, inability to don
49
Give 4 contraindications for RGOs
Obesity, hip flexion contracture +20 deg. , spasticity, non plantargrade foot, hip dislocation
50
Name 3 clinical signs of charcot joints at ankle mortise
Swelling, instability, excessive joint mobility, pain, anaesthetic foot, visual deformity
51
Name 3 mechanical principles for treatment of charcot joints
Immobilize in total contract AFO, minimal weight bearing, rocker bottom
52
Name 3 signs in evaluation of heel spur pain
Valgus foot, pes planus, localized pain @ loading
53
Mechanical principles treating heel spurs
Distribute and reduce pressure in arch support, UCBL for hindfoot and or forefoot control
54
Where should you place the mechanical hip joint?
1/2" anterior, 1" superior to greater trochanter
55
How would elevating the shoe heel effect a solid ankle afo?
Increase knee flexion moment at heel strike
56
What effect would posterior placement of knee joint have on the KAFO?
Migrates proximally with pressure on anterior calf cuff
57
What modifications can you make to a plastic KAFO to reduce recurvatum?
Trim proximal and distal sections closer to the knee, pad shells- shallow shells
58
Why would you choose a metal AFO over plastic for a patient with Charcot joints?
Prevent skin breakdown due to insensate foot
59
What are the stance phases of gait and what is the hip position through each
```
IC- 30 flexion
LR-25-30 flexion
MS- 20 flexion to 5° extension
TS- 10 extension
PrSw-10 extension
```
60
How can you prevent a knee orthosis from migrating down
Supracondylar wedge, suprapatellar strap, attach to footplate, lightweight belt
61
What is the basic theory of fx bracing?
Using hydrostatic pressure to stabilize the fx, micro motion at fx site promotes healing, mobilization of joints above and below the fx decreases habilitation time
62
How would you treat a stable, ten day old, distal 1/3 femoral fx with acute signs of swelling and pain absent
Functional femoral fx brace with free knee and ankle
63
What would you recommend for a 3 week old tibial plateau fx.
AK fx brace with free knee and ankle
64
Would you fit a tibial fx brace on a painted itch an open wound on the tibia?
No, fx bracing is contraindicated with open wounds
65
What could you do to fracture brace to better align a lateral or medial tibial plateau fx?
Stress brace into varus or valgus ( if directed by MD)
66
What is the best position for a patient to be in when being fitted with a tibial fracture brace
Sitting with legs dangling knees at 90
67
Should of put a femoral fx brace on a proximal femoral fx?
No never brace femoral fx above the distal 1/3
68
3 ways to manage a T11 anterior compression fx.
Jewett, taylor, body jacket
69
What is the biomechanical principle of a jewett
3 pt pressure, hyperextension
70
What is ox recommendation for patient with an odontoid fx who was just removed from a halo
SOMI, extended philadelphia
71
What is the major advantage of a SOMI ox?
Can be fit on a supine patient
72
Recommend an ox to control flexion and extension for a stable c3 fx
Four post, SOMI, two post
73
What is spondylolisthesis
Anterior slippage of L4 on L5 or L5 on S1- 4 grades of slippage
74
How would you treat spondylolisthesis
BOB brace, williams, raney flexion jacket
75
47 yr old male sustained an L4 compression fx during a fall what is your ox recommendation?
BOB, Jewett, chairback, corset
76
What is your ox recommendation for a 68 year old emails with osteoporotic kyphosis
Dorsal lumbar corset, taylor
77
How would you treat T3 fx
Body jacket with cervical extension
78
Can you use a halo ring on a child
Yes more pins less torque
79
Would u apply a halo vest to a patient in ICU w/o a doctor?
No, doctor should stabilize neck
80
For stable compression fx of the cervical spine the head should be positioned in flexion or extension
Extension
81
Describe the ox treatment and rx rationale for burn patient
Pressure garments, burn masks- to reduce hypertrophic scarring
82
What is torticollis
Contracture of the sterno-cleido-mastoid muscle
83
What is the recommended torque for halo pins in adult and a child
Adult- 8 in pounds
| Child-4-6 in pounds
84
What is the reasoning behind using non-ferrous components in halo system
MRI compatible
85
Hallo pins are tightened in what fashion
2in/lb alternating opposing diagonal forces until 6-8 in/lbs is reached
86
During anterior pin placement should the patients eyes be open or closed
Closed
87
What tool would you use to apply halo pins
Torque screwdriver
88
The pins on a halo should be re tightened at what time interval after initial application
24-? 48 hrs.
89
An inflamed pin-site, pain at pin-site, noise or movement are indications of what
Loose pin
90
Your patient comes into your office with a loose pin. You try to re-tighten and no resistance is met. Your next step would be:
Call the doctor- puncture of bone..
91
What are the advantages of using a breakages torque wrench
Wrench breakers off at set amount of torque. Smaller in size for getting into cramped areas
92
At what spinal level would you consider using a CTLSO rather than a TLSO for scoliosis
T6-t8
93
What are the upper and lower limits in degrees for treatment of scoliosis ox.
25° to 40° AND progressive
94
Do you treat functional and structural scoliosis the same
No, functional curves are fit with corrective devices, structural curves are usually treated with an accommodative device
95
What is the most common type of scoliosis
Idiopathic, more often in girls
96
How long does a patient normally wear a scoliosis ox?
Until skeletal maturity, then painted is weaned off the ox
97
What is the proper clearance of the throat mold on a CTLSO
Two fingers (1") below chin
98
What is proper placement for throacic pad on the CTLSO
| Name and describe two other pads on CTLSO
Thoracic pad: two ribs inferior to the apex of the curve pad is 'L' shape
Shoulder ring, lumbar (kidney shape) anterior derotation
99
Why are the anterior bars on the Milwaukee made of aluminum?
So that it is X-ray transparent
100
What is the purpose of the neck ring on a milwaukee
The upper pressure point for high scoliosis curves or kyphosis- not a distractive force
101
What is risser sign
Method of determining bone maturity, using x-ray, reading the iliac epiphysis, grade 0-5
102
What is two nerves could be compromised with incorrect positioning of the anterior pins
Supra orbital and supratrochlear nerves
103
How do you determine which is the primary curve and the compensatory?
The primary curve is the most structural curve will always have rotation, compensatory curves accommodate the primary to center the head over the pelvis
104
Synostotic plagiocephaly occurs when
When the sutures fuse early
105
The FDA has classified the CRO as a class ____ device
Class II
106
The average male to female ration of plagio is
3:1
107
What % of normal skull growth is achieved by 12 months
85%
108
Positional plagiocephaly doe not normally resolve it self after___months of age
5 months
109
Including the auditory ossicles how many bones make up the skull
28
110
T or F: The best treatment period for an infant with plagiocephaly is between 3-8 months
True
111
T or f: About 80%of children affected with plagiocephaly show some sort of torticollis
True
112
What nerve is affected with ape hand deformity
Median
113
What nerve is affected with wrist drop
Radial
114
What is normal position for the wrist and arm in a WHO?
15-30° Dorsiflexion (extension), no ulnar or radial deviation neutral pronation-supination
115
What residual function would you expect with a complete C-6 cervical lesion
Wrist extension
116
How does a wrist driven function
Ten odes is action from wrist extension to cause grasp
117
Name the six pretension patterns
Spherical, tip, palmar, cylindrical, hook, lateral
118
A thumb post should hold the thumb in what position
In opposition to index and second fingers
119
What type of orthotic device would you use for a patient with a complete C-5 lesion?
Static WHO, mobile arm support
120
What type of orthosis would you use for an intrinsic minus hand?
HO
121
What is clonus
Rapid alternating involuntary movement elicited by stretch
122
Home many cervical neural segments are there
8
123
Tor F: At the neural segmental level of the spinal cord lesion there will always be a return reflex action
False
124
Describe a rotator cuff injury?
Damage to the SITS muscles in the shoulder: supraspinatus, infraspinatus, teres minor, subscapularis
125
What is your orthotic recommendation for rotator cuff?
Immobilize shoulder in slight abduction- airplane splint
126
Describe Erb's palsy and make orthotic recommendation
A upsilon of C5-6 root resulting in a flail arm( finger flexors and extensors intact) gunslinger ox to position hand and support shoulder
127
What type of neural injury normally results in flaccid paralysis ( upper motor, central nervous system, peripheral)
Peripheral nervous system injuries
128
What muscles flexes, abducts, extends, and supports the shoulder joint
Deltoid
129
What should one of your primary concerns be in upper extremity orthotics for spinal injury
Insensate skin sensitive to pressure
130
What ox would you recommend for a hand with lubricales, interossei, and thumb abduction out?why?
HO with C-bar and M-P extension stop to maintain thumb web space, flex M-P's allowing long extensors to extend I-P's DIP's
131
Etiology of carpel tunnel syndrome
Compression of the median nerve with the carpal canal caused by edema, synovitis, and fibrosis of the tendon sheath
132
How would you treat a mid-numeral fx with radial nerve lesion
Humeral fx brace with positional cock up splint and sling
133
How do you position for carpal tunnel syndrome
Immobilize in neutral
134
Describe the muscle picture for radial nerve injury
Loss extensors of wrist and elbow, supinator, and thumb abduction
135
Describe muscle picture for median nerve injury
Lose lumbricales 1 and 2, opponents pollux, flexure pollicis brevis and palmer sensation- ape hand
136
Describe muscle picture for ulnar nerve injury
Lose of most intrinsic of the hand "claw hand"
