Test 1 Flashcards
The three “activation methods for stance control ox:
Weight, Ankle, Gait
T or f: ankle motion is required for all SCO’s?
False
The stance phase of gait is___% of gait cycle?
60%
Normal gait has how many phases?
8
Name one of the three different weight activated SCO’s
Horton SCPKJ, Becker e-knee, otto bock SensorWalk
T or f: Gait activated SCO’s require a reciprocal gait pattern
True
T or f: Spasticity is a contraindication for SCO’s
True
T or f: a knee flexion moment at terminal stance is required for SCO’s?
False: a knee flexion moment at terminal stance will prevent the SCO from unlocking at TS, except with the SensorWalk
What MMT grade at the hip flexor is normally required for SCO’s?
Gr. 3, unless patient has a compensatory pattern that is equal to a gr. 3 in motion
What are two of the effects of locking a knee in normal gait
Hip hiking, circumspection, vaulting, excessive lateral trunk lean, increased energy consumption, decreased cadence
The ankle is in what position durning the swing phase of gait
Neutral to 5 degrees pf
T or f: Locking the knee during normal gait is always safer for the patient
False
How do you determine stirrup length?
2 times height of distal tip of medial malleolus + SOLE THICKNESS + width of heel +1/4” or 6mm
How doe you determine band length
Half circumference pulse 1.5” or 38mm
What are the min. Clearance for ankle joints and knee joints?
Ankle: lateral side 3/16” or 5mm- medial 1/4” or 6mm
Knee: lateral side 1/8” or 3mm- medial 1/4” or 6mm
A conventional KAFO what changes could you use to reduce recurvatum?
Shallow bands, move calf band up-distal thigh down-move theses two closer, increase heel height
KAFO, what problems could you encounter in moving the bands?
Peroneal nerve impingement, limited knee flexion of orthosis
How much pf would you allow a patient who has suffered a CVA?
Neutral
How do you determine if a patient requires locks on his KAFO vs. free knee?
Hip and or knee extensor weakness
What do you recommend for a patient who exhibits foot slap at heel strike
AFO- Conventional or plastic w/ Dorsi-assist and or plantar stop
What is Legge-calve-perches disease?
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
Name 3 ox used for legge-calve-perthes?
Atlanta (scottish rite), toronto, newington
3 ox for the treatment of Hip dysplasia
Frejka pillow, pavlik harness, llfeld splint
What is tibial torsion?
Difference between knee and ankle joint axes as viewed in the transverse plane
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.
WHAt type(s) of functional devices can be used for excessive pronation of the foot?
Foot ox, UCBL
A UCBL is used for more control of what part of the foot?
Hindfoot (calcaneus), sub-Talar joint
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)
Eval. Of a patient with a gunshot wound to the hip revivals a weak hip flexors. What peripheral nerve is injured?
Femoral nerve
What is your ox recommendation for damage to femoral nerve with weak hip flexors?
Cane used on the contralateral side
What is the name for contralateral pelvis drop?
Trendeleberg sign, gluteus medius limp
Describe condromalacia
Softness of the articulate cartilage usually involving patella-femoral joint
What is your ox recommendation for condromalacia?
Palumbo ox or other patellar stabilizing ox
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
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
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
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
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
Describe charcot-marie-tooth
Inherited progressive neuromuscular atrophy characterized by progressive weakness of the distal muscles of arms and feet usually develops in childhood
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
Name two contraindications for plastic AFOs
Uncontrolled edema, sensitive skin
Name two methods of minimizing knee flexion torque at initial contract in a lower extremity ox.
Beveled, undercut, or SACH heel
What implications do weak hip flexors have in your design of a KAFO
A Lightweight design could encourage hip flexion at swing phase
For what diagnoses would you recommend a rocker bottom shoe?
Diabetes, arthritis, ankle fusion, etc.
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
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
Six weeks post ACL repair-how do you cast? What two mechanical principles do you want?
Cast in slight flexion
- Prevent hyperextension
- Control rotation
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
Give 4 contraindications for RGOs
Obesity, hip flexion contracture +20 deg. , spasticity, non plantargrade foot, hip dislocation
Name 3 clinical signs of charcot joints at ankle mortise
Swelling, instability, excessive joint mobility, pain, anaesthetic foot, visual deformity
Name 3 mechanical principles for treatment of charcot joints
Immobilize in total contract AFO, minimal weight bearing, rocker bottom
Name 3 signs in evaluation of heel spur pain
Valgus foot, pes planus, localized pain @ loading
Mechanical principles treating heel spurs
Distribute and reduce pressure in arch support, UCBL for hindfoot and or forefoot control
Where should you place the mechanical hip joint?
1/2” anterior, 1” superior to greater trochanter
How would elevating the shoe heel effect a solid ankle afo?
Increase knee flexion moment at heel strike
What effect would posterior placement of knee joint have on the KAFO?
Migrates proximally with pressure on anterior calf cuff
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
Why would you choose a metal AFO over plastic for a patient with Charcot joints?
Prevent skin breakdown due to insensate foot
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
How can you prevent a knee orthosis from migrating down
Supracondylar wedge, suprapatellar strap, attach to footplate, lightweight belt
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
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
What would you recommend for a 3 week old tibial plateau fx.
AK fx brace with free knee and ankle
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
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)
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
Should of put a femoral fx brace on a proximal femoral fx?
No never brace femoral fx above the distal 1/3
3 ways to manage a T11 anterior compression fx.
Jewett, taylor, body jacket
What is the biomechanical principle of a jewett
3 pt pressure, hyperextension
What is ox recommendation for patient with an odontoid fx who was just removed from a halo
SOMI, extended philadelphia
What is the major advantage of a SOMI ox?
Can be fit on a supine patient
Recommend an ox to control flexion and extension for a stable c3 fx
Four post, SOMI, two post
What is spondylolisthesis
Anterior slippage of L4 on L5 or L5 on S1- 4 grades of slippage
How would you treat spondylolisthesis
BOB brace, williams, raney flexion jacket
47 yr old male sustained an L4 compression fx during a fall what is your ox recommendation?
BOB, Jewett, chairback, corset
What is your ox recommendation for a 68 year old emails with osteoporotic kyphosis
Dorsal lumbar corset, taylor
How would you treat T3 fx
Body jacket with cervical extension
Can you use a halo ring on a child
Yes more pins less torque
Would u apply a halo vest to a patient in ICU w/o a doctor?
No, doctor should stabilize neck
For stable compression fx of the cervical spine the head should be positioned in flexion or extension
Extension
Describe the ox treatment and rx rationale for burn patient
Pressure garments, burn masks- to reduce hypertrophic scarring
What is torticollis
Contracture of the sterno-cleido-mastoid muscle
What is the recommended torque for halo pins in adult and a child
Adult- 8 in pounds
Child-4-6 in pounds
What is the reasoning behind using non-ferrous components in halo system
MRI compatible
Hallo pins are tightened in what fashion
2in/lb alternating opposing diagonal forces until 6-8 in/lbs is reached
During anterior pin placement should the patients eyes be open or closed
Closed
What tool would you use to apply halo pins
Torque screwdriver
The pins on a halo should be re tightened at what time interval after initial application
24-? 48 hrs.
An inflamed pin-site, pain at pin-site, noise or movement are indications of what
Loose pin
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..
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
At what spinal level would you consider using a CTLSO rather than a TLSO for scoliosis
T6-t8
What are the upper and lower limits in degrees for treatment of scoliosis ox.
25° to 40° AND progressive
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
What is the most common type of scoliosis
Idiopathic, more often in girls
How long does a patient normally wear a scoliosis ox?
Until skeletal maturity, then painted is weaned off the ox
What is the proper clearance of the throat mold on a CTLSO
Two fingers (1”) below chin
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
Why are the anterior bars on the Milwaukee made of aluminum?
So that it is X-ray transparent
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
What is risser sign
Method of determining bone maturity, using x-ray, reading the iliac epiphysis, grade 0-5
What is two nerves could be compromised with incorrect positioning of the anterior pins
Supra orbital and supratrochlear nerves
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
Synostotic plagiocephaly occurs when
When the sutures fuse early
The FDA has classified the CRO as a class ____ device
Class II
The average male to female ration of plagio is
3:1
What % of normal skull growth is achieved by 12 months
85%
Positional plagiocephaly doe not normally resolve it self after___months of age
5 months
Including the auditory ossicles how many bones make up the skull
28
T or F: The best treatment period for an infant with plagiocephaly is between 3-8 months
True
T or f: About 80%of children affected with plagiocephaly show some sort of torticollis
True
What nerve is affected with ape hand deformity
Median
What nerve is affected with wrist drop
Radial
What is normal position for the wrist and arm in a WHO?
15-30° Dorsiflexion (extension), no ulnar or radial deviation neutral pronation-supination
What residual function would you expect with a complete C-6 cervical lesion
Wrist extension
How does a wrist driven function
Ten odes is action from wrist extension to cause grasp
Name the six pretension patterns
Spherical, tip, palmar, cylindrical, hook, lateral
A thumb post should hold the thumb in what position
In opposition to index and second fingers
What type of orthotic device would you use for a patient with a complete C-5 lesion?
Static WHO, mobile arm support
What type of orthosis would you use for an intrinsic minus hand?
HO
What is clonus
Rapid alternating involuntary movement elicited by stretch
Home many cervical neural segments are there
8
Tor F: At the neural segmental level of the spinal cord lesion there will always be a return reflex action
False
Describe a rotator cuff injury?
Damage to the SITS muscles in the shoulder: supraspinatus, infraspinatus, teres minor, subscapularis
What is your orthotic recommendation for rotator cuff?
Immobilize shoulder in slight abduction- airplane splint
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
What type of neural injury normally results in flaccid paralysis ( upper motor, central nervous system, peripheral)
Peripheral nervous system injuries
What muscles flexes, abducts, extends, and supports the shoulder joint
Deltoid
What should one of your primary concerns be in upper extremity orthotics for spinal injury
Insensate skin sensitive to pressure
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
Etiology of carpel tunnel syndrome
Compression of the median nerve with the carpal canal caused by edema, synovitis, and fibrosis of the tendon sheath
How would you treat a mid-numeral fx with radial nerve lesion
Humeral fx brace with positional cock up splint and sling
How do you position for carpal tunnel syndrome
Immobilize in neutral
Describe the muscle picture for radial nerve injury
Loss extensors of wrist and elbow, supinator, and thumb abduction
Describe muscle picture for median nerve injury
Lose lumbricales 1 and 2, opponents pollux, flexure pollicis brevis and palmer sensation- ape hand
Describe muscle picture for ulnar nerve injury
Lose of most intrinsic of the hand “claw hand”
