Unit 1: The Orthotic Supply

Question 1

What are the 5 components of Perry’s functional model of normal physical activities

Answer 1

Articulated levers
Source of motion
Awareness of need and action
Control of motion
Control of energy

Question 2

How is the source of motion controlled

Answer 2

Efferent pathways of LMN’s and their myoneural junctions

Question 3

What is the difference between concentric and eccentric muscle action

Answer 3

Concentric = Contraction
Eccentric = Elongating

Question 4

What is the source of motion control

Answer 4

CNS: conscious and reflex action

Question 5

What is the source of energy control

Answer 5

Digestive and cardiopulmonary systems

Question 6

Give 5 causes of structural insufficiency

Answer 6

Fractures
Ligaments strains/ruptures
Deformities
Discrepancies
Deficiencies

Question 7

What is the main consequence of structural insufficiency

Answer 7

Early fatigue and degeneration of structure

Question 8

What is motor insufficiency and give 2 causes

Answer 8

The inability to produce joint motion.

Causes: trauma (causing direct muscle/tendon/nerve injury) and neurological conditions (polio, peripheral neuropathy)

Question 9

What is the characteristic appearance of motor insufficiency

Answer 9

Flaccid muscle paresis

Progressive loss of muscle bulk

Question 10

Give examples where motor insufficiency is combined with impaired sensory feedback

Answer 10

Spinal cord injuries
Spina bifida

Note: pattern of dysfunction will be dictated by the level and extent of the spinal lesion

Question 11

What pattern of involuntary movement does UMN lesions create

Answer 11

Spasticity

Question 12

Give 2 of the most common presentations of UMN spasticity

Answer 12

Cerebral palsy (children) and hemiplegia due to CVA/stroke (adults)

Question 13

What is the spasticity pattern commonly seen in stroke patients

Answer 13

Mass extensor response: creates an equinovarus foot = difficulty achieve hip and knee extension, foot clearance problems

Question 14

What are the patterns commonly seen in children with cerebral palsy

Answer 14

Spastic paralysis

Dyskinesia

Question 15

Describe the differences between hemi/di/quadri/tetraplegia

Answer 15

Hemi = one sided
Di = both lower limbs
Quadri/Tetra = all four limbs

Question 16

What pattern is scissoring (creating severe balance problems during walking) seen in

Answer 16

Quadriplegia

Question 17

What is the most common form of dyskinesia seen

Answer 17

Athetosis: involuntary writhing movements which occur when any voluntary postural demand is made

Question 18

What is assessed during physical assessment of functional loss

Answer 18

Joint ROM, stability and alignment
Skeletal integrity and alignment (inc limb length)
Muscle power and control
Sensation, proprioception and balance
Vascular status and skin condition
Location and cause of pain/discomfort

Question 19

How is muscle power graded

Answer 19

0 = no activity
1 = flicker under gravity
2 = power with gravity excluded
3 = power against gravity but with no additional resistance
4 = some weakness 
5 = normal activity

Question 20

How do you distinguish between proprioception and muscle weakness causes of loss of balance

Answer 20

Test the patients balance when standing and when seated

Question 21

What is the main way of assessing vascular status of the lower limbs

Answer 21

Distal pulses

Question 22

How must any functional deviation be described with reference to

Answer 22

The joint or segment where the deviation is occurring
The plane of movement
The phase of the gait cycle at which the deviation is apparent
The nature of the deviation (e.g. increased/reduced motion)

Question 23

What movements are used to assess hand function

Answer 23

Cylindrical grasp
Tip pinch
Hook pinch
Palmar pinch
Spherical grasp
Lateral pinch

Question 24

Factors that must be considered when selecting the materials and components to use in an orthosis

Answer 24

Functional requirements
Cosmesis
Presence of oedema
Presence of sensory/vascular deficit
Ability to don and doff
Anticipated level and duration of physical activity when wearing the orthosis
Environment that orthosis will be exposed to
Presence of incontinence

Question 25

Give 4 ways of treating spastic equino-varus deformity

Answer 25

Surgery
Physio
Drugs
Orthotics