Written Flashcards
A patient has sustained a stroke and you note that he has a flexion synergy pattern in his
upper extremity and lower extremity. Pick the best answer that describes both synergy
patterns:
UE: shoulder abduction, external rotation, elbow flexion, forearm supination, wrist
flexion LE: hip flexion, abduction, external rotation, knee flexion, ankle dorsiflexion,
inversion
During normal heel strike, the forward hip is how flexed:
25 degrees flexed
Gait cycle is described by the activity between
Heel strike on one side and the following heel strike on the same side
Pick the following choice that best describes Legg-Calve-Perthes disease (osteochondrosis):
Males>females, average age onset 6 years old, psoatic limp due to psoas major
weakness, lower extremity moves into external rotation, flexion and adduction, MRI
will show collapse of subchondral bone at femoral neck
A patient is seen in clinic and presents with lumbar DJD. The patient has handed you a
script with RX: LSO aligned appropriately. How would you align the patient in the sagittal
plane:
Decrease lumbar lordosis
A patient is seen in clinic and presents with L5,S1 spondylolisthesis. The patient has
handed you a script with RX: LSO aligned appropriately. How would you align the patient in
the sagittal plane:
Decrease lumbar lordosis
It is early in the recovery phase of a patient with a L3 complete spinal cord injury. The
expected outcome would MOST likely be:
Some recovery of function since damage is to peripheral nerve roots
With regards to spondylolisthesis, what are the radiographic signs that contraindicate
orthotic intervention and indicate a surgical candidate:
Anterior translation of the superior vertebrae over the inferior vertebrae greater
than 50%
Superior vertebrae angulations of 50 deg relative to the inferior vertebrae
A patient is seen in the hospital. The patient presents with a L1 burst fracture from a
snowmobile accident. Which orthosis would be most appropriate:
Polymer TLSO
With a traction injury to the anterior division of the brachial plexus you would expect,
weakness of the elbow flexors, wrist flexors and forearm pronators. What other muscle group
would you expect to be weak:
Thumb abductors
A patient is seen in the hospital. The patient presents with a T11 anterior compression fracture from a bike accident. The patient is neurologically intact and the fracture is stable. Which orthosis(s) would be most appropriate:
CASH TLSO or Jewett TLSO
When taking an impression for a custom polymer LSO for a patient with L5, S1
spondylolisthesis, how would you position the patient if they were allowed to stand through
the procedure:
Patient should be asked to flex their hips and knees slightly
You have a patient that presents for evaluation for an AFO after a stroke. You notice he has
a forward flexed posture. What positive muscle length test would you expect to see associated
with this posture:
Hip extensor tightness
What are some of the biomechanical principals behind a LSO corset? Choose all that
apply:
A) Kinesthetic reminder
B) Increased intra-abdominal pressure
C) Multiple three point pressure systems
A patient is seen in clinic. The patient presents with a separated connective tissue in her
symphysis pubis. What orthosis is recommended and what hormone can cause the elasticity
of the symphysis pubis to increase during pregnancy, choose two answers:
B) Relaxin hormone
D) SI belt
You are working with a therapist on gait training for a patient that has a L1 complete
spinal cord injury along with another patient that has an L4 spinal cord injury. What bracing
would you expect most appropriate for these patients and ambulation tolerance respectively:
L1 spinal cord injury: Independent ambulation with knee ankle foot orthosis (KAFO)
household distance
L4 spinal cord injury: ankle foot orthosis, community ambulator
independent
Posterior trim lines on a TLSO extend from the sacrococcygeal joint to just inferior
to_____________ . Anterior trim lines extend from symphysis pubis to
the_____________:
Scapular spine, sternal notch
What pathology would indicate the use of a Williams Flexion LSO:
Sponylolisthesis
The “unhappy triad” includes injury to what structures:
ACL, MCL, medial meniscus
A patient is seen in clinic. The patient has bilateral pars fractures at L5 and is currently
utilizing a custom polymer overlapping style LSO with decreased lumbar lordosis. The
physician is not satisfied with the orthosis results and wants to know what you can do to
further immobilize the fracture site? Choose the appropriate answer:
Add a hip spica to the LSO
A Knight Taylor TLSO is classified as _______________ where a Taylor TLSO is
classified as ______________:
A/P M/L control, A/P control
A patient with an upper motor neuron disorder has a posterior loss of balance with
immediate sit to standing due to either tight muscles or weakness. What would be the most
likely cause of this:
Spasticity of the gastrocnemius-soleus
A scoliosis patient is seen in clinic. Upon radiographic reading you note that the thoracic
curve apex is located at T6. Which orthosis is appropriate:
Milwaukee CTLSO
Posterior Trim lines on an LSO extend from the sacrococcyxgeal joint to just inferior
to_____________ . Anterior trim lines extend from symphysis pubis to
the_____________:
Inferior angle of the scapula, xiphoid process
You are seeing a patient with a one year history of amyotrophic lateral sclerosis. She is
ambulating with bilateral canes, shows limited endurance and foot drop. Based on the
diagnosis what device would you recommend for trial:
ALS is a progressive degenerative disease where due to the progressive nature you
feel trial of ankle foot orthosis would be appropriate due to her fatigue and foot drop
A patient is seen at the local hospital Ortho/Neuro floor. The patient presents with an
unstable odontoid fracture. Which orthosis would you recommend:
HALO CTLSO
A patient is seen in clinic. The patient presents with DX: lower lumbar stenosis and a RX:
LSO align appropriately. Which option would you recommend:
LSO aligned in flexion
A patient has a fixed forefoot varum. All of the following are considered compensatory
strategies for a fixed forefoot varus malalignment EXCEPT:
Subtalor supination
When selecting anterior pin placement in a HALO CTLSO application, where is the proper
starting position:
Lateral 1/3 of eyebrow, slightly superior to eyebrow
When selecting posterior pin placement in a HALO CTLSO application, where is the
proper starting position:
Slightly superior to ear, opposing the anterior pin directly, inferior to equator of the
cranium
A patient you are working with has a medial nerve lesion, you would expect that they will
have loss of all functions EXCEPT one of the following:
Flexor carpi ulnaris (ulnar nerve)
Choose all answers that are clinical “visible by the eye” signs of scoliosis:
A) Arm gap, shoulder asymmetry
B) Pelvic obliquity
C) Rib hump
D) Prominent scapula
T/F - When fabricating a Williams Flexion LSO for spondylolisthesis, the anterior corset
panel should be fabricated out of an inelastic material:
False
In the hospital you see a 6 year old girl with spina bifida. You are consulted due to the
patient’s club foot and a 30 deg scoliotic thoracic curvature. Please circle one choice that
would be part of the normal treatment for a child with spina bifida:
A)Prevent contractures due to neurogenic deformities
B) With hydrocephalus, decompress and place shunt in place
C) Prevent pressure sores
D) Fit patient with an ankle foot orthosis and a TLSO
Scoliosis is sometimes sub-divided into different types. What are signs of congenital
scoliosis:
Wedged, bar, and hemi-vertebrae
Scoliosis is sometimes sub-divided into different types. What are signs of neuromuscular
scoliosis:
Right lumbar curve and left thoracic curve
Gowers sign is seen when a person gets up from the floor, walking hands up his legs to get
upright. Choose the most common diagnosis where this is seen:
Duschenne Muscular Dystrophy
When applying a HALO CTLSO for pediatric applications, how may your protocol differ
from adult applications:
B) Use more HALO pins
D) Use less torque on the pins
When examining a scoliosis radiograph, the vertebral body is seen to rotate toward the
_________ in relation to the curve and the spinous process is seen to rotate toward
the__________ in relation to the curve:
Convexity, Concavity
A brachial plexus injury occurs resulting in decreased wrist and hand function. Choose
which type of brachial injury would likely be the cause:
Erb’s palsy
When evaluating to see if a scoliotic curve is non-structural what will you notice with
forced lateral side bending:
Rotational components of the curve will correct themselves
Which types of scoliotic curves would you expect to progress more given only the location
of the curve:
B) Single lumbar
C) Thoracolumbar
Parkinson’s disease is a chronic, progressive disease of the CNS with degeneration of
dopaminergic neurons. What are the four hallmark symptoms of PD:
Rigidity, bradykinesia, tremor, and impaired postural reflexes
A scoliosis patient is seen in clinic. Upon radiographic reading you note that the patient
has a risser sign of 5. How would you describe this risser sign:
Osseous cap noted on 100% of the iliac crest apophyseal plate
A scoliosis patient is seen in clinic for her initial evaluation. After cobbing her x-ray, you
and her physician agree that she has a 35 deg left lumbar curve with no signs of progression.
What should your treatment consist of at this time:
Immediate scoliosis orthotic management
You see a patient who describes pain in her shoulder after chopping wood. You find on
physical examination weakness with shoulder flexion and you note scapular winging. The
patient’s problem could be accounted by what MOST LIKELY:
Compression of the long thoracic nerve
A 15 year old scoliosis patient is seen in clinic for her initial evaluation. After cobbing her
x-ray, you and her physician agree that that she has a 20 deg left lumbar, 22 deg right
thoracic curves with no signs of progression. What should your treatment consist of at this
time:
Observation only at this time and schedule a follow up appointment after her next
radiograph series
A patient is seen in clinic. DX: Sheurmann’s Kyphosis apex= T9, RX: Orthosis. What type
of orthosis would you recommend:
Custom TLSO
A patient is diagnosed with an anterior cerebral artery stroke. You may need to assist with
bracing. Based on the diagnosis you can expect that the patient will present with:
Contralateral hemiparesis, leg more affected than the arm
Why is Sheurmann’s kyphosis typically easier to manage with an orthosis compared to
scoliosis:
Sheurmann’s Kyphosis only has a sagittal plane component of deformity