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Orthotics Written – Questions With Complete Solutions
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Orthotics Written – Questions With Complete SolutionsA patient presents with separated connective tissue at the pubis symphysis.
What orthosis do you recommend and what hormone is responsible for the
increased elasticity of the pubis symphysis during pregnancy. Correct Ans
- Relaxin hormone - is released in pregnant women which increases the
elasticity of connective tissue to assist and ease birth.
SI belt - used when pubis symphysis becomes too elastic causing pain and
instability
Describe the flexion synergy pattern in the upper extremity and lower
extremity. Correct Ans - UE: shoulder abduction, external rotation,
elbow flexion, forearm supination, wrist flexion
LE: hip flexion, abduction, external rotation, knee flexion, ankle dorsiflexion,
inversion
Describe the extensor synergy pattern in the upper extremity and lower
extremity. Correct Ans - UE: Shoulder adduction, internal rotation,
elbow extension, forearm pronation, wrist flexion
LE: hip extension, adduction, internal rotation, knee extension, ankle
plantarflexion, inversion
During normal heel strike, the forward hip is how flexed? Correct Ans -
25 deg flexed
Gait cycle is described by the activity between Correct Ans - Heel
strike on one side and the follow heel strike on the same side
Describe Legg-Calve-Perthes disease (osteochondrosis). Correct Ans -
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
Describe slipped capital femoral epiphysis. Correct Ans -
Males>females, age onset 13 years, AROM restricted in abduction, flexion, and
internal rotation, vague pain at hip, knee, and thigh
,Describe avascular necrosis Correct Ans - Etiologies resulting in lack
of blood supply to the femoral head, AROM is decreased in hip flexion, internal
rotation, and abduction, pain at groin, thigh, and tenderness at hip
Describe adhesive capsulitis Correct Ans - Characterized by restriction
in shoulder motion in external rotation, abduction, and flexion, inflammation
and fibrosis at shoulder
How would you align a patient with lumbar DJD in the sagittal plane?
Correct Ans - Decrease lumbar lordosis which moves pressure off the
affected posterior portion of the vertebrae onto the vertebral body and away
from the arthritic joints.
How would you align a patient with L5, S1 spondylolisthesis in the sagittal
plane? Correct Ans - Decrease lumbar lordosis which is the most
appropriate position to prevent progression and allow for healing of the
pathology
It is early in the recovery phase of a patient with a L3 complete spinal cord
injury. The expect outcome would most likely be? Correct Ans - Some
recovery of function since damage is to the peripheral nerve roots. Spinal cord
ends at L1 at the conus medularis; a spastic bladder is expected with an upper
motor neuron injury
With regard to spondylolithesis, what are the radiographic signs that
contraindicate orthotic intervention and indicate a surgical candidate?
Correct Ans - Superior vertebrae angulation of 50 degrees relative to
inferior vertebrae
Anterior translation of the superior vertebrae over the inferior vertebrae
Patient presents with an L1 burst fracture from a snowmobiling accident;
which orthosis is most appropriate? Correct Ans - Custom polymer
TLSO - to have coverage spaning several levels above and below the
pathological site. Burst fractures are most unstable in the transverse plane.
Custom TLSO is most efective at rotational control and has proper coverage
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 weakness would you expect? Correct Ans - Thumb
abductors - Anterior nerve root gives rise to C6 nerve root, median nerve,
which abducts the thumb
Patient presents with a T11 anterior compression fracture. Patient is
neurologically intact and the fracture is stable. Which orthoses would be
appropriate? Correct Ans - CASH TLSO and Jewett TLSO - both
effective for anterior compression FX near the thoracolumbar junction. By
placing the thoracic spine in extension, pressure is removed from anterior
portion of the vertebral body allowing natural bone remodeling to occur
When taking an impression for a patient with a L5/S1 spondylolihesis, how
would you position the patient if they were allowed to stand for the
procedure? Correct Ans - Ask the patient to flex their hips and knees
slightly to reduce lumbar lordosis for optimal alignment for spondylolisthesis
You have a patient for an evaluation post stroke. You notice a forward flexed
posture. What positive muscle length test do you expect with this? Correct
Ans - Thomas test - test for iliopsoas (hip flexion) tightness
What are some of the biomechanical principles behind a LSO corset?
Correct Ans - Kinesthetic reminder - to use proper posture and to
discourage certain motions
Increase intradominal pressure - solidifies soft tissie hydrostatically whereby
providing support to the lumbar spine
Multiple three-point pressure systems - work to hold proper alignment and
resist/stop certain motions
You are working with a physical therapist for gait training with a patient wh
has complete L1 spinal cord injury along with a patient with L4 spinal cord
injury. What orthosising do you expect and with what ambulation tolerance
respectively? Correct Ans - L1: independent ambulation with KAFO
(most likely needed due to iliopsoas weakness as innervated by L2 nerve
root) at household distance (due to high energy costs)
L4: independent ambulation with AFO (LMN lesion resulting in ankle DF and
anterior tibialis weakness -> foot drop) in community
Posterior trim lines for TLSO?
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