A patient has sustained a stroke and you note that he has a flexion synergy
pattern in his upper and lower extremity. Pick the best answer that describes
both synergy patterns:
A) UE: Shoulder abduction, internal rotation, elbow flexion, forearm
pronation, wrist flexion LE: hip flexion, external rotation, knee flexion, ankle
dorsiflexion, inversion
B: UE: Shoulder abduction, external rotation, elbow flexion, forearm
supination, wrist flexion LE: LE: hip flexion, external rotation, knee flexion,
ankle dorsiflexion, inversion
C: Shoulder adduction, internal rotation, elbow extension, forearm pronation,
wrist flexion LE: Hip flexion, abduction, knee extension, ankle plantarflexion
D: Shoulder adduction, internal rotation, elbow extension, forearm pronation,
wrist flexion LE: Hip extension, adduction, internal rotation, ankle
plantarflexion Correct Ans - B: UE: Shoulder abduction, external
rotation, elbow flexion, forearm supination, wrist flexion LE: LE: hip flexion,
external rotation, knee flexion, ankle dorsiflexion, inversion
During normal heel strike, the forward hip is how flexed:
A: neutral
B: 10 deg flexed
C: 25 deg flexed
D: 40 def flexed Correct Ans - C: 25 deg flexed
Gait cycle is described as the activity between:
A: Heel strike and push off
B: Heel strike on one side and the following heel strike on the opposite side
C: Heel off to push off on the same side
D: Heel strike on one side and the following heel strike on the same side
Correct Ans - D: Heel strike on one side and the following heel strike on
the same side
Pick the following choice than best described Legg-Calve-Perthes disease
(osteochondrosis):
A: Males>females, age onset 13 years, AROM restricted in abduction, flexion,
and internal rotation, vague pain at the hip, knee and thigh
,B: 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
C: 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
D: Characterized by restriction in shoulder motion in external rotation,
abduction and flexion, inflamattion and fibrosis as the shoulder Correct
Ans - C: 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 describes slipped capital femoral epiphysis
B describes avascular necrosis
D describes adhesive capsulitis
A patient is seen in clinic and presents with lumbar DJD. The patient has
handed you a script with RX: LSO aligned appropriately. How could you align
the patient in the sagittal plane:
A: increase lumbar lordosis
B: decrease lumbar lordosis
C: Utilized 3 point pressure system to provide m/l stability
D: Increase intra-abdominal pressure Correct Ans - B: decrease
lumbar lordosis
Decreasing lumbar lordosis moves pressures off the posterior "affected"
portion of the vertebrae onto the vertebral body away from the arthritic joints
A patient is seen in clinic and presents with L5, S1 spondylolysthesis. The
patient has handed you a script withRX: LSO aligned appropriately. How could
you align the patient in the sagittal plane:
A: increase lumbar lordosis
B: decrease lumbar lordosis
C: Utilized 3 point pressure system to provide m/l stability
D: Increase intra-abdominal pressure Correct Ans - B: decrease
lumbar lordosis
,Decreasing lumbar lordosis causes lumbar flexion, 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 L3 complete spinal cord
injury. The expected outcome would MOST likely be:
A: With a complete spinal cord injury you would not expect any progress in
motor or sensory function below the level of the lesion
B: A spastic bladder
C: Some recovery function since damage is to peripheral nerve roots
D: Increased weakness in the upper extremities compared to lower
extremities Correct Ans - C: Some recovery function since damage is to
peripheral nerve roots
The spinal cord ends at level L1 at the conus medularis, from L1 distal (cauda
equina lesion) a spinal cord injury would be damaged to a peripheral nerve.
Some recovery can be expected. A spastic bladder would be associated with an
upper motor neuron injury.
With regards to spondylolisthesis, what are the radiographic signs that
contraindicate orthotic intervention and indicated a surgical candidate:
A: Anterior translation of the superior vertebra over the inferior vertebrae
greater than 25%
B: Superior vertebrae angulations of 25 deg relative to the inferior vertebrae
C: Anterior translation of the superior vertebra over the inferior vertebrae
greater than 50%
D: Superior vertebrae angulations of 50 deg relative to the inferior vertebrae
Correct Ans - C: Anterior translation of the superior vertebra over the
inferior vertebrae greater than 50%
D: Superior vertebrae angulations of 50 deg relative to the inferior vertebrae
Anterior translation of the superior vertebrae over the inferior vertebrae
greater than 50% and superior vertebrae angulations of 50 degrees relative to
the inferior vertebrae are indications to discontinue bracing and explore
alternatives treatments and or surgical intervention.
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:
A: Knight-Taylor TLSO
, B: BOB "overlapping style" LSO
C: Jewett TLSO
D: Polymer TLSO Correct Ans - D: Polymer TLSO
Burst fractures are the most unstable in the traverse plane. A custom polymer
TLSO is most effective at rotational control and has the 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 group would you expect to be weak:
A) Wrist extensors
B) Thumb abductors
C) Shoulder flexors
D) Elbow extensors Correct Ans - B) Thumb abductors
Anterior nerve roots give rise to C6 nerve root, median nerve which abducts
the thumb.
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 appropriate:
A: CASH TLSO
B: Williams LSO
C: Jewett TLSO
D: Corset LSO Correct Ans - A: CASH TLSO
C: Jewett TLSO
The CASH and Jewett TLSO's are both effective for anterior compression
fractures near the thoracolumbar junction. By placing the thoracic spine in
extension, pressure is removed from the anterior portion of the vertebral
body allowing natural bone remodeling to occur
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 for the procedure:
A: Patient should be standing upright with hips extended
B: Patient should stand with normal posture
C: Patient should be asked to arch their lower lumbar spine
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