Orthotic Written Study Guide

Orthotic Written Study Guide

1. Which of the following is not a component of the Knight-Taylor TLSO?

a. Paraspinal Bars
b. Lateral Bars
c. Pelvic Band
d. Sternal Extension
e. Thoracic Band

2. After receiving an Rx for a KAFO, you evaluate an elderly patient. You find that the patient presents with poor hip extensors and genu recurvatum and poor upper body strength. Which of the following knee joints should you utilize?

a. Drop locks
b. Ratchet
c. Posterior offset
d. Bail lock

3. The obturator nerve innervates all of the following except:

a. Adductor brevis
b. Adductor longus
c. Gracillis
d. Vastus medialis

4. Where is the origin and insertion of the Anterior Cruciate Ligament?

a. O – Medial wall of femoral condyle; I – the middle of the tibial intercondylar area
b. O – Lateral wall of femoral condyle; I – the anterior aspect of the tibial intercondylar area
c. O – the middle of the tibial intercondylar area; I – Medial wall of femoral condyle
d. O – the anterior aspect of the tibial intercondylar area; I – lateral wall of femoral condyle

5. A patient presents with Trendelenburg gait pattern. What muscle is affected?

a. Gluteus medius/minimus of stance phase limb
b. Gluteus medius/minimus of swing phase limb
c. Gluteus maximus of stance phase limb
d. Gluteus maximus of swing phase limb

6. You have received a Rx for a corrective scoliosis orthosis. After examining the provided radiograph, you discover a double major curve. The superior curve has an apex of T5. Traditionally, which type of orthosis would have been the suggested?

a. Minerva
b. Milwaukee
c. “Boston brace” type TLSO
d. SOMI

7. Ideally orthotic treatment of plageocephaly should begin by what age?

a. 1-3 months of age
b. 4-6 months of age
c. 7-8 months of age
d. 9-12 months of age

8. A patient comes in to your office with a diagnosis of Posterior Tibial Tendon Dysfunction. What is a simple test used to diagnose this condition?

a. Thomas Test
b. Posterior Drawer Sign
c. Single Limb Heel Rise
d. Trendelenburg Test

9. A patient has a SCI at level C7. What functions does he have remaining?

a. Independent Breathing
b. Bladder/Bowel Control
c. Complete function of the elbow, wrist, and hand
d. Neck flexion and extension
e. Some shoulder movement

10. Ligaments connect __________ to _________ while tendons connect __________to ___________?

a. Bone to bone; muscle to bone
b. Muscle to bone; muscle to muscle
c. Muscle to muscle; bone to bone
d. Muscle to bone; bone to muscle

11. The term thrombotic when referring to a stroke, means what?

a. Blood flow is blocked by a clot in an artery leading to the brain
b. Blood clot forms elsewhere in the body, breaks free, and lodges in the brain
c. Blood clot forms directly in a brain vessel
d. Vessel in the brain ruptures causing blood to fill around the brain causing pressure

12. A 75 year old post-polio patient comes in to your office wearing a right conventional style KAFO with double uprights, drop lock knee joints, klenzak ankle joints, and split caliper that attaches to multiple shoes. She states that her leg has atrophied and that the brace is too loose. She is worried about getting a new brace because she is on a fixed income. She has also noticed that her ankle is rolling out more. Inspection of her skin reveals a callous along her lateral malleoli and fifth met. Head. Her equinovarus position is still flexible to neutral. What type of orthotic would you recommend for this patient?

a. Double upright conventional KAFO with drop locks, double action ankle joints, split calipers, and a lateral T-strap.
b. Single upright conventional KAFO with the bar on the medial side with drop lock, klenzak joint, and a UCBL footplate
c. Double upright thermoplastic KAFO with drop locks, lateral sabolich tab, and solid ankle
d. Double upright conventional KAFO with drop locks, klenzak joint, and UCBL style footplate

Answer Key w/ Explanations
Be prepared & Pass your first time!

1. D) The components of a Knight-Taylor TLSO include thoracic band, pelvic band, paraspinal bars, lateral bars, interscapular band, and axillary straps.

2. D) The genu recruvatum is likely a secondary condition due to the poor hip extensors. From the list provided the bail lock would be the ideal choice for the following reasons.

• The posterior offset joint would be great to treat the genu recurvatum but would not provide any security for the poor hip extensors and could lead to the patient overall feeling unstable as the genu recruvatum is likely her stabilizing force in stance phase.
• While both the ratchet lock and drop locks would provide her increased security with her weak hip extensors while better supporting her genu recruvatum, they would be difficult for her to disengage. Furthermore, the ratchet lock would be excessive and require more work from her hip extensors to fully engage. The ratchet lock would be excessive and unnecessarily difficult for an elderly patient to disengage, as well as, the drop locks.
• The bail lock provide sufficient control and is much more convenient to operate .

3. D) The obturator nerve runs through the obturator foramen and innervates the adductor of the thigh. The vastus medialis is part of the quadriceps muscle group and is innervated by the femoral nerve.

4. A) The ACL originates along the medial wall of the femur and inserts into the middle of the intercondylar area of the tibia. It prevents anterior translation of the tibia in relation to the femur. (change all of the answer options on this question).

5. A) Trendelnburg gait is when there is weakness of the hip abductor muscles (gluteus medius/minimus). During gait, the when the affected side is in stance phase, the “sound side” limb is in swing and there is a noticeable drop of the pelvis.

6. B) The Milwaukee CTLSO was traditionally used to treat an Apex of T6 and Superior.

7. B) Documented in the AAOS Atlas of Orthoses and Assistive Devices (edition 4) orthotic treatment should begin within 4 and 8 months of age and should not be used longer than 12 months of age.

8. C) Single Limb Heel Rise test is used to help diagnose PTTD. Patient is asked to stand up on his toes. A patient with positive PTTD often cannot or has pain with performing this task.

9. A, D, and E) Patient will be able to breathe on his own (C3, C4, C5 keep the diaphragm alive). Writst and elbow extension are likely maintained but not motions of the hand and flexion motions making C not an option. Neck flexion and extension still controlled. Some shoulder movement available due to C5-C6 being intact.

10. A) Ligaments connects bone to bone while tendons connect muscle to bone.

11. C) A thrombotic stroke is the most common type of ischemic stroke.

12. D) One of the most important things of working with a post-polio patient is to keep the brace as close as possible to the original. While (A) would be a possible option, double action joints would be heavier and a lateral T-strap would be required to be added on to every shoe, and she is already concerned about finances. (D) is a better option as the brace remains almost the same, she can continue to switch shoes as she is accustomed to, and she will have the needed support of the equinovarus deformity.