Pt 736 Orthotics And Prosthetics Exam 2

Front 1

What is the most frequently injured joint in athletics?

Back 1

Ankle

Front 2

What percent of all injuries involve running and jumping?

Back 2

25%

Front 3

Which ligaments provide varus stability?

Back 3

Lateral ligaments

Front 4

Which is the weakest and most commonly injured ligament?

Back 4

ATFL

Front 5

Which ligament prevents excessive anterior displacement of the talus?

Back 5

ATFL

Front 6

Which ligament is 2.5 times stronger than the ATFL?

Back 6

Calcaneofibular

Front 7

Which ligament is the strongest and least frequently injured?

Back 7

PTFL

Front 8

What is the most common mechanism of injury?

Back 8

Plantar flexion and inversion

Front 9

What percentage of all ankle sprains involve the ATFL?

Back 9

2/3

Front 10

More than ___% of patients with repeated ankle sprains exhibit weakness of peroneal muscles rather than ligamentous laxity.

Back 10

50

Front 11

Loss of ___________ from ankle mechanoreceptors may be responsible for increasing risk of re-injury.

Back 11

sensory input

Front 12

What are the objectives of orthotic management of the ankle?

Back 12

1. prevention or correction of deformity
2. support or immobilization of a body segment
3. assistance or restoration of mobility and function.

Front 13

What are advantages of orthotics over adhesive taping?

Back 13

1. orthotics more cost effective
2. taping requires assistance of another person
3. tape causes skin irritation and breakdown
4. tape loosens significantly shortly after use.

Front 14

What are the two types of orthoses?

Back 14

1. Softshell – made of canvas or neoprene rubber.
2. Semi-rigid – made of orthoplast or other semi-rigid material

Front 15

What are the effects of pneumatic compression on stress fracture healing?

Back 15

• Pneumatic leg brace causes increased hydrostatic and venous pressures resulting in shifting of fluids and electrolytes from the capillary space to the interstitial fluid space.
• Increases bone rate of repair
• Unloads the tibia and fibula by stabilizing surrounding musculature permitting the bone to heal.

Front 16

How can orthotic help achilles tendinitis?

Back 16

Orthotics can change the pull on the achilles tendon thereby reducing stress.

Front 17

How does the achilles tendon affect plantar fasciitis?

Back 17

Decreased flexibility of Achilles tendon results in excessive pronation & overstretch to the plantar fascia.

Front 18

How do pronation and pes cavus affect plantar fasciitis?

Back 18

Over pronation during stance phase - normal supination not allowed which results in the foot not becoming a “rigid lever” during push off causing excessive stresses to the plantar fascia.
Pes Cavus - may result in plantar fasciitis due to inability to provide shock absorption and dissipate forces.

Front 19

Which joint is judged to be the least congruent in the body?

Back 19

Patellofemoral

Front 20

What are functions of the patella?

Back 20

1. Anatomic pulley – increases lever arm of quadriceps; improves mechanical advantage of quadriceps
Patellectomy – decreases quad strength by about 20%
2. Absorbs compressive forces imparted to femur
3. Prevents excessive friction on quadriceps tendon.

Front 21

Which muscle controls the dynamic tracking of the patella?

Back 21

Quadriceps femoris

Front 22

What must occur for there to be proper patellar tracking?

Back 22

There must be a balance between the activity of the vastus medialis oblique and the vastus lateralis.

Front 23

What is the normal range for Q angle in men and women?

Back 23

Range for males: 10-12°
Range for females: 15-18°

Front 24

What are associated with larger Q angles?

Back 24

1. Increased femoral ante-version
2. Excessive external tibial torsion
3. Genu valgus
4. Excessive lateral forces on patella

Front 25

Maximum contact force occurs at ___ degrees of flexion and approximates 6.5 times body weight.

Back 25

90

Front 26

Why does the medial aspect of the patella receive more contact?

Back 26

Increased degenerative changes in the cartilage on the medial side.

Front 27

What are the PFJ reaction forces during dynamic motions such as gait, stair climing, cycling, and deep knee bends?

Back 27

1. During gait – one half of body weight
2. Stair climbing or running – 3.3 times body weight
3. Cycling – 1.5 times body weight
4. Deep knee bends – 7.8 times body weight

Front 28

What percent of military recruits suffer from patellofemoral pain syndrome?

Back 28

20%

Front 29

What is the etiology of PFPS?

Back 29

1. abnormal stress imposed on the articular surface of the patella as a result of mal-alignment and mal-tracking.
2. High correlation between PFPS and foot alignment – excessive & premature subtalar pronation during gait results in excessive tibial internal rotation; increasing pressure between lateral articular surfaces and PF joint; results in cartilage irritation & degeneration.

Front 30

Subluxation and dislocation of the patella is caused by excessive instability of the ______ pull of the patella.

Back 30

lateral

Front 31

What is the most common site of patellar tendinitis?

Back 31

Attachment to the inferior patellar pole

Front 32

What is softening of the articular cartilage that results in irregular surface on the cartilage with fractures and fissures in the articular surface?

Back 32

Chondromalacia Patellae

Front 33

What is the purpose of a patellar orthotic?

Back 33

The purpose of orthotics is to achieve and maintain optimal patellar tracking so as to prevent abnormal compressive forces and subsequent degenerative changes.

Front 34

What corrects patellar orientation & controls tracking; reduces pain so as to permit retraining of the VMO?

Back 34

Patellar Taping

Front 35

What should treatment of patellar tendinitis focus on?

Back 35

Choose knee supports which dissipate stress on the patellar tendon.

Front 36

What is a velcro strap which pushes against the patellar tendon and facilitates tracking; raises patella from its articular surface?

Back 36

Cho-Pat Strap

Front 37

What is the use of tape around the patella to reduce forces allowing tendon to heal?

Back 37

McConnell Taping

Front 38

The ACL provides ____% of passive restraint of anterior movement of tibia on femur

Back 38

95%

Front 39

The PCL provides ____% of the passive restraint of posterior movement of tibia on femur.

Back 39

86%

Front 40

The MCL provides ____% restraint of valgus load on the knee.

Back 40

80%

Front 41

What is the mechanism of injury for the ACL?

Back 41

• Knee slightly flexed
• Foot fixed on ground
• Internal rotation of femur combined with valgus stress at knee.

Front 42

What is the objective of function bracing of the ACL?

Back 42

Decrease knee hyperextension tibial rotation and anterior tibial translation.

Front 43

What are the characteristics of prophylactic knee braces?

Back 43

1. Supplement the stiffness of the knee against injury producing loads.
2. Not interfere with normal function.
3. Not increase risk of injury else-where in lower extremity.
4. Adaptable to various anatomical shapes and sizes.
5. Not harming other players.
6. Cost effective and durable.
7. Documented to prevent injuries.

Front 44

What are characteristics of rehabilitative knee braces?

Back 44

1. Provides accurate control of knee motions avoiding excessive loads on healing tissues.
2. Remains in position without slippage.
3. Adapts to various leg sizes and shapes
4. Adapts for edema and atrophy
5. Comfortable for user.
6. Easily applied and removed
7. Allows brace to be locked at a given joint angle.
8. Durable and economical.

Front 45

Function ACL braces show a ____% decrease in isokinetic knee strength at high speeds.

Back 45

30%

Front 46

What percent of patients felt the brace helped improve athletic performance?

Back 46

70%

Front 47

What is the success rate for unloader knee brace for OA?

Back 47

80% success rate

Front 48

Adults will always go with _______ at the expense of ______.

Back 48

stability
mobility

Front 49

What are indications, advantages, and disadvantages to rigid polypropylene AFOs?

Back 49

Indications:
– Prevent excessive plantarflexion or dorsiflexion during stance.
– Controls mediolateral instability at subtalar joint during stance phase.
– Facilitates limb clearance in mid-swing.
– Positions the foot for appropriate heel initial contact.
Advantages:
• Lighweight in design
• Cosmetically appealing
• Can be worn with different footwear.
Disadvantages:
• Difficulty with sitting to standing due to lack of ankle dorsiflexion
• Bending over
• Climbing stairs.

Front 50

What are indications, advantages, and disadvantages to bichannel adjustable ankle locking AFOs?

Back 50

Indications:
Advantages:
• Adjustments to brace can be easily made to accommodate changes in patient’s walking abilities.
• Accommodates to normal plantar flexion which occurs at heelstrike.
Disadvantages:
• Lacks cosmetic appeal
• Wearer un

Front 51

Which type of patient would use a KNFO?

Back 51

• Designed mainly for patients with spinal cord injury, polio, or progressive neurological conditions.
• Patients who have deficits due to CVA or closed head injuries typically do better with an AFO.

Front 52

What are indications for KAFO prescription?

Back 52

1. Inability to stabilize the knee at weight acceptance and through single-limb support phase of gait. This instability is a result of weakness to the quadriceps (mainly) and also weakness of the hip extensors and ankle plantarflexors Patient compensates for this weakness by hyperextending the knee during weight bearing. In this situation, a KAFO can prevent excessive ligamentous strain and minimize joint pain. 2. Impaired or absent proprioception at the knee.

Front 53

Patient with bilateral KAFO and a swing through crutch assisted gait pattern demonstrate a ____% greater energy cost.

Back 53

500%

Front 54

What is defines as an appreciable lateral deviation in the normally straight vertical line of the spine; a rotational deformity of the spine and ribs?

Back 54

Scoliosis

Front 55

During scoliosis the entire thoracic cage takes on an ovoid shape, causing the ribs on the concave side to protrude _______ while the ribs on the opposite side are recessed.

Back 55

anteriorly

Front 56

What is usually noted in later years of first decade? Curves are always slight and disappear on lying down.

Back 56

Postural Scoliosis

Front 57

What is usually the result of a leg length discrepancy? Pelvis dips down on the short side

Back 57

Compensatory Scoliosis

Front 58

What is not true scoliosis; an irritative form caused by pressure on the nerve roots from a herniated disc?

Back 58

Sciatic Scoliosis

Front 59

Which scoliosis is rare that usually requires psychiatric treatment?

Back 59

Hysterical Scoliosis

Front 60

What is the most common form of scoliosis (70%)?

Back 60

Idiopathic

Front 61

How is idiopathic scoliosis classified?

Back 61

Classified by age of onset.

1. Infantile – before 3 years of age
2. Juvenile – age 3 to onset of puberty; usually the age of 10 years
3. Adolescent – from age 10 until maturity

Front 62

What type of brace is used for scoliosis?

Back 62

Milwaukee Brace

Front 63

What are key characteristic of the Milwaukee Brace?

Back 63

• Can successfully halt progression of curve in 70% of cases.
• Incidence of success rises with addition of exercise program.

Front 64

What are factors for bracing treatment for scoliosis?

Back 64

1. an orthotist who can supply and service the brace.
2. an orthopedic surgeon who will follow the brace treatment
3. a skeletally immature willing patient
4. fully cooperative parents.

Front 65

What are indications for bracing scoliosis?

Back 65

1. any child with progressive spinal curvature.
2. children with paralytic scoliosis supported with brace until they have regain muscle power to maintain straight spine.
3. to maintain spinal alignment until skeletal maturity with subsequent fusion.
4. all structural curves 20 to 40 degrees of skeletally immature adolescents

Front 66

What are goals for exercise programs for those who suffer from scoliosis?

Back 66

1. Develop or enhance the patient’s awareness of his or her posture
2. Augment the function of the orthosis through active exercise while in the brace.
3. Enhance respiratory function and chest mobility.
4. Improve or prevent further loss of ROM of the upper and lower
extremities.
5. Enhance proper body mechanics and activities of daily living while wearing the orthosis.

Front 67

What are specific exercises for scoliosis?

Back 67

1. Exercises for muscle function & flexibility of the trunk and pelvis
2. Posterior pelvic tilts in multiple functional positions.
3. Abdominal exercises for upper, lower, and oblique muscle groups.
4. Anterior chest wall stretches
5. Spinal stabilization and stretching into the curve convexity.
6. Hip flexor stretches and strengthening
7. Hamstring stretches and strengthening
8. Iliotibial/tensor fascia latae stretches and strengthening
9. Erector spinae stretches and strengthening.

Front 68

What are functions of orthoses with spinal dysfunction?

Back 68

1. reduce gross spinal motion (limiting bending & twisting of torso)
2. stabilize individual motion segments
3. apply closed chain force systems designed to correct or prevent progression of vertebral column deformities & to stabilize instabilities.
4. protect post surgical interventions.

Front 69

What is the most frequent corset prescribed?

Back 69

Lumbosacral Corset

Front 70

When are thermoplastic spinal orthoses used?

Back 70

Used when the goal is immobilization of the spine in all 3 planes.

Front 71

When are thermoplastic spinal orthosies effective?

Back 71

1. instability of spine
2. post-operative care for traumatic thoracic or lumbar fractures.
3. spinal cord injuries
4. spinal fusion

Front 72

For patients with an osteoporotic spinal fracture, what is the main objective of orthoses?

Back 72

Improve quality of life
Reduce pain

Front 73

Cervical soft collars are comfortable and minimally restrict cervical motion, but what is the main purpose?

Back 73

Used primarily as a kinesthetic reminder for patients with mild whiplash injury or neck pain to restrict cervical motions.

Front 74

Which cervical collar provides more stability than a soft collar and is the most used and best prescribed?

Back 74

Philadelphia

Front 75

What is used for complete control of cervical and upper thoracic spine in all three planes?

Back 75

Cervical Halo

Front 76

What are the two main classifications of splints?

Back 76

Articular
Non-articular

Front 77

What is the terminology used when naming splints?

Back 77

Location
Direction

Front 78

What are the purposes of splints?

Back 78

1. Immobilize a structure
2. Mobilize a tissue
3. Restrict an aspect of joint motion

Front 79

The purpose of immobilization is to place a structure in its anatomical or most comfortable ________ position.

Back 79

resting

Front 80

What is defined as moving or stretching specific soft tissues or joints to create change?

Back 80

Mobilization

Front 81

How will tissues lengthen during mobilization?

Back 81

The tissues will lengthen due to cell growth and not stretching of the tissues.

Front 82

When a splint restricts, it also ______ an aspect of joint motion

Back 82

blocks

Front 83

What are characteristics of static splints?

Back 83

Have a rigid base
Immobilize the joints they traverse

Front 84

Serial static splints are applied to joints, soft tissue, or musculotendinous units they cross and hold them in a _________ position.

Back 84

lengthened

Front 85

What uses an elastic type force to mobilize specific tissues to achieve increases in ROM?

Back 85

Dynamic Splint

Front 86

What achieves tissue mobilization by applying low load force to the tissue’s end range in one direction; the force applied is non-elastic?

Back 86

Static Progressive Splint

Front 87

What are objectives to immobilizing splints?

Back 87

- provide symptom relief
- protect and position edematous structures
- aid in maximizing functional use
- maintain tissue length
- protect healing structures and surgical procedures
- provide support and protection for soft tissue healing
- maintain and protect reduction of fracture
- improve and preserve joint alignment
- block and transfer muscle and tendon forces
- influence a spastic muscle
- prevent possible contracture development

Front 88

What are objectives to mobilizing splints?

Back 88

- remodel long standing, dense, mature scar
- elongate soft tissue contractures, adhesions, and musculotendinous tightness
- increase passive joint ROM
- realign or maintain joint and ligament profile
- substitute for weak or absent motion
- maintain reduction of an intraarticular fracture with preservation of joint mobility

Front 89

What are objectives to restriction splinting?

Back 89

- limit motion after nerve injury or repair
- limit motion after tendon injury or repair
- limit motion after bone or ligament injury or repair
- provide and improve joint stability and alignment
- assist in functional use of the hand

Front 90

The arch system of the hand is vital for positioning the hand to allow for normal function related to _______ and _________.

Back 90

grasp
prehension

Front 91

What are characteristics of the proximal transverse arch of the hand?

Back 91

• Carpal tunnel
• Long flexors and median nerve pass en route to the hand.

Front 92

What are characteristics of the distal transverse arch of the hand?

Back 92

Increases the mobility of the peripheral digits allowing for optimal grasping abilities.

Front 93

What are characteristics of the longitudinal arch of the hand?

Back 93

A disruption of this arch occurs with an ulnar nerve injury resulting in loss of intrinsic muscle function.

Front 94

Is the position of function (rest) of the hand a long term or short term position?

Back 94

Short term

Front 95

What are superficial structures of the arm that are vulnerable to pressure?

Back 95

Front 96

What are characteristics of the antideformity position of the hand?

Back 96

• Prevents MP joint contractures
• MP contractures would impair grasping abilities.

Front 97

What may older adults experience with hand orthoses?

Back 97

• May report pain, redness, & irritation over the bony areas
• Use padding or gel
• Flare away during the molding process.

Front 98

What should you consider with regard to peripheral nerves when bracing or splinting the hand?

Back 98

• Avoid compression
• Patients may report pain, redness, paresthesias, and numbness in that nerve’s distribution.

Front 99

What should you consider with regard to vascular supply when bracing or splinting the hand?

Back 99

• Avoid compression
• Patients may report throbbing, color changes, temperature changes, and pain.

Front 100

What purposes do splints serve when treating for burns?

Back 100

1. protect fragile wounds or newly grafted burn wounds
2. position joints to maintain achieved ROM
3. as dynamic devices to apply gentle prolonged stretch to increase ROM
4. enhance pressure applied to a scar.

Front 101

When treating burns, should splints replace active exercise?

Back 101

No

Front 102

What will form is patients are constantly splinted in a particular position?

Back 102

Contracture

Front 103

Splints should be fabricated with a good fit to reduce _______ and skin breakdown

Back 103

friction

Front 104

When are splints often donned?

Back 104

Rest
Sleep

Front 105

What can be remolded to adjust the fit to retain gains made after exercise?

Back 105

Thermoplastics

Front 106

____% of splints contain micro-organisms that may cause infections.

Back 106

50%

Front 107

When cleaning splints, 1 oz of quaternary ammonia per gallon of water is ____% effective

Back 107

100%

Front 108

What is a previous name for developmental dysplasia of the hip?

Back 108

Congenital dislocation of the hip

Front 109

What is the purpose of orthotic management of DDH in the first 6 months of life?

Back 109

Limit extension and adduction
Allow flexion and abduction
Initially worn 24/7

Front 110

What is the hallmark sign of legg-calve-perthes disease?

Back 110

Flattening of the femoral head, often accompanied by avascular necrosis

Front 111

Legg-Calve-Perthes disease is ____ times more common in boys than girls ages 4-8

Back 111

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