Orthotics
Prosthetics
Gait
Extras
More extras
100
Which of the following shoe components distinguishes a blucher-style shoe from a balmoral-style shoe?
(a) Throat
(b) Toe box
(c) Heel
(d) Vamp
(a) Throat
100
A 16-year-old male with a right above-knee amputation presents to your clinic to get your opinion on operating a motor vehicle. You advise him that he would be required to
(a) strengthen his hip extensors.
(b) change the position of the car’s accelerator
and brake.
(c) obtain a special driving prosthesis.
(d) install a handbrake on the vehicle’s left
floor.
(b) The only situation that applies in this scenario is changing the position of the pedals in order to operate the vehicle with the left lower limb. Installing a handbrake is reserved for persons with right upper limb amputations. Other acceptable recommendations could include automatic transmission and/or hand controls.
100
Double limb stance is what percentage of the entire gait cycle?
A. 10
B. 20
C. 40
D. 60
B. 20
100
Which K level best describes an individual who is able to ambulate within the household, but not out in the community?
(a) K 1
(b) K 2
(c) K 3
(d) K 4
(a) The K level of 1 represents that of a household ambulator; K 2 limited community ambulator; K 3 unlimited community ambulator; K4 a very active community ambulator. The household exception FIM score of 5 indicates an independent ambulator who can handle household distances (i.e., less than 50 feet) inside or out.
100
What is the most common complication in a pediatric amputee whose growth plates have not yet fused?
A. Neuroma formation
B. Phantom limb pain
C. Phantom limb sensation
D. Terminal overgrowth
D. Terminal overgrowth
200
What shoe modification can be used to treat medial compartment knee OA?
A. Rocker bottom sole
B. Solid ankle cushioned heel
C. Medial wedge
D. Lateral wedge
D. Lateral wedge
200
When comparing quadrilateral sockets with ischial containment sockets, a successful fitting is more likely in a quadrilateral socket when
(a) the adductor musculature is intact.
(b) the residual limb is fleshy.
(c) trunk stability demands are high at mid
stance.
(d) the residual limb is shorter.
(a) Chances of a successful fitting of a quadrilateral socket are best when the residual limb is longer with a firm residuum and intact adductor musculature. Ischial containment sockets are more successful than quadrilateral sockets for persons with shorter, fleshy, unstable residual limbs.
200
Which of the following is true regarding running and the gait cycle?
A. Stance and swing phase each occur for 50% of the cycle
B. Double stance does not occur
C. Initial contact occurs exclusively with the heel
D. Center of gravity is at its highest point during mid stance
B. Double stance does not occur
200
What prosthesis is most appropriate for a 6- month-old child who has a congenital transhumeral amputation?
(a) curved shaped “banana” arm
(b) myoelectric hand
(c) body powered hook
(d) friction elbow arm
(a) The banana arm is a passive prosthesis designed to help in reaching and bimanual midline activities in the very young child. A myoelectric hand is most appropriate to initiate about age 1 year; a body-powered hook is appropriate for children age 4-5 years; a friction-elbow arm is appropriate about when a child with a transhumeral amputation starts to walk
200
What is the primary disadvantage of moving the rear axle of a wheelchair forward?
(a) ascending curbs becomes more difficult
(b) it takes more muscle effort to propel the
wheelchair
(c) more strokes are required to push the wheelchair
(d) ascending a ramp becomes more difficult
(d) Moving a wheelchair’s rear axle forward enables the user to propel the chair with less muscle effort and fewer strokes. Because the modification causes more weight to be centered over the rear wheels, it is easier to pop a wheelie, negotiate obstacles and ascend or descend curbs. However, moving the axle forward can also make the wheelchair more “tippy” (likely to tip backwards) and that tendency to tip backwards makes it more difficult to push the chair up a ramp.
300
A spring placed in the posterior channel of a dual-channel ankle orthotic joint will result in:
A. Resistance to plantar flexion
B. Resistance to dorsiflexion
C. Assistance with plantar flexion
D. Assistance with dorsiflexion
D. Assistance with dorsiflexion
300
What is the shortest functional level for a transtibial amputation?
(a) Just proximal to the tibial tuberosity
(b) Just distal to the tibial tuberosity
(c) Six centimeters distal to the tibial tuberosity
(d) Ten centimeters distal to the tibial tuberosity
(b) The shortest functional amputation level for a transtibial amputation is just distal to the tibial tuberosity. Knee flexion and extension can occur with this level of amputation because the patella tendon and hamstring tendon attachments are still present. Control of knee flexion and extension of the knee is lost with amputations proximal to the tibial tuberosity.
300
During pre-swing in a normal gait cycle, which muscle is most active?
A. Ipsilateral iliopsoas
B. Ipsilateral tibialis anterior
C. Contralateral gluteus maximus
D. Contralateral gluteus medius
A. Ipsilateral iliopsoas
300
Which of the following measures of the extremity arterial blood supply is predictive of a favorable outcome of a foot ulcer?
A. Toe BP of 20mmHg
B. Absent dorsalis pedis and posterior tibial pulses
C. Ankle brachial index <0.45
D. Transcutanial oxygen tension >35mmHg
D. Transcutanial oxygen tension >35mmHg
300
Which of the following will result in an increased knee flexion moment during stance of a transtibial prosthesis?
A. Foot aligned posterior to the socket
B. Pistoning of the limb in the socket
C. Insufficiency anterior flexion in socket alignment
D. Plantar flexion alignment of the prosthetic foot
A. Foot aligned posterior to the socket
400
Describe the splint used for a mallet finger.
Finger ring splint with DIP extension
400
Which characteristic of an AKA prosthesis promotes knee stability during gait?
A. Knee compartment anterior to the socket
B. Hard heel in the prosthetic foot
C. Poly-centric 4-bar linkage prosthetic knee
D. Anterior position of the shank on the prosthetic foot
C. Poly-centric 4-bar linkage prosthetic knee
400
DOUBLE JEOPARDY!!!!!!
What are the 6 determinants of gait?
1. Pelvic rotation
2. Pelvic tilt
3. knee flexion
4/5. ankle/foot motion
6. lateral pelvic displacement
400
During the second rocker of stance phase (ankle rocker):
A. The tibia advances over the ankle-foot complex
B. Controlled lowering of the foot occurs with a fulcrum of the heel
C. The foot supinates and body weight rolls over the first MTP joint
D. The ankle plantar flexes and the foot pronates
A. The tibia advances over the ankle-foot complex
400
Which setting of a power wheelchair is best for maneuvering around tight areas/corners?
A. Rear wheel drive
B. Front wheel drive
C. Mid wheel drive
D. All wheel drive
C. Mid wheel drive
500
A 75-year-old woman falls and fractures her distal humerus. In the process, the ulnar nerve is damaged. She presents 6 months later with weakness in the fourth and fifth digits, claw deformity, and loss of grip power. Which of the following orthotic components could benefit this patient and, therefore, should be included in the orthotic prescription?
(a) Dorsal outrigger
(b) C bar
(c) Lumbrical bar
(d) Opponens bar
(c) A dorsal metacarpophalangeal extension stop (also called a lumbrical bar) to the fourth and fifth digits is usually quite effective at preventing hyperextension of the fourth and fifth metacarpophalangeal joints. This permits the proper wrapping of the fingers around an object and thus allows a stronger grip.
500
In a patient with a transfemoral amputation, what is the most likely cause of excessive knee flexion during ambulation?
(a) Hip flexion contracture
(b) Prosthetic knee alignment in an excessively
posterior position
(c) Excessive socket extension
(d) Too soft a plantar flexion bumper in the heel
(a) One of the most common gait deviations in patients with transfemoral amputations is abrupt or excessive knee flexion during ambulation. The prosthetic knee joint should normally be stable in extension in stance phase from heel contact to foot flat. This stability is accomplished by aligning the prosthetic knee axis posterior to the trochanteric knee ankle line. Adequate strength and range of motion in hip extension are critical to maintaining this alignment. Thus, weak hip extensors and hip flexion contractures can cause knee instability. Two prosthetic causes of knee instability are (1)knee malalignment in an excessively anterior position relative to the hip and ankle joints, and (2) excessive socket flexion. A plantar flexion bumper that is too stiff, extensive foot dorsiflexion, or a change in shoe heel height from low to high may all promote knee flexion.
500
Which circumstance is most likely to result in left knee hyperextension at initial contact (heel strike) in a patient with spastic left hemiparesis?
(a) Solid ankle, double-metal, upright ankle- foot orthosis set in 5° of plantar flexion
(b) Addition of a solid one-quarter inch heel to the left shoe
(c) Addition of ankle dorsiflexion spring assistance to a dual-channel, double-metal, ankle- foot orthosis
(d) Addition of a T-bar strap to a double-metal upright ankle-foot orthosis to reduce foot inversion
(a) Placing a solid ankle, double-metal, upright ankle-foot orthosis in 5° of plantarflexion will increase the extension moment (forces) at the knee and this can result in knee hyperextension, especially at the time of initial contact (heel strike). Addition of a T-bar strap should not effect the knee and the addition of dorsiflexion spring assistance or a one-quarter inch heel will reduce the tendency to have knee hyperextension.
500
DOUBLE JEOPARDY!!!!!!
Name 3 reasons for a circumducted gait pattern in a transfemoral amputee
Amputee: weak hip flexors, fear of flexing prosthetic knee, hip abduction contracture
Prosthesis: prosthetic is too long or functionally too long (inadequate suspension, foot plantar flexion)
500
Which of the following adjustments would correct a lateral whip on a transfemoral prosthesis?
A. Internally rotating the socket
B. Externally rotating the knee bolt
C. Tightening the suspension socket
D. Increasing the length of the prosthesis
B. Externally rotating the knee bolt