CFO Risk Assessment & Mitigation 3 — Questions and Answers
Question 1: A patient with severe osteoporosis is being fitted with a TLSO. What is the primary structural risk the fitter must mitigate?
- Increased spinal lordosis
- Pathological fracture from device pressure (Correct answer)
- Respiratory restriction
- Skin hyperpigmentation
Correct answer: Pathological fracture from device pressure
In severe osteoporosis, the weakened bone structure can sustain a pathological fracture if the orthosis applies excessive localized load.
Question 2: Which of the following is the most appropriate strategy to mitigate the risk of contact dermatitis from an orthotic liner?
- Apply talcum powder over the liner
- Perform a material sensitivity review before fabrication (Correct answer)
- Recommend the patient take antihistamines
- Use a thicker liner to reduce skin contact
Correct answer: Perform a material sensitivity review before fabrication
Reviewing the patient's known material sensitivities or allergies before fabrication prevents the use of allergenic components.
Question 3: During gait analysis, a patient using a knee-ankle-foot orthosis (KAFO) demonstrates excessive lateral trunk lean. What risk does this compensatory pattern signal?
- Increased risk of shoulder joint injury
- Hip abductor weakness leading to falls (Correct answer)
- Knee hyperextension inside the device
- Ankle plantar flexion contracture
Correct answer: Hip abductor weakness leading to falls
A Trendelenburg-type lean during gait indicates hip abductor weakness, which increases fall risk and energy expenditure.
Question 4: What is the most significant risk of over-correcting a flexible flatfoot deformity in an adult patient with a rigid foot orthosis?
- Hallux valgus progression
- Lateral column overload and stress fracture (Correct answer)
- Achilles tendon elongation
- Increased plantar fascia tension
Correct answer: Lateral column overload and stress fracture
Excessive medial arch support shifts load to the lateral column, potentially causing stress fractures of the fourth and fifth metatarsals.
Question 5: Which risk is most associated with prescribing a solid ankle AFO for a patient with significant spasticity and strong extensor synergy?
- Reduced energy cost during gait
- Increased knee hyperextension during stance (Correct answer)
- Decreased dorsiflexion ROM
- Greater toe clearance during swing
Correct answer: Increased knee hyperextension during stance
A solid AFO holding the ankle at 90° can lever the knee into hyperextension in patients with strong extensor spasticity during loading response.
Question 6: An orthotic patient on anticoagulation therapy develops a small hematoma at the proximal strap site. What is the most important next action?
- Apply ice and instruct the patient to monitor
- Immediately contact the referring physician (Correct answer)
- Loosen the strap and continue use
- Discontinue the device permanently
Correct answer: Immediately contact the referring physician
Patients on anticoagulants are at elevated bleeding risk, and a hematoma under a strap requires prompt physician notification to guide management.
Question 7: Which element of the patient history is most critical for risk stratification before fitting a cervical orthosis post-injury?
- Patient's occupation
- Imaging results confirming injury level and stability (Correct answer)
- Patient's pain tolerance rating
- Date of last physical therapy visit
Correct answer: Imaging results confirming injury level and stability
Imaging results define the injury level and stability, determining which cervical orthosis provides appropriate immobilization without risking spinal cord injury.
CFO Risk Assessment & Mitigation 3
A patient with severe osteoporosis is being fitted with a TLSO.
What is the primary structural risk the fitter must mitigate?