CO Patient Care, Fitting & Follow-Up Procedures 2 — Questions and Answers
Question 1: When fitting a diabetic patient with a custom foot orthosis, the orthotist's PRIMARY concern during the fitting appointment is:
- Cosmetic appearance of the device
- Skin integrity and pressure distribution (Correct answer)
- Patient's preference for shoe style
- Cost of the orthotic materials
Correct answer: Skin integrity and pressure distribution
Diabetic patients are at high risk for pressure ulcers and neuropathic wounds, so skin integrity and even pressure distribution are the primary concerns during fitting.
Question 2: A patient returns for a follow-up visit and reports that their AFO causes a red mark that persists for more than 20 minutes after removal. The orthotist should:
- Reassure the patient this is normal break-in pressure
- Pad the area inside the AFO immediately
- Modify or adjust the AFO to relieve the pressure point (Correct answer)
- Recommend the patient wear thicker socks
Correct answer: Modify or adjust the AFO to relieve the pressure point
Redness persisting more than 20 minutes indicates excessive pressure that requires orthotic modification, not just padding or reassurance.
Question 3: During an initial patient evaluation for a knee orthosis, range of motion measurements should be documented:
- Only if the patient reports pain with movement
- Bilaterally for comparison to the uninvolved extremity (Correct answer)
- On the involved limb only to save time
- After the orthosis has been fabricated and fitted
Correct answer: Bilaterally for comparison to the uninvolved extremity
Bilateral ROM measurements provide a baseline comparison to the uninvolved extremity and help set functional goals for the orthosis.
Question 4: Which of the following patient instructions is MOST important after dispensing a new thoracolumbosacral orthosis (TLSO)?
- Avoid all physical activity for 6 weeks
- Inspect the skin daily for signs of irritation or breakdown (Correct answer)
- Apply lotion liberally inside the orthosis before donning
- Wear the TLSO only during sleeping hours
Correct answer: Inspect the skin daily for signs of irritation or breakdown
Daily skin inspection is critical with a rigid TLSO because restricted movement and prolonged contact can cause pressure injuries that the patient may not feel.
Question 5: A patient fitted with a wrist-hand orthosis (WHO) reports difficulty performing fine motor tasks at work. The BEST initial intervention is to:
- Fabricate an entirely new orthosis with different material
- Refer the patient back to the prescribing physician only
- Re-evaluate functional needs and modify the orthosis design accordingly (Correct answer)
- Advise the patient to remove the orthosis during work tasks
Correct answer: Re-evaluate functional needs and modify the orthosis design accordingly
Re-evaluating the patient's functional demands and modifying the orthosis allows the orthotist to balance support with the dexterity required for daily activities.
Question 6: When performing a functional assessment prior to fabricating a lower limb orthosis, gait analysis should include observation of the patient:
- Only walking in a straight line on flat ground
- Walking on varied surfaces including stairs and ramps when appropriate (Correct answer)
- Only walking in bare feet without any assistive devices
- Only after the orthosis has been worn for one week
Correct answer: Walking on varied surfaces including stairs and ramps when appropriate
A comprehensive gait analysis includes varied surfaces to understand the patient's real-world functional needs and challenges the orthosis must address.
Question 7: A pediatric patient fitted with a Denis Browne bar and straight-last shoes for clubfoot correction returns for a 6-week follow-up. The parent reports the child wears the device only at night. The orthotist should first:
- Accept the parent's report and schedule the next appointment in 3 months
- Verify the wear schedule prescribed by the physician and counsel the parents on compliance (Correct answer)
- Reduce the prescribed wearing hours to improve family compliance
- Immediately contact child protective services
Correct answer: Verify the wear schedule prescribed by the physician and counsel the parents on compliance
The orthotist must verify the physician's wear schedule prescription and educate parents on the consequences of non-compliance, as inadequate wear leads to clubfoot relapse.
CO Patient Care, Fitting & Follow-Up Procedures 2
When fitting a diabetic patient with a custom foot orthosis, the orthotist's PRIMARY concern during the fitting appointment is: