CO Patient Care, Fitting & Follow-Up Procedures 3 — Questions and Answers
Question 1: When taking a cast for a custom ankle-foot orthosis (AFO), the ankle should typically be held in:
- Maximum plantarflexion to accommodate footwear
- Neutral (90°) dorsiflexion unless otherwise indicated (Correct answer)
- 5–10° of plantarflexion for patient comfort
- The position of maximum comfort as reported by the patient
Correct answer: Neutral (90°) dorsiflexion unless otherwise indicated
The ankle is typically held at neutral (90°) during casting to produce an AFO that positions the foot for functional ambulation unless the clinical goal dictates otherwise.
Question 2: A patient with a C6 spinal cord injury is being fitted with a wrist-driven wrist-hand orthosis (tenodesis orthosis). The key functional principle of this device is that:
- Active wrist extension drives passive finger flexion for grasp (Correct answer)
- Active finger flexion drives passive wrist extension for release
- Electrical stimulation activates finger flexion independently
- The orthosis locks the wrist to provide a static grasp position
Correct answer: Active wrist extension drives passive finger flexion for grasp
A tenodesis orthosis harnesses active wrist extension to drive passive finger flexion, enabling functional grasp in patients with preserved wrist extensors but absent hand intrinsics.
Question 3: During a fitting appointment, the patient reports that a new KAFO feels too tight around the thigh proximally. The orthotist should:
- Tell the patient the tightness will resolve after a break-in period
- Check for appropriate trim lines and relief areas, then adjust if necessary (Correct answer)
- Add foam padding circumferentially to distribute pressure
- Refer the patient back to the physician for a new prescription
Correct answer: Check for appropriate trim lines and relief areas, then adjust if necessary
Proximal thigh tightness requires assessment of trim lines and bony prominences to identify and correct pressure points through orthotic modification.
Question 4: According to best practice, a written home exercise and orthosis wear schedule provided to the patient at discharge should include:
- Only the physician's contact information
- Wear schedule, skin inspection instructions, donning/doffing technique, and emergency contacts (Correct answer)
- A list of activities the patient must permanently avoid
- Only the next scheduled appointment date
Correct answer: Wear schedule, skin inspection instructions, donning/doffing technique, and emergency contacts
Comprehensive written instructions covering wear schedule, skin care, donning/doffing, and emergency contacts support safe orthosis use and patient independence.
Question 5: When evaluating a patient with peripheral neuropathy for a custom foot orthosis, total contact casting principles suggest that the orthosis should:
- Have high arch support to reduce midfoot stress
- Distribute plantar pressure evenly across the entire foot contact area (Correct answer)
- Provide rigid toe extension to prevent toe deformity
- Leave the heel area open to reduce Achilles tendon tension
Correct answer: Distribute plantar pressure evenly across the entire foot contact area
Total contact orthotic principles minimize peak plantar pressure by distributing force evenly across the entire plantar surface, reducing ulceration risk.
Question 6: A patient fitted with a scoliosis orthosis (TLSO) reports that the underarm area causes skin irritation after 6 hours of wear. The MOST appropriate first step is:
- Prescribe a topical antibiotic ointment for the irritated area
- Inspect the axillary trim line and modify the orthosis to relieve the pressure (Correct answer)
- Advise the patient to apply thick padding in that area independently
- Reduce prescribed wearing hours by 50%
Correct answer: Inspect the axillary trim line and modify the orthosis to relieve the pressure
Axillary irritation from a scoliosis TLSO indicates improper trim lines that must be assessed and corrected by the orthotist to maintain safe long-term wear.
Question 7: Which assessment tool is commonly used by orthotists to objectively document functional mobility outcomes following orthotic intervention?
- Glasgow Coma Scale (GCS)
- Timed Up and Go (TUG) test (Correct answer)
- Mini-Mental State Examination (MMSE)
- Hamilton Anxiety Rating Scale (HAM-A)
Correct answer: Timed Up and Go (TUG) test
The Timed Up and Go (TUG) test is a validated, widely used functional mobility assessment that orthotists use to document baseline and outcome changes after orthotic intervention.
CO Patient Care, Fitting & Follow-Up Procedures 3
When taking a cast for a custom ankle-foot orthosis (AFO), the ankle should typically be held in: