CO Treatment Planning & Protocols 3 — Questions and Answers
Question 1: A patient with L3-L4 spinal stenosis has neurogenic claudication limiting walking to 50 feet. Which orthotic approach is supported by evidence?
- Rigid lumbar corset to maximize extension
- Lumbar flexion orthosis to open the spinal canal (Correct answer)
- TLSO in neutral alignment
- No orthotic intervention is indicated
Correct answer: Lumbar flexion orthosis to open the spinal canal
Lumbar flexion orthoses open the posterior elements of the spinal canal, reducing stenotic compression and alleviating neurogenic claudication symptoms.
Question 2: Which outcome measure is MOST appropriate for assessing functional improvement in a patient fitted with a lower limb orthosis for stroke?
- Visual Analog Scale (VAS) for pain
- 10-Meter Walk Test (10MWT) (Correct answer)
- Berg Balance Scale score only
- Radiographic limb alignment
Correct answer: 10-Meter Walk Test (10MWT)
The 10-Meter Walk Test is a validated, functional measure of walking speed that directly captures the ambulation benefits of lower limb orthotics in stroke patients.
Question 3: A patient with idiopathic scoliosis (Cobb angle 28°, Risser 2) presents for orthotic management. Which brace and wearing protocol is standard of care?
- Boston TLSO, worn 8 hours/day (nighttime only)
- Charleston Bending Brace, worn 23 hours/day
- Boston TLSO or equivalent, worn 16-23 hours/day (Correct answer)
- Rigid cervicothoracic orthosis, worn full-time
Correct answer: Boston TLSO or equivalent, worn 16-23 hours/day
Evidence-based guidelines (SRS/POSNA) recommend a rigid TLSO worn 16-23 hours per day to halt curve progression during the adolescent growth phase.
Question 4: When writing a treatment plan for a unilateral transtibial amputee, what is the primary biomechanical purpose of a prosthetic sock fit check at each visit?
- Assess cosmetic appearance of the prosthesis
- Evaluate residual limb volume changes affecting socket fit (Correct answer)
- Determine if the patient needs a new prosthetic foot
- Check alignment of the ankle joint
Correct answer: Evaluate residual limb volume changes affecting socket fit
Residual limb volume fluctuates due to activity, edema, and tissue remodeling; sock ply adjustments ensure proper socket fit and prevent skin breakdown.
Question 5: A pediatric patient with myelomeningocele at the L2 level has no active hip flexion below that level. Which orthotic system best enables therapeutic ambulation?
- Bilateral solid AFOs only
- Hip-knee-ankle-foot orthoses (HKAFOs) with pelvic band (Correct answer)
- Knee-ankle-foot orthoses (KAFOs) without hip control
- Bilateral SMOs (supramalleolar orthoses)
Correct answer: Hip-knee-ankle-foot orthoses (HKAFOs) with pelvic band
L2 level spina bifida results in absent hip extension and knee control; HKAFOs with a pelvic band provide the necessary proximal stability for therapeutic ambulation.
Question 6: In treatment planning for plantar fasciitis, which orthotic feature is MOST supported by clinical evidence to reduce pain?
- Rigid full-length carbon fiber insole
- Medial arch support with heel cushioning (Correct answer)
- Metatarsal bar positioned proximal to metatarsal heads
- Toe separator between first and second digits
Correct answer: Medial arch support with heel cushioning
Medial arch support with heel cushioning reduces tensile loading of the plantar fascia and offloads the calcaneal enthesis, the primary pain source.
Question 7: A patient with rheumatoid arthritis of the wrist and hand needs an orthosis. What is the recommended protocol regarding joint immobilization?
- Immobilize all affected joints continuously to prevent joint damage
- Use resting splints at night; mobilization splints during activity to preserve function (Correct answer)
- Avoid all orthotic intervention as it causes muscle atrophy
- Use dynamic splints exclusively to maximize ROM
Correct answer: Use resting splints at night; mobilization splints during activity to preserve function
Current RA management uses resting splints at night for pain control and mobilization splints during activity to balance joint protection with functional maintenance.
CO Treatment Planning & Protocols 3
A patient with L3-L4 spinal stenosis has neurogenic claudication limiting walking to 50 feet.
Which orthotic approach is supported by evidence?