COF COF Neuromuscular Conditions & Orthotics 5 — Questions and Answers
Question 1: A patient with amyotrophic lateral sclerosis (ALS) has wrist extensor weakness affecting hand function. Which orthosis is MOST appropriate to maintain functional grasp?
- Resting hand splint worn at night only
- Wrist-hand orthosis (WHO) in functional position with dynamic finger extension assist
- Static wrist cock-up splint in 30° extension (Correct answer)
- Ulnar deviation correction splint
Correct answer: Static wrist cock-up splint in 30° extension
A static wrist cock-up splint in 30° extension positions the wrist to optimize tenodesis grasp function when wrist extensors are weak.
Question 2: During gait analysis of a patient with cerebral palsy (spastic diplegia), the fitter observes jump gait pattern. Which combination is MOST characteristic of jump gait?
- Hip flexion, knee extension, ankle dorsiflexion
- Hip flexion, knee flexion, ankle plantarflexion (Correct answer)
- Hip extension, knee flexion, ankle equinus
- Hip abduction, knee extension, ankle valgus
Correct answer: Hip flexion, knee flexion, ankle plantarflexion
Jump gait is characterized by simultaneous hip flexion, knee flexion, and ankle plantarflexion throughout the gait cycle due to spasticity across multiple joints.
Question 3: Which neurological condition is MOST associated with autonomic dysreflexia that the orthotist must screen for during fitting appointments?
- Traumatic brain injury above C5
- Spinal cord injury at or above T6 (Correct answer)
- Multiple sclerosis with cervical involvement
- Peripheral neuropathy with autonomic involvement
Correct answer: Spinal cord injury at or above T6
Autonomic dysreflexia occurs in spinal cord injuries at or above T6, where tight orthoses or pressure sores can trigger dangerous hypertensive episodes.
Question 4: A fitter is working with a patient who has Guillain-Barré syndrome in the recovery phase. The patient has improving but asymmetric strength. What orthotic strategy is MOST appropriate?
- Bilateral rigid KAFOs to prevent all motion
- Modular or adjustable AFOs that can be modified as strength returns (Correct answer)
- Permanent custom AFOs to each limb immediately
- No orthoses until full neurological recovery
Correct answer: Modular or adjustable AFOs that can be modified as strength returns
Modular or adjustable AFOs allow progressive weaning of support as strength recovers asymmetrically during Guillain-Barré rehabilitation.
Question 5: A patient with spastic hemiplegia after stroke uses an AFO but reports knee instability during mid-stance. The AFO is set in neutral. What adjustment would MOST improve knee stability?
- Add a plantarflexion stop to prevent any equinus
- Adjust the AFO to 5° of plantarflexion to increase knee extension moment (Correct answer)
- Change to a posterior leaf spring for more energy return
- Add a knee extension assist to the current AFO
Correct answer: Adjust the AFO to 5° of plantarflexion to increase knee extension moment
Setting the AFO in slight plantarflexion creates a ground reaction force that generates a knee extension moment, improving stability in mid-stance.
Question 6: In a patient with Duchenne muscular dystrophy who is still ambulatory, which orthotic intervention BEST prolongs walking ability?
- Bilateral KAFOs used full-time from initial diagnosis
- Lightweight bilateral AFOs to control foot drop combined with stretching (Correct answer)
- Spinal orthosis to address developing scoliosis
- Hip orthosis to prevent hip flexor contracture
Correct answer: Lightweight bilateral AFOs to control foot drop combined with stretching
Lightweight AFOs controlling foot drop, combined with regular stretching, prolong ambulation in DMD by preventing equinus contractures without adding excessive weight.
Question 7: A patient with peripheral neuropathy from diabetes has a Charcot foot in the consolidation phase. Which orthotic management is MOST appropriate at this stage?
- Custom accommodative foot orthosis in standard footwear
- Total contact cast changed every 1-2 weeks
- Charcot Restraint Orthotic Walker (CROW) for protected weight-bearing (Correct answer)
- Rigid carbon fiber AFO with rocker sole modification
Correct answer: Charcot Restraint Orthotic Walker (CROW) for protected weight-bearing
The CROW (Charcot Restraint Orthotic Walker) is the definitive orthosis for the consolidation phase of Charcot foot, providing total contact support while allowing protected ambulation.
COF COF Neuromuscular Conditions & Orthotics 5
A patient with amyotrophic lateral sclerosis (ALS) has wrist extensor weakness affecting hand function.
Which orthosis is MOST appropriate to maintain functional grasp?