COF Pediatric Orthotics 2 â Questions and Answers
Question 1: What hip flexion angle is typically maintained by a Pavlik harness during DDH treatment?
- 30 to 45 degrees
- 50 to 70 degrees
- 90 to 100 degrees (Correct answer)
- 110 to 130 degrees
Correct answer: 90 to 100 degrees
The Pavlik harness maintains approximately 90 to 100 degrees of hip flexion combined with abduction, which places the femoral head into the acetabulum and promotes socket development.
Question 2: Genu varum (bowlegs) observed in an otherwise healthy 18-month-old child is BEST characterized as:
- A pathological deformity requiring immediate orthotic correction
- A normal developmental variant that typically self-corrects by age 2 to 3 (Correct answer)
- An indication for urgent surgical referral
- A sign of severe nutritional deficiency requiring laboratory workup before any observation period
Correct answer: A normal developmental variant that typically self-corrects by age 2 to 3
Mild genu varum is a normal finding in toddlers due to in-utero positioning and physiological bone remodeling; it generally resolves spontaneously by age 2 to 3 without orthotic intervention.
Question 3: Which spinal orthosis is MOST commonly prescribed for adolescent idiopathic scoliosis with a Cobb angle between 25 and 40 degrees in a skeletally immature patient?
- Milwaukee brace (CTLSO)
- Thoracolumbosacral orthosis (TLSO) such as the Boston or Rigo ChĂȘneau brace (Correct answer)
- Rigid lumbosacral orthosis (LSO)
- Soft spinal corset
Correct answer: Thoracolumbosacral orthosis (TLSO) such as the Boston or Rigo ChĂȘneau brace
The TLSO (e.g., Boston brace or Rigo ChĂȘneau) is the current standard of care for adolescent idiopathic scoliosis curves of 25 to 40 degrees, as it controls thoracic and lumbar curves effectively and is more cosmetically acceptable than the Milwaukee brace.
Question 4: The Milwaukee brace (CTLSO) is specifically indicated over a standard TLSO in pediatric scoliosis when:
- The curve is located in the thoracolumbar or lumbar region
- The curve apex is at or above T6 (high thoracic or cervicothoracic region) (Correct answer)
- The Cobb angle exceeds 45 degrees
- The patient is post-operative
Correct answer: The curve apex is at or above T6 (high thoracic or cervicothoracic region)
The Milwaukee brace's cervical ring and superstructure allow it to address high thoracic and cervicothoracic curves whose apex is above T6, where a TLSO cannot reach.
Question 5: In a child with spastic diplegic cerebral palsy, the PRIMARY goal of AFO prescription is to:
- Completely eliminate all ankle and foot motion
- Improve functional mobility, gait efficiency, and energy expenditure (Correct answer)
- Eliminate the need for physical therapy
- Prevent skin breakdown as the only outcome
Correct answer: Improve functional mobility, gait efficiency, and energy expenditure
AFOs for children with cerebral palsy are prescribed to normalize gait kinematics, reduce energy expenditure, and maximize functional independence in mobility.
Question 6: Which consideration is UNIQUE to pediatric orthotic fitting and does NOT apply in adult orthotic care?
- Documentation for third-party payer reimbursement
- Patient compliance counseling
- Frequent size adjustments and device replacement due to ongoing skeletal growth (Correct answer)
- Preference for lightweight materials
Correct answer: Frequent size adjustments and device replacement due to ongoing skeletal growth
Skeletal growth in children means that pediatric orthoses must be reassessed and replaced every few months, a consideration that is absent in skeletally mature adult patients.
Question 7: According to the Ponseti protocol, what is the recommended brace wear schedule immediately after completing serial casting for clubfoot?
- Nighttime wear only from the start
- 23 hours per day for approximately 3 months, then nighttime and nap-time wear until age 4 to 5 (Correct answer)
- Continuous wear for 5 years
- Wear only during physical activity for 1 year
Correct answer: 23 hours per day for approximately 3 months, then nighttime and nap-time wear until age 4 to 5
The Ponseti protocol requires 23 hours per day of foot abduction bracing for approximately 3 months post-casting, transitioning to nighttime and nap-time wear (approximately 12 to 14 hours/day) until age 4 to 5 to prevent relapse.
COF Pediatric Orthotics 2
What hip flexion angle is typically maintained by a Pavlik harness during DDH treatment?