COF Pediatric Orthotics 4 — Questions and Answers
Question 1: A child with cerebral palsy demonstrates excessive knee flexion during stance phase. Which orthotic intervention is most appropriate?
- Ground reaction AFO (GRAFO) (Correct answer)
- Posterior leaf spring AFO
- Supramalleolar orthosis (SMO)
- University of California Biomechanics Laboratory (UCBL) insert
Correct answer: Ground reaction AFO (GRAFO)
A ground reaction AFO creates an extension moment at the knee during stance, directly addressing crouch gait caused by excessive knee flexion.
Question 2: When fitting a Pavlik harness for developmental dysplasia of the hip (DDH), what hip position should be maintained?
- 90° flexion and 45–60° abduction (Correct answer)
- 45° flexion and 90° abduction
- Full extension and neutral rotation
- 60° flexion and neutral abduction
Correct answer: 90° flexion and 45–60° abduction
The Pavlik harness positions the hip in approximately 90° of flexion and 45–60° of abduction to seat the femoral head in the acetabulum.
Question 3: Which orthosis is most commonly used for Legg-Calvé-Perthes disease to maintain femoral head containment?
- Scottish Rite orthosis (Correct answer)
- Denis Browne bar
- Rhino cruiser abduction brace
- Wheaton brace
Correct answer: Scottish Rite orthosis
The Scottish Rite (Atlanta) orthosis holds the hips in abduction to contain the femoral head within the acetabulum while allowing ambulation.
Question 4: A 4-year-old with myelomeningocele at L3–L4 has active hip flexors and quadriceps but no ankle control. What is the most likely appropriate orthosis?
- AFO with free ankle (Correct answer)
- KAFO with locked knee
- HKAFO
- SMO
Correct answer: AFO with free ankle
With preserved quadriceps and hip flexors but absent ankle musculature, an AFO providing ankle-foot control while allowing knee function is most appropriate.
Question 5: Scoliosis bracing with a TLSO is generally indicated when the Cobb angle falls within which range in a skeletally immature patient?
- 25–40° (Correct answer)
- 10–20°
- 45–55°
- Greater than 60°
Correct answer: 25–40°
Bracing is indicated for curves between 25–40° Cobb angle in skeletally immature patients to halt progression without surgery.
Question 6: Which brace design for adolescent idiopathic scoliosis (AIS) is designed to be worn only at night?
- Charleston bending brace (Correct answer)
- Milwaukee brace
- Boston brace
- Wilmington TLSO
Correct answer: Charleston bending brace
The Charleston bending brace is a nighttime brace that overcorrects the curve while the patient sleeps, requiring only 8–10 hours of wear.
Question 7: In pediatric orthotics, 'Risser sign' is used primarily to assess what?
- Skeletal maturity of the iliac crest apophysis (Correct answer)
- Degree of vertebral rotation
- Hip acetabular depth
- Tibial torsion severity
Correct answer: Skeletal maturity of the iliac crest apophysis
The Risser sign grades iliac crest apophysis ossification (0–5) to estimate remaining skeletal growth potential, which guides bracing decisions.
COF Pediatric Orthotics 4
A child with cerebral palsy demonstrates excessive knee flexion during stance phase.
Which orthotic intervention is most appropriate?