COF Pediatric Orthotics 5 — Questions and Answers
Question 1: A toddler presents with tibial torsion causing in-toeing gait. When is orthotic intervention with a Denis Browne bar typically indicated?
- It is rarely indicated; most cases resolve spontaneously by age 8 (Correct answer)
- Immediately upon diagnosis regardless of severity
- Only after surgical consultation at age 3
- When the thigh-foot angle exceeds 30° at any age
Correct answer: It is rarely indicated; most cases resolve spontaneously by age 8
Internal tibial torsion usually resolves spontaneously during normal growth, and orthotic devices like the Denis Browne bar are no longer routinely recommended.
Question 2: Which material property is most critical when selecting thermoplastic for a pediatric AFO that must flex during push-off?
- Flexibility and fatigue resistance (Correct answer)
- Maximum rigidity
- High melting temperature
- Radiopacity
Correct answer: Flexibility and fatigue resistance
A dynamic pediatric AFO requires a material that flexes under load and resists fatigue cracking to maintain function over repeated cycles of use.
Question 3: When fabricating a TLSO for an infant with congenital scoliosis, what casting position is recommended to achieve optimal correction?
- Derotation and side-bending away from the convexity (Correct answer)
- Neutral spinal position with lumbar lordosis
- Forward flexion with arms elevated
- Side-bending toward the convexity
Correct answer: Derotation and side-bending away from the convexity
Casting in derotation and side-bending toward the concavity (away from the convexity) maximizes three-dimensional spinal correction during brace fabrication.
Question 4: A child with Down syndrome presents with hypermobility and pes planus causing fatigue and pain. The first-line orthotic choice is typically:
- Custom supramalleolar orthosis (SMO) (Correct answer)
- Rigid KAFO
- Standard OTC arch support
- Patellar tendon-bearing brace
Correct answer: Custom supramalleolar orthosis (SMO)
A custom SMO provides medial-lateral stability at the subtalar joint while accommodating the hypermobility common in Down syndrome, improving alignment and reducing fatigue.
Question 5: For a child fitted with a Resting Hand Splint following spastic hemiplegia, what wrist and finger position should be maintained?
- Wrist 20–30° extension, fingers and thumb in functional alignment (Correct answer)
- Full wrist flexion and finger extension
- Wrist neutral, fingers fully extended
- Wrist 45° extension, fingers fully flexed
Correct answer: Wrist 20–30° extension, fingers and thumb in functional alignment
A resting hand splint for spasticity positions the wrist in 20–30° extension with fingers and thumb in gentle abduction to prevent contracture while allowing some functional posture.
Question 6: Which growth-related consideration is unique to pediatric orthotic fitting compared to adult fitting?
- Frequent refabrication or adjustments are required as the child grows (Correct answer)
- Children require heavier materials for durability
- Pediatric devices never need realignment
- Skeletal maturity eliminates the need for follow-up
Correct answer: Frequent refabrication or adjustments are required as the child grows
Children grow rapidly, requiring orthotics to be monitored, adjusted, or replaced regularly to maintain proper fit and avoid skin breakdown or pressure sores.
Question 7: A school-aged child with spina bifida at the thoracic level requires ambulation for exercise purposes. Which assistive orthotic system is most appropriate?
- Parapodium or swivel walker (Correct answer)
- AFO alone
- KAFO with free knee
- Knee immobilizer
Correct answer: Parapodium or swivel walker
A parapodium or swivel walker provides full-trunk and lower-extremity support for thoracic-level spina bifida, enabling upright stance and therapeutic ambulation.
COF Pediatric Orthotics 5
A toddler presents with tibial torsion causing in-toeing gait.
When is orthotic intervention with a Denis Browne bar typically indicated?