COT Visual Assessment 3 — Questions and Answers
Question 1: During a visual assessment of a patient's gait, you notice the patient leans their trunk laterally toward the stance limb during the loading response phase. This compensatory pattern most likely indicates weakness in which muscle group?
- Hip abductors on the stance side (Correct answer)
- Hip flexors on the swing side
- Ankle plantar flexors on the stance side
- Knee extensors on the stance side
Correct answer: Hip abductors on the stance side
Lateral trunk lean toward the stance limb (Trendelenburg gait) is a compensatory strategy used when the hip abductors (primarily gluteus medius) are weak. By shifting the center of mass over the stance limb, the patient reduces the demand on the abductors to keep the pelvis level during single-limb support.
Question 2: When performing a visual postural assessment in the sagittal plane, a therapist observes increased thoracic kyphosis combined with forward head posture. Which of the following cervical spine adaptations is MOST commonly associated with this finding?
- Upper cervical flexion with lower cervical extension
- Upper cervical extension with lower cervical flexion (Correct answer)
- Uniform cervical flexion throughout all segments
- Lateral cervical flexion toward the dominant side
Correct answer: Upper cervical extension with lower cervical flexion
With forward head posture arising from thoracic kyphosis, the lower cervical spine tends to flex (following the thoracic curve), while the upper cervical spine extends to maintain a horizontal gaze. This 'craniovertebral extension' pattern is the classic adaptation seen with this postural deviation.
Question 3: A COT candidate is observing a patient performing a unilateral overhead reach task. They note the patient demonstrates early scapular elevation and reduced posterior tilting on the reaching side. This scapular movement pattern most directly suggests dysfunction in which muscle?
- Serratus anterior
- Lower trapezius (Correct answer)
- Pectoralis minor
- Rhomboid major
Correct answer: Lower trapezius
The lower trapezius is primarily responsible for scapular depression and posterior tilting during overhead elevation. Deficiency in this muscle leads to compensatory early and excessive scapular elevation and insufficient posterior tilt, reducing subacromial space and compromising optimal glenohumeral mechanics.
Question 4: During visual assessment of a patient's standing posture, the therapist notes that the patient's right iliac crest is higher than the left. In the frontal plane, which of the following lateral deviations of the lumbar spine would MOST likely accompany this finding?
- Lumbar lateral flexion concave toward the left
- Lumbar lateral flexion concave toward the right (Correct answer)
- No lumbar curve change — only pelvic deviation occurs
- Lumbar lateral flexion equally distributed bilaterally
Correct answer: Lumbar lateral flexion concave toward the right
When the right iliac crest is elevated (right pelvic hike or left pelvic drop), the lumbar spine typically develops a lateral curve that is concave toward the right (a right lateral convexity) to keep the trunk centered over the base of support. The concavity faces the elevated side.
Question 5: A therapist performing a visual assessment of stair descent observes a patient who demonstrates excessive knee valgus on the right during the loading phase on each step. Which combination of findings would BEST support a proximal cause for this movement fault?
- Reduced ankle dorsiflexion range and tibial varum
- Hip internal rotation with ipsilateral pelvic drop and weak hip abductors (Correct answer)
- Pes planus and forefoot pronation on the right
- Tight iliotibial band with lateral knee pain
Correct answer: Hip internal rotation with ipsilateral pelvic drop and weak hip abductors
Proximal contributors to knee valgus during weight-bearing tasks include hip internal rotation and contralateral (or ipsilateral) pelvic drop, both of which indicate hip abductor and external rotator weakness. These proximal deficits cause the femur to adduct and internally rotate, collapsing the knee medially regardless of foot position.
Question 6: During a standing visual assessment, a COT observes that a patient has a bilateral 'swayback' posture characterized by a posterior shift of the pelvis relative to the feet and an anterior shift of the thorax. Compared to an ideal plumb line alignment, where would you expect the patient's lumbar spine to fall?
- Anterior to the plumb line with increased lordosis
- Posterior to the plumb line with reduced lordosis or flexion (Correct answer)
- Directly on the plumb line with no lumbar deviation
- Anterior to the plumb line with reduced lordosis
Correct answer: Posterior to the plumb line with reduced lordosis or flexion
In swayback posture, the pelvis shifts posteriorly and the hips move forward in front of the plumb line, while the thorax shifts anteriorly. This creates a long, flat (or slightly flexed) lumbar curve — the lumbar spine falls posterior to the plumb line and lumbar lordosis is reduced, unlike in hyperlordosis where the lumbar spine is anterior with an increased curve.
COT Visual Assessment 3
During a visual assessment of a patient's gait, you notice the patient leans their trunk laterally toward the stance limb during the loading response phase.
This compensatory pattern most likely indicates weakness in which muscle group?