CTO Device Fitting & Adjustment 3 — Questions and Answers
Question 1: A patient with a new lumbar corset complains of difficulty breathing when the corset is fastened. The FIRST corrective action should be:
- Prescribe a shorter corset
- Reassess the superior trim line and ensure it clears the rib cage (Correct answer)
- Add rigid stays to improve structure
- Refer immediately to the prescribing physician
Correct answer: Reassess the superior trim line and ensure it clears the rib cage
The superior trim line of a lumbar corset must clear the rib cage to prevent restriction of respiratory expansion.
Question 2: When performing a static alignment check of a new AFO-shoe combination, the technician observes that the patient stands with the foot excessively supinated. The adjustment should be to:
- Add a lateral heel wedge inside the shoe
- Add a medial heel wedge inside the shoe (Correct answer)
- Increase dorsiflexion angle of the AFO
- Shorten the lateral upright
Correct answer: Add a medial heel wedge inside the shoe
A medial heel wedge shifts weight laterally, correcting excessive supination (varus) foot position during standing.
Question 3: For a patient fitted with a cervical collar for cervical strain, the correct position for the chin is:
- Resting below the chin shelf
- Resting on the chin shelf with head in neutral (Correct answer)
- Elevated above the collar edge
- Flexed forward against the anterior panel
Correct answer: Resting on the chin shelf with head in neutral
The chin should rest on the chin shelf with the head in neutral alignment to maintain proper cervical positioning and support.
Question 4: A patient using a dynamic elbow orthosis for post-burn contracture presents with skin breakdown at the medial epicondyle. The technician should:
- Discontinue device use permanently
- Pad the area and relieve pressure by modifying the proximal cuff trim line (Correct answer)
- Apply a thick layer of adhesive tape over the area
- Switch to a static progressive orthosis
Correct answer: Pad the area and relieve pressure by modifying the proximal cuff trim line
Modifying the proximal cuff trim line to relieve pressure over the medial epicondyle while adding padding addresses the mechanical cause of skin breakdown.
Question 5: During gait analysis with bilateral KAFOs, the patient exhibits hip hiking on one side. This most commonly indicates:
- The contralateral KAFO is too long
- The ipsilateral KAFO limb is effectively longer than the other (Correct answer)
- Inadequate knee lock mechanism
- Hip flexor weakness unrelated to the orthosis
Correct answer: The ipsilateral KAFO limb is effectively longer than the other
Hip hiking occurs when the orthotic limb is functionally too long, requiring the patient to hike the hip to allow foot clearance during swing.
Question 6: Which tool is MOST commonly used to check brim fit and contact of a custom-molded lower extremity orthosis?
- Goniometer
- Tape measure
- Pressure indicator film or lotion transfer (Correct answer)
- Digital caliper
Correct answer: Pressure indicator film or lotion transfer
Pressure indicator film or lotion transfer tests reveal actual contact areas between the orthosis and limb, identifying high-pressure zones.
Question 7: When fitting a scoliosis TLSO (Boston brace), the apical pad should be positioned:
- Above the apex of the curve
- Directly over the apex of the scoliotic curve (Correct answer)
- Below the apex of the curve
- At the iliac crest level regardless of curve location
Correct answer: Directly over the apex of the scoliotic curve
The apical pad exerts a three-point force system correction and must be placed directly over the curve's apex to provide maximum corrective force.
CTO Device Fitting & Adjustment 3
A patient with a new lumbar corset complains of difficulty breathing when the corset is fastened.
The FIRST corrective action should be: