CTO Device Fitting & Adjustment 5 — Questions and Answers
Question 1: During fitting of a thoracic extension orthosis (Jewett brace), the sternal pad should be positioned to apply pressure at:
- The xiphoid process
- The manubrium only
- The sternal body between the manubrium and xiphoid (Correct answer)
- The clavicles bilaterally
Correct answer: The sternal body between the manubrium and xiphoid
The sternal pad of a Jewett brace should contact the sternal body to create an anterior force that counteracts thoracic flexion without injuring the xiphoid.
Question 2: A pediatric patient with cerebral palsy wearing a solid AFO develops a pressure sore over the navicular. The MOST appropriate immediate intervention is:
- Discontinue AFO use for four weeks
- Spot heat and relieve the AFO shell directly over the navicular (Correct answer)
- Add extra padding over the navicular
- Replace the AFO with a dynamic AFO
Correct answer: Spot heat and relieve the AFO shell directly over the navicular
Spot heating and relieving (bubbling out) the thermoplastic shell over the navicular removes direct pressure at the source of the wound.
Question 3: A patient wearing a new wrist orthosis for carpal tunnel syndrome reports that the thumb feels numb and the thenar eminence is blanching. The technician should:
- Tell the patient this is a normal break-in symptom
- Check and relieve the thenar bar or palmar flange pressing on the thenar area (Correct answer)
- Replace with a soft neoprene wrist wrap
- Increase the wrist extension angle
Correct answer: Check and relieve the thenar bar or palmar flange pressing on the thenar area
Blanching and numbness of the thenar area indicates the palmar flange or thenar bar is compressing the thenar eminence and possibly the recurrent motor branch of the median nerve.
Question 4: When setting the height of footplates in a wheelchair-mounted lower extremity orthosis, the footplate should be set so that the hip flexion angle is approximately:
- 0-10 degrees (nearly extended)
- 45-60 degrees
- 90-100 degrees (Correct answer)
- 110-120 degrees
Correct answer: 90-100 degrees
A hip flexion angle of 90-100 degrees places the hip in a functional seated position that minimizes pressure and maintains pelvic stability.
Question 5: An adult patient fitted with a functional position hand orthosis is observed with the thumb adducted flat against the palm. The correction requires:
- Increasing the wrist extension angle
- Adding or adjusting a C-bar or thumb post to maintain palmar abduction (Correct answer)
- Reducing the intrinsic-plus finger position
- Shortening the radial border of the orthosis
Correct answer: Adding or adjusting a C-bar or thumb post to maintain palmar abduction
A C-bar or thumb post maintains the first web space open in palmar abduction, which is essential for opposition and functional grip.
Question 6: After delivering a new scoliosis orthosis, the first recommended wear-schedule for skin adaptation is typically:
- Full 23-hour wear immediately
- Gradual increase starting with 2-4 hours per day and progressing over 1-2 weeks (Correct answer)
- Wearing only at night for the first month
- Alternating days on and off for three weeks
Correct answer: Gradual increase starting with 2-4 hours per day and progressing over 1-2 weeks
A gradual break-in schedule allows the skin to adapt to pressure areas and helps identify problem zones before full-time wear is initiated.
Question 7: When evaluating a patient with a new hip abduction orthosis for developmental dysplasia, the correct hip position maintained by the device is typically:
- 0 degrees abduction, 30 degrees flexion
- 45 degrees abduction, 90-100 degrees flexion (Correct answer)
- 20 degrees abduction, 0 degrees flexion
- 60 degrees abduction, 45 degrees flexion
Correct answer: 45 degrees abduction, 90-100 degrees flexion
A position of 45 degrees abduction and 90-100 degrees flexion (Pavlik harness position) centers the femoral head in the acetabulum for optimal remodeling in DDH.
CTO Device Fitting & Adjustment 5
During fitting of a thoracic extension orthosis (Jewett brace), the sternal pad should be positioned to apply pressure at: