Gait, Balance, and Orthotics Flashcards

A patient with a right transtibial amputation demonstrates lateral trunk bending toward the prosthetic side during stance. What is the MOST likely cause?

Answer: Prosthetic shank too long

Lateral trunk lean toward the prosthetic side during stance is most commonly caused by a prosthetic shank that is too long, causing the patient to lean over it.

During the swing phase of gait, a patient with a below-knee brace (AFO) exhibits toe drag. Which AFO adjustment would BEST correct this?

Answer: Add a dorsiflexion assist spring

A dorsiflexion assist spring in the AFO helps lift the foot during swing phase, preventing toe drag caused by inadequate dorsiflexion.

Which Berg Balance Scale score BEST indicates a high fall risk in a community-dwelling older adult?

Answer: Below 41

A Berg Balance Scale score below 41 is associated with a significantly high fall risk in older adults.

A patient with L4 nerve root dysfunction will MOST likely require which orthotic device?

Answer: AFO with dorsiflexion assist

L4 innervates the tibialis anterior (dorsiflexors); weakness causes foot drop, best managed with a dorsiflexion-assist AFO.

During quiet standing, which system provides the PRIMARY sensory input for balance in a well-lit environment on a firm surface?

Answer: Proprioceptive/somatosensory

On a firm, stable surface, the proprioceptive/somatosensory system provides the dominant input for balance control.

A patient demonstrates a steppage gait pattern. Which muscle group is MOST likely weak?

Answer: Ankle dorsiflexors

Steppage gait (exaggerated hip and knee flexion during swing) compensates for weak ankle dorsiflexors causing foot drop.

Which outcome measure uses a 6-item test including single-leg stance and tandem walking to assess fall risk?

Answer: Tinetti POMA

The Tinetti Performance-Oriented Mobility Assessment (POMA) includes balance and gait subscales, and is widely used to assess fall risk in older adults.

A patient post-CVA walks with the pelvis dropping on the unaffected side during stance on the affected leg. This is MOST consistent with weakness of which muscle?

Answer: Affected hip abductors

Contralateral pelvic drop (Trendelenburg sign) during single-limb stance on the affected side indicates weakness of the ipsilateral hip abductors.

Which component of a KAFO is MOST important for a patient with severe quadriceps weakness who needs to lock the knee during stance?

Answer: Drop-lock knee joint

A drop-lock (ring-lock) knee joint mechanically locks the knee in full extension, providing stability for patients with severe quadriceps weakness.

During the Romberg test with eyes closed, a patient sways excessively and nearly falls. This finding MOST suggests dysfunction in which system?

Answer: Proprioceptive/vestibular system

The Romberg test isolates vestibular and proprioceptive contributions by removing vision; a positive result implicates somatosensory or vestibular dysfunction.

A patient with Parkinson's disease demonstrates festinating gait. Which description BEST characterizes this deviation?

Answer: Shuffling, accelerating steps with forward trunk lean

Festinating gait in Parkinson's disease is characterized by short, shuffling steps that accelerate involuntarily with a forward-flexed trunk posture.

The normal cadence for an adult walking at comfortable speed is approximately:

Answer: 90–120 steps/minute

Normal comfortable walking cadence in adults is approximately 90–120 steps per minute (steps, not strides).

Which type of AFO is MOST appropriate for a patient who needs mediolateral ankle stability but requires some sagittal plane motion for functional activities?

Answer: Articulated AFO with motion stops

An articulated AFO with adjustable motion stops allows some controlled sagittal plane movement while providing mediolateral stability.

During gait analysis, loading response (initial double support) is characterized by which combination of joint events?

Answer: Hip flexion, knee flexion, ankle plantarflexion

During loading response, the hip flexes slightly, the knee flexes 15–20° for shock absorption, and the ankle plantarflexes to lower the foot to the floor.

A patient with a T6 complete spinal cord injury uses a KAFO with forearm crutches. Which gait pattern is MOST energy-efficient for this patient over short distances?

Answer: Swing-through gait

Swing-through gait is the fastest and most energy-efficient pattern for patients with thoracic SCI using bilateral KAFOs and crutches, despite its high-energy demands.

Which balance assessment tool specifically examines anticipatory postural adjustments and reactive balance strategies under six sensory conditions?

Answer: Sensory Organization Test (Computerized Dynamic Posturography)

The Sensory Organization Test (SOT), part of computerized dynamic posturography, systematically assesses balance under six conditions that isolate and manipulate visual, vestibular, and somatosensory inputs.

A patient with a painful right knee uses a cane. On which side should the cane be held and why?

Answer: Left side to reduce hip abductor demand on the right

The cane is held on the contralateral (left) side so that it contacts the ground simultaneously with the affected leg, reducing the load through the right knee joint.

Which gait deviation is MOST commonly associated with excessive foot pronation in the stance phase?

Answer: Medial collapse of the knee (dynamic valgus)

Excessive foot pronation during stance causes internal tibial rotation, which is transmitted proximally, resulting in dynamic knee valgus.

A reciprocal gait orthosis (RGO) is MOST appropriate for which patient population?

Answer: Patients with thoracic-level paraplegia for household ambulation

The RGO enables reciprocal walking in patients with thoracic paraplegia by linking the hip joints with cables so hip extension on one side drives flexion on the other.

The Timed Up and Go (TUG) test uses what threshold score to identify community-dwelling older adults at increased fall risk?

Answer: Greater than 12 seconds

A TUG score greater than 12 seconds is commonly used to identify older community-dwelling adults at increased fall risk.