Orthotics CPM Study Guide 2024-2025. Questions & Correct, Verified Answers. Graded A+, Exams of Nursing

Download Orthotics CPM Study Guide 2024-2025. Questions & Correct, Verified Answers. Graded A+ and more Exams Nursing in PDF only on Docsity! Orthotics CPM Study Guide 2024-2025. Questions & Correct, Verified Answers. Graded A+ 3-Point Force System for Correction of Valgus Weakness/Deformity - ANSProximal counterforce: Medially directed along the proximal lateral calf. Corrective force: Laterally directed force at medial supra or infra malleolus. Distal counterforce: Medially directed force along the 5th metatarsal. 3-Point Force System for DF Weakness - ANSProximal force: Anteriorly directed force at calf Counter force: Posterior and distal directed forces at instep. Distal force: Superiorly directed force at the metatarsal heads. 3-Point Force System for PF Weakness - ANSProximal force: Posteriorly directed force at proximal tibia. Counter force: Anteriorly and proximally directed force at heel. Distal force: Distally directed force at metatarsal head. 3-Point Force System for Varus Weakness/Deformity - ANSProximal counterforce: Laterally directed force at proximal medial calf. Corrective force: Medially directed force at lateral supra or infra malleolus. Distal counterforce: Laterally directed force along the medial first metatarsal (encapsulate 1st metatarsal head). A patient utilizing a metal and leather KAFO with drop locks and double action ankle joints has complaints of feeling unsteady and frequently trips when going down ramps. What adjustments can be made to correct this? - ANS-Allow for PF moment at ankle. -Provide DF assist. -Add a cushion heel to shoe. Adam's Forward Bending Test - ANSMost common test for scoliosis. Have patient stand with feet shoulder width apart and bend at hips with arms hanging. Typically, you'll see a rib hum, indicating that there is scoliosis. AFO Casting - ANS---------- AFO Casting Procedure - ANS-EXPLAIN procedure to patient! Warn about cast saw noise! -Apply stockinette. -Mark landmarks. -Apply rubber tubing (tape on or cut slits in stockinette). -Wrap in casting material, making sure to encapsulate fibular head-Position foot. -Draw line along cut strip and draw horizontal lines. -Use cast saw to remove cast. -Clean patient's limb, assist with donning shoes/socks if needed. -Seal cast and put name on it. -Clean area. -Answer questions. AFO Considerations for Hyperextension - ANS-May be controlled by providing a longer proximal trim line, but making sure not to impinge the fib head/neck. -Posterior stop can be used to block plantarflexion, decreasing knee extension. -Initially set up in 3-4 degrees of DF to promote knee flexion. -Shorten foot plate first to sulcus, then met length to promote flexion through mid foot, promoting knee flexion. AFO Landmarks - ANS-Fibular head -Fibular neck -Malleoli -Calcaneal tuberosity, if prominent -Base of 5th metatarsal Axis: Palmar aspect of first CMC joint. *Starting position should be where the patient feels most comfortable at resting* Cobb Angle - ANS1) Find the proximal most tilted vertebra and draw a line on superior aspect. 2) Find the distal most tilted vertebra and draw a line on the inferior aspect. Columns of the Spine - ANSAnterior: Includes anterior 2/3 of vertebral body Middle: Includes posterior 1/3 of vertebral body Posterior: Included vertebral arch Compensated vs. Decompensated - ANSCompensated: Secondary curve above or below major curve. Head appears to be midline over pelvis and shoulders are level. Decompensated: The major curve is greater than the secondary curve (if there is one). Shoulders are not level and head is shifted (C7 is not directly above S1). Consideration for AFO for Valgus Weakness/Deformity - ANS-Excessive Pronation and/or valgus relating to the ankle often have these related deviations: -Excessive forefoot abduction. -Calcaneal valgus. -1st metatarsal head discomfort/callus. -When designing an AFO, it may be prudent to encapsulate the 5th metatarsal head to prevent excessive forefoot abduction. -Adding a medial Sabolich tab can help reduce valgus. Considerations for AFO for Varus Weakness/Deformity - ANS-Excessive supination and/or varus relating to the ankle often have these related deviations: -Excessive forefoot adduction. -Calcaneal varus-5th metatarsal head discomfort/callus. -When designing an AFO, encapsulating the 1st metatarsal head may be beneficial. -Adding a lateral supra-malleolar Sabolich tab can help to reduce varus. Derotation Pad - ANSAttempts to derotate the spine require posterior and anterior pads, as well as fixation of the pelvis below and counter-rotation of the thorax above. DIP Extension - ANSROM: 0-30 Stationary Arm: Midline of middle phalanx. Movable Arm: Midline of distal phalanx. Axis: Dorsal aspect of DIP joint. DIP Flexion - ANSROM: 0-70 Stationary Arm: Midline of middle phalanx. Movable Arm: Midline of distal phalanx. Axis: Dorsal aspect of DIP joint. Distal Humeral Fx - ANSSarmiento humeral fracture brace with: -Medial/lateral elbow hinges to maintain primary elbow motion, while preventing varus, valgus, and translator motions. -Distal forearm cuff serves as the distal point of attachment for the hinges and provides a long lever arm. Drop Foot - ANSPresentation: Inability to provide sufficient DF Common causes: -CVA -Stroke -MS -Weak dorsiflexors Elbow Flexion/Extension - ANSROM: 0-145 (Flexion) ROM: 0-0 (Extension) Stationary Arm: In line with lateral midline of humerus. Movable Arm: Lateral midline of radius using radial styloid as reference. Axis: Lateral epicondyle of humerus. Equinovarus - ANSPresentation: Excessive plantarflexion and varus. Lacks heel contact at initial contact. Common causes: -Spastic hemiplegia (CVA, CP) Foot Slap - ANSPresentation: The foot makes an audible slapping noise as the foot progresses quickly/uncontrolled towards the floor. Common causes: -Weak dorsiflexors -Hypotonia Gait Analysis: - ANS------------ General Spinal Measurements - Circumferences - ANS-Axilla -Chest -Xyphoid -Waist -ASIS -Trochanter (or 1" above) -Bra size, if required General Spinal Measurements - Lengths - ANSAll measurements take to waist Superior: Stationary Arm: Lateral midline of pelvis. Movable Arm: Lateral midline of femur using the lateral epicondyle as reference. Axis: Greater trochanter. *Test ROM in SUPINE position* Hip Hike - ANSPresentation: Excessive upward rotation of hip. Common causes: -Compensating for weakness of hip flexors and knee flexors Hip Internal Rotation - ANSROM: 0-35 Stationary Arm: Perpendicular to floor or parallel to table. Movable Arm: In line with anterior midline of lower leg. Axis: Anterior aspect of patella. *Test ROM in SEATED position. Lower leg will move laterally for internal hip rotation* Horizontal Shoulder Abduction/Adduction - ANSROM: 0-90 (Abduction) ROM: 0-30 (Adduction) Stationary Arm: Parallel over shoulder towards neck. Movable Arm: Midline of humerus. Axis: Acromion process. *Start measuring with arms and goniometer at 90 degrees* How can you correct excessive genu varum/valgum after fabrication of a KAFO? - ANS-Add a pullover strap attached just above or below the knee joint axis. -Add increased padding (if there's space) at KC or just above/below. Adding the padding above/below reduces risk of skin breakdown, but isn't possible with some designs. How to find waist on x-ray? - ANSDraw a line between L2 and L3. How would you fabricate the AFO section of a KAFO for a patient presenting with excessive varus moment? - ANSPlastic KAFO: -Sabolich tab just proximal to lateral malleolus. -Encapsulate the medial 1st metatarsal head to complete 3-point force system. Conventional Metal/Leather KAFO: -Padded T-strap attached laterally with medial chafe. Idiopathic Scoliosis - ANS-Cause is unknown -Most common type of scoliosis -Often presents with an "s" or "c" type of lateral curvature -Usually has a rotational component as well Inadequate Push Off - ANSPresentation: Lack of propulsion at pre-swing into initial swing (leads to short step length on contralateral side). Common causes: -Weak plantarflexors -Pain in forefoot -Poor ROM Indications for Full Length Foot Plate - ANSUse only when indicated, because donning/doffing shoes is much easier without it. Use when: -Clawing toes, hammer toes, or toe grasp are present (to improve comfort and ease shoe donning) -Midfoot Fx -Tone or spasticity present (to reduce risk of inducing tone with quick stretch) KAFO Knee Joint Alignment - ANSSagittal plane: the bisection of the adductor tubercle and medial tibial plateau. Coronal plane: 60% anterior/40% posterior. KAFOs - ANS--------- Knee Extension - ANSROM: 0-0 (If greater than 5 degrees in adults = genu recurvatum. Up to 10 degrees of knee hyperextension may be seen in kids) Stationary Arm: Lateral midline of femur using the greater trochanter as reference. Movable Arm: In line with midline of fibula. Axis: Lateral epicondyle of femur. *For hamstrings length, measure with the hip flexed to 90 degrees o measure knee extension ROM* Knee Flexion - ANSROM: 0-140 Stationary Arm: Lateral midline pf femur using the greater trochnater as reference. Movable Arm: In line with midline of fibula. Axis: Lateral epicondyle of femur. *For rectus femoris length, measure with the hip in 0 degrees of flexion for knee flexion* Lordosis - ANSNormal lordosis: ~15 degrees from L5-S1When measuring lumbar lordosis, place the goniometer halfway between T11/12 and S1/2. Lumbar Pad Placement - ANSStarts at apical rib of lumbar curve and connects to waist roll and then connect bottom of waist roll to inferior endlimit of that curve. MCP Abduction/Adduction - ANSROM: 0-20 Stationary Arm: On midline of metacarpal. Movable Arm: Midline of proximal phalanx. Axis: Dorsal aspect of MCP joint. *No known ROM for adduction* MCP Extension - ANSROM: 0-45 -Weak inverters -Genu valgum Pronation - ANSROM: 0-90 Stationary Arm: Parallel to anterior midline of humerus. Movable Arm: Across dorsal aspect of wrist proximal to styloid processes of radius and ulna. Axis: Lateral to ulnar styloid process. *Start measuring with elbows by the patient's side* Proximal Humeral Fx - ANSSarmiento orthosis: The orthosis may not contain the fracture, but compression of the biceps and triceps with the orthosis can stabilize the fracture. Radial Deviation - ANSROM: 0-20 Stationary Arm: Midline of forearm. Movable Arm: In line with 3rd metacarpal. Axis: Capitate. Rib Window - ANSThe window on the a Boston brace goes from one rib level above apical rib down to waist (or lumbar pad). Risser Scores - ANSThe Risser is a grading system and correlates to the amount of iliac crest ossification. 0 = no ossification 1 = 25% of growth (beginning of skeletal maturity) 2 = 50% of growth (considerable growth remaining) 3 = 75% of growth (minimal growth remaining) 4 = 100% growth (end of growth) 5 = The iliac apophysis is fused to the iliac crest (end of growth) Risser Sign - ANSIndication of skeletal maturity. On a radiograph of the iliac crests, divide the crest into four equal parts. There is a line of ossification that can be seen along the crest. The location of the line within the four parts determines the score. For Risser Scores 0 and 5, there will not be a line (no ossification yet for 0 and completely fused for 5) ROM & Goniometer Placements - ANS----------- Rotational Deformity - ANSThe spinous processes rotate towards the concavity and the vertebral body towards the convexity. Most scoliotic curves have a rotational component. Scoliosis - ANS------------- Semi-Solid AFO Trimlines - ANSProximal: 1.5" distal to fibular head or neck. Ankle: Through the center of the malleoli, but will need plenty of relief to avoid impingement. Metatarsal heads: Keep trimlines proximal unless varus or valgus modifications are needed. Foot plate: Sulcus or full length. Shoulder Abduction/Adduction - ANSROM: 0-180 (Abduction) ROM: 0-0 (Adduction) Stationary Arm: Parallel to spinous processes of the vertebral column. Movable Arm: Lateral midline of humerus. Axis: Posterior aspect of acromion process. Shoulder Extension - ANSROM: 0-45 Stationary Arm: In line with midaxillary area of throax. Movable Arm: Lateral midline of humerus using lateral epicondyle as reference. Axis: Close of acromion process. Shoulder Flexion - ANSROM: 0-180 Stationary Arm: In line with midaxillary area of thorax. Movable Arm: Lateral midline of humerus using lateral epicondyle as reference. Axis: Close to acromion process. Shoulder Internal Rotation/External Rotation - ANSROM: 0-70 (Internal Rotation) ROM: 0-90 (External Rotation) Stationary Arm: Parallel to floor. Movable Arm: In line with ulna using the olecrannon process as reference. Axis: Over olecrannon process. Solid AFO Trimlines - ANSProximal: 1.5" distal to fibular head and neck. Ankle: Anterior to malleoli. Metatarsal heads: Keep trimline proximal to reduce bulk in shoe unless otherwise needed. Foot plate: Sulcus length or full length. May require varus or valgus modfications. Spinal: - ANS---------- Steppage Gait - ANSPresentation: Excessive knee and hip flexion, potential vaulting on contralateral side. Common causes: -Lack of proprioception -Weak dorsiflexors Supination - ANSPresentation: Excessive contact with lateral border of foot throughout stance. Usually associated with calcaneal varus, plantarflexion, and forefoot adduction. Common causes: -Excessively high MLA -Genu varum