ORTHOTIC WRITTEN SIMULATION EXAM (REAL EXAM 2026/2027) | COMPLETE QUESTIONS
AND CORRECT ANSWERS | BRAND NEW VERSION!!!
Question 1
A patient presents with a spinal cord injury resulting in limited movement of the head and neck,
paralysis of the arms, hands, trunk, and legs, and requires assistance for breathing. Which level
of injury is most likely?
A) C1-C3
B) C4
C) C5
D) C6
E) T1
Correct Answer: A) C1-C3
Rationale: Injuries at the C1-C3 level are the most severe, typically resulting in limited head
and neck movement, total paralysis of the extremities and trunk, and significant impairment of
autonomic functions like breathing and coughing, often requiring ventilator support.
Question 2
What is the primary orthotic recommendation for a patient with a C1-C3 spinal cord injury?
A) Tenodesis orthosis
B) Static Hand Orthosis (HO)
C) Powered specialized wheelchair
D) Custom AFO
E) KAFO with offset joints
Correct Answer: C) Powered specialized wheelchair
Rationale: Because C1-C3 injuries result in total paralysis of the limbs and limited head/neck
control, the patient cannot propel a manual chair. A powered specialized wheelchair is necessary
for mobility and independence.
Question 3
,ORTHOTIC WRITTEN SIMULATION EXAM (REAL EXAM 2026/2027) | COMPLETE QUESTIONS
AND CORRECT ANSWERS | BRAND NEW VERSION!!!
Which of the following functions is typically preserved in a C4 spinal cord injury that
distinguishes it from a C3 injury?
A) Elbow flexion
B) Wrist extension
C) Head and neck control; ability to shrug shoulders
D) Full hand function
E) Trunk stability
Correct Answer: C) Head and neck control; ability to shrug shoulders
Rationale: At the C4 level, the patient usually gains control over the head and neck and can
shrug their shoulders (via the trapezius), though they still experience paralysis in the hands,
trunk, and legs.
Question 4
A patient can flex their elbows and turn their palms face down, but has no hand or trunk control.
What is the most likely level of spinal cord injury?
A) C3
B) C4
C) C5
D) C7
E) T1
Correct Answer: C) C5
Rationale: C5 is characterized by the presence of shoulder control and elbow flexion. The
ability to turn the palms down (pronation) is also associated with this level, while distal functions
like wrist and hand movement remain paralyzed.
Question 5
What is a defining characteristic of a C6 spinal cord injury regarding upper extremity
movement?
,ORTHOTIC WRITTEN SIMULATION EXAM (REAL EXAM 2026/2027) | COMPLETE QUESTIONS
AND CORRECT ANSWERS | BRAND NEW VERSION!!!
A) Ability to straighten the elbows
B) Ability to extend the wrists
C) Full finger flexion
D) Total trunk control
E) Ability to abduct the fingers
Correct Answer: B) Ability to extend the wrists
Rationale: C6 is the level where wrist extension is gained. This is a critical functional
milestone as it allows for the use of a tenodesis grip.
Question 6
Which orthotic strategy is most appropriate for a patient with a C6 spinal cord injury?
A) Total assist for all ADLs with no orthosis
B) Utilize natural tenodesis
C) Shoulder Elbow Wrist Hand Orthosis (SEWHO)
D) Ankle Foot Orthosis
E) Spinal jacket (TLSO)
Correct Answer: B) Utilize natural tenodesis
Rationale: Since C6 patients have active wrist extension, they can utilize the natural tenodesis
effect (where wrist extension causes passive finger flexion) to grasp objects. Orthotic
intervention often focuses on enhancing this mechanics.
Question 7
A patient has the ability to shrug shoulders, bend and straighten elbows, and extend the wrists,
but has paralysis of the trunk and legs. What is the level of injury?
A) C5
B) C6
C) C7
, ORTHOTIC WRITTEN SIMULATION EXAM (REAL EXAM 2026/2027) | COMPLETE QUESTIONS
AND CORRECT ANSWERS | BRAND NEW VERSION!!!
D) T1
E) T6
Correct Answer: C) C7
Rationale: At the C7 level, patients regain the ability to extend/straighten their elbows (via the
triceps) as well as extend their wrists, while distal hand and trunk control remain impaired.
Question 8
Which orthotic recommendation is most appropriate for a patient with a C7 spinal cord injury?
A) Powered specialized wheelchair
B) Static Hand Orthosis (HO) with MP extension stop
C) Shoulder Elbow Wrist Hand Orthosis (SEWHO)
D) Reciprocating Gait Orthosis (RGO)
E) Ankle Foot Orthosis (AFO)
Correct Answer: B) Static Hand Orthosis (HO) with MP extension stop
Rationale: Patients with a C7 injury have active elbow extension and wrist extension, allowing
them to utilize a Static Hand Orthosis (HO) with an MP extension stop to harness their own
tenodesis effect for functional grasp.
Question 9
A patient with a spinal cord injury demonstrates full upper extremity muscle function, including
fine motor control and finger dexterity, but exhibits complete trunk and lower extremity
paralysis. Which level of injury is most likely?
A) C6
B) C7
C) C8
D) T1
E) L1
AND CORRECT ANSWERS | BRAND NEW VERSION!!!
Question 1
A patient presents with a spinal cord injury resulting in limited movement of the head and neck,
paralysis of the arms, hands, trunk, and legs, and requires assistance for breathing. Which level
of injury is most likely?
A) C1-C3
B) C4
C) C5
D) C6
E) T1
Correct Answer: A) C1-C3
Rationale: Injuries at the C1-C3 level are the most severe, typically resulting in limited head
and neck movement, total paralysis of the extremities and trunk, and significant impairment of
autonomic functions like breathing and coughing, often requiring ventilator support.
Question 2
What is the primary orthotic recommendation for a patient with a C1-C3 spinal cord injury?
A) Tenodesis orthosis
B) Static Hand Orthosis (HO)
C) Powered specialized wheelchair
D) Custom AFO
E) KAFO with offset joints
Correct Answer: C) Powered specialized wheelchair
Rationale: Because C1-C3 injuries result in total paralysis of the limbs and limited head/neck
control, the patient cannot propel a manual chair. A powered specialized wheelchair is necessary
for mobility and independence.
Question 3
,ORTHOTIC WRITTEN SIMULATION EXAM (REAL EXAM 2026/2027) | COMPLETE QUESTIONS
AND CORRECT ANSWERS | BRAND NEW VERSION!!!
Which of the following functions is typically preserved in a C4 spinal cord injury that
distinguishes it from a C3 injury?
A) Elbow flexion
B) Wrist extension
C) Head and neck control; ability to shrug shoulders
D) Full hand function
E) Trunk stability
Correct Answer: C) Head and neck control; ability to shrug shoulders
Rationale: At the C4 level, the patient usually gains control over the head and neck and can
shrug their shoulders (via the trapezius), though they still experience paralysis in the hands,
trunk, and legs.
Question 4
A patient can flex their elbows and turn their palms face down, but has no hand or trunk control.
What is the most likely level of spinal cord injury?
A) C3
B) C4
C) C5
D) C7
E) T1
Correct Answer: C) C5
Rationale: C5 is characterized by the presence of shoulder control and elbow flexion. The
ability to turn the palms down (pronation) is also associated with this level, while distal functions
like wrist and hand movement remain paralyzed.
Question 5
What is a defining characteristic of a C6 spinal cord injury regarding upper extremity
movement?
,ORTHOTIC WRITTEN SIMULATION EXAM (REAL EXAM 2026/2027) | COMPLETE QUESTIONS
AND CORRECT ANSWERS | BRAND NEW VERSION!!!
A) Ability to straighten the elbows
B) Ability to extend the wrists
C) Full finger flexion
D) Total trunk control
E) Ability to abduct the fingers
Correct Answer: B) Ability to extend the wrists
Rationale: C6 is the level where wrist extension is gained. This is a critical functional
milestone as it allows for the use of a tenodesis grip.
Question 6
Which orthotic strategy is most appropriate for a patient with a C6 spinal cord injury?
A) Total assist for all ADLs with no orthosis
B) Utilize natural tenodesis
C) Shoulder Elbow Wrist Hand Orthosis (SEWHO)
D) Ankle Foot Orthosis
E) Spinal jacket (TLSO)
Correct Answer: B) Utilize natural tenodesis
Rationale: Since C6 patients have active wrist extension, they can utilize the natural tenodesis
effect (where wrist extension causes passive finger flexion) to grasp objects. Orthotic
intervention often focuses on enhancing this mechanics.
Question 7
A patient has the ability to shrug shoulders, bend and straighten elbows, and extend the wrists,
but has paralysis of the trunk and legs. What is the level of injury?
A) C5
B) C6
C) C7
, ORTHOTIC WRITTEN SIMULATION EXAM (REAL EXAM 2026/2027) | COMPLETE QUESTIONS
AND CORRECT ANSWERS | BRAND NEW VERSION!!!
D) T1
E) T6
Correct Answer: C) C7
Rationale: At the C7 level, patients regain the ability to extend/straighten their elbows (via the
triceps) as well as extend their wrists, while distal hand and trunk control remain impaired.
Question 8
Which orthotic recommendation is most appropriate for a patient with a C7 spinal cord injury?
A) Powered specialized wheelchair
B) Static Hand Orthosis (HO) with MP extension stop
C) Shoulder Elbow Wrist Hand Orthosis (SEWHO)
D) Reciprocating Gait Orthosis (RGO)
E) Ankle Foot Orthosis (AFO)
Correct Answer: B) Static Hand Orthosis (HO) with MP extension stop
Rationale: Patients with a C7 injury have active elbow extension and wrist extension, allowing
them to utilize a Static Hand Orthosis (HO) with an MP extension stop to harness their own
tenodesis effect for functional grasp.
Question 9
A patient with a spinal cord injury demonstrates full upper extremity muscle function, including
fine motor control and finger dexterity, but exhibits complete trunk and lower extremity
paralysis. Which level of injury is most likely?
A) C6
B) C7
C) C8
D) T1
E) L1
