Orthotics/Prosthetics/Gait EXAM QUESTIONS AND
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19. The Gross Motor Functional Measure (GMFM) is designed to measure (a) motor changes over time.
(b) quality of motor performance. (c) achievement of motor milestones. (d) only walking, running, and
jumping ability. - ANSWER-19. (a) The Gross Motor Functional Measure (GMFM) evaluates motor
changes over time in children with cerebral palsy. It includes activities in prone and supine positions,
rolling, sitting, crawling, kneeling, standing, walking, running, and jumping. It does not measure the
quality of motor performance.
50. What does the acronym SACH stand for? (a) Simple amputation, cadence heel (b) Single axis, carbon
heel (c) Standard adult, control heel (d) Solid ankle, cushion heel - ANSWER-50. (d) SACH is an acronym
for solid ankle, cushion heel. The SACH foot has a cushioned heel that compresses during heel strike,
stimulating plantar flexion, and has a rigid anterior keel to roll over during late stance. It is light, durable,
and inexpensive, and is the orthosis most often prescribed for juvenile and geriatric amputees.
100. What is the arrow pointing to in this upper extremity prosthesi s? (a) An excursion cable (b) An
anterior split cable (c) The elbow-lock control cable (d) The elbow flexion cable - ANSWER-100. (c) This is
an elbow-lock control cable. Its proximal end originates at the anterior suspension strap and its distal
end engages the elbow-locking mechanism. The principal of the elbow-lock mechanism is pull-and-
release to lock, pull-and-release to unlock.
110. The primary advantage of a 4-point crutch gait over a 2-point c rutch gai t is (a) stability. (b) speed.
(c) weight-bearing relief. (d) efficiency of gait. - ANSWER-110. (a) The 4-point crutch gait has stability as
its primary advantage. At least 3 points are always in contact with the ground. It is more difficult to learn
than the other gait patterns and is a relatively slow form of ambulation. The 3-point crutch gait is used
by patients with lower limb fractures, amputations, or toe-touch weight-bearing. The 4-point gait
pattern enables the crutch user to eliminate all the weight-bearing on the affected lower limb. The 2-
point crutch gait is much faster than the 4-point gait and yet still provides some weight-bearing relief to
both lower limbs.
189. You have just finished admitting a 60-year-old diabetic man who has rece ntly unde rgone a right
below-knee amputation. The patient's son stops you in the hallway and inquires about his father's
health status and prognosis for walking again. You have never met the patient's son before, and before
answering the questions, you would first (a) further review the patient's medical record and determine
his ca rdiac sta tus. (b) perform a literature review of outcomes research in individuals with belo w-knee
am putat ion s. (c) ask the patient for permission to discuss his health status with his son. (d) ask the son
if the patient has a living will or a health care po wer-of-at torney. - ANSWER-189 (c) Maintaining
,confidentiality of patient information is important even when discussing health information with family
members. Before discussing the patient's health status with his son, the appropriate first step would be
to ask the patient for permission. The other options listed would not be appropriate initial management
strategies.
"40. When should upper extremity prosthesis fitting be in itiated i n th e adult? (a) Within the first
month after amputation - ANSWER-(b) When residual limb strength is full. (c) When the patient requests
a prosthesis (d) When residual limb volume has stabilized" 40. (a) The first month after upper limb
amputation is the optimal period for prosthesis fitting. Fitting should be initiated during this time to
maximize the level of acceptance and use of the prosthesis.
" - ANSWER-70. Double limb stance is what percent of the entire g ait cycle ? (a) 5% (b) 10% (c) 20% (d)
30%" 70 (c) The average double limb support is 20% and single limb support is 40% of the entire gait
cycle. Stance phase accounts for 60% of the gait cycle and swing phase accounts for 40%.
80. What is a possible cause for circumduction during mi d swing i n th e transfemoral amputee? (a)
Insufficient knee friction (b) Prosthesis too short (c) Excessive medial brim pressures (d) Inadequate hip
extension - ANSWER-80. (c) Possible causes for circumduction in the gait of a transfemoral amputee
include excessive mechanical resistance to knee flexion, prosthesis aligned with too much stability,
prosthesis too long, increased medial brim pressures, inadequate suspension, patient lacks confidence
or has inadequate hip flexion.
81. To allow pronation of the foot, which 2 joints must have thei r ax is of rotation in parallel? (a)
Lisfranc and talonavicular (b) Subtalar and calcanocuboid (c) Talocrural and subtalar (d) Talonavicular
and calcaneocuboid - ANSWER-81. (d) The transverse tarsal joint, namely the talonavicular and
calcaneocuboid joints, must have their joint axes in parallel to allow for a flexible midfoot and pronation.
If the axes intersect, the midfoot becomes rigid, which enables proper supination.
"90. - ANSWER-In a transtibial amputee, ambulation with a prosthe sis, inst ead of unilateral non-weight
bearing (with crutches) results in (a) higher rate of energy expenditure. (b) lower heart rate. (c) higher
respiratory exchange rate. (d) equivalent amounts of energy to walk the same distan ce." 90 (b)
Transtibial amputees have a lower rate of energy expenditure, heart rate and oxygen consumption
when using a prosthesis (vs. non-weight bearing crutch gait). The cardiovascular demand of crutch
walking is high, with increased rate of oxygen consumption, increased heart rate, increased energy
costs, and respiratory exchange rate in the anaerobic range.
" - ANSWER-40. The most common reason for prescribing a pl as tic leaf-spring ankle-foot orthosis is to
(a) overcome ankle spasticity. (b) reduce lower-extremity edema. (c) prevent plantar flexion deformity.
, (d) support weak ankle dorsiflexors." 40 (d) A plastic leaf-spring orthosis (PLSO) is probably the most
commonly prescribed type of ankle-foot orthosis (AFO). It substitutes for weak ankle dorsiflexors and
provides some medial lateral stability. Severe spasticity of the ankle may require prescription of a solid
AFO. A plastic spiral AFO may be prescribed for concomitant weakness of both the ankle dorsiflexors
and plantar flexors when spasticity is absent. Ref: Ragnarsson KT. Low extremity orthotic shoes and gait
aids. In: DeLisa JA, Gans BM, Walsh NE, editors. Physical medicine and rehabilitation: principles and
practice. 4th ed. Lippincott Williams & Wilkins. 2005. p 1383-5.
90. The gluteus maximus is primarily active du rin g which part of the gait cycle? (a) Pre swing (b)
Loading response (c) Midstance (d) Terminal stance - ANSWER-90. (b) The gluteus maximus is primarily
active from terminal swing through initial contact and loading response. During midstance, terminal
stance, and pre swing the gluteus maximus is actually silent. Ref: Perry J. Gait analysis, normal and
pathologic function. Soack;1992. p 111-8.
100. Your patient demonstrates ipsilateral pel vic d rop during gait. What is the most likely cause? (a)
Scoliosis (b) Short contralateral limb (c) Hip adductor weakness (d) Weak hip extensors - ANSWER-100.
(a) Deformity in the spine presents with malalignment of in the pelvis as either contralateral or
ipsilateral drop. Two other causes of ipsilateral pelvic drop are contralateral hip abductor weakness and
short ipsilateral limb. Weak hip extensors are a cause of backward lean. In stance, a backward lean of
the trunk substitutes for weak hip extensors. Ref: Perry J. Gait analysis, normal and pathologic function.
Soack; 1992. p 269-73.
110. What is the 5-year mortality rate for per son s with diabetes after sustaining a major lower limb
amputation? (a) 0.15 (b) 0.25 (c) 0.33 (d) 0.5 - ANSWER-110. (d) At least 50% of persons with diabetes
and peripheral arterial disease who undergo major limb amputation will die within 5 years of sustaining
major lower limb amputation. Ref: (a) Pandian G, Hameed F, Hammond M. Rehabilitation of the patient
with peripheral vascular disease anddiabetic foot problems. In: DeLisa J, Gans B, editors. Physical
medicine: principles and practice. 3rd ed. Philadelphia: Lippincott Raven; 1998. p1517-44.(b) Moolik P,
Gill G. Mortality in diabetic patients with foot ulcers. Diabetic Foot 2002: Spring.
130. A potential benefit of osseointegration ( the d irect skeletal attachment of the prosthesis to bone) is
(a) elimination of poor prosthetic socket fit. (b) ability to return to running activities. (c) early prosthetic
fitting. (d) ability to perform heavy manual work. - ANSWER-130. (a) The primary benefits of attaching a
prosthesis directly to the skeleton are comfort, elimination of poor prosthetic socket fit, and elimination
of skin problems. Recipients report improved sensory feedback from the skeletally attached limb.
Limitations include a 2-stage procedure, which results in an extended time of non-weight bearing, and
extended rehabilitation (up to 2 years). The procedure poses a significant risk of infection, and the
recipient must limit running, jumping, and heavy manual work in order to minimize loosening of the
prosthesis. Ref: Pasquini PS, Bryant PR, Huang NE, Robert TL, Nelson VS, Flood KM. Advances in amputee
care. Arch Phys Med Rehabil 2006:87(3 Suppl1);S34-43
VERIFIED ACCURATE SOLUTION |GET IT 100%
ACCURATE
19. The Gross Motor Functional Measure (GMFM) is designed to measure (a) motor changes over time.
(b) quality of motor performance. (c) achievement of motor milestones. (d) only walking, running, and
jumping ability. - ANSWER-19. (a) The Gross Motor Functional Measure (GMFM) evaluates motor
changes over time in children with cerebral palsy. It includes activities in prone and supine positions,
rolling, sitting, crawling, kneeling, standing, walking, running, and jumping. It does not measure the
quality of motor performance.
50. What does the acronym SACH stand for? (a) Simple amputation, cadence heel (b) Single axis, carbon
heel (c) Standard adult, control heel (d) Solid ankle, cushion heel - ANSWER-50. (d) SACH is an acronym
for solid ankle, cushion heel. The SACH foot has a cushioned heel that compresses during heel strike,
stimulating plantar flexion, and has a rigid anterior keel to roll over during late stance. It is light, durable,
and inexpensive, and is the orthosis most often prescribed for juvenile and geriatric amputees.
100. What is the arrow pointing to in this upper extremity prosthesi s? (a) An excursion cable (b) An
anterior split cable (c) The elbow-lock control cable (d) The elbow flexion cable - ANSWER-100. (c) This is
an elbow-lock control cable. Its proximal end originates at the anterior suspension strap and its distal
end engages the elbow-locking mechanism. The principal of the elbow-lock mechanism is pull-and-
release to lock, pull-and-release to unlock.
110. The primary advantage of a 4-point crutch gait over a 2-point c rutch gai t is (a) stability. (b) speed.
(c) weight-bearing relief. (d) efficiency of gait. - ANSWER-110. (a) The 4-point crutch gait has stability as
its primary advantage. At least 3 points are always in contact with the ground. It is more difficult to learn
than the other gait patterns and is a relatively slow form of ambulation. The 3-point crutch gait is used
by patients with lower limb fractures, amputations, or toe-touch weight-bearing. The 4-point gait
pattern enables the crutch user to eliminate all the weight-bearing on the affected lower limb. The 2-
point crutch gait is much faster than the 4-point gait and yet still provides some weight-bearing relief to
both lower limbs.
189. You have just finished admitting a 60-year-old diabetic man who has rece ntly unde rgone a right
below-knee amputation. The patient's son stops you in the hallway and inquires about his father's
health status and prognosis for walking again. You have never met the patient's son before, and before
answering the questions, you would first (a) further review the patient's medical record and determine
his ca rdiac sta tus. (b) perform a literature review of outcomes research in individuals with belo w-knee
am putat ion s. (c) ask the patient for permission to discuss his health status with his son. (d) ask the son
if the patient has a living will or a health care po wer-of-at torney. - ANSWER-189 (c) Maintaining
,confidentiality of patient information is important even when discussing health information with family
members. Before discussing the patient's health status with his son, the appropriate first step would be
to ask the patient for permission. The other options listed would not be appropriate initial management
strategies.
"40. When should upper extremity prosthesis fitting be in itiated i n th e adult? (a) Within the first
month after amputation - ANSWER-(b) When residual limb strength is full. (c) When the patient requests
a prosthesis (d) When residual limb volume has stabilized" 40. (a) The first month after upper limb
amputation is the optimal period for prosthesis fitting. Fitting should be initiated during this time to
maximize the level of acceptance and use of the prosthesis.
" - ANSWER-70. Double limb stance is what percent of the entire g ait cycle ? (a) 5% (b) 10% (c) 20% (d)
30%" 70 (c) The average double limb support is 20% and single limb support is 40% of the entire gait
cycle. Stance phase accounts for 60% of the gait cycle and swing phase accounts for 40%.
80. What is a possible cause for circumduction during mi d swing i n th e transfemoral amputee? (a)
Insufficient knee friction (b) Prosthesis too short (c) Excessive medial brim pressures (d) Inadequate hip
extension - ANSWER-80. (c) Possible causes for circumduction in the gait of a transfemoral amputee
include excessive mechanical resistance to knee flexion, prosthesis aligned with too much stability,
prosthesis too long, increased medial brim pressures, inadequate suspension, patient lacks confidence
or has inadequate hip flexion.
81. To allow pronation of the foot, which 2 joints must have thei r ax is of rotation in parallel? (a)
Lisfranc and talonavicular (b) Subtalar and calcanocuboid (c) Talocrural and subtalar (d) Talonavicular
and calcaneocuboid - ANSWER-81. (d) The transverse tarsal joint, namely the talonavicular and
calcaneocuboid joints, must have their joint axes in parallel to allow for a flexible midfoot and pronation.
If the axes intersect, the midfoot becomes rigid, which enables proper supination.
"90. - ANSWER-In a transtibial amputee, ambulation with a prosthe sis, inst ead of unilateral non-weight
bearing (with crutches) results in (a) higher rate of energy expenditure. (b) lower heart rate. (c) higher
respiratory exchange rate. (d) equivalent amounts of energy to walk the same distan ce." 90 (b)
Transtibial amputees have a lower rate of energy expenditure, heart rate and oxygen consumption
when using a prosthesis (vs. non-weight bearing crutch gait). The cardiovascular demand of crutch
walking is high, with increased rate of oxygen consumption, increased heart rate, increased energy
costs, and respiratory exchange rate in the anaerobic range.
" - ANSWER-40. The most common reason for prescribing a pl as tic leaf-spring ankle-foot orthosis is to
(a) overcome ankle spasticity. (b) reduce lower-extremity edema. (c) prevent plantar flexion deformity.
, (d) support weak ankle dorsiflexors." 40 (d) A plastic leaf-spring orthosis (PLSO) is probably the most
commonly prescribed type of ankle-foot orthosis (AFO). It substitutes for weak ankle dorsiflexors and
provides some medial lateral stability. Severe spasticity of the ankle may require prescription of a solid
AFO. A plastic spiral AFO may be prescribed for concomitant weakness of both the ankle dorsiflexors
and plantar flexors when spasticity is absent. Ref: Ragnarsson KT. Low extremity orthotic shoes and gait
aids. In: DeLisa JA, Gans BM, Walsh NE, editors. Physical medicine and rehabilitation: principles and
practice. 4th ed. Lippincott Williams & Wilkins. 2005. p 1383-5.
90. The gluteus maximus is primarily active du rin g which part of the gait cycle? (a) Pre swing (b)
Loading response (c) Midstance (d) Terminal stance - ANSWER-90. (b) The gluteus maximus is primarily
active from terminal swing through initial contact and loading response. During midstance, terminal
stance, and pre swing the gluteus maximus is actually silent. Ref: Perry J. Gait analysis, normal and
pathologic function. Soack;1992. p 111-8.
100. Your patient demonstrates ipsilateral pel vic d rop during gait. What is the most likely cause? (a)
Scoliosis (b) Short contralateral limb (c) Hip adductor weakness (d) Weak hip extensors - ANSWER-100.
(a) Deformity in the spine presents with malalignment of in the pelvis as either contralateral or
ipsilateral drop. Two other causes of ipsilateral pelvic drop are contralateral hip abductor weakness and
short ipsilateral limb. Weak hip extensors are a cause of backward lean. In stance, a backward lean of
the trunk substitutes for weak hip extensors. Ref: Perry J. Gait analysis, normal and pathologic function.
Soack; 1992. p 269-73.
110. What is the 5-year mortality rate for per son s with diabetes after sustaining a major lower limb
amputation? (a) 0.15 (b) 0.25 (c) 0.33 (d) 0.5 - ANSWER-110. (d) At least 50% of persons with diabetes
and peripheral arterial disease who undergo major limb amputation will die within 5 years of sustaining
major lower limb amputation. Ref: (a) Pandian G, Hameed F, Hammond M. Rehabilitation of the patient
with peripheral vascular disease anddiabetic foot problems. In: DeLisa J, Gans B, editors. Physical
medicine: principles and practice. 3rd ed. Philadelphia: Lippincott Raven; 1998. p1517-44.(b) Moolik P,
Gill G. Mortality in diabetic patients with foot ulcers. Diabetic Foot 2002: Spring.
130. A potential benefit of osseointegration ( the d irect skeletal attachment of the prosthesis to bone) is
(a) elimination of poor prosthetic socket fit. (b) ability to return to running activities. (c) early prosthetic
fitting. (d) ability to perform heavy manual work. - ANSWER-130. (a) The primary benefits of attaching a
prosthesis directly to the skeleton are comfort, elimination of poor prosthetic socket fit, and elimination
of skin problems. Recipients report improved sensory feedback from the skeletally attached limb.
Limitations include a 2-stage procedure, which results in an extended time of non-weight bearing, and
extended rehabilitation (up to 2 years). The procedure poses a significant risk of infection, and the
recipient must limit running, jumping, and heavy manual work in order to minimize loosening of the
prosthesis. Ref: Pasquini PS, Bryant PR, Huang NE, Robert TL, Nelson VS, Flood KM. Advances in amputee
care. Arch Phys Med Rehabil 2006:87(3 Suppl1);S34-43
