Question 1

The shape of the forearm changes as it moves from supination to pronation.When a volar splint is being made,which of the following techniques will assist in accommodating this change in the fabrication process?

A) Have the patient lie down to fabricate the splint.
B) Pronate and supinate the forearm continuously during the splint fabrication process.
C) Pronate the forearm before the splint material has set.
D) Make the splint with the forearm in neutral.

D
Forearm-based splints should be repositioned to accommodate the difference in forearm shape before the splint material has set.

Accepted Answer

Forearm-based splints should be repositioned to accommodate the difference in forearm shape before the splint material has set.

Question 2

An OT practitioner is working with a client experiencing proximal upper extremity weakness as a result of polymyositis.The client wants to be able to feed himself while sitting up in his wheelchair.The therapist has set up a MAS ,but the client is having difficulty flexing his elbow enough to reach his hand to his mouth.Which adjustment can the therapist make to facilitate this motion?

A) Lower the semireclining mount on the wheelchair upright.
B) Move the rocker arm more distally on the forearm support.
C) Roll the semireclining mount outwardly.
D) Move the rocker arm more proximally on the forearm support.

Accepted Answer

Adjusting for vertical motion such as elbow flexion and extension is done by moving the rocker arm position on the forearm support.Moving the rocker arm more distally will shift more of the arm's weight proximally to facilitate elbow flexion,whereas moving the rocker arm more proximally will shift weight to facilitate extension.Lowering the mount on the wheelchair upright would bring the hand further away from the mouth.Rolling the mount influences horizontal motion,not vertical motion.

Question 3

An occupational therapy (OT)practitioner is working with a 30-year-old police officer who reports a painful wrist after trying to restrain a prisoner.The police officer has persistent pain and weakness with resistive tasks 2 months after the incident.The pain is on the ulnar side of the hand.The OT practitioner may opt to send the patient back to the physician for further evaluation for which of the following possible reasons?

A) The client is exaggerating the pain.
B) The client has a median nerve compression.
C) There is injury to the triangular fibrocartilage complex (TFCC).
D) None of the above.

C
The TFCC includes the ligaments and cartilage that suspends the distal ulna and the proximal carpus.Injuries to this area will not be evident on X-ray examination.

Accepted Answer

The TFCC includes the ligaments and cartilage that suspends the distal ulna and the proximal carpus.Injuries to this area will not be evident on X-ray examination.

Question 4

An OT practitioner is working with a client who must wear a thumb spica splint for 3 more weeks after cast removal for a scaphoid fracture.The physician has allowed the patient to use the hand with the splint in place for light activities.When making the splint,the therapist must be sure to position the thumb in what position to allow light activities?

A) Thumb extension
B) Thumb flexion
C) Palmar prehension
D) Hook grasp

Accepted Answer

Thumb flexion and extension positioning full time in the splint would not allow use of the thumb for light activities.Hook grasp does not require the use of the thumb.Palmar prehension allows for thumb pad-to- pad opposition and holding small objects,lifting objects from a surface,and tying a bow.

Question 5

A 54-year-old woman is fitted with a wrist splint for night wear because of carpal tunnel syndrome.At a return visit the client reports that she has less numbness and tingling at her volar thumb and index and middle digits,but she has increased pain at the radial dorsal side of her hand. The OT practitioner should consider which of the following possibilities?

A) The client has been using her hand too much.
B) The client has not been wearing her splint.
C) The new splint is not helping her carpal tunnel syndrome symptoms.
D) The new splint is pressing on the radial digital nerve near the anatomical snuffbox.

Accepted Answer

Care must be taken to keep from applying pressure over the sights where the nerves are superficial and prone to compression.In this case the patient is describing the nerve distribution of the radial digital nerve,which is a new symptom that emerged since the splint application.The therapist should modify the splint to prevent pressure in this area.

Question 6

An OT practitioner is working with a 21-year-old client who has suffered a traumatic brain injury resulting from a car accident and is comatose in the intensive care unit.The OT practitioner has been asked to make hand splints in a resting position.To prevent shortening of the metacarpophalangeal (MP)joint collateral ligaments,the splint should place the MP joints in which of the following?

A) 0 degree of MP extension
B) 60-70 degrees of MP flexion
C) 10-35 degrees of MP flexion
D) 10-35 degrees of MP extension

Accepted Answer

If the MP joints are immobilized in extension,the lax collateral ligaments can shorten,limiting MP flexion and functional use of the hand.This would be important to the client's recovery should the client regain consciousness and neurological functioning.

Question 7

An OT is working with a client experiencing upper extremity weakness from a spinal cord injury.The client wants to be able to use her arm to drive a power wheelchair.The therapist has set up a MAS,but the client is having difficulty horizontally abducting her shoulder enough to reach the joystick control.Which adjustment can the therapist make to facilitate this motion?

A) Roll the semireclining mount outwardly.
B) Pitch the semireclining mount toward the rear of the wheelchair.
C) Lower the semireclining mount on the wheelchair upright.
D) Move the rocker arm more proximally on the forearm support.

Accepted Answer

Adjusting for horizontal motion such as horizontal abduction and adduction is done by rolling the semireclining mount.Rolling it outwardly will facilitate horizontal abduction.Pitching or lowering the semireclining mount or moving the rocker arm would not solve the problem.

Deck 32: Orthotics