NPTE-PT Test Test Gait, Balance, and Orthotics 1 — Questions and Answers
Question 1: During the loading response phase of gait (0–12% of the gait cycle), the quadriceps act eccentrically primarily to:
- Extend the hip and propel the body forward
- Control knee flexion and absorb impact forces (Correct answer)
- Dorsiflex the ankle to prevent foot slap
- Stabilize the subtalar joint in neutral
Correct answer: Control knee flexion and absorb impact forces
During loading response, the knee flexes approximately 15–20° to absorb shock. The quadriceps contract eccentrically to control this flexion and prevent the knee from collapsing. Failure results in a knee-flexion gait deviation or 'buckling knee' pattern.
Question 2: A patient post-CVA demonstrates circumduction of the lower extremity during the swing phase. This compensatory movement most directly substitutes for inadequate:
- Hip extension during terminal stance
- Hip abductor strength during single-limb support
- Knee flexion and ankle dorsiflexion during swing (Correct answer)
- Plantarflexor push-off at pre-swing
Correct answer: Knee flexion and ankle dorsiflexion during swing
Circumduction is a compensatory arc of the limb to achieve foot clearance when the patient cannot adequately flex the knee or dorsiflex the ankle during swing. Both motions are needed to shorten the functional limb length for clearance.
Question 3: On the Berg Balance Scale (BBS), a score below which threshold is most strongly associated with high fall risk and likely dependence on an assistive device for safe ambulation?
- 20 out of 56
- 36 out of 56
- 45 out of 56 (Correct answer)
- 50 out of 56
Correct answer: 45 out of 56
A BBS score below 45/56 is the widely cited threshold for significantly elevated fall risk. Scores of 0–20 suggest wheelchair dependence, 21–40 suggest ambulatory with assistance, and 41–56 suggest independent, with the 45-point cut-off being the clinically actionable fall-risk marker.
Question 4: Which muscle is the primary restraint controlling forward tibial progression during midstance, preventing excessive ankle dorsiflexion and maintaining upright posture?
- Tibialis anterior
- Gastrocnemius
- Soleus (Correct answer)
- Peroneus longus
Correct answer: Soleus
The soleus, with its origin on the tibia and fibula, acts as a posterior restraint on the tibia during midstance. It works eccentrically to control how quickly the tibia advances over the fixed foot. The gastrocnemius assists but is less active at this phase because the knee remains relatively extended.
Question 5: A patient with a complete T12 spinal cord injury requires orthotic prescription for ambulation. Which orthotic is MOST appropriate to support ambulation in this patient?
- Supramalleolar orthosis (SMO)
- Ankle–foot orthosis (AFO)
- Knee–ankle–foot orthosis (KAFO)
- Hip–knee–ankle–foot orthosis (HKAFO) (Correct answer)
Correct answer: Hip–knee–ankle–foot orthosis (HKAFO)
A complete T12 injury results in loss of all lower-extremity motor function below the lesion, including the hip flexors (L2–L3) and all distal musculature. An HKAFO controls the hip, knee, and ankle, allowing reciprocal gait with forearm crutches. A KAFO alone would not address the absent hip control.
Question 6: During the Functional Reach Test (FRT), what is being measured that makes it a valid clinical indicator of dynamic balance and fall risk?
- The maximum weight a patient can shift laterally while seated
- The maximum forward distance a patient can reach while maintaining a fixed base of support standing (Correct answer)
- The time required to complete a 360° turn from a standing position
- The number of steps taken before requiring a balance correction
Correct answer: The maximum forward distance a patient can reach while maintaining a fixed base of support standing
The FRT measures the maximum distance (in inches or centimeters) a patient can reach forward with an outstretched arm beyond arm's length while maintaining a standing fixed base of support. A reach of less than 6 inches (15 cm) is associated with a significantly elevated fall risk. It quantifies the limits of the anterior stability boundary.
NPTE-PT Test Test Gait, Balance, and Orthotics 1
During the loading response phase of gait (0–12% of the gait cycle), the quadriceps act eccentrically primarily to: