NPTE-PT Gait, Balance, and Orthotics 5 — Questions and Answers
Question 1: A patient with spastic hemiplegia walks with the knee in hyperextension throughout stance. This MOST likely results from:
- Weak quadriceps with compensatory locking
- Spastic plantarflexors causing a rigid forefoot rocker (Correct answer)
- Excessive dorsiflexion range of motion
- Hip flexor spasticity driving anterior pelvic tilt
Correct answer: Spastic plantarflexors causing a rigid forefoot rocker
Spastic plantarflexors create a rigid equinus foot that acts as a lever, pushing the tibia posteriorly and forcing the knee into hyperextension during stance.
Question 2: A scoliosis patient with a 25-degree Cobb angle is prescribed a TLSO. The PRIMARY goal of this orthosis is to:
- Correct the existing curvature to under 10 degrees
- Prevent curve progression during skeletal growth (Correct answer)
- Strengthen paraspinal muscles on the concave side
- Eliminate pain associated with scoliosis
Correct answer: Prevent curve progression during skeletal growth
TLSOs for adolescent idiopathic scoliosis are prescribed primarily to prevent curve progression during the growth period, not to fully correct the existing deformity.
Question 3: Which single-leg stance test finding is considered abnormal in an adult under age 60?
- Unable to maintain for 30 seconds with eyes open (Correct answer)
- Unable to maintain for 10 seconds with eyes closed
- Unable to maintain for 5 seconds with eyes open
- Any sway with eyes open
Correct answer: Unable to maintain for 30 seconds with eyes open
Adults under 60 should be able to maintain single-leg stance with eyes open for at least 30 seconds; failure indicates balance impairment.
Question 4: During the Sensory Organization Test, Condition 6 (sway-referenced surface, sway-referenced vision) primarily tests which sensory system?
- Visual system
- Somatosensory/proprioceptive system
- Vestibular system (Correct answer)
- Combined visual-somatosensory integration
Correct answer: Vestibular system
In SOT Condition 6, both the surface and visual field move with the patient, eliminating proprioceptive and visual inputs, leaving only vestibular information available for balance control.
Question 5: A patient with L5 nerve root compromise will MOST likely demonstrate which gait deviation?
- Trendelenburg gait due to weak hip abductors (Correct answer)
- Hyperextended knee due to quadriceps weakness
- Foot drop due to weak dorsiflexors
- Antalgic gait due to hip joint pain
Correct answer: Trendelenburg gait due to weak hip abductors
L5 innervates the gluteus medius (hip abductor); weakness causes a Trendelenburg gait with contralateral pelvic drop during ipsilateral stance.
Question 6: Which prosthetic foot type is MOST appropriate for a highly active K4 transtibial amputee who participates in running and high-impact sports?
- SACH (solid ankle cushion heel) foot
- Single-axis foot
- Energy-storing-and-returning (carbon fiber) foot (Correct answer)
- Multiaxial foot
Correct answer: Energy-storing-and-returning (carbon fiber) foot
Carbon fiber energy-storing-and-returning (ESR) prosthetic feet are designed for high-activity (K4) amputees, providing elastic energy return during push-off for running and sports.
Question 7: A patient with a CVA demonstrates circumduction of the right lower extremity during swing phase. This is MOST likely compensating for:
- Weak right hip flexors reducing limb advancement
- Inability to shorten the right limb (inadequate knee flexion or dorsiflexion) (Correct answer)
- Excessive right hip abductor tone pulling the leg laterally
- Right hip extensor spasticity limiting forward swing
Correct answer: Inability to shorten the right limb (inadequate knee flexion or dorsiflexion)
Circumduction compensates for an inability to functionally shorten the limb during swing, most often due to spastic knee extensors limiting flexion and/or spastic plantarflexors limiting dorsiflexion.
NPTE-PT Gait, Balance, and Orthotics 5
A patient with spastic hemiplegia walks with the knee in hyperextension throughout stance.
This MOST likely results from: