Orthotics Pathologies Flashcards

Question

What is Spina Bifida?

Answer 1

Spina bifida is a condition that affects the spine and is usually apparent at birth. It can happen anywhere along the spine if the neural tube does not form properly or close all the way. The severity of spina bifida can range from mild to severe.

Answer 2

Neural tube defect that occurs early in pregnancy when the embryonic neural tube fails to close completely, leaving an opening in the spine that can expose the spinal cord and nerves. This incomplete closure also leads to improper formation of the vertebrae.

Answer 3

The four main types of spina bifida are myelomeningocele, meningocele, lipomyelomeningocele, and spina bifida occulta. Myelomeningocele is the most severe form, where a sac containing part of the spinal cord and nerves protrudes through the back. Meningocele involves a sac of fluid, but the spinal cord is not in it, causing milder issues. Spina bifida occulta is the mildest type, where there is a small gap in the spine but no visible opening or sac, and it often causes no disabilities.

Answer 4

Spina bifida orthotic management aims to optimize mobility and independence by providing support and correcting deformities through devices AFOs, KAFOs, and standing frames.

Answer 5

Spina bifida can involve both UMN and LMN dysfunction. Lower limb motor impairment results from damage to both the UMN pathways (which control movement from the brain) and the LMN pathways (which are directly connected to the muscles).

Answer 6

Polio is a viral infection that can lead to paralysis, while post-polio syndrome (PPS) is a neurological condition that can develop years after the initial infection, causing new or worsening muscle weakness, pain, and fatigue.

Answer 7

Polio pathophysiology begins when the poliovirus enters the body through the mouth, replicates in the throat and intestines, and spreads to lymph nodes. Virus can enter into bloodstream and CNS. The poliovirus destroys motor neurons. Post-polio syndrome (PPS) pathophysiology is driven by the long-term breakdown of motor neurons that were compensated for during initial polio recovery

Answer 8

Types of Paralytic Polio (Based on Severity) Spinal Polio: The most common form, characterized by asymmetrical, flaccid paralysis of the limbs, particularly the legs. Bulbar Polio: Affects the brainstem, leading to weakness in muscles controlling breathing, swallowing, and speech. Bulbospinal Polio: A combination of both spinal and bulbar symptoms. Other Classifications Non-paralytic polio: A milder, common infection that does not lead to permanent paralysis. Post-polio Syndrome (PPS): A cluster of functional disabilities that occur decades after recovery from the original infection.

Answer 9

LMN. Polio is a disorder of the anterior horn cells of the spinal cord.

Answer 10

Cerebral palsy is a group of conditions that affect movement and posture. It's caused by damage that occurs to the developing brain, most often before birth. Symptoms appear during infancy or preschool years and vary from very mild to serious.

Answer 11

CP pathophysiology involves damage to or malformation of the developing brain, leading to impaired motor control. This can result from issues like stroke, infection, lack of oxygen, or genetic factors occurring before, during, or shortly after birth. The specific brain regions affected, such as the cerebral cortex, basal ganglia, or cerebellum, determine the type of motor impairment, including spasticity, dyskinesia, or ataxia.

Answer 12

The four main types of cerebral palsy are spastic, dyskinetic, ataxic, and mixed. Spastic CP involves muscle stiffness. Dyskinetic CP causes involuntary movements. Ataxic CP results in problems with balance and coordination. Mixed CP includes a combination of symptoms from different types. These types can be further classified by which parts of the body are affected, such as spastic quadriplegia (all four limbs) or spastic diplegia (legs).

Answer 13

AFOs SMOs TLSOs

Answer 14

UMN. Cerebral palsy (CP) is primarily an upper motor neuron (UMN) disorder, caused by damage to the brain that affects the motor neurons that control voluntary movement. This damage to the UMNs leads to the characteristic symptoms of CP, such as spasticity, weakness, and hyperreflexia.

Answer 15

A stroke, or brain attack, occurs when blood flow to the brain is interrupted, either by a blockage (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke).

Answer 16

Involves two main types: ischemic stroke (blockage of blood flow) and hemorrhagic stroke (bleeding in the brain)

Answer 17

Ischemic stroke leads to a rapid energy failure in brain cells due to lack of oxygen, triggering an "ischemic cascade" of cell damage including excitotoxicity and free radical formation. Hemorrhagic stroke causes injury through the direct impact of bleeding and the resulting increase in pressure on brain cells and surrounding tissue.

Answer 18

A stroke is considered an upper motor neuron (UMN) lesion because it damages the brain cells that control movement, disrupting the signals sent to the lower motor neurons. This damage can lead to symptoms like weakness, spasticity, and hyperreflexia, which are characteristic of UMN lesions.

Answer 19

Diabetes is a chronic condition where the body has high blood glucose (sugar) because it either can't produce enough insulin or can't use insulin properly.

Answer 20

Diabetes pathophysiology involves high blood glucose levels (hyperglycemia) due to problems with the hormone insulin. In Type 1 diabetes, the body's immune system destroys the insulin-producing beta cells in the pancreas, leading to a severe lack of insulin. In Type 2 diabetes, the body either doesn't produce enough insulin or the cells become resistant to its effects, meaning they don't respond properly.

Answer 21

Type 1 and Type 2

Answer 22

Specialized soft, full-contact insoles that redistribute pressure to prevent sores and ulcers, particularly for those with neuropathy

Answer 23

Clubfoot is a congenital (present at birth) foot deformity where the foot is twisted inward and downward. This condition involves bones, muscles, tendons, and ligaments, causing the foot to point down and the front of the foot to rotate toward the opposite leg. It can affect one or both feet and may result in a smaller foot and calf.

Answer 24

Clubfoot pathophysiology involves the soft tissues (tendons and ligaments) being short and tight, which twists the bones of the foot and ankle into an abnormal position.

Answer 25

The three main types of clubfoot are idiopathic, non-idiopathic (or syndromic), and positional. Idiopathic clubfoot is the most common and has no known cause. Non-idiopathic clubfoot is associated with other medical conditions like spina bifida or arthrogryposis. Positional clubfoot is a milder form caused by the baby's position in the womb and often resolves with stretching.

Answer 26

Boots and bars orthotics.

Answer 27

Ehlers-Danlos syndrome (EDS) is a group of inherited connective tissue disorders that cause symptoms like overly flexible joints, stretchy skin, and fragile tissues.

Answer 28

Ehlers-Danlos syndrome (EDS) is a group of inherited connective tissue disorders caused by genetic mutations that lead to defects in collagen and other connective tissue proteins.

Answer 29

There are 13 types of Ehlers-Danlos syndrome (EDS), which is a group of genetic connective tissue disorders. The most common types are classical, hypermobile, and vascular EDS.

Answer 30

FOs AFOs KO TLSO WHO Finger splint

Answer 31

Guillain-Barré syndrome (GBS) is a rare neurological disorder where the body's immune system mistakenly attacks its peripheral nerves, causing muscle weakness and sometimes paralysis.

Answer 32

Guillain-Barré syndrome (GBS) is an autoimmune disorder where the immune system attacks the peripheral nervous system, typically triggered by an infection.

Answer 33

The main types of Guillain-Barré syndrome are: Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), which is the most common form. Miller Fisher syndrome (MFS). Acute motor axonal neuropathy (AMAN).

Answer 34

AFOs KAFOs FOs Shoe mods

Answer 35

Guillain-Barré syndrome (GBS) is a lower motor neuron (LMN) syndrome because it affects the peripheral nervous system, including the motor neurons that connect the spinal cord to the muscles.

Answer 36

Osteoarthritis is the most common form of arthritis, a progressive disease that causes the protective cartilage in joints to break down. This wear-and-tear leads to pain, stiffness, and swelling, and can eventually affect the underlying bone. It most commonly affects the hips, knees, spine, and hands, but can impact nearly any joint.

Answer 37

The pathophysiology of osteoarthritis (OA) is a complex process that begins with damage to the articular cartilage, but involves the entire joint. Mechanical stress and other risk factors trigger an inflammatory response, causing the breakdown of cartilage and subchondral bone. Chondrocytes (cartilage cells) attempt to repair the damage by proliferating, but are eventually overwhelmed by matrix-degrading enzymes, leading to apoptosis (cell death). This progressive degeneration results in joint pain, stiffness, and loss of function.

Answer 38

Osteoarthritis is classified into two main types: primary, which develops over time with no known specific cause, and secondary, which is a direct result of an identifiable factor like a past injury, other diseases, or abnormal mechanical forces.

Answer 39

Orthotics can help manage osteoarthritis (OA) by redistributing pressure, cushioning the foot, and improving alignment to reduce stress on joints. KO

Answer 40

Rheumatoid arthritis (RA) is an autoimmune disease where the immune system attacks the body's own joints, causing chronic inflammation, pain, stiffness, and swelling. This inflammation can spread beyond the joints and damage other organs, and while there is no cure, treatments can manage symptoms and prevent long-term damage.

Answer 41

Rheumatoid arthritis (RA) pathophysiology involves an autoimmune response where the immune system attacks the joints, leading to inflammation, joint damage, and pain. It begins with a genetic predisposition, environmental triggers (like smoking), and the production of autoantibodies, such as rheumatoid factor (RF) and anti-CCP antibodies. These autoantibodies trigger immune cells, leading to an amplification phase with chronic inflammation and the formation of pannus, an abnormal tissue growth that destroys cartilage and bone.

Answer 42

JRA The two main types of rheumatoid arthritis (RA) are seropositive and seronegative, distinguished by the presence or absence of specific antibodies (like anti-CCP) in the blood. Seropositive RA: This is the most common type, found in 60% to 80% of people with RA. It is defined by the presence of high levels of antibodies, particularly anti-cyclic citrullinated peptides (anti-CCPs), in the blood. Seronegative RA: This type is defined by the absence of these specific antibodies. While the symptoms are similar, seronegative RA is sometimes considered less aggressive, though treatment is still necessary to manage symptoms like joint pain and swelling.

Answer 43

Orthotics can help manage rheumatoid arthritis (RA) by reducing pain, cushioning feet, and improving stability through custom or over-the-counter inserts that redistribute pressure and support the foot's structure.

Answer 44

Charcot foot is a condition where nerve damage in the feet leads to bone and joint breakdown, often caused by poorly controlled diabetes.

Answer 45

The pathophysiology of Charcot foot involves a combination of neurovascular and neurotraumatic factors. Neuropathy leads to both loss of protective sensation and autonomic dysfunction, which causes increased blood flow to the foot. This increased blood flow, combined with microtrauma to the insensitive foot, triggers an excessive inflammatory response.

Answer 46

Charcot foot is classified into different types based on the location of the affected joints, with the most common system including three primary types: midfoot (Type 1), hindfoot (Type 2), and ankle (Type 3). Type 3 is further subdivided into Type 3A (ankle) and Type 3B (calcaneus).

Answer 47

Orthoses for Charcot foot are designed to stabilize the foot, prevent further damage, and relieve pressure to promote healing. The most common and effective orthosis is the custom-made Charcot Restraint Orthotic Walker (CROW) boot, which immobilizes the foot and ankle while allowing ambulation and can be removed for wound care. Other options include a Removable Cast Walker (RCW) boot (often less custom) or a Total Contact Cast (TCC), though the TCC's inability to be removed makes skin checks difficult.

Answer 48

Spinal muscular atrophy (SMA) is a genetic disorder that causes progressive muscle weakness and wasting due to the degeneration of motor neurons, which control voluntary muscles.

Answer 49

Spinal muscular atrophy (SMA) is caused by a genetic defect in the SMN1 gene, which leads to a lack of the survival motor neuron (SMN) protein. This protein is vital for the health and function of motor neurons, the cells in the spinal cord that control voluntary muscles. The resulting loss of these motor neurons causes progressive muscle weakness and atrophy, affecting abilities like breathing, swallowing, and walking.

Answer 50

Spinal muscular atrophy (SMA) is classified into four main types based on the age of onset and severity, with some additional rare forms. Type 1 (Infantile): Onset within the first six months of life, it is the most severe type and often results in death before age 2 without treatment. Type 2 (Intermediate): Appears between 6 and 18 months old; individuals can sit up but cannot walk independently. Type 3 (Juvenile): Develops after 18 months and is a milder form where individuals can walk, though they may have difficulty with activities like running, standing, or climbing stairs. Type 4 (Adult-onset): Starts in adulthood and is the least severe form, rarely impacting life expectancy.

Answer 51

Orthoses for Spinal Muscular Atrophy (SMA) include ankle-foot orthoses (AFOs), knee-ankle-foot orthoses (KAFOs), and thoraco-lumbo-sacral orthoses (TLSOs) to support weakened muscles, improve mobility, and correct deformities like scoliosis.

Answer 52

Legg-Calve-Perthes disease (also known as Perthes disease) is a rare condition that affects the hip joint in children, typically between the ages of 4 and 10. It occurs when the blood supply to the rounded head of the femur (the ball part of the hip joint) is temporarily interrupted, causing the bone to weaken and die (a process known as avascular necrosis). Over time, the body may restore blood flow, and the bone can heal, but it may not return to its original shape, potentially leading to long-term complications such as arthritis.

Answer 53

Legg-Calvé-Perthes disease is an idiopathic condition that leads to the death of bone tissue due to a lack of blood supply (avascular necrosis). The pathophysiology involves several key factors: Ischemia: The primary mechanism behind LCPD is ischemia, which refers to the reduced blood flow to the femoral head. This lack of blood supply leads to necrosis of the bone tissue, particularly in the capital femoral epiphysis. Age and Growth Factors: The disease typically occurs during periods of rapid growth in children, particularly between the ages of 4 and 8 years. The rapid development of the secondary ossification centers in the femoral head may contribute to the vulnerability of the blood supply during this time. Genetic and Environmental Factors: While the exact cause of LCPD remains unclear, several genetic and environmental factors have been implicated. These include potential mutations (e.g., COL2A1), endocrine abnormalities (such as insulin-like growth factor dysfunction), and socioeconomic factors. Bone Remodeling: Following the initial necrosis, the body attempts to replace the dead bone with new bone through a process of remodeling. The success of this process can vary based on the age of the child at diagnosis and the extent of necrosis. In some cases, the new bone may heal completely, while in others, it may lead to deformities that predispose the child to early-onset arthritis. Clinical Manifestations: The disease often presents with symptoms such as hip pain, limping, and limited range of motion. Children may also exhibit a Trendelenburg gait due to weakness in the hip abductors resulting from pain.

Answer 54

The disease progresses through four stages, each involving different phases of bone healing and regrowth: Initial Stage: The blood supply is absent, causing inflammation and pain. The bone begins to die, and the hip joint may show subtle changes on X-rays. Fragmentation Stage: The body starts absorbing the dead bone, making the hip appear as if it is breaking into pieces. The bone is soft and at risk for flattening. Re-ossification Stage: New bone begins to form and replaces the dead bone, leading to the femoral head's return to a more normal shape. Residual Stage: After the bone fully regrows, the shape of the ball continues to develop until the child stops growing. The exact cause of Legg-Calve-Perthes Disease is unknown, but it is more common in boys and can run in families. Treatment focuses on preventing the hip joint from becoming misaligned, which can lead to hip arthritis later in life. Most children recover from the disease with time and age, and the long-term prognosis is generally good.

Answer 55

Hip Abduction orthoses.

Answer 56

Amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease, is a progressive, fatal neurodegenerative disease that destroys motor neurons in the brain and spinal cord, causing muscles to waste away and losing the ability to walk, speak, eat, and breathe. It primarily affects people between ages 50 and 75, with most cases (90-95%) being sporadic, while 5-10% are familial. No cure exists, but treatments can manage symptoms and slow progression.

Answer 57

ALS pathophysiology involves the progressive degeneration and death of motor neurons (upper and lower) in the brain and spinal cord, leading to muscle weakness and paralysis, driven by complex interactions including glutamate excitotoxicity, oxidative stress, mitochondrial dysfunction, impaired RNA metabolism, protein aggregation (especially TDP-43), and neuroinflammation, disrupting cell function and causing widespread neuronal loss

Answer 58

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, generally divided into early, middle, and late stages. Early Stage: Symptoms are often limited to one region (e.g., one limb) and may include muscle twitching (fasciculations), cramping, or weakness, leading to difficulties with daily tasks like walking, writing, or grasping objects. Middle Stage: The disease spreads to other regions of the body. Symptoms worsen, with increased muscle loss, paralysis of some muscles, and difficulty swallowing or speaking (bulbar symptoms). Mobility becomes significantly impaired, requiring assistive devices like walkers or wheelchairs. Late/End Stage: The person experiences near-total paralysis, requiring full-time assistance. Breathing muscles become severely weakened, needing mechanical ventilation. The inability to swallow and breathe, leading to respiratory failure, defines the final stages.

Answer 59

Orthotic treatment for ALS focuses on maintaining mobility, independence, and comfort by addressing muscle weakness and joint stiffness. Key devices include Ankle-Foot Orthoses (AFOs) for foot drop and stability, cervical collars for neck weakness, and hand splints to prevent contractures. These interventions improve gait, reduce pain, and assist with activities of daily living.

Answer 60

Brown-Séquard syndrome is a rare neurological condition from damage to one side of the spinal cord, causing weakness, paralysis, and loss of proprioception/vibration on the same side as the injury, but loss of pain and temperature sensation on the opposite side, below the injury level. It results from a "hemisection" (half-cut) of the cord, often from trauma (like a stab wound), tumors, or vascular issues, leading to a unique pattern of motor and sensory deficits.

Answer 61

Brown-Séquard syndrome (BSS) is an incomplete spinal cord injury caused by a hemisection (half-section) of the cord, typically due to trauma. It presents with ipsilateral (same-side) motor paralysis, loss of proprioception/vibration, and contralateral (opposite-side) loss of pain and temperature sensation below the lesion.

Answer 62

It evolves from an acute, flaccid, and areflexic state into a chronic, spastic stage with potential for significant recovery within 6 months. Acute Phase (Immediately post-injury): Characterized by "spinal shock," which includes flaccid paralysis on the same side of the lesion and a complete absence of reflexes. Motor function, vibration, and fine touch are lost ipsilaterally below the injury. Intermediate Phase (Days to weeks): As spinal shock resolves, the ipsilateral flaccid paralysis transforms into spastic paralysis. Muscles become hypersensitive due to a lack of upper motor neuron stimulation, leading to increased tone. Chronic Phase/Recovery: The initial, severe deficits often stabilize, and individuals with BSS generally have a better prognosis for recovery compared to other spinal cord syndromes. Substantial motor recovery is possible within the first 6 months, though some sensory and motor impairment may persist.

Answer 63

Orthotic treatment for Brown-Séquard syndrome (BSS) focuses on stabilizing the spine, managing spasticity, and improving mobility through customized bracing. Common devices include rigid cervical collars for neck injuries, thoracolumbar braces, and lower limb orthotics (e.g., AFOs) to prevent foot drop and stabilize joints, often used during rehabilitation to support recovery.

Answer 64

Developmental dysplasia of the hip (DDH) involves a spectrum of abnormal hip development, ranging from shallow sockets (acetabular dysplasia) to complete dislocation, often due to ligamentous laxity and mechanical instability.

Answer 65

Orthotic treatment for hip dysplasia, involves using devices to hold an infant’s hip joints in an abducted ("frog-leg") position, promoting proper socket development. The most common device for newborns to 6-month-olds is the Pavlik harness, which is successful in approximately 85% of cases.

Answer 66

Hip abduction orthoses for developmental hip dysplasia should hold the hips in a "seated squat" or "human" position, characterized by over 90° of flexion (knees up) and 30° to 60° of abduction (legs apart).

Answer 67

Osteogenesis imperfecta (OI), or brittle bone disease, is a genetic disorder characterized by fragile bones that fracture easily, often with little or no trauma, due to defective or insufficient type I collagen. Loose joints, weak muscles, brittle teeth (dentinogenesis imperfecta), and hearing loss starting in the 20s or 30s.

Orthotics Pathologies Flashcards

Basic info on common Orthotic pathologies (94 cards)