Assistive Device Selection - National Physical Therapy Examination NPTE

1. Which option is most appropriate for a patient needing moderate balance support: quad cane or single-point cane?

   Quad cane. Offers a broader base of support than a single-point cane, improving stability for moderate balance needs.

2. Which AFO is most appropriate for dorsiflexion weakness causing foot drop during swing?

   Posterior leaf spring AFO (or dorsiflexion-assist AFO). Provides dorsiflexion assistance during swing phase to clear the foot and prevent drop foot.

3. What is the correct gait sequence for using a cane with a weak left leg?

   Cane and left leg advance together, then right leg. This sequence allows the cane to support the weak leg during advancement, mimicking a three-point gait pattern.

4. Which AFO is most appropriate when mediolateral ankle instability is the primary impairment?

   Solid AFO. Offers rigid support to restrict unwanted mediolateral motion, enhancing ankle stability.

5. Which mobility device is most appropriate for long distances when gait is unsafe despite training?

   Wheelchair (manual or power based on UE strength and endurance). Provides safe, efficient mobility over distances when ambulation risks falls despite assistive devices.

6. Which gait pattern is most appropriate for non-weight bearing on the left leg with crutches?

   Three-point gait (NWB: both crutches then right leg). Crutches advance first to support body weight, allowing the unaffected leg to swing through without loading the injured side.

7. Which gait pattern is most appropriate for a patient who can partially weight bear on one leg with crutches?

   Three-point gait. Allows partial weight on the affected leg while crutches provide additional support and stability.

8. Which orthosis is primarily indicated to control excessive knee flexion in stance (crouch gait)?

   Ground-reaction AFO (floor-reaction AFO). Uses ground reaction forces to create an extension moment at the knee, counteracting flexion instability.

9. Which side should a cane be held on for a patient with right hip osteoarthritis pain?

   Left hand (contralateral to the painful limb). Holding contralaterally reduces joint loading on the affected hip by shifting weight away during stance.

10. What is the key safety risk of improper axillary crutch fit with weight bearing through the axilla?

    Brachial plexus compression (crutch palsy). Weight on axilla compresses neurovascular structures, leading to temporary or permanent nerve damage.

11. Which assistive device provides the greatest stability for gait: cane, crutches, or walker?

    Walker. Features the widest base of support, enhancing stability for patients with significant balance or weakness issues.

12. What is the recommended clearance between the axilla and axillary crutch pad during standing?

    Approximately $2$ to $3$ finger widths. Prevents axillary pressure by ensuring weight is borne through hands, minimizing nerve compression risk.

13. Which crutch type is most appropriate for long-term use with good trunk control: axillary or forearm crutches?

    Forearm (Lofstrand) crutches. Distributes weight through forearms, reducing axillary pressure risks for prolonged use with adequate stability.

14. Which gait pattern is most appropriate for a patient with bilateral LE weakness using two crutches?

    Four-point gait. Alternates support between crutches and legs, providing maximum stability for bilateral impairments.

15. What is the standard fitting landmark for cane height in standing with arms relaxed?

    Wrist crease at the ulnar styloid level. Aligns the handgrip at this level to achieve optimal elbow flexion of $20^circ$ to $30^circ$ for comfortable support.

16. What is the primary advantage of a rolling walker compared with a standard walker?

    Improves gait speed and reduces energy cost for continuous ambulation. Allows continuous forward motion without lifting, facilitating smoother and more efficient walking patterns.

17. Which upper-extremity support is most appropriate for reducing dependent shoulder subluxation post-stroke?

    Shoulder sling (used selectively; avoid prolonged immobilization). Supports the arm to minimize glenohumeral subluxation from gravity in hemiplegic patients, with caution for mobility.

18. Which walker type is most appropriate when the patient cannot lift a standard walker safely?

    Rolling walker (front-wheeled or four-wheeled as appropriate). Enables propulsion without full lifting, suitable for patients with limited strength or coordination.

19. Which prosthetic foot is most appropriate for a low-activity household ambulator needing maximal stability?

    SACH foot (solid ankle cushioned heel). Delivers stability through a fixed ankle and cushioned heel, ideal for low-demand users prioritizing balance.

20. What is the primary clinical indication for prescribing a single-point cane?

    Unilateral mild weakness or pain with need for minimal balance support. Provides minimal base of support to offload the affected side and assist with minor balance deficits during ambulation.

21. Which prosthetic knee mechanism is most appropriate for a new transfemoral amputee needing stance stability?

    Single-axis knee with stance-phase control (manual lock if needed). Ensures knee stability during stance to prevent buckling, critical for safety in early prosthetic training.

22. Which AFO setting is used to limit plantarflexion after stroke to reduce toe drag and improve heel strike?

    Plantarflexion stop (limits plantarflexion). Prevents excessive plantarflexion, promoting proper heel contact and reducing drag in swing phase.

23. Which knee orthosis is most appropriate for ACL deficiency to limit anterior tibial translation?

    Functional hinged knee brace. Hinged design stabilizes the knee and restricts anterior tibial movement to protect the ACL.

24. Which orthosis is most appropriate to offload a compartment in unicompartmental knee osteoarthritis?

    Unloader knee brace (valgus or varus as indicated). Shifts load away from the affected compartment via valgus or varus force, reducing pain and wear.

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