National Physical Therapy Examination (NPTE) Practice Exam

What orthosis is MOST appropriate to facilitate improved gait for a patient with L4-5 paraplegia who is independent in all activities of daily living?

1. Bilateral solid ankle-foot orthosis

2. Bilateral knee-ankle-foot orthosis

3. Thoracic-lumbar-sacral orthosis

4. Hip-knee-ankle-foot orthosis

The correct answer is: Bilateral knee-ankle-foot orthosis

For a patient with L4-5 paraplegia, the most appropriate orthosis to facilitate improved gait is the bilateral knee-ankle-foot orthosis (KAFO). This type of orthosis provides stability and control at both the knee and ankle joints, which is essential given the patient's lower extremity weakness. At the L4-5 level, the patient may retain some function in hip flexion and knee extension, but the ability to effectively control knee stability during gait is often compromised. The bilateral KAFO is designed to support this population by preventing knee buckling during weight-bearing phases of gait and allows for some degree of passive control. This can enhance the patient's ability to walk, particularly when using assistive devices such as crutches or a walker. Moreover, since this patient is noted to be independent in all activities of daily living, the option of using a bilateral KAFO aligns with their functional goals. This orthosis allows for more mobility and participation in community activities, which is likely a priority for someone at this functional level. In contrast, other options such as solid ankle-foot orthoses or hip-knee-ankle-foot orthoses may not provide the necessary knee control, and the thoracic-lumbar-sacral orthosis