100+ Free BOCO Practice Questions

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A patient presents with a prescription for an ankle-foot orthosis (AFO) following a stroke. Which assessment finding is MOST critical to document before initiating the treatment plan?

Patient's insurance coverage details

Degree and pattern of spasticity in the affected limb

Patient's preferred color for the orthosis

The referring physician's office location

to track

2026 Statistics

Key Facts: BOCO Exam

165

MCE Questions

BOC Candidate Handbook

3 hours

MCE Time Limit

BOC Candidate Handbook

$350+

Total Exam Fees

BOC Application

CEUs per 5-Year Cycle

BOC Recertification Policy

300+

PSI Test Centers

BOC / PSI Services

3 exams

MCE + CSE + VPE Required

BOC Candidate Handbook

BOC lists the orthotist MCE as 165 questions in 3 hours (150 scored + 15 pretest). Candidates also complete a clinical simulation exam (8 tasks in 4 hours) and a video practical exam. Application fee is $150 and MCE fee is $200. BOC uses PSI Services for test administration at 300+ US locations or via live remote proctoring.

Sample BOCO Practice Questions

Try these sample questions to test your BOCO exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A patient presents with a prescription for an ankle-foot orthosis (AFO) following a stroke. Which assessment finding is MOST critical to document before initiating the treatment plan?

A.Patient's insurance coverage details

B.Degree and pattern of spasticity in the affected limb

C.Patient's preferred color for the orthosis

D.The referring physician's office location

Explanation: Documenting the degree and pattern of spasticity is most critical because it directly influences the AFO design, material selection, and joint configuration. Spasticity patterns determine whether a rigid, articulated, or dynamic AFO is appropriate and affect alignment decisions throughout the treatment process.

2During gait analysis of a patient with foot drop, the orthotist observes excessive knee flexion during stance phase. Which orthotic intervention would BEST address this gait deviation?

A.A flexible posterior leaf spring AFO

B.A solid ankle AFO set in slight plantarflexion

C.A solid ankle AFO set in 5 degrees of dorsiflexion

D.A hinged AFO with a free dorsiflexion stop

Explanation: A solid ankle AFO set in approximately 5 degrees of dorsiflexion creates a knee extension moment during stance phase by positioning the ground reaction force anterior to the knee joint axis. This effectively counteracts excessive knee flexion while still addressing the foot drop during swing phase.

3Which material is MOST appropriate for fabricating a custom rigid thoracolumbosacral orthosis (TLSO) for a patient with a stable thoracic compression fracture?

A.Low-temperature thermoplastic

B.High-temperature copolymer polypropylene

C.Soft closed-cell foam

D.Elastic fabric with steel stays

Explanation: High-temperature copolymer polypropylene is the most appropriate choice for a rigid TLSO because it provides the necessary structural rigidity to restrict spinal motion and support the fractured vertebra. It can be vacuum-formed over a positive model for precise fit and is durable enough for long-term wear.

4What is the PRIMARY biomechanical principle used in a knee-ankle-foot orthosis (KAFO) to control genu recurvatum?

A.Two-point force system

B.Three-point force system

C.Hydrostatic pressure

D.Total contact compression

Explanation: A three-point force system is the primary biomechanical principle used to control genu recurvatum in a KAFO. Posterior forces are applied at the thigh and calf, while an anterior counterforce is applied at the knee. This system creates a moment that prevents knee hyperextension during stance phase.

5A patient with L4-L5 radiculopathy is prescribed a lumbosacral orthosis (LSO). Which motion should the LSO PRIMARILY restrict?

A.Cervical rotation

B.Lumbar flexion and extension

C.Hip abduction

D.Thoracic lateral flexion

Explanation: An LSO for L4-L5 radiculopathy should primarily restrict lumbar flexion and extension to reduce intradiscal pressure and limit motion at the affected spinal segment. By stabilizing the lumbar spine, the orthosis helps decrease nerve root irritation and allows healing of the affected disc or nerve structures.

6During the fabrication of a polypropylene AFO, the orthotist notices air bubbles trapped between the plastic and the positive model during vacuum forming. What is the MOST likely cause?

A.The plastic was heated to an excessively high temperature

B.Insufficient vacuum pressure or inadequate model preparation

C.The positive model was too smooth

D.The plastic sheet was too thin

Explanation: Air bubbles between the plastic and the model during vacuum forming are most commonly caused by insufficient vacuum pressure, air leaks in the system, or inadequate model preparation such as failure to apply a proper stockinette or insufficient perforation of the model for air evacuation. These issues prevent complete air removal between the plastic and the model surface.

7Which cranial nerve is responsible for motor innervation of the muscles of facial expression, and damage to it may require a cervical orthosis combined with eye protection?

A.Trigeminal nerve (CN V)

B.Facial nerve (CN VII)

C.Glossopharyngeal nerve (CN IX)

D.Accessory nerve (CN XI)

Explanation: The facial nerve (CN VII) provides motor innervation to the muscles of facial expression. Damage to this nerve, as in Bell's palsy, can result in inability to close the eyelid on the affected side, potentially requiring eye protection. If the underlying cause involves cervical pathology, a cervical orthosis may also be indicated.

8A patient with a C5-C6 spinal cord injury has intact deltoid and biceps function but no wrist extension. Which upper extremity orthosis is MOST appropriate?

A.Shoulder abduction orthosis

B.Wrist-hand orthosis (WHO) with wrist extension assist

C.Elbow orthosis with flexion assist

D.Static resting hand splint only

Explanation: A patient with a C5-C6 spinal cord injury retains deltoid and biceps function but lacks wrist extensors (innervated by C6-C7). A wrist-hand orthosis with wrist extension assist supports the wrist in a functional position and may facilitate tenodesis grasp, significantly improving hand function and independence.

9When fitting a patient with a custom molded TLSO, which anatomical landmark is used to determine the inferior trim line anteriorly?

A.Xiphoid process

B.Symphysis pubis

C.Anterior superior iliac spine (ASIS)

D.Umbilicus

Explanation: The symphysis pubis is used to determine the inferior anterior trim line of a TLSO. This landmark ensures the orthosis extends low enough to control lumbar lordosis and pelvic tilt effectively. The anterior inferior trim line at the pubic symphysis provides a foundation for the three-point pressure system used to manage thoracolumbar fractures.

10What is the PRIMARY purpose of a patellar tendon-bearing (PTB) design in a below-knee orthosis?

A.To increase knee range of motion

B.To offload weight from the tibia and foot by transferring load to the patellar tendon

C.To correct genu valgum alignment

D.To restrict ankle plantarflexion

Explanation: A patellar tendon-bearing (PTB) design transfers a portion of the patient's body weight from the lower leg and foot to the patellar tendon area, which is a pressure-tolerant region. This offloading is used to reduce stress on injured or healing structures such as tibial fractures or foot lesions.

About the BOCO Exam

The BOCO certification is awarded by the Board of Certification/Accreditation (BOC) to qualified orthotists who demonstrate competence in evaluating patients, designing, fabricating, fitting, and adjusting custom orthoses for lower extremity, upper extremity, and spinal conditions. Candidates must pass a multiple-choice exam, clinical simulation exam, and video practical exam.

Questions

165 scored questions

Time Limit

3 hours (MCE) + 4 hours (CSE) + VPE

Passing Score

Scaled score (criterion-referenced, Angoff method)

Exam Fee

$150 application + $200 MCE + CSE/VPE fees (BOC / PSI Services)

BOCO Exam Content Outline

~28%

Patient Assessment

Gathering patient history, physical examination, gait analysis, range of motion, manual muscle testing, and clinical evaluation

~18%

Treatment Planning

Formulating orthotic treatment goals, selecting designs, materials, and components, and developing patient-centered care plans

~27%

Implementation

Fabrication, casting, model rectification, fitting, alignment, and delivery of custom orthoses

~15%

Follow-up

Assessing outcomes, modifying orthoses, evaluating patient function, and developing long-term care plans

~12%

Practice Management

Compliance with regulations, documentation, billing, ethics, infection control, and professional development

How to Pass the BOCO Exam

What You Need to Know

Passing score: Scaled score (criterion-referenced, Angoff method)
Exam length: 165 questions
Time limit: 3 hours (MCE) + 4 hours (CSE) + VPE
Exam fee: $150 application + $200 MCE + CSE/VPE fees

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

BOCO Study Tips from Top Performers

1Focus on the three largest exam domains: Patient Assessment (28%), Implementation (27%), and Treatment Planning (18%)

2Master biomechanical force systems (especially three-point systems) and their application to specific orthotic designs

3Practice gait analysis using the Rancho Los Amigos 8-phase classification and identify orthotic solutions for common gait deviations

4Know materials properties, fabrication techniques, and when to use each material (polypropylene, carbon fiber, low-temp thermoplastics)

5Review anatomy and pathology of conditions commonly requiring orthotic management, including dermatomes, peripheral nerves, and muscle testing

Frequently Asked Questions

How many questions are on the BOCO multiple-choice exam?

The BOC orthotist MCE contains 165 questions (150 scored + 15 unscored pretest items) with a 3-hour time limit. Candidates also take a clinical simulation exam and video practical exam.

What is the difference between BOCO and ABC CO certification?

Both BOCO (BOC) and CO (ABC) certify orthotists, but they are issued by different organizations. BOC is accredited by NCCA and requires MCE + CSE + VPE. ABC requires a written exam, simulation exam, and clinical patient management exam. Both are recognized by CMS for Medicare billing.

What are the prerequisites for BOCO certification?

Candidates need a bachelor's degree in orthotics (or bachelor's plus certificate) from a CAAHEP-accredited program and at least 12 months of structured clinical affiliation under a certified orthotist.

How much does the BOCO exam cost?

The application fee is $150 (non-refundable) and the MCE fee is $200. Additional fees apply for the clinical simulation and video practical exams. Total certification costs vary.

Where can I take the BOCO exam?

BOC exams are administered at approximately 300 PSI testing locations throughout the United States or via live remote proctoring (LRP) from your home or office. Exams are available year-round on business days.

How should I prepare for the BOCO exam?

Study the BOC Detailed Content Outline (DCO), use the self-assessment examination, review textbooks and journal articles on orthotics, attend continuing education programs, and practice with study partners or exam preparation courses.