Hip Knee Ankle Foot Orthoses and RGOs

Question 1

Hip Knee Ankle Foot Orthoses

Answer 1

Orthosis is extension of KAFO with hip joint and pelvic band

Can be bilateral

Hip may be locked with a drop lock

Dial lock hip joints are also available

Hip joints attached to pelvic band laterally

Band is made of steel and padded

In front, soft belt closure is used or a leather buckle closure system

Pelvic band is located between iliac crest and GT

Question 2

Hip Joint Axis

Answer 2

1 inch anterior and superior to greater trochanter

Question 3

Free Motion Hip Joints

Answer 3

Controls abduction, adduction, rotation, no locks can be added

Question 4

Hip Drop Locks

Answer 4

Controls flexion, extension, rotation, abduction and adduction

Question 5

HKAFO Indicators

Answer 5

Posterior lean due to weak hip extensors

Gluteus medius limp from absent abductors

Adduction spasticity with scissor gait

Adduction weakness results with wide base of support

Internal/external rotational deformities

Question 6

Pelvic Bands

Answer 6

Unilateral

Attaches to anterior superior iliac spine
Extends 1 inch lateral to posterior superior iliac spine

Bilateral

Attaches to R and L lateral proximal uprights between the greater trochanter and the iliac crest

Question 7

Twister Cables

Answer 7

Used for torsional deformities

Bilateral pelvic strap with lateral cables attached on to the shoes

Controls internal or external rotation of hip depending on orientation of cable

Can cause genu valgus stresses or lax ligaments

Question 8

Reciprocating Gait Orthosis (RGO)

Answer 8

Designed to compensate for absent hip extensors

Reciprocal design allows for alternating leg motion, usually initiated by hip flexors

Contraindications

Spasticity
Poor hip flexors
Poor hip range of motion
Low motivation

Question 9

3 elements needed for RGo

Answer 9

Swing leg clearance

Stance hip extension

Swing leg flexion

Question 10

HKAFO Conventional Indications

Answer 10

Weak hip extensors, abductors, or adductors

Internal/external rotational deformities

Question 11

HKAFO Conventional Contrainidications

Answer 11

Poor trunk control

Poor upper body strength

Question 12

HKAFO Conventional Advantages

Answer 12

HIp can be stabilized and range of motion controlled

Question 13

HKAFO Conventional Disadvantages

Answer 13

Heavy

Stiff legged gait

Question 14

RGO indications

Answer 14

Paraplegic children
Spinal Bifida
Motivated
Supportive family

Question 15

RGO contraindications

Answer 15

Obesity
Spasticity
Contractures
Poor upper extremity strength
Cardio-respiratory deficits
Poor exercise tolerance

Question 16

RGO advantages

Answer 16

Flexion and extension for reciprocating gait

Increased energy expenditure (for exercise)

Upright stance to increase body image

Question 17

RGO disadvantages

Answer 17

Difficulty donning and doffing

Question 18

Hip Extensor Insufficiency

Answer 18

Can also be managed in children with a HKAFO with a locked hip joint

Bracing above the hip joint is not indicated in the adult population for situations taht involve insufficient muscle strength

Question 19

Hip flexion insufficiency

Answer 19

Not orthotically manageable condition

Question 20

Legg-Calve-Perthes

Answer 20

Avascular necrosis of the femoral head

Orthotic attempts to unload the hip and maintain hip abduction and internal roation

Patten Bottom
Trilateral Socket
Toronto Brace
Sam Brown Belt
Scottish Rite