Chapter 27: Lower Limb Orthoses for persons with spinal cord injury Flashcards
(39 cards)
What does ASIA stand for?
American Spinal Injury Association
What are the levels scored in the ASIA examination
C2 to S4-5 The pinpricks are measured on a 0-2 0: absent 1: impaired 2: normal
how do you classify a person as an incomplete SCI?
Partial preservation of sensory and motor function is found below the neurological level and must include the lowest sacral segment
How do you classify a person as complete SCI?
He or she has no sensory or motor function inthe lowest sacral segment.
What are some possible complications in children with SCI?
Hip dislocation/subluxation
Scoliosis
Pressure ulcers
What are the different walking patterns seen in patients with SCI?
Step to
Step through
Swing to
Swing through
For a patient with SCI using an Floor reaction or Ground reactionAFO, what muscles must be present?
Hip flexion
quad strength of 4/5
For a patient with SCI using an articulated AFO, what muscles must be present?
Hip flexion
Quad strength of 4/5
Knee strength
What muscle strength is absent for a patient with SCI to use a KAFO?
Quads
What is parastance?
The most stable stance involving neutral ankle
Knee in extension
Hips in passive extension
Why would a patient with SCI require a HKAFO?
The level of injury is higher
Hip flexion, knee flexion, or ankle plantarflexion contractures,
Poor balance
Decreased motor control.
What are HGO ORLAU parawalkers?
Hip Guidance Orthosis
Orthotic Research and Locomotor Assessment Unit (ORLAU) parawalker
Theses are HKAFOs with free-moving hip joints that allow a reciprocal gait pattern.
What is a RGO?
A Reciprocating Gait Orthosis
An HKAFO that uses a mechanical system that connects the two sides of the brace by an isocentric bar (IRGO), double cable (LSU RGO from Louisiana State Univeristy), or single push/pull cable system (advanced RGO [ARGO])
The patient achieves a reciprocal gait by shifting body weight forward and laterally while extending the hips and upper trunk.
What is the HALO in regards to Lower limb SCI?
Hip and Ankle Linked Orthosis
It is a cable system that links both ankle joints with a medial hip joint. The linkage of the ankles by way of a pulley system results in assistance of the swinging leg when the contralateral ankle is flexed.
What is the SCO?
Stance Control Orthosis
Has knee joints that provide stability during stance but free motion during swing. It reduces the energy required during gait.
What are the different standers available for children?
L-Frame
Parapodium
Swivel standers
The Rabbit: Strapped into a stander with wheelchair like wheels for mobility.
You have an athletic patient with a T9 injury and no significant comorbidities. Their goal is spontaneity of activities for short distances. What orthoses could work for them?
KAFOs
You have a patient with a T9 injury and no significant comorbidities. The patient is interested in using an orthosis for limited function and prefers a reciprocating gait pattern. What orthoses should they use?
A Parawalker or RGo to be more stable.
What orthopedic considerations might affect the patient if they want to stand?
Scoliosis Pelvic Obliquity Hip subluxation/dislocation Lower Limb contractures Spasticity History of Lower limb fractures.
Which contractures might prevent the patient from standing?
30 degrees hip flexion contracture
20 degree knee flexion contracture
15 degrees of plantarflexion contracture
What might reduce spastisity or make it worse?
Standing reduces spasticity
But movement may trigger a patient’s spasticity
Which braces can be used for patients with SCI at motor level L2 or above?
HKAFOs (including RGOs) and KAFOs
What are the benefits of the HGO?
Lateral stiffness, which prevents adduction during swing through of the free limb, and broad footplates, which encourage stability during double limb stance.
What patient’s will benefit from an added pelvic section in a HKAFO
Patient’s with hip obliquity due to scoliosis or hip subluxation.
Children with pliable Y-ligaments.
