Lecture 2: AFOs Flashcards by Braden Talbert

CPO responsibilities

pt assessment, formulation of treatment plan, pt follow up

select appropriate device/material s

design, fabricate, and fit orthoses and/or prostheses

demonstrate how to use to pt

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O&P assistant vs tech

assistant
- practice under CPO, assist with P&O procedures and tasks related to pt management
- fabricates, repairs, and maintenance of devices

tech
- assists via technical support
- fabricates, repairs, or maintains orthoses and/or prostheses
- must be proficient in current fabricating techniques, familiar with material properties and skilled in use of necessary equipment

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requirements to be an orthotic fitter

HS diploma, GED, or college

complete orthotic fitter pre-certiciation course

500-1000 hours supervised pt care

holds license in related allied health profession, includes PT

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scope of practice for a orthotic fitter

prefabricated orthoses

evaluation of pt needs

formulate and implement treatment plan

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PT role in O&P

assessment for indentified purposes

preparation for use

evaluation of fit

edu in fit and training in use

gait training, transfer training, high level training

assessment and quantification of functional benefits and uses

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level I vs II codes for documentation of P&O

level I = current procedural terminology (CPT)

level II = codes that identify services, projects, and supplies not included in CPY codes such as P&O; “L codes”

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what are the different ankle rockers

heel rocker = IC to loading response

ankle rocker = loading response to foot flat

forefoot rocker = terminal stance

toe rocker = preswing; MTP ext 60 deg

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purposes of foot orthoses (aka inserts)

alignment correction
deformity accommodation
facilitate supination/pronation
pain relief
improve foot and/or proximal alignment
relieve weight bearing stress

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important pt edu for foot orthoses

recommend progressive increase in wear time

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fixed vs flexible/dynamic deformity

fixed = cant passively correct

flexible = can be partially or fully corrected
- possible causes = irregular mm activity, mm length, ligamentous deficit

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prefabricated vs custom foot orthoses

prefabricated
- generic fit
- good for short term use; healing, function/training aid, contracture prevention
- low cost

custom
- individualized
- short or long term use
- higher cost (device and labor)

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different lengths of foot orthoses

full = extends to toes

Sulcus length = proximal to toes (toe crease)

3/4 length = to met heads

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varying flexibilities of foot orthoses

soft
- cushions
- absorbs shock
- may redistribute plantar pressures

semi-rigid
- provides some flexibility and shock absorption
- provides control of the foot

rigid
- stabilizes deformities
- controls abnormal motion
- provides support

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what to document related to foot orthoses

length
fabrication method
flexibility

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orthoses for pes planus

if flexible can correct with FO

posterior tibialis mm supports arch

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orthoses goal for pes cavus

support deformity

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causes of leg length discrepancy

previous injury to leg, bone infection, congenital, idiopathic

“normal” leg length discrepancy

up to 3/5 inch

leg length discrepancy that will result in gait abnormalities

1 and 2/3 inch

orthotics for rear foot varus

medial wedge to accomodate (decreases hyperpronation)

lateral wedge to correct

orthotics for rear foot valgus

lateral wedge to accomodate (decrease supination)

medial wedge to correct

uses of AFOs

provide ankle stability
correct malalignment
control foot drop
enhance mobility
deformity prevention
regulate or reduce mm tone

how is a custom traditional AFO fabricated

pt casted

cast created

create positive mold

AFO fabricated

AFO delivered/fitted

traditional vs 3D scan AFO

traditional = time consuming and poor reliability

3D scanning = faster for experience users and poor reliability

steps of prescribing orthotic devices

1. identify where in gait cycle the abnormal time or mm performance is; where is the gait deviation 2. determine what factors could be compromising the particular abnormal phases of Gait cycle 3. identify what specific orthotic interventions would benefit the particular abnormal phases of gait cycle

function of AFO during swing

provide external support during swing for foot clearance (positioning of foot/ankle) optimize position of limb for IC in prep for stance stability

AFOs during stance function

optimize position of ankle/foot may also influence proximal alignment provide external support for stance stability depending on device, may also facilitate fwd progression

types of AFOs

solid/fixed hinged/articulating anterior floor reaction energy storage and return tone inhibiting

impact of solid/fixed AFO on gait

stance stability medial lateral support accelerated heel rocker loss of ankle and forefoot rocker assist with foot clearance positions foot for IC - ideal position = plantar grade and neutral ankle/subtalar

solid AFO effect on hyperextended knee

pushes tibia forward and prevents backward movement/knee hyper ext

what happens when an AFO is placed in 5 deg PF vs Df

PF = produces knee extension Df = produces knee flexion

hinged/articulating AFO effect on gait/function

allows for limited ankle ROM provide medial lateral stability can have DF/PF assist/stop some rockers are preserved

posterior leaf spring impact on gait/function

control PF from IC to loading response allows for DF in stance support foot during swing phase trimlines posterior to malleoli = pt needs good M-L stability

anterior floor reaction AFO impact on gait/function

maintains proper ankle alignment compensates for weak or absent gastroc/soleus mm facilitates PF knee ext couple anterior shell controls fwd tibial progression *not appropriate for those with knee ligamentous instability or gene recurvatum

energy return or dynamic AFOs impact on gat/function

assist limb clearance positions heel for IC assists with fwd propulsion *not appropriate for those with mod to severe hypertonicity

function of tone inhibiting AFO

controls ankle position provide stance stability inhibits reflexes induced by tactile stimulation controls mm length (i.e. spasticity caused by stretch) indicated for pts with significantly impaired motor control

alternative options to AFOs

functional electrical stimulation; relies on stimulating common peroneal nn (anterior tibia's) ossur foot up DF assist with ACE

what should you document with gait deviations in objective portion

magnitude (i.e. increased, decreased, inadequate, etc) timing related to ROM side joint direction/motion phases of Gait

what to include in you assessment in regard to gait deviations

possible etiology (i.e. impaired motor control , abnormal ROM, pain, sensation) impact and significance on functional task (i.e. weight acceptance, SLS, swing limb advancement)