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Term 5 > POAT: LE Orthoses > Flashcards

POAT: LE Orthoses Flashcards

Pages 220-258 and Table 9.2 (48 cards)

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1
Q

What are the 2 categories that AFOs fall into?

A

Static and Dynamic AFOs

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2
Q

What is the purpose of a static AFO?

A

The most aggressive of the AFO designs in providing external support

It prohibits motion in any plane at the ankle
- It greatly compromises transitions through the first (heel), second (ankle) and third (toe) rockers of stance phase

  • Individuals do better functionally wearing a shoe with a cushion heel and rocker bottom to simulate these key transitions
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3
Q

What is the purpose of a dynamic AFO?

A

It allows some degree of sagittal plane motion at the ankle; may permit DF during stance phase to facilitate the ankle rocker of gait but restrict Pf during swing phase to facilitate swing limb clearance

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4
Q

What is the primary goal of an AFO?

A

To provide enough external support for stability in stance and clearance in swing with minimal compromise of forward progression through the heel, ankle, and toe rockers of gait

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5
Q

In Doc

What are the characteristics of the UCBL Orthosis?

University California Biomechanics Laboratory

A

Static Orthosis

  • Stabilizes subtalar and tarsal joints in stance
    (Moderate to severe foot conditions in coronal plane)
  • Trimline is distal to malleoli

This orthosis is not appropriate for those with swing phase clearance issues, which requires the trim line of the orthosis be placed above the ankle joint

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6
Q

What does the UCBL Orthosis help control?

University California Biomechanics Laboratory

A

Flexible calcaneal deformities (rearfoot valgus/varus) and transverse plane deformities of the midtarsal joints (forefoot ABD or ADD) by “grabbing” the calcaneus and supporting the midfoot with high medial and lateral tirm lines

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7
Q

In Doc

What are the Indications and Contraindications for using a UCBL Orthosis?

University California Biomechanics Laboratory

A

Indications

  • Rearfoot valgus/varus Flexible pes planus and/or Mild Posterior Tibialis Tendon Dysfunction

Contraindications

  • Rigid foot deformity
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8
Q

In Doc

What are the characteristics of the DAFO Orthosis?

A

aka Supramalleolar orthosis (SMO); evolved from the UCBL shoe insert to better address sagittal plane control during stance and to facilitate foot clearance in swing

Dynamic Orthosis

  • Stabilizes subtalar and tarsal joints in stance
  • Its proximal trimlines are superior to ankle joint and its distal trimline encase more of the forefoot than the UCBL
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9
Q

In Doc

What are the Indications and Contraindications for using a DAFO Orthosis?

A

Indications

  • Flexible pes planus, Mild to Moderate spastic diplegic or hemiplegic CP, Hypotonic CP

Contraindications

  • Rigid foot deformitiy
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10
Q

In Doc

What are the characteristics of the Supramalleolar (SMO) Orthosis?

A

Dynamic Orthosis

  • Stabilizes subtalar and tarsal joints in stance preposition foot for IC by heel (Controls motions in coronal plane, but allows sagital plane motions)
  • Trimline proximal to malleoli
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11
Q

In Doc

What are the Indications and Contraindications for using a Supramalleolar Orthosis (SMO)?

A

Indications

  • Flexible pes planeus, Mild to moderate spaastic diplegic or hemiplegic CP, Hypotonic CP

Contraindications

  • Significant equinovarus hypertonicity
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12
Q

In Doc

What are the characteristics of the Posterior Leaf Spring Orthosis?

A

Dynamic Orthosis

  • Assist limb clearance in swing preposition foot for IC by heel
  • Trimlines Posterior to malleoli
  • Flexion of plastic stores energy to advance limb
  • Provides DF assist by restance to PF
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13
Q

The Posterior leaf Spring Orthosis is designed to accomplish what 2 things?

A
  • Support the weight of the foot during swing phase as a means of enhancing swing limb clearance
  • Asssit with controlled lowering of the foot during loading response in stance as part of the first/heel rocker
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14
Q

What can a Posterior Leaf Spring do to aid a person in gait?

A
  • Position the foot sagittally at IC
  • Control PF from IC to LR (1st rocker)
  • Allow DF (2nd rocker)
  • Support forefoot during swing phase
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15
Q

In Doc

What are the Indications and Contraindications for using a Posterior Leaf Spring Orthosis?

A

Indications

  • DF weakness, impaired motor control, LMN Flaccid paralysis of DF

Contraindicators

  • Moderate to severe hypertonicity
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16
Q

In Doc

What are the characteristics of the Articulating/Hinged Ankle Orthosis?

A

Dynamic Orthosis

  • Assist limb clearance in swing preposition foot for IC by heel permit advancement of tibia (2nd rocker) in stance
  • Can control Genu Recurvatum in CVA patients
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17
Q

What can a Articulating/Hinged AFo do to aid a person in gait?

A
  • Allow progression through first rocker
  • Control knee hyperextension in Midstance w/ PF stop
  • Control knee flexion during TS (limit DF with DF stop in weak ankle PF)
  • Provide medial lateral stability at the ankle and STJ

STJ = Subtalar joint

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18
Q

In Doc

What are the Indications and Contraindications for using a Articulating Ankle Orthosis?

A

Indications

  • Impaired motor control of ankle musculature, potential for recovery of neuromotor function

Contraindications

  • LMN paralysis (flacciditiy) or hypotonicity as primary problem
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19
Q

In Doc

What are the characteristics of the SAFO?

Solid Ankle-Foot Orthosis

A

Aka Rigid AFO

Static Orthosis

  • Trimline Anterior to malleoli
  • Control ankle position throughout stance, provide stance phase stability via ankle-knee coupling, Assist limb clearance in swing, Preposition foot for IC by heel distal trim line behind metatarsal heads or extended toeplate
  • Limits the Function of all 3 rockers (This was on quiz)
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20
Q

In Doc

What can a SAFO do to aid a person in gait?

Solid Ankle-Foot Orthosis

Study These Flashcards
A
  • Assist swing foot clearance
    —Substitute for weak DF
  • Preposition the foot for IC
  • Promote ankle and knee stability in stance
    —Substitute for weak PFs
    —Substitute for weak invertors/evertors
21
Q

What are the 4 control Systems for a SAFO?

Solid Ankle-Foot Orthosis

Study These Flashcards
A
  • To resist PF during swing
  • To resist DF during stance
  • To resist varus and inversion
  • To resist valgus and eversion
22
Q

In Doc

What are the Indications and Contraindications for using a SAFO?

Solid Ankle-Foot Orthosis

Study These Flashcards
A

Indications

  • Significant hypertonicity with seriously impaired motor control at ankle and knee

Contraindications

  • LMN paralysis (flaccidity) or hypotonicity as primary problem
23
Q

In Doc

What are the characteristics of the Semisolid AFO?

Study These Flashcards
A
  • Trimlines at midline of malleoli
  • Provides resistance to excessive PF and DF
  • Can provide knee flexion and extension resistance
24
Q

What are the characteristics of the Anterior Floor Reaction AFO?

Study These Flashcards
A

Static orthosis

  • Provides stability in stance via ankle-knee coupling, Control ankle position throughout stance
  • This holds the ankle in a few degrees of PF
25
What does the Anterior Floor Reaction AFO restrict?
Restricts the ability of the tibia to roll forward over the foot in the second/ankle rocker of gait, creating an extensor moment that stabilizes the knee during stance
26
What are the control systems for an Anterior Floor Reaction AFO?
*Same as SAFO* - To resist PF during swing - To resist DF during stance - To resist varus and inversion - To resist valgus and eversion
27
What patient population offen uses an Anterior Floor Reaction AFO?
Often children with neurologic conditions who demonstrate "crouch gait", who have paralysis or who have weakness at the knee and ankle
28
What are the Indications and Contraindications for using a Anterior Floor Reaction AFO?
**Indications** - Weakness or impaired motor control at knee and ankle **Contraindications** - Ligamentous insufficiency at the knee, **Genu Recuvatum**
29
What are the characteristics of the Weight-Relieving AFO?
Static orthosis - Protects lower leg and foot during swing stance by reducing weight bearing forces
30
What are the Indications and Contraindications for using a Weight-Relieving AFO?
**Indications** - Healing soft tissue, ligamentous or bone injuries of the lower leg, ankle, or foot **Contraindication** - Mechanical instability of the knee or injury to proximal tibia; patient intolerance of PTB weight bearing forces (rare)
31
What are the Characteristics of a Total Contact AFO?
- Used to treat ankle equinovarus and spasticity - Commonly seen in pediatric and spinal cord populations - Molded footplate aligns foot and contracts reflex points in foot
32
What are the Characteristics of a Traditional or Metal AFO attached to shoe?
- Anterior to Posterior channels allow for complete sagittal control - Indicated for patients with diabetes or fluctuating edema - Heavy - Typically double upright metal stirrups - Mechanical axis with spring loaded DF / PF assist It can: - Assist swing foot clearance - Assist in smoother transition from IC to LE
33
What are the characteristics of Carbon Fiber AFOs?
- Lightweight and strong - Very low profile-can fit in dress shoes - **Cannot be heated for modifications**
34
What Neuro-orthosis/Myo-orthosis can be used for Foot Drop?
- L-300 vs WalkAide - Both Stimulate the Common Peroneal/Fibular Nerve
35
# **In Doc** When should KAFOs be considered?
**Indicated for patients with < 3+ *QUADS*** - The presence of hyperextension or recurvatum that jeopardizes structural integrity of the knee joint - Abnormal or excessive valgus and varus angulation that occurs during weight bearing in stance phase ## Footnote Must be as lightweight as possible
36
Does the KAFO use a 3 or 4 point pressure system?
A 3 point pressure system is used to stabilize the knee in the sagittal plane to control Flexion/Extension. Also in the frontal plane to control varus/valgus
37
# **In Doc** WIth Orthosis and Patient Acceptance, what does WIFE mean?
**W**eightless **I**nvisible **F**ree **E**ffortless to utilize
38
How can we increase Traditional KAFO Acceptance?
- The patient has retained some Hip Flexor and Extensor Function - Gait efficiency and speed increases with KAFO use
39
Prescription of a KAFO are based primarily on what?
40
What can Conventional Non-Locking KAFOs aid with?
- Reduce Knee hyperextension - Control of mild to moderate varus/valgus angulations
41
What can Locking KAFOs aid with?
Control of knee buckling
42
What can Stance Control (SCKAFOs) aid with?
- Control of knee buckling - Assistance of knee extension
43
# **In Doc** What are Characteristics of Drop Lock KAFO?
- Most secure form of locking knee joint - Rings "drop" when leg reaches **full extension** - May need 2 hands to release lock
44
# **In Doc** What are the Characteristics of Bale Lock KAFO?
- Metal hoop (bale) connects both knee joints - Lock engages when leg reaches **full extension** - Lock disengages when bale is lifted - Bale can be contoured to disengage on chair
45
What are the Characteristics of Ratchet or Step Locks KAFO?
- Provides locking of knee joints at 10 degree intervals - Used to protect static progressive stretch of knee flexion tightness
46
# **In Doc** What are the Characteristics of HKAFO?
- Hip joints provide proximal stability - Commonly indicated for spina bifida and spinal cord injury - Patient must possess 3+ hip flexors
47
# **In Doc** What are the Characteristics of Reciprocating Gait Orthosis (RGO)?
- Reciprocating cable uses trunk extension to initiate hip flexion - Used to complete SCI or spina bifida
48
What are the Basic Factors we should consider in any KAFO Rx?

Term 5 (16 decks)

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