Test 2: AFOs Flashcards by Braden Talbert

some purposes of orthotics in general

improve performance of functional activities
improve/enhance mobility (i.e. amputation)
prevent deformity
correct passively modifiable deformity
immobilization/control/prevention
regulate/reduce muscle tone
stabilize weak/flaccid muscles
improve quality of life

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describe the three point (counter force) system

includes middle force and 2 end forces

prevents plantar flexion and inversion

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characteristics of metal AFOs

strong
heavy
doesn’t work well if volume fluctuates

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characteristics of thermoplastic AFOs

conforms to body when custom fitted

lightweight

easy to mold

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characteristics of composite material AFOs

thin
strong
durable
store and release energy

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ways to restrict movement to different degrees

how enclosed the AFO is

more material = more control

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describe a free ankle joint

no control

can go through full ROM in designated plane

provides some medial lateral stability

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describe ankle joint with assist

plantar flexion assist most common

assists motion using external force

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how does a dorsiflexion assist AFO work

uses a spring or elastic to help with DF

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how does a dorsiflexion plantar flexion assist (dual channel) or bi channel ankle locks (BiCAAL) work

joint with anterior and posterior spring that assiste with plantar and dorsiflexion to varying degrees according to settings of the spring

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describe a plantar flexion stop

restricts PF but allows DF

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describe a dorsiflexion stop

restricts DF but allows full PF

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what is a limited stop motion AFO

limits or stops joint movement

can set specific ROM restrictions

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describe the cinical decision making process for selecting an AFO

identify impairments- location/type/joints
functional goals- PLOF, prognostic, disease progression
orthotic goals - type of impairment relates; stabilize, protect, correct, etc
possible orthotic solutions to meet goal - biomechanical features
develop orthotic prescription - most appropriate device for pt

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factors to consider with orthotic Rx

effective but least controlling

limit interference woth normal movement of adj joints

energy efficiency

foces on adj joints

minimize negative side effects

pt satisfaction/ease of use

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how does DF paresis compensate

steppage gait

increase hip and knee flexion in swing

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how does DF paresis impact spactial temporal factors of gait

decreased step length
decrease time to foot flat

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how does PF paresis compensate

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increase stance knee flexion

increase stance phase DF

how does PF paresis affect temporal spatial parameters of gait

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prolonged midstance

decrease stance time

prefabricated vs custom AFOs

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prefabricated
- off the shelf
- generic fit
- size selection
- more accessible
- quicker/cheaper

custom
- specific to pt
- need orthotist
- more expensive/takes more time

functions of a solid or fixed AFO

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stance stability (ROM impeded, especially with SLS)

ML support

assists with foot clearance

position foot for initial contact

blocks DF and PF

how to fit an AFO to avoid knee hyperextension

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align the AFO into more DF = prevent hyperextension

opposite of patient is staying in too much knee flexion

negative impact of solid AFO

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cant go into DF with:
- sit to stand
- stairs
- walking up/down hill

functions of hinged/articulating AFOs

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allows for ankle ROM- depends on PF or DF stop

provide ML stability

can have DF assist

aids in foot clearance

describe metal upright articulating AFOs

utilize bichannel adjustable ankle locks (BiCHAALs) highly adjustable to limit and/or assist ankle motion can be for DF assist with PF stop or PF assist with DF stop

describe posterior leaf spring

flexible thermoplastics trimline posterior to malleoli; doesnt provide much ML support

functions of posterior leaf spring

control PF from initial contact to loading response allows for DF during stance support foot during swing

what does a posterior leaf spring not work well for

individuals with moderate to severe hypertonicity

metal upright articulating AFOs dont work well for

those with limb volume fluctuations abnormal foot position

anterior floor reaction AFOs are not appropriate for

individuals with knee ligamentous instability or genu recurvatum

functions of anterior floor reaction AFOs

maintain proper ankle alignment compensates for weak or absent gastroc soleus muscles facilitate plantar flexion knee extension couple anterior shell controls forward tibial progression

what are the coupling movements for the knee and ankle

DF and knee flexion PF and knee extension

describe energy return or dynamic response AFOs

typically made of carbon fiber inappropriate for individuals with moderate to severe hypertonicity

functions of energy return or dynamic response AFOs

assist limb clearance in swing position heel for initial contact assist with forward propulsion

what is the rancho ROADMAP

recommendations for orthotic assessment, decision making, and prescription

what is a factor that can indicate a pt needs an orthoses more involved than an AFO

if the pt has <3+/5 quad strength or impaired proprioception on test limb

what types of AFOs does medicare cover that are not used during ambulation

PF contracture reasonable expectation of ability to correct contractire contracture interferes with functional abilities uses a component of therapy program, including active stretch plantar fasciitis

what are reasons AFOs are covered by medicare when used during ambulation

individuals with weakness or deformity of the foot and ankle who: require stabilization for medical reasons have potential to benefit function

advantages of functional electrical stimulation, FES and how it works

cosmesis less bulky less restrictive rely on stimulating common peroneal n (anterior tibialis) sensor used to detect lower leg position

describe the ossur foot up

light weight easily adjusted low maintenance affordable must be used with shoes assists with foot clearance

benefits of AFOs for adults with hemiplegia

prevent or reduce PF or IV contractures improve balance enhance gait reduce genu recurvatum if PF stop facilitate weight shift to involve limb if DF stop

effects of AFO on people with DF paresis

improve energy efficiency improve exercise tolerance improve DF during swing circular/elestic = more comfy than dorsal AFO circular/elastic increase walking speed more than dorsal

benefits of FES for post stroke pt

improve DF improve balance improved functional mobility increase gait speed when combined with PT

describe importance of prescribing proper AFO

providing an AFO too early or with too much support could impede neuroplasticity/recovery if ankle is fully supported, normal muscleactivation may not occur = learned nonuse insurance only reimburses for AFO every 2 years

Test 2: AFOs Flashcards

(44 cards)