Assistive Technology For Locomotion Flashcards
what are the two assistive technologies for locomotion?
ADs and LE orthotics
t/f: we want to know what the assistive technology is going to change when we prescribe them
true
we want to try and use what kind of ADs for as long as possible as you progress to the least restrictive device?
bilateral
what do we need to consider when making a prescription for assistive technologies?
the interaction bw fxnal performance and personal/environment factors and how they are going to effect gait speed, endurance, and balance
what 3 things do we want to be aware of with prescription of assistive technologies?
the pt fxn, prognosis, and ambulatory status
with d/c disposition home, home health, or outpatient, do we prescribe assistive technologies?
yes
with d/c disposition to IFR–> home or subacute–>home, do we prescribe assistive technologies?
sometimes
with d/c disposition to ECF and or with non-ambulatory pts, do we prescribe assistive technologies?
no
what are the reasons for orthotics?
limited DF (BIG ONE)
pt independence
stability
the PT exam for LE orthotics includes what?
a needs assessment for assistive technologies or other supportive devices
who is involved in the decision making team for LE orthotics?
the pt
the PT
the certified orthotist
the physician/physiatrist
what is the role of the pt in LE orthotics prescription?
know their expectations, compliance, co-morbidities, health condition, expected improvement, and resources
what is the role of the PT in the LE orthotics prescription?
they do the eval of gait and documentation of their current status and potential of the pt with an orthotic
what setting is the PT often more involved in the prescription of orthotics?
inpatient
what is the role of the certified orthotist in the prescription of orthotics?
they make the final determination in collaboration with the PT
expert in both materials and kinematics
what is the role of the physician/physiatrist in the prescription of orthotics?
they sign the prescription based upon the orthotist’s recommendation and provides oversight of the medical and rehab situation
what are the various types of LE orthoses?
HKAFO/HO
KAFO
AFO
what does the Rancho R.O.A.D.M.A.P stand for?
recommendations for orthotic assessment, decision-making, and prescription
t/f: the Racho R.O.A.D.M.A.P is widely used and accepted but has limitations for orthotic prescription
true
what is an AFO?
ankle foot orthotic
t/f: AFOs give mechanical advantage of crossing the ankle for increased control and stability of the jt
true
t/f: FOs change the angle of the foot w/relation to the floor in the sagittal and coronal places to effect change at the ankle or sometimes even at the knee
true
are FOs accommodative or corrective?
they can be either
what are the indications for AFOs?
muscle weakness/paralysis
some cases of genu recurvatum (<30 deg)
ligament laxity/damage (PTTD)
post-op (stability/limit motion)
OA
anatomical deformities (Charcot)
what are the contraindications for AFOs?
when knee instability is too great, so you need a higher level or support or stability
genu recurvatum >30 deg
some cases of severe spasticity
pt is nonabulatory
why is it a contraindication for LE orthotics when the pt is nonambulatory?
bc orthotics for positional purposes will not likely be covered
t/f: ground reaction forces of AFOs can provide a knee moment that can produce knee stability if the knee buckles bc the AFO in terminal stance wont allow DF as much, forcing back the knee
true
how are LE orthotics typically donned?
in sitting/EOB using the webbed space of the hand to push the heel in first then the leg
should an orthotic be donned distal to proximal or proximal to distal?
distal to proximal
M/L clearance on the leg should be ___ mm for conventional, total contact for polymer
3-6
medial ankle jt clearance should be__ mm
6
lateral ankle jt clearance should be ___ mm
5
the shell/frame should have ___ mm clearance below the fibular head
20
describe the initial wear schedule for LE orthotics
start low and ramp up the wear schedule by an hour a day working up to all waking Horus so the skin can support the change of what has been introduced to the LE
t/f: the shoes worn over AFOs are important
true
often, the shoes over AFOs are ___ size(s) bigger than the contralateral foot
1/2
what shells/frames are available with LE orthotics?
tibial (ant)
post
med
lat
if a pt has fluctuant edema, should they be prescribed a total contact AFO?
NO
t/f: you need increased pressure relief when prescribing a total contact AFO
true
what are the various frame materials for LE orthotics?
thermoplastic polymer, carbon graphite, and others
if the ____ trimline is too proximal, it interferes with knee flexion
posterior
what are the various trimlines of LE orthotics?
proximal, anterior, ankle, and footplate
t/f: trimline on the polymer can determine fxn
true
what is one of the most important pieces of an AFO prescription?
the ankle jt
which type of AFO ankle jt allows no movement at the ankle?
solid AFO
which type of AFO ankle jt allows some flexibility in material?
semisolid AFO
which type of AFO ankle jt allows some ankle movement?
articulating jt AFO
if you think a pt may progress a few months or a year down the line to need an articulating ankle jt AFO, can you plan ahead to modify a solid jt to an articulating jt?
yes!!!
if you plan ahead for a modification can it be paid for rather than getting a new orthotic?
yes!
a full footplate trimline is generally chosen for what pts?
pts with a lot of spasticity
a metatarsal trimline is generally chosen for what pts?
when pts need more terminal stance and push off w/toe extension allowed
what footplate trimline allows more terminal stance and push off w/toe extension allowed?
metatarsal trimline
does a static or dynamic AFO prohibit motion in any plane in the ankle?
static AFO
does static or dynamic AFO allow some deg of sagittal plane motion at the ankle?
dynamic AFO
are posterior leaf spring (PLS) AFOs and spiral AFOs static or dynamic AFOs?
dynamic AFOs
what are SAFOs?
static AFOs
are MAFOs with solid ankle static or dynamic AFOs?
static AFOs
are articulating SAFOs and MAFOs static or dynamic AFOs?
dynamic AFOs
are tone inhibiting AFOs static or dynamic AFOs?
static AFOs
are ground reaction/anterior AFOs static or dynamic AFOs?
static AFOs
are carbon graphite AFOs static or dynamic AFOs?
dynamic AFOs
are metal DBL upright open AFOs static or dynamic AFOs?
dynamic AFOs
are Klenzak/metal DBL upright locked AFOs static or dynamic AFOs?
static AFOs
are neuro-orthoses static or dynamic AFOs?
dynamic AFOs
t/f: an anterior shell can provide greater knee stability
true
what are the characteristics of an ideal orthosis?
meets mobility needs and goals
maximizes stance phase stability
minimizes abnormal alignment
minimally compromises swing clearance
effectively prepositions the limbs for IC
allows for energy conservation
what factors for comfort of AFOs need to be considered?
can be worn long periods w/o risk to skin or pain
can be easily donned/doffed
considered clothing, footwear and toileting needs
what are the cosmesis characteristics of an ideal orthosis?
it meets the individual’s needs to fit in with peers
what are the fabrication characteristics of an ideal orthosis?
can be made in the shortest period of time
uses a minimally complex design
is durable
what are the cost characteristics of the ideal orthosis?
can be made with minimal initial cost
has min cost for maintenance
is w/in the pt/s available budget or funding
if not enough DF is allowed in terminal stance, what happens at the hip and knee?
they will go backward and hip flexors won’t get a stretch
what are the 5 determinants of fxnal gait?
stance phase stability
clearance in swing
swing phase in pre-positioning
adequate step length
energy conservation
what are the 3 stance transitions?
1st heel rocker
2nd ankle rocker
3rd toe rocker
what is stance phase stability?
adequate stability to support the body weight and respond to ground rxn forces during the 3 stance transitions
t/f: it is essential to achieve adequate terminal hip extension of the involved limb to drive flexor phase of the CPG
true
what is clearance in swing?
advancing the limb must clear the ground adequately during swing phase
clearance in swing requires what two things?
level pelvis
adequate hip/knee/ankle flexion in the swing limb
what is swing phase pre-positioning for?
effective IC and loading response
what is an essential driver for the limb extensor phase of the limb through CPG?
swing phase pre-positioning
what is involved in getting adequate step length?
adequate motor control
adequate ROM at the hip knee and ankle of both limbs
t/f: the energy cost of walking rises substantially and is effectively compromised if there are problems with muscles fxn, coordination, postural controls, or stability during gait
true
walking energy and efficiency is compromised if there are problems with what parts of gait?
muscle fxn
coordination
postural control
stability
adequate ___ is the CPG driver for limb extension
IC
what is the 1st heel rocker?
controlled lowering of the foot from neutral ankle position
the heel rocker requires eccentric contraction of what 2 muscles?
the quads and ant tib
what is the 2nd ankle rocker?
roll over of tibial advancement over the WB foot
the ankle rocker requires concentric contraction of the ___ with eccentric braking of the ___
tib ant; GS
t/f: we don’t want so much limb clearance (DF) that we lose knee stability in terminal stance
true
how are LE orthotics a balancing act?
they provide some deg of external stability but can disrupt smooth transitions through the rockers and forward progression
othotics can have a negative affect on what 3 factors in gait?
SLS, cadence, step length
what does a posterior channel pin do?
limits PF
what are the indications for a posterior channel pin?
plantar spasticity
toe drag
pain with ankle motion
what does a posterior channel spring do?
assists DF
what are the indications for a posterior channel spring?
flaccid foot drop
knee hyperextension
what does an anterior channel pin do?
limits DF
what are the indications for an anterior channel pin?
weak PFers
weak knee extensors
pain with ankle motion
what does an anterior channel spring do?
assists PF
what are the indications for an anterior channel spring?
none, not really ever used
if you allow more DF, what happens to the knee/tibia?
there is more tibial advancement and knee flexion
what is the most common indication for an anterior channel pin?
weak knee extensors
if a pt is lacking DF ROM, will a posterior channel spring work for them?
no bc they simply don’t have the ROM for it do give them any DF
t/f: an anterior channel pin produces a knee extension moment by stopping forward progression of the tibia and forcing it back
true
t/f: an anterior channel spring allows forward tibial progression and provides a spring on toe off
true (don’t worry too much on this one bc its not commonly used AT ALL)
t/f: a posterior pin produces a knee flexion moment by placing the ankle in relative DF stopping the posterior progression of the tibia into knee hyperextension
true
what things do we need to consider when deciding on a solid, PLS, or articulating ankle jt?
how stability do we need? ankle? knee? hip?
how much weakness is present?
how much active motor control is present?
how much spasticity is present?
how much recovery do you expect?
if there is a lot of weakness present, what type of AFO should be your first choice?
a static AFO
if only a little active motor control is present, what type of AFO should be your first choice?
a static AFO
if mod/severe spasticity or fluctuant spasticity is present, what kind of AFO is required?
a static AFO
how do we decide on the type of orthosis to use?
what is the primary deviation you’re trying to fix? what is the underlying cause?
are there any secondary deviations/issues? is there a balance/ROM loss or edema or DM?
what therapeutic handling does it take to correct it? a lot of inhibition? facilitation? or a little? what is needed and where?
t/f: when an AFO is set in relative DF, it eliminates the 1st heel rocker, the 2nd ankle rocker, and the 3rd toe rocker in started very early
true
what is the issue with orthotics set in relative DF?
the eliminate the heel and ankle rockers and lack knee stability
what are the 3 orthoses in the static orthoses (group A)?
double adjustable ankle jt
SAFO
GRAFO
why would a static orthosis be chosen?
to prohibit motion in any plane at the ankle
significant hypotonicity, hemiparesis at the knee or ankle
foot deformities
mod/severe/fluctuant spasticity
when is a double adjustable ankle jt orthotic indicated?
for significant/fluctuant edema, sensory loss, or DM
what kind of orthotic is a ground reaction force AFO?
static orthotic (group A)
t/f: GRF AFOs produce a knee extension moment via relative PF with DF stop (resists knee flexion)
true
what are the indications for GRF AFOs?
crouched gait
weakness of the quads
knee buckling
what condition will we commonly see crouching gait in?
CP
for GRF AFOs, the pt MUST have at least ____ quad MMT and good ___ stability
3/5, hip
what are the indications for articulating AFOs?
hemiparesis and impaired muscle performance eof DF
potential for recovery of neuromotor fxn
what are the contraindications for articulating AFOs?
severe paralysis
flaccidity/hypotonicity
severe spasticity
t/f: articulating AFOs can induce clonus in pts with severe spasticity
true
what do articulating AFOs with PF stop do?
block PF motion (typically at 90 deg)
allow free DF
what are the indications for articulating AFOs with PF stop?
weak DF or tight PF
what do articulating AFOs with DF assist do?
assists toe clearance during swing phase
helps control PF at IC
what are the indications for articulating AFOs with DF assist?
primarily for weak DF
limited resistance to PF
what is the main advantage of the carbon graphite AFOs?
their energy storage and return capabilities
how do carbon graphite AFOs help with push off?
they store energy when compressed in terminal stance
an anterior shell carbon graphite AFO provides ___ resistance during mid-late stance and assists _____ as the limb is unloaded at toe off
DF; PF/propulsion
t/f: the anterior shell carbon graphite AFO provides considerable strength and force
true
when is a lateral strut used?
on pts w/ a pronated ankle to avoid skin integrity compromise as the ankle moves medially
when is a medial strut used?
on pts w/a supinated ankle to avoid skin integrity compromise as the ankle moves laterally
what type of orthotic is a posterior leaf orthosis?
dynamic orthosis (group C)
what is a posterior leaf orthosis?
a narrow orthosis trimmed behind the malleoli with a flange that can be added to control excessive pro/sup
t/f: the posterior leaf orthosis provides swing phase DF assist to permit foot clearance, but provides no stance control or frontal plane control
true
what are the indications for posterior leaf orthoses?
drop foot
DF weakness
what are the contraindications for the posterior leaf orthosis?
genu recurvatum
ML instability
mod/severe spasticity
which has more control, a posterior leaf orthosis or a MAFO?
a MAFO
what is a Saebo step device?
a device pts will often buy off of Amazon to attach to the ankle and shoe laces to “help DF” but doesn’t really do anything for them
t/f: neuro-orthoses assist limb clearance during swing and improve pre-positioning for IC by the heel
true
what are the indications for neuro-orthoses?
DF weakness
low tone
what are the contraindications for neuro-orthoses?
flaccid paralysis
pt intolerance to ESTIM
how do neuro-orthoses work?
electrodes stimulate a nerve based on loading/unloading of the limb
what does the CPG for AFO vs FES post stroke tell us?
the efficacy of and when to use AFO vs FES post CVA
t/f: there is no difference in QOL, gait speed, dynamic balance, gait kinematics, or walking endurance outcomes with AFOs vs FES according to the CPG
true
what AFO is best for the pt according to he CPG?
one customized to the pt
____ may be better for slower walker, ___ may be better for faster walkers according to the CPG
AFO, FES
more meaningful improvements were observed in the CPG when AFOs/FE was combined with what?
skilled PT
t/f: consistent reassessments of AFO/FES are needed to meet changing needs according to the CPG
true
____ provision early in recovery enhances participation and leads to faster progress towards goals according to the CPG
AFO
t/f: wearing an AFO doesn’t hinder muscles activation according to the CPG
true
t/f: FES can improve muscles activation through a therapeutic effect according to the CPG
true
t/f: there is evidence that AFOs/FES can reduce PF spasticity according to the CPG
false
an AFO that allows ___ motion may lead to greater effects of gait speed according to the CPG
PF
